The next day, before I returned Liveing’s book to the library, I photocopied the whole thing. Then, bit by bit, I started to write my own book. The joy I got from doing this was
7
Patterns: Visual Migraines
I have had migraines for most of my life; the first attack I remember occurred when I was three or four years old. I was playing in the garden when a shimmering light appeared to my left, dazzlingly bright. It expanded, becoming an enormous arc stretching from the ground to the sky, with sharp, glittering, zigzagging borders and brilliant blue and orange colors. Then behind the brightness came a growing blindness, an emptiness in the field of vision, and soon I could see almost nothing on my left side. I was terrified—what was happening? My sight returned to normal in a few minutes, but these were the longest minutes I had ever experienced.
I told my mother what had happened, and she explained to me that what I had had was a migraine aura—a feeling or sensation that precedes a migraine; she was a doctor, and she too was a “migraineur.” It was a visual migraine aura, and the characteristic zigzag shape, she would later tell me, resembled that of medieval forts, so it was often called a fortification pattern. Many people, she said, would get a terrible headache after seeing the aura.
I was lucky to be one of those people who got only the aura without the headache, and lucky, too, to have a mother who could reassure me that everything would be back to normal within a few minutes, and with whom, as I got older, I could share my migraine experiences. She explained that auras like mine were due to a sort of electrical disturbance like a wave passing across the visual parts of the brain. A similar “wave” could pass over other parts of the brain, too, she said, so one might get a strange feeling on one side of the body or experience an odd smell or find oneself temporarily unable to speak. A migraine might affect one’s perception of color or depth or movement, might make the whole visual world unintelligible for a few minutes. Then, if one were unlucky, the rest of the migraine would follow: violent headaches, vomiting, painful sensitivity to light and noise, abdominal disturbances, and a host of other symptoms.38 Migraine was common, my mother said, affecting at least 10 percent of the population. Its classic visual presentation is a scintillating, zigzag-edged, kidney-shaped form like the one I saw, expanding and moving slowly across one half of the visual field over the course of fifteen or twenty minutes. Inside the shimmering borders of this shape is often a blind area, a scotoma—thus the whole shape is called a scintillating scotoma.
For most people with classical migraine, the scintillating scotoma is the chief visual effect, and things go no further. But sometimes, within the scotoma, there are other patterns. In my own migraine auras, I would sometimes see—vividly with closed eyes, more faintly and transparently if I kept my eyes open—tiny branching lines like twigs or geometrical structures: lattices, checkerboards, cobwebs, and honeycombs. Unlike the scintillating scotoma itself, which had a fixed appearance and a slow, steady rate of progression, these patterns were in continual motion, forming and re-forming, sometimes assembling themselves into more complicated forms like Turkish carpets or complex mosaics or three-dimensional shapes like tiny pinecones or sea urchins. Usually these patterns stayed inside the scotoma, to one side or the other of my visual field, but sometimes they seemed to break loose and scatter themselves all over.
One has to call these hallucinations, even though they are only patterns and not images, for there is nothing in the external world that corresponds to the zigzags and checkerboards—they are generated by the brain. And there may also be startling perceptual changes with migraine. I might sometimes lose the sense of color or of depth (for other people, color or depth may intensify). Losing the sense of movement was especially startling, for instead of continuous movement, I would see only a stuttering series of “stills.” Objects might change size or shape or distance, or get misplaced in the visual field so that, for a minute or two, the whole visual world would be unintelligible.
There are many variations on the visual experiences of migraine. Jesse R. wrote to me that during a migraine, “I think my mind loses its ability to read shapes and misinterprets them. . . . I think I see a person instead of the coat rack . . . or I often think I see movement across a table or floor. What is strange is that the mind always errs toward giving life to inanimate objects.”
