I got my first migraine at 23. I had no idea it was a migraine, and the word didn’t register. My thinking was: Geez, my headaches are pretty bad. I’m sure glad I don’t have migraine! Eventually I learned I did indeed have this condition, and while it was helpful to know why my headaches were so awful, I soon found out that diagnosis did not mean relief.
At first, whenever the throbbing on the left side of my head came on (usually coordinated with my monthly menstrual cycle), I just needed to eat a stick-to-the-ribs snack, take two aspirins, have a good strong cup of coffee and lie down for a little while in a dark room. How quaint. As time went on, the headaches began to last for hours and even days, and sometimes included nausea and vomiting.
Things got worse. My headaches dragged on longer, or would dissipate and then come back a few hours later. Any activity exacerbated the throbbing. The nausea and vomiting became more severe and long-lasting, sometimes going on to the point of dehydration. My second pregnancy was particularly miserable.
Eventually I pinned all my hopes on menopause, which apparently helps in many cases. But menopause came late, and when it arrived, the migraines only became more frequent, longer and severe.
I stopped being able to make plans; I was constantly having to cancel things at the last minute. One headache could last four or five days. Though I did manage to get some writing done, it was often while flat on my back, my head resting on a picnic ice block while I worked at my laptop between naps.
Of course, I went to various neurologists and pain doctors. I tried all kinds of drugs, both preventive and for attacks. I got a prescription for a barbiturate, which worked well — sometimes. I tried biofeedback, herbs, homeopathy, cranio-sacral work and acupuncture. I tried Botox injections. I tried giving up dairy, then grains, then sugar and high-carb foods.
It was difficult for me not to internalize my migraine condition — not to think of it as something I had caused or was causing. I was in a constant battle with myself: if your headaches are this debilitating, there must be something wrong with you vs. you’re doing the best you can. It was hard to find self-compassion about my migraine condition when I felt it was somehow my fault.
Meanwhile, I was recovering from a childhood of domestic violence, emotional brutality and abandonment. I was a resilient young person, and became a competent, caring mother, wife, friend and neighbor. I knew how to soldier on — which felt like the only way to prove to myself that I could have a good life after my difficult upbringing.
But my traumatic early years had taken their toll, and I was very emotionally reactive. Secretly, I was always just a moment away from tears. While I knew I was anxious, I didn’t consider myself depressed.
I was so high-functioning that I didn’t think of my moodiness as a medical problem; I talked things through in therapy instead. There were times when I dabbled in pharmaceutical interventions, but mostly I figured I just had to buck up. I was busy rearing kids, writing and so on; I had no time for depression.
Besides, I was able to engage with others, laugh and be funny, get lots of stuff done and fall madly in love with cute puppies. To me, all this was proof that depression wasn’t my problem. I had no idea there was such a thing as “smiling depression,” in which highly productive, outwardly cheerful people masterfully hide what’s going on inside.
I also didn’t realize that according to various studies, adverse childhood experiences, such as the physical violence I grew up with, make it more likely that a person will develop migraine. And people who get migraines are two to five times more likely than others to experience depression. If the depression is left untreated, the migraine condition can worsen.
But had I known these things, I probably still wouldn’t have taken my depression symptoms seriously. Of course I was depressed! My world had gotten smaller and smaller thanks to the problem — migraine.
Also, who needed another stigma? Well-meaning people in my life already seemed to think my headaches were either psychological or somehow related to my mental state — never mind that migraine is hereditary, and all three of my cousins as well as two of my three siblings have had it. I’ve also felt people’s judgment that, given my condition, I wasn’t handling it better — by “reducing stress,” or trying Feldenkrais, or going paleo.
I had no desire to be judged for having depression when I already felt judged for having such a severe case of migraine.
After four decades of migraine, why would I have faith that anything new would help? A couple of years ago, when an acquaintance my age told me she’d also been experiencing migraines since her early twenties and had finally gotten relief, I was curious.
She explained that migraine is linked with depression, i.e., that the two conditions act off similar biochemicals in the brain. Her neurologist understood this and treated her accordingly — and it had worked. Yeah, depression, whatever, part of me thought, but I scribbled down the doctor’s number. And then, without much confidence, I made an appointment.
It turned out this neurologist is also a psychiatrist, giving him a different perspective on migraine from most other migraine specialists. After having me fill out a simple questionnaire, he told me I had a mild to moderate case of “major depression.” I was a bit shocked by the diagnosis. This was the first doctor to take my depression as seriously as he took my debilitating head pain. He wanted to treat the depression as a way of treating the migraine. I didn’t quite know what to make of it.
But I was intrigued enough I decided to give it a go. I suspected the process would take a lot of trial and error, and it did. For months I tried different doses of different drugs, adding, subtracting and just trying to be patient while my migraines continued to roil. I stuck it out until we finally came up with a cocktail of pharmaceuticals — anti-depression drugs — that worked on both my depression and the migraine.
For more than a year now, I’ve been doing great. I do still get migraines sometimes, but while I keep the barbiturate around, I use it only sparingly. That’s because my headaches are so manageable that most of them require — wait for it — ibuprofen or acetaminophen. In short, after nearly a lifetime of suffering, I now have what I call “headaches for amateurs.”
As for my depression, I’m much happier and less emotionally reactive. After years of faking calm, I’ve had a chance to experience it. I can barely remember what it felt like to be constantly on the verge of tears, soldiering on so that no one would know. I had to face up to the fact that functionality didn’t guarantee a fulfilling life. I had to face my depression.
It was worth it.