Still in the headache phase, and I’m planning a really special migraine post for Thursday, so maybe it is time to state some definitions. It is such a comfortable mode of discourse for mathematicians. We know exactly where the story is going to go and instead of telling you what the point is, we start defining words. This is a terrible way of telling a story—with the exception of the Dictionary of the Khazars by Milorad Pavić. There are migraineurs who will fire their neurologists for the use of any term that does not have an ICD-10 code. I am not one of them.

Common Migraine: One-sided headache. Throbbing pain. You start to feel really confident that you should be saying numbers like 8 and 9 (probably 9) on that 10-point pain scale. If you are not saving the number 10 for something really special, then you might even say 10. Even a single photon of light causes searing pain deep inside your brain. The headache is so incapacitating that you can barely make your way from the bedroom to the bathroom. You barf. You sleep. You feel better several hours later. No aura. These are not the headaches that I have been writing about. I do get these headaches, but only once every few years.

Classic Migraine: Like above, but preceded by an aura. Almost always a visual aura that takes on a particular form (when I say the phrase “zig-zag rainbow snake” to my neurologist, he knows exactly what I mean) and lasts for a short while before the headache starts. I don’t really think of myself as having these headaches. I sort of wish that I did have these instead of the Common Migraines. These are some of the most prestigious migraines to have. It reminds me of when Michelle told me about the hierarchy of eating disorders. She didn’t think of herself as a purging anorexic (even though she was); she insisted that she was a pure restricting anorexic (the most prestigious type). Does the difference really matter? She’s been dead for almost 26 years. Don’t tell anyone, but I follow her sister-in-law on Twitter.

Migraine with Aura: This is the official name (with an ICD-10 code) for Classic Migraine. I have actually been diagnosed with this. Most recently on August 5, 2017. Once you have been diagnosed with any sort of migraines (and I do not question at all that I have had common migraines), any unexplained neurological symptom becomes “migraine aura,” and you now have migraine with aura. Code G43.1. The eclipse-spot? Migraine aura. The weird creepy-crawly pulsing sensation that I get every now and then? Migraine aura. The ringing in my ears that comes and goes? Migraine aura. The zig-zag rainbow snake and the flashing rainbow crystal? Migraine aura. The extra sun that I saw last week? Migraine aura. I wish that I could read my migraine auras like an oracle might read her visions and use them to make predictions and threats. Do old-timey oracles get to consult with compliance attorneys before making a threat?

Transformed migraine (chronic migraine): Welcome to my everyday life. If I did not have a history of those light-sensitive+barfing headaches and personal experience with the zig-zag rainbow snake, it would probably take me a lot of time and effort to convince a physician to prescribe me my beloved triptans. When I’m above a certain headache parameter (like I have been for the past 12 days), I spend a significant fraction of my days with headache pain around level 1 on the pain scale. Maybe a 2. Rarely as much as a 3. As much as I complain about these headaches, they are mostly an annoyance. They make me feel like a character from “Harrison Bergeron,” with these constant low-level headaches keeping me from doing truly amazing things. But then I remember that it is my fixed mindset holding me back, not my headaches. Unlike normal-people headaches, you can’t chase these away with stardard OTC painkillers, and you are not supposed to take too much medicine for these (or else you will also have Medication Overuse Headaches). If I take a triptan, the headache and all of its distractions disappear within an hour. It is a rule that one may only take nine doses of triptans per month. Why nine? Back in 1991, Pico Iyer wrote an essay entitled “The Many Lives and Tricks of Nine.” When the doctor in the emergency room was trying to decide if my headaches were really migraines or if they were seizures, she used the fact that my headaches respond really well to triptans to decide on migraine.

Status Migrainosus: Migraine symptoms that last over 72 hours. I was diagnosed with this was on August 11, 2017. One might reasonably claim that those symptoms lasted for 17 days. More about this on Thursday. Spoiler: this might explain why my GitHub profile shows no commits for several weeks in August.

Diagnosis

Complex Migraine: This does not have an ICD-10 code. It means, “wow, that is weird, and we don’t know what is happening, and the patient has a history of migraine.” Again, more on Thursday. I’ll try really hard to scan the drawings that I made and include them in the post.

Weird back-of-the-head headache: This is a term of my own invention. When I wake up with a headache, it is probably one of these. They rarely localize to one side. They rarely progress to a bad headache, but they also don’t respond well to medication.

Dirty headache: Again, another one of my own descriptors. These headaches remind me of a cross between that, “wow, I could really use a cup of coffee” feeling and the, “wow, I have drunk way too much coffee” feeling. One cup is too much, and too much is never enough. They are not localized to a particular part of the head. They are never bad enough to be worth taking medication over. The dirty headache can progress to the disorganized headache. Sometimes I can have a dirty headache or a disorganized headache without any headache pain.

Disorganized headache: The last of my own descriptors. These are the worst of the headaches that I have on a regular basis, and they are capable of becoming common migraines. Usually they don’t, though. I am rather light-sensitive, but they are not localized to a particular part of my head. My mental model is that there are these static electricity fireflies flying around my brain, and they are headache particles. But if they all settle in once place and start blinking in unison, like the synchronous fireflies in the Great Smokey Mountains National Park, then I end up with a full-blown common migraine.

Migralepsy: A migraine followed by a seizure. The Wikipedia says that this is very rare. There is no evidence that I have ever had a seizure. (Several EEGs—including one performed when I was having symptoms—have shown no epileptiform activity.) Migraines can be misdiagnosed as seizures, and seizures can be misdiagnosed as migraines. One of the most effective medications for preventing migraines is an anti-seizure medication. Once you have a history of migraine, any unexplained neurological symptom is declared to be a migraine aura. No one understands anything about the brain.