I get migraines. Very frequent. Very severe. Luckily, they are fairly well-managed with: medications that have relatively few side effects; enough sleep; enough water; cold enough rooms to sleep in; and avoiding life’s finer pleasures, such as alcohol, chocolate, peanut butter, and watermelon.
I consider this fact about my life very slightly interesting, rather than merely deeply and pointlessly fishing annoying, for two reasons.
First, when considering the definition of disability. I’m not talking the ADA-definition, but our concept of disability. I suppose it seems we should consider someone disabled when she functions differently from most people in such a way that makes her life more difficult (how to construe that is another issue). Or debatably that she perceives her life is more difficult. The title character on House walks with a cane and he is considered disabled. I think someone with chronic lower back pain, erectile dysfunction, or migraines would not generally be considered disabled. I certainly don’t consider myself disabled. But when in the throes of the worst migraine, I’m undoubtedly more functionally impaired than House. Maybe if the problem is intermittent? But I would think someone who intermittently could not walk is disabled. No?
The second occurred to me last night as I was in the relatively rare situation, when all failsafes failed, of the throes of super killer migraine. The kind where you can’t take a sip of water for 24 hours without repeated vomiting. The kind where you scamper away, whimpering and cringing, Gollum-like, from a 15-watt bulb. And of course, I thought about Michele Bachmann.
Because, if you recall waaaaaaay back in 2011, there was a brief period where Michele Bachmann actually looked like a serious candidate for President. There were about 10,000 reasons why Michele Bachmann should not have been president. And one that seemed to get some serious play was that the woman gets serious migraines. So I was wondering, last night, as I was puking my guts up for maybe the eighth time. Should this disqualify me for the presidency? (NB: Like Bachmann, I have plenty of other disqualifying properties. So the question was really: should this be in itself a reason I should not be president?)
The Politico article on the subject sounds, frankly, a bit nuts to me (emphases mine):
- A migraine attack in May 2010 forced Bachmann to retreat to her congressional office and lie down in the dark. She managed to attend early afternoon congressional votes before flying to California to attend two political events, but she was in pain much of the time and sought emergency treatment. When Congress reconvened the following Tuesday, Bachmann missed a day of votes.
- In July 2010, Bachmann missed eight House votes while being treated and released for a migraine by a Washington hospital. Her staff at the time said an unspecified illness was the reason for the missed votes. The attack caused her to cancel a campaign trip. According to her own account, it took her four days to recover.
The Daily Caller also reported an October 2010 incident that forced Bachmann to lie down at the home of a Connecticut donor who was hosting a fundraiser, then to seek urgent care in New York. Sources with firsthand knowledge confirmed the report to POLITICO…
In her statement Tuesday, read at a South Carolina event, Bachmann acknowledged that she suffers from migraines and takes medication to treat them. But she denied that the condition — a neurological disorder characterized in part by its incompatibility with normal activity — interferes with her work…
Migraines are a chronic condition neurologically distinct from regular headaches, characterized by overpowering pain that can cause sufferers to have to rest in a dark room…
The issue may be complicated for Bachmann by the fact that the condition affects her brain and requires her to take psychoactive drugs.
Bachmann’s campaign denied her brother, Paul Amble, a psychiatrist in Connecticut, permission to speak to POLITICO about her condition. But the congresswoman’s son, Dr. Lucas Bachmann, a medical resident at the University of Connecticut who has knowledge of her treatment, told The New York Times on Tuesday that the congresswoman takes two prescribed medications to treat the symptoms of cranial pressure and vomiting. He said the preventive drugs are “standard migraine treatment medications.”
Okay. A couple two three things. First of all, Judith Warner has a point that what really matters is whether or not someone’s migraines are well-controlled (and I note she refers to it as a disability). It sounds like Bachmann’s might possibly not be well-controlled, although it’s hard to tell from these descriptions of incidents. If she is not taking care of her migraines, or is taking certain kinds of medications, it’s worth some public disclosure.
But.
Second, the question of whether migraines are neurologically distinct from typical headaches is not a settled one.
Third. Migraine is a neurological disorder and it does “affect your brain.” And there is no question it affects your functioning. But the way this is phrased implies it affects your judgment and thinking. If I were president, there might be a time, maybe once every few months, where I’d have to go in a dark room. But if someone entered the room to ask me if bombing North Korea was an excellent idea, it’s not like I would just say, “Of course! Bombs away! Now leave me alone, and shut the door on your way out!” I mean, I am still able to think clearly and reason. I don’t particularly want to, but I am available to. I am not hiking the Appalachian trail. I am also not of the belief that I am seized by a pink ray and am communicating with a quadripartite godhead. I am there and could make trustworthy decisions. I would just need to do it from a dark room and only if it were urgent. It makes perfect sense to me that Bachmann would need to withdraw sometimes. That doesn’t mean she is incapable of thought.
Fellow migraineurs, do you disagree?
Migraines are a brain abnormality. But if we decided that people who undergo brain abnormalities could not become president, well, then we’d have to disallow anyone who has the epileptic fits we generally call orgasms. And even if, as rarely happens, one has an orgasm strong enough to knock you unconscious, I think we can safely say that is not a disqualifying event.
There should be some amount of time allowed where one can be medically incapacitated, and still be President. If nothing else, a couple of weeks a year (equivalent to vacation) should be fine, I suppose.
I… what? You’re saying… huh?
I swear, Kim. Your comments often reach a koan-like level of nonsensical inscrutability, which I find almost charming.
This one may just have been the best ever. Man, I never knew I had a chronic epilepsy problem before, but I sure as hell ain’t going to the doctor to figure out how to stop it.
+1.
In theory, this sounds fantastic. Can’t say as I’ve had the pleasure, and I’m kind of dubious this exists. I suppose now half the League’s commenters are going to chime in with, “Oh, no, man, that totally happens to me,” and “What, you haven’t had an orgasm that good, I thought everyone had!” and “You must be doing it wrong, Burt. Too bad for your wife! LOL.” Har de har har.
Assuming this actually exists, it could be a bit awkward for the partner who isn’t on top, though. We turned down a P.I. case in which He crushed Her ribs while “kissing” and She wouldn’t have minded so much except He went back to His wife afterwards. (Really. We turned it down. The story seems to lacks that je ne sais quoi which successful plaintiff’s attorneys search for.)
And, what if you gave yourself one of these knockout superorgasms while masturbating? And then your mom just found you there afterwards?
I know someone who’s managed to induce this in a girl or two.
Never happened to me.
I don’t see the allure, actually. I mean, you’re unconscious…
re: mom finding you: That would be totally awkward, man…
It certainly would have made for an interesting scene in “Portnoy’s Complaint.”
I am also not of the belief that I am seized by a pink ray and am communicating with a quadripartite godhead.
You’re NOT?! Our friendship is over.
And Rose is never going to write Valis. It’s a good think Philip K. Dick already did.
Look. There’s more than one way to skin a cat, as you’ll see when my novel comes. Out.
If you want to talk about cat skinning, please head over to my recent FP posts.
I did. Was going to write “suffering” and “intentions,” saw others had been there, and decided to leave it at that.
Several thoughts are bouncing through my head… not all of them related or even fully formed…
1.) Anecdotally, my experience tells me women are more frequently the victims of migraines than men. Is this accurate? If so, it’d seem like we’d need to consider the potential ramifications of this when deciding if it is a disqualifier or not.
2.) Along similar lines, I know folks (all men, surprise-surprise) who think that a woman would be unfit for the the Presidency because of menstruation, because of similar logic about her ability to perform the functions of the job when, well, going through the motions, I’ll say.
3.) Based on what I know about migraines, I would not think they worthy of consideration when evaluating a political candidate unless they are being grossly mismanaged. Might there be certain hours/days of the month where the person-in-question is at less than their best? Yes. But isn’t that true for everyone? I would be more interested in how the person responded to and managed their migraines than in the presence of migraines themselves.
4.) Regarding treating migraines as a disability, I wonder if the temporary nature of individual migraine attacks leads people to not think of them as such. If you are completely able 90 or 95% of the time and only disabled 10 or 5% of the time, I can understand the logic in not considering that the same as a disability that is pervasive and permanent. I don’t necessarily agree with it, but I understand it.
5.) Sounds like migraines suck. Like, really hard. For a few years, I battled something somewhat similar to migraines that the doctors could never figure out (call House!), but they paled in comparison to what is being described here and have seem to resolved themselves.
1-2) Yes, 3 times more common in women. And very common, so all the more worrisome as a disqualifier. Should have brought this up in OP. I tend to forget this because in my family my mother does not have them, but my father and brother do. And, alas, I see my oldest son getting a childhood version. But the more severe versions are associated with menstrual cycle issues. So illogic piled on top of illogicon top of woman ickiness. I also tend to think people think it’s just a little headache, so when you claim it is incapacitating, you are being a hysterical, shrill woman.
3) Judith Warner’s point, and I agree. Is she seeing a quack? Does she deny herself any pain medication for silly reasons?
4) Yeah. I don’t know if I agree with it or not, but it is probably where the distinction lies.
5) And yeah, it sucks, but not nearly so much as it used to. It took my an embarrassingly long time to figure out all the medications/sleeping in cold rooms/getting enough sleep/no alcohol and certain yummy foods, etc. (My poor husband, when we first moved in together, had to put up with a couple of military-brass-style, “That thermostat is not to be adjusted one degree without checking with me! If you’re cold, put on a fishing sweater!” before he realized how serious the issue was.) And count me among the women who is just dying for menopause!
But the more severe versions are associated with menstrual cycle issues.
There’s also rumor that they ‘go away’ after the change, but get worse during.
Mine didn’t go away, they got worse and stayed that way.
I’m of the opinion that more women know they have migraine then men, not that they’re more common in women then men. I’m guessing that this has something to do with the combination of hormone triggers from menstruation/menopause and the water retention which their bodies experience at those times. It may help move migraine from general migraine into into headache migraine on such a regular basis that the malady is easily recognized.
After my change — during which I was so afflicted I could barely speak for over a year — mine have calmed down, meaning I don’t have as much headache. I still have nearly constant migraine, however. And exposure to those environmental triggers like flashing light or a food trigger or a strong smell or a disrupted sleep schedule will put it over the top. I also experience pain and twitching (mini seizures) in other parts of my body.
It should also be noted that I’ve suffered severe head trauma and have neck damage, both of which complicate migraine. While in my early 30’s, they treated my neck injury pain and migraines with analgesics, often in large doses of 600 to 800 mg/ibuprofen 3x a day, which may have actually caused them to go from occasional to chronic. It’s pretty likely the ‘treatment’ made them nearly constant and disabling.
Much that I thought of as migraine before menopause was limited to the menstrual headache; the other symptoms I sort of thought as something else. Now that I now longer ride a hormonal-shift roller coaster, I can see how it was all the same thing, that much of the migraine I experienced I didn’t recognize as such because it didn’t have the severe water retention/hormone triggered headache.
This is also why I’m pretty sure migraine is under-diagnosed; with only occasional and non-patterned headache to go on, things like a twitching eyelid just don’t seem significant, even though it may indicate some neural overloading in process.
The Diane Rehms link’s here: http://thedianerehmshow.org/shows/2012-12-28/living-migraine-and-search-new-treatments-rebroadcast
The Buddha said “Whatever is felt is within suffering.”
Yet another admirable bit of writing, Rose. The best sort of writing leaves the reader feeling “Jeebus, I learned something” and this is just such a piece.
Somehow, I’m not sure where it began, perhaps with the Platonic mind-body distinction, we’ve come to think of our “disabilities” as if without them we might be “better” people. Speaking only for myself, my problems define me as much as any of my successes. We suffer, we struggle, we endure, we overcome. Our salvation in all this suffering is to understand we do not suffer alone. We suffer in the context of a suffering world. I believe there is hope in that knowledge.
Oh be kind. Everyone you will ever meet is fighting a hard battle.
It’s so easy to laugh, it’s so easy to hate
It takes strength to be gentle and kind
It’s so easy to laugh, it’s so easy to hate
It takes guts to be gentle and kind
Oh be kind. Everyone you will ever meet is fighting a hard battle. Ain’t it the truth.
Migraine is a brain dysfunction; there some evidence now that the overexcited synapses are always overexcited; it’s always present, though disabling effects may and do very from day to day.
Mine are disabling; I am disabled by them, frequently. I would be incapable of making presidential-level decisions when they’re at their worst.
Because they are so disabling, I wish for a world where there’s some level of consideration for my disability — particularly when it comes to lights. No more blinky stuff; none of those pigtail lights my friends have in their homes to save energy and none of those long tubes they use in schools. Forget the flashing neons or those blue blinkers on police cars. And we’ll have to find another method of signaling a turn in an automobile. . . does this seem extreme? (I do believe we’d have better luck educating our kids if we put better lights in their classrooms.)
Sigh.
Diane Rehms had a great show on migraine on Dec. 28; sadly, her website seems to have technical difficulties right now or I’d give a link to it. Worth reading is the Q&A held with listeners after the show was over.
Key here is that migraine is so much more then just ‘headache,’ and headache may not be present at all. It’s an over-excited brain, an electrical storm in the synapses. I suspect migraine is severely under-detected because of this; we need the headache thing to make the connections. Yet without the headache, it can make one groggy, sick to your stomach, cause vision and speech difficulties. I always feel like I loose about 20 points on my IQ, with or without the headache I feel stupider.
No, I could not function as a reliable employee, let alone run a business or a nation. Migraine can be disabling; though it isn’t always disabling. As with all things, it varies. And one of the things I learned from the links provided by Rehm’s website is that severe migraine is recognized as a disability for SSI benefits, though getting them is pretty difficult because so few doctors know how to treat them and understand when treatment isn’t a working option.
severe migraine is recognized as a disability for SSI benefits, though getting them is pretty difficult because so few doctors know how to treat them and understand when treatment isn’t a working option.
My neurologist, who is a migraineur herself, is totally opposed to this, and I gather there are several in the field who are. They are of the belief that it is basically never non-manageable. Going on disability creates a condition where triptan overuse becomes easier. I don’t know if they are unsympathetic or pragmatic.
I have word recall issues during migraines and after. But I don’t know about actual IQ differences. So I guess it varies person to person. And there are certainly times I have the other symptoms (vomiting, etc.) without the headache.
Flashing lights are annoying, as are when people douse themselves in perfume. But I suppose each have their uses.
I should also add that she thinks it discourages the trial-and-error process (which is very long and painful) of figuring out all the lifestyle triggers.
Yes, I agree that many doctor’s have a lot of concern about making sure their patients spend the time identifying triggers. And experimenting with the potential drugs that might help.
But here’s an alternative view: many triggers — those flashing lights, weather changes, someone’s perfume, store lighting, and many common foods (peanuts!) are common; they’re hard to avoid. So the avoiding trigger approach means avoiding shopping, eating out, all sorts of ‘normal’ situations, in fact. It becomes very limiting.
And prophylactic treatment with drugs is not successful for many people. In trying various anti-seizure medications (which did stop my migraines) we discovered that I’ve an allergy to something in the base of most pills, and I nearly lost my vision — two separate side effects.
So I am effectively disabled because I cannot 100% avoid triggers, cannot treat effectively. I do take maxalt/imatrix (spelling?) when they’re severe and I need to function; I always travel with those two prescriptions.
But I think there’s a bit of the blaming the victim in suggesting that having migraine rise to the level of disability is wrong; it’s dependent on the person with the migraine.
And I want you to know that I forcefully defended Bachman’s right to run for president despite migraine; they claimed they were well managed, and I believed that. I don’t think it should ever be considered a reason for disallowing someone something, unless does disable that person, quite like seizure or bipolar shouldn’t disqualify someone unless the illnesses are so severe they cannot be managed properly.
As Blaise said, everyone suffers. And everyone who suffers suffers differently.
Yeah, I hear you. My father’s migraines are such that he takes a nap, wakes up, and they’re gone. Everyone does indeed suffer differently. I didn’t mean to suggest you didn’t. I ended the post with a query if other migraineurs felt differently about cognition.
I’m on low dose topamax and butterbur, and cannot travel anywhere without excedrin, imitrex, and zomig. So it’s not like I’ve weened myself off triptans entirely. But lifestyle changes have helped more than I thought.
I am so irritated at so many people who insist I cannot properly do my job (mostly as mother of child with severe disabilities in a mostly-male field; I doubt people at work even know I have migraines because I don’t talk about it) that your willingness to say – yes, I can’t be a regular employee is very striking to me.
Rose, I didn’t think you meant to suggest anything about me; and I apologize if I gave that impression. I’ve just had my life really, really limited by migraine, and to comprehend that limitation, I’ve had to learn as much about it as I could. And I like to tell other people about the stuff I’ve learned, old habit that even forced me to commit random acts of journalism.
Topamax caused severe vision problems for me. I felt like my eyeballs were filled with grit, and grinding in the top of my head. The same day I called my doctor and said I could barely see, the FDA issued a warning on it causing vision problems. I did stop the migraine. You’re young still, so this shouldn’t be a problem yet, but it also caused nearly debilitating hot flashes, the kind that make you want to rip your clothes off in public and make men think you’re a cougar. In reality, you feel like your cooking from the inside out, and need to release heat instantly.
They weaned me off Topamax over three days, and then it took a couple more for my vision to begin normalizing. The two weeks after, I sat and knit free-form sculptures, totally improvised on the spot. A horse for my mother, a bear for one son, turtle for another. Space alien for my husband.
I could not knit those things now. I look at them, and cannot, for the life of me, understand what I did; they’re extremely complex sculptures. My husband tells me I brightened, I went from dull and flat to bubbling with potential; as if all the potential from my time on that drug had built up and came spewing out as it left my system.
Rose,
Isn’t part of the problem that we tend to view ability as binary? Shouldn’t we consider degrees of ability and disability? And the contexts wherein someone might be disabled versus those where they might not be? Isn’t is possible that zic’s migraines and the day-to-day situations she may find herself in justify her being identified as having a form of disability that you do not? And I’m also tempted to say that having to avoid environmental triggers itself can be disabling. I mean, I doubt you’d be capable of fulfilling the duties of a club DJ, even if you can fully perform the duties in your current roles.
Kazzy, yes, absolutely. Clearly, zic’s are more incapacitating than mine. Mine used to be more incapacitating than they are. As I said, my dad’s migraines are not really very incapacitating at all.
I was just saying that there’s a view in the neurology community specifically opposed to claiming SSI benefits for migraine. And I wasn’t saying I endorse it; my neurologist does. I’m not talking about the definition of disability or anything. So docs discourage SSI benefits because they think finding the right combo of preventive meds and lifestyle triggers involves some period of fairly sginificant pain, and then a lifetime of self-denial to one degree or another. If you get SSI benefits, you will be unwilling to put yourself through this, and will medicate yourself unnecessarily. FWIW, I notice that the neurologist interviewed for the Politico article to which I linked above seems to be of this camp: “The good news, Marcus said, is that a variety of treatments are effective to reduce the severity of migraine attacks. Preventive therapies include beta-blockers, antidepressants and anti-seizure drugs. Relaxation techniques, stress management and keeping a regular schedule can be just as effective as medication, Marcus said.
“Most people should be able to get [migraines] under control and function at a very high level, even if they are very frequent and severe,” Marcus said. “Maybe there would be a day where you had to take a couple of hours off because you had a really killer attack.”
I will assert that many migraineurs think that when docs tell them to find lifestyle triggers, it means the docs are not taking the migraine seriously. I know I did. And when you do, it is a complex process. Figuring it out involves many many headaches. No triggers set you off reliably 100% of the time. Some only, say, 10% of the time, and only in concert with other triggers. Some are not, as Zic suggests, under your control (damn you, perfume-doused-woman!). And frankly, you have to live your life as a nut job. I can never ever drink alcohol without accepting that there’s a 95% chance of migraine (it’s my no. 1 trigger). But Jesus, I love alcohol! Once in a while, I say fish it, gimme cocktails, and drink ’em down and load up on triptans. I absolutely have to eat regular meals, and put A/C on when it is 80 degrees outside. It’s an annoying way to live, and annoys everyone around you. If you didn’t really really value your job or autonomy or something, you might not want to go through it.
That said, like I said, I have no idea whether this bunch of neurologists is right.
It should be noted here that one prob docs are concerned about is that triptans, the absolute best migraine solution, without which I would indeed be a far less functioning human being, come with a major coast. They cause rebound headaches with overuse. So ideally, you should be using them as infrequently as possible to maximize their effectiveness. The more you use them, the more headaches you will have.
This fellow migraineur is largely in agreement with the sentiment. If I really, really had to, I could function during a migraine — I’ve tried cases during an event, for instance. Went home to a dark, quiet place as soon as I could, but I’ve pushed through it.
Since my migraines involve blind spots, it’s disorienting and particularly a problem if I have do something like read a document or look at evidence. Fortunately, most things that happen in trials are either all oral — I can listen, understand, and speak — or involve evidence that I’m familiar enough with by the time I get to trial that I don’t need to look at it to know what it is. My blind spots and nausea have never interfered with a trial, although light sensitivity has sometimes made me look rather odd trying the case with my eyes cradled in my hands while I sit at counsel table (usually you want to look at the witness).
With that said, trials can be very high-stress events under the best of circumstances and I’m very much not at my best during an event. Work that I can defer, like in the office, I do. The longer I push myself during an event, and the more stress I push myself through, the longer it seems to make the recovery, and it can get quite painful.
This exactly where I am. Deferrable work should be deferred. Talking is easier than reading, although I do have word recall problems. When I’ve taight with I migraine, I think I look irritable and very serious (my usual tone is light-hearted). I think I may have called off class only once or twice in 8 years if vomiting non-stop. But it can be done, cognitively, if not ideally.
Very good post. I will be dealing with many of these issues as well..