The Migraineur’s Dilemma

Amy Burvall and I share at least two things in common. One of these is awesome (we were both History teachers), the other the exact opposite: migraines.

For those that don’t get migraines, it’s impossible to explain what they feel like from the inside. Amy’s image (above) is an attempt to represent it in artistic form, but there’s nothing that can really do it justice. Migraines are about as much like ‘headaches’ as someone flicking your ear is to being punched (hard) in the face.  

I’m writing this post in the spirit of having a URL for everything. I do tend to mention the following on a regular basis to people and it’s good to be able to point people towards something they can digest at their own pace. I also realised recently that I haven’t written directly about migraines since this 2008 post on their relationship to synaesthesia and creativity.

The dilemma I reference in the title of this post is only likely to be experienced by a subset of migraineurs (i.e. those who suffer from migraines). It can be expressed quite simply, but I haven’t yet found an adequate solution.

As well as stress, lack of sleep, and a couple of food and drink-based triggers, my migraines are linked to photophobia:

Photophobia is a symptom of abnormal intolerance to visual perception of light. As a medical symptom, photophobia is not a morbid fear or phobia, but an experience of discomfort or pain to the eyes due to light exposure or by presence of actual physical sensitivity of the eyes.

The Wikipedia article goes on to explain how photophobia can be caused by many things, including migraines. I’ve also got extremely pale blue eyes, which may or may not be a factor, as well as corneas so thin that I couldn’t get laser eye surgery!

This is admittedly not an ideal state of affairs but, in and of itself, it’s reasonably easy to deal with. I use a bluelight filter on my (Android) phone, the new Night Shift (since iOS 9.3) feature on my iPad Mini, f.lux on my laptops, and g.lux on my Chromebook. It’s manageable.

The kicker is that I suffer from Seasonal Affective Disorder (SAD), which I’m only just coming out of now it’s April. Unsurprisingly, the best treatment for this is bright light, which is why I sit or stand in front of a Lumie Arabica SAD box for an hour a day between November and March. This, of course, means I suffer some pretty intense glare, which then triggers my photophobia…

I wasn’t always like this. I only started getting migraines in early adulthood, and had only very mild photophobia. I do sometimes wonder if this is to do with the amount and type of sport I did when I was young (football, swimming, etc.) compared to my routine now (mainly gym-based).

Returning to the Wikipedia article:

The best treatment for light sensitivity is to address the underlying cause. Once the triggering factor is treated, photophobia disappears in many but not all cases.

A study by Stringham and Hammond, published in the Journal of Food Science, discusses the improvement in visual performance and decrease in light sensitivity (glare) in subjects taking 10 mg Lutein and 2 mg Zeaxanthin per day.

Following the link to Lutein, we find:

Lutein was found to be concentrated in the macula, a small area of the retina responsible for central vision. The hypothesis for the natural concentration is that lutein helps keep the eyes safe from oxidative stress and the high-energy photons of blue light. Various research studies have shown that a direct relationship exists between lutein intake and pigmentation in the eye.

The article goes on to list fruits and vegetables high in Lutein. Those I’m likely to consume include kale, swiss chard, watercress, zucchini (i.e. aubergine), brussels sprouts, pistachios (yum!), broccoli, carrots, and avocados. It turns out that these are also sources of Zeaxanthin, which was also referenced in the article on photophobia.

This may all seem a little navel-gazing and unworthy of your time and attention, but it’s important to remember that these effects are very real and have an impact on the working lives of people like me:

Photophobia may also affect patients’ socioeconomic status by limiting their career choices, since many workplaces require bright lights for safety or to accommodate the work being done. Sufferers may be shut out of a wide range of both skilled and unskilled jobs, such as in warehouses, offices, workshops, classrooms, supermarkets and storage spaces.

I cannot, for example, work in an environment on a daily basis which is lit via fluorescent lights. I’m writing this in a train carriage on the way to London. It’s dark outside and the fluorescent lights are already making me a feel a bit strange. Then, if I continued, would come the fuzzyness, and then the migraine aura. I avoid places with no natural light like the plague.

The answers to my problems seem simple to come up with, if difficult to implement:

  • move somewhere sunny during the winter months (to receive plenty of natural light)
  • stay away from fluorescent lighting
  • limit time on screens
  • eat lots of green leafy vegetables
  • wear spectacles with special coatings

Like anything, though, these things are simple to write, but can be difficult to achieve. The first would uprooting (or being away from) my family on an annual basis. The second means working in offices is out of the questions. The third means changing careers. The fourth isn’t too bad, but the final one is a confidence thing – I much prefer wearing contact lenses.

I haven’t really got a conclusion to all this, to be honest. This is mainly for reference and as a public URL I can point people towards when I start acting in a way that may appear strange. The upside to all this, of course, is that migraineurs tend to be, on average, more creative than the rest of the population: Virginia Woolfe, Nietzsche, Elvis Presley, Van Gogh, and Monet, to name but a few famous examples.

Finally, then, for those who may be reading this looking for some kind of insight into our condition, I’d highly recommend reading the late Oliver Sacks’ book Migraine, described as “An investigation of the many manifestations of migraine, including the visual hallucinations and distortions of space, time and body image which migraineurs can experience.” For me, it was a true insight into the fact that this is part of who I am.