Part 2 of 3 talyzing these experiences. I reflect on the unique function and roles these aspects have adapted to fill, and how my brain has facilitated the fulfillment of this. I’ve found that the answer involves central sensitization.
During a migraine attack, signals to the trigeminal nucleus caudalis in the brainstem trigger the activation of trigeminal nerves, which innervate the sensory endings in the face and sinuses, as well as the blood vessels surrounding the brain. This activation is responsible for the typical pain experienced, as well as the presence of head-based allodynia. In chronic migraine, repeated peripheral sensitization of these first and second order neurons causes the sensitization of third order neurons deep in the thalamus, aka Grand Central Station, which is responsible for processing all sensation in the body. Consequently, widespread allodynia and body pain ensue, completing this central sensitization mayhem.
After I absorb the reality of this process, I question the functionality of my brain. Though highly dysregulated and imbalanced, the brain is responding to the conditions it has been given. If human evolution is an ongoing process of adaptation, then I am indeed evolving, just not the way I desire.
The Cost of Multiplicity: Conditioning Into a Constant State of Pain
Inhabiting a body host to both migraine and fibromyalgia presents unique challenges. When one experiences frequent pain, the central nervous system becomes conditioned to function in a state of pain and remains “on”, even when the threat has passed. The consequence? Increased disability and likelihood of developing additional pain disorders.
Self-blame, anxiety, depression, and guilt double down when migraine and fibromyalgia bear their unyielding weight. My mental chatter consists of compromises and negotiations in efforts to appease, pacify, and cope with pain. Pain becomes a cruel game…“should I take sumatriptan today, or save it should I need it later in the week, which I most likely will?” Resigning myself to full days in bed has distorted time and held me in a peculiar space, in chronic retreat.
Knowing when to accept or push my limits is an active problem I face day in and day out. I’ve grappled with respecting the parameters of treatments and questioning their efficacy when I’ve continued to feel pain and discouraged. “Good days” are relative but graciously welcomed. I’ve learned time is precious, and though my participation varies, my presence never leaves, and I am always here.
Is living a life avoiding pain still living? When evading pain has constituted so much of my life, I answer a self-assured “yes.” Feeling constrained has fostered a creativity that blooms as abundantly as pain spreads. While I’m thankful for the flexibility and adaptations I’ve nourished, regaining stability is an ever-present hope and work in progress.
Adapting, Once More
In light of these adaptations, I’ve begun to question: If my brain has adapted to a life with pain, can it not adapt to a life with less pain? Thankfully, it can, by reason of a phenomena called neuroplasticity, or the ability of the brain to adapt and change.
For those with episodic migraine, treating migraine early is especially important, as it interrupts the central sensitization process. However, when this process does take hold, treatment should prioritize multiple ways to manage pain. Pharmacologic intervention encompasses both acute and preventive treatments, some of which may include triptans, DHE, NSAIDs, or gepants. Alternative methods, such as talk therapy, mindfulness-based stress reduction, physical therapy, strengthening, grounding, massaging, meditation, yoga, acupuncture, and deep breathing have paved alternate trails and opened new channels within me.
Finding a Pulse
Disentangling pain from self and extracting my essence from disease challenges me to quit the checks and balances act. Searching for reasons, building lists, and marking my strengths, weaknesses, and growth edges comes with limits, amounting to mental gymnastics at best, and at worst, more chaos at Grand Central Station.
I hurt. All over.
For me, these sentences live in a repetitive loop. I struggle. I doubt. I wonder if life carves its own way or if I can wield the knife in my favor, and if so, am I capable? Can I find a pulse?
Pain is arriving just as fast as healing is unfolding.
Whatever part I bear witness to, or shifting perspectives I occupy, I still check my boxes from time to time.
Receptive? Check. Alive and well? Check.
[Expert Interview] Ailani, J., MD, FAHS, FAAN (2022). Expert Tips to Manage Persistent Migraine Pain. Migraine World Summit. Retrieved January 9, 2022, from https://migraineworl