Δαφνη Ευτυχια Αρθουρος

"What do you do when the sleeping elephant has contracted mad cow disease?" -- realinterrobang, 2005-12-18

Introduction

Preamble

Okay, there's migraine and there's migraine.

There's the "please kill me now because if we wait for the blood to just squirt out my ears and eyes like it feels like it's going to that'll be a terrible mess and I can't wait that long anyhow and would you please stop breathing where I can hear you in the meantime" migraine. That was me on Tuesday. I started thinking about how that could've been what inspired various cultures to invent trepanation, and wondering whether it would help.

There's the "this hurts a whole hell of a lot and in characterisic migraine hurty-spots and I'm dizzy and hypersensitive to bass so it must be a migraine" migraine. That was me much of yesterday.

There's the "it doesn't really hurt any worse than a garden variety headache but the other neurological symptoms are things associated with migraine and interfere with my ability to concentrate and judge speed and distance so I'd better not drive and I can't get much else done and I don't know what else to call it" migraine. That happens all too fucking often. That was what almost kept me from Christmas (there was quite a bit of codeine involved in getting my ass to the family Christmas celebration, and while I'm glad I did get there, I was a little too distracted by the balance between migraine symptoms and unpleasant drug effects -- more the caffeine in the codeine tablets than the codeine itself -- to really appreciate the festivities as much as I normally would have).

And there's the "these symptoms are scary enough that we're sending you off to stick your head in a tube surrounded by magnets and get expensive pictures taken because it sounds like a stroke" migraine. That happened at Pennsic. Apparently I was really scary just to look at, based on the shocked and frightened faces people made as they asked me whether I needed help (and then ignored my answer (okay, okay, correctly as it turns out) to provide me help anyhow).

And then, of course, there are ordinary headaches without all the migraine-related perceptual weirdness, but those aren't so bad: all they do is hurt.

Background

I don't like having to medicate migraine symptoms. With the right drugs, being productive and medicated is better than pissing away two or three days trying to out-stubborn the migraine (or, for that matter, a fibromyalgia flare) and not being able to accomplish anything, but let's face it: I'm a little scared of the almost-right drugs and find the migraine-specific drug I was given in the past unpleasant.

Using Vicodin or Percoset, when I can get them, is usually effective and doesn't leave me feeling doped up, but I worry because they're addictive, I worry about building up a tolerance to them if I use them too often, I worry about running out, and I worry whether I'm "wimping out" and using them as a crutch. (The thing is, with the fibromyalgia pain, I'll go three to five days saying, "it's not cut-my-arm-off bad, so I should be able to tough it out without narcotics," but get absolutely nothing done; then I'll give in and take the drugs and get lots of things done in the next twelve hours, kicking myself for having wasted all that time being stubborn or afraid.) I've written about this before, so longtime readers will be nodding their heads and wondering why I haven't just gotten over this issue already fercryinoutloud. Sorry, still working on that.

With codeine, which is easier to obtain than Vicodin or Percoset, there's an added disincentive: the stuff I can obtain legally has caffeine mixed in, and my body fails to appreciate the alchemical marvel that caffeine is for most people. Now a little caffeine at the right time can be a net win -- it can help quite a bit with a headache -- but it can also be very uncomfortable. If I don't already have a headache and I ingest caffeine, either in a beverage or with codeine for fibromyalgia pain, the caffeine is likely to induce a headache. And regardless of whether it's helping or hurting headache-wise, it usually makes me feel groggy and anxious at the same time, tired and sleepy but unable to fall asleep. With or without codeine, caffeine makes me "feel drugged", which is something I find quite unpleasant.

Note that theophylline affects me in a manner very similar to caffeine. I keep some non-decaffeinated black tea in the house for treating mild headaches, but avoid theophylline the rest of the time. "Decaf" Earl Grey is my non-medicinal tea.

(Ultram (tramadol) is useful for moderate-by-fibromyalgia-standards muscle pain (which is to say, well beyond the range where ibuprofen is useful), but doesn't do jack for headaches (for me, anyhow). And although it carries none of the addiction or tolerance fears of the narcotics, nor any noticeable side effects, it's not something I have access to legally. So when dealing with fibromyalgia pain, I'm hesitant to use up my stash. Ifwhen I get some degree of medical care (plans are currently in motion to that end), a prescription for lots of Ultram will make me very happy, assuming I can afford it. Then I can take it instead of the (cheaper and more easily obtained but more scary) narcotics when my fibromyalgia pain is in that range. But that's tangential here, because I'm mostly thinking about migraines today.)

The one migraine-specific drug I've been given is Midrin, a mix of three other drugs. I do not like it, I do not like how it makes me feel, but I'll say this: it's way the fuck better than the migraine it treats. Midrin really makes me feel drugged; dopey, woozy, sleepy, incoherent. (Fortunately it also puts me to sleep, so I don't have to experience the drugged-feeling for too long.) But it Makes The Pain STOP. It may take a couple hours (the instructions are to take two capsules, then another after an hour if the pain isn't gone, then another an hour after that if it's still needed, up to a maximium of five capsules -- sometimes the first two do the trick after about forty-five minutes and no more is needed, and sometimes I go all the way to five capsules) but the pain will stop. Not just get knocked down a notch or two, which is usually the best I get from any pain medication (let me tell you my novacaine stories later), but actually gone. Better yet, it seems to protect me from having the migraine come back, for a couple of days. The thing is, I'm going to be useless after I take it, so I'm disinclined to take it for a "merely uncomfortable as hell but I'm still functioning" migraine; it's only useful if the migraine has already pretty much knocked me out anyhow. And there's no thought of driving a car after it takes effect. The other thing is that until/unless I've got a doctor to prescribe it again, I'm out of it.

The Experiment

Initial Observations and Hypothesis

Which brings us to today's bit of DIY pharmacology... I'd been trying to practice moderation in my chocolate consumption, but on ... Tuesday I think, or was it yesterday? ... I decided to give in to a craving and ate a mess of Hershey Special Dark all at once. An hour or two later I noticed a rather steep lessening of the pain in my head (which I'd not been taking anything for because I'd taken so much on Christmas), along with a feeling of greater "focus". This could be due to the fat and sugar in the chocolate, which seems unlikely, but I suspect it was the theobromine that helped. I decided to test this.

This Afternoon's Trial

Feeling a little wobbly for driving and having a headache bad enough to be uncomfortable and distracting, I decided to try eating cocoa powder to see whether that would lift my symptoms at least enough to get to a grocery store (and ideally enough to make me feel well enough to head to Arlington). I consumed 50 cc of Hershey unsweetened cocoa powder (not the "Dutch Process" kind, what I guess is "regular") chased with about half a liter of water. I guessed that would be enough to make me feel some effect, that it would probably either make me sick or help my headache, and that I could adjust the dosage up or down in future trials. Then I sat down to type this journal entry.

Observations

After about an hour, the feeling of increased ability to focus kicked in, along with a lessening of pain, but neither was quite enough to make me feel clearheaded. The effect doesn't seem to be lasting very long, however, as the next twenty minutes have seen a gradual increase in pain and the onset of the "caffeinated" feeling (I am aware that there is caffeine as well as theobromine in chocolate, and would welcome an opportunity to repeat this experiment with theobromine alone if that were to become possible). My peripheral vision initially sharpened and/or widened towards non-migraine normal, but is starting to become less distinct while a sensation of pressure behind my eyes is developing.

From the fifty minute mark to about seventy-five minutes after ingesting the cocoa, I experienced pronounced feelings of tranquility and alertness simultaneously.

N.b.: The actual range of my peripheral vision, measured by seeing how far to the side I can still see a finger, appears unchanged throughout; but my ability to pay attention to it varies, along with the sharpness and the speed at which information in that part of my visual field registers. The "narrowing" effect is not tunnel vision, but something I'm having difficulty describing.

While loud noises are still uncomfortable, the frequency range that causes the most pain has shifted lower, and loud noises just seem painfully loud instead of feeling like physical blows to the face with a sharp object.

I may be able to make use of what's left of this period of diminshed migraine symptoms to go fetch some groceries, or possibly to fall asleep. I'm not sure yet.

Preliminary Conclusions

Theobromine may be useful but a) I'm not certain yet and b) I've probably not gotten the dosage right. I'm not sure whether the second-wave effects -- the dizziness, diminished peripheral vision, and "hatband too tight" and pressure-behind-the-eyes sensations -- are merely the resumption of migraine symptoms as a too-small dose wears off already, side effects of the theobromine, or effects of the caffeine also present in the cocoa powder.

I will increase the dosage to 75 cc next time and see whether the intensity and timing of the "caffeinated" feeling changes, the duration of respite from migraine increases, or both.

It is also possible that the fat in bar (candy) chocolate protects me somewhat from the effects of the caffeine, and the lack of it accounts for today's results feeling different from Tuesday's. (I know that a caffeinated beverage with pizza bothers me significantly less than the same drink with other food.) Depending on the outcome of trials using different dosages of unsweetened cocoa powder, I may need to experiment farther with large doses of the candy form as well. I'd hoped to avoid the extra calories (after all, I might as well save those for when I really specifically want to eat chocolate and am going to enjoy it, not when I'm just shoving it into my body in hope of alleviating migraine symptoms), but whether that will work is still undetermined.

Suggestions, conjectures, and Real Pharmocological Clue are all appreciated.