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A Memoir and Cultural History of Migraines by Andrew Levy

Audio

Aired 10/1/09

More than one in ten Americans suffer from migraines, and yet this chronic condition is difficult to diagnose and treat. In his mid-forties, writer Andrew Levy suffered from daily migraines. To help combat the pain, he began keeping a journal and researching the medical and cultural history of migraines. The result is his memoir "A Brain Wider Than the Sky: A Migraine Diary."

MAUREEN CAVANAUGH (Host): I'm Maureen Cavanaugh and you're listening to These Days on KPBS. In popular culture, a migraine is understood to be a very bad headache. For people who get migraines, they are so much more than a headache. A migraine contains a constellation of symptoms that may include aura, weakness, stomach upset, light and sound sensitivity, fatigue, depression, and most often, extreme, debilitating, long-lasting pain in the area of the head and face. A migraine attack can strike when you least expect it, it can change form over time, it can be resistant to all medication and it can last for days. So now that it's been made clear that migraines are very bad things, what's left to say about them? Actually, quite a lot. My guest Andrew Levy has written a book that's not just about his own experience with migraines, but about migraine through the centuries. He tells us how it's been treated, how it has influenced great names of the past in politics, art, literature and music. He explores the different types of migraines, the different constellations of symptoms that make up the disease, its prevalence in our society, and perhaps, what's most intriguing, he talks about the psychological aspect of migraines and how being trapped by this strange illness can lead to personal insights and creativity. Andrew Levy’s book is called “A Brain Wider Than the Sky: A Migraine Diary.” And it’s a pleasure to welcome you to These Days, Andrew.

ANDREW LEVY (Author): Thanks for having me on, Maureen.

CAVANAUGH: And we’d like to invite our listeners to join the conversation. We’re not giving out any medical advice today but we are talking about the different aspects of migraine. Do you suffer from migraine attacks? How do they affect your life, your work, your relationships? Have you had any unusual insights or ideas during a migraine? Give us a call with your questions and your comments. Our number is 1-888-895-5727, that’s 1-888-895-KPBS. Well, Andrew, when did you start getting migraine headaches and what were those first few migraines like for you?

LEVY: Well, I first – my first migraine attacks, which weren’t headaches at all, were auras…

CAVANAUGH: Right.

LEVY: …which are sort of, in my case and in most people’s case, visual hallucinations. When I was about six years old, I just saw some shimmering stars in front of me and at six, you know, you actually think that’s part of the real world and it’s sort of like cool. My first migraine attacks that were headaches were – started in my early twenties, which is very common that people get them around then. And they went through until my early forties, about once a month, maybe even twice a month and they tended to last a day. And then when I was 43, about three years ago, I got one that came every day for four straight months. And that was my inspiration for the book, so to speak.

CAVANAUGH: I would imagine it would be. Did you ever figure out why the migraines transformed in that way so…

LEVY: No, I didn’t. You know, and one of the terms for them are transformed migraines. They say about five to seven million Americans get these. They’re also called chronic daily migraines or chronic migraines. And doctors are very interested in them right now. There – for me, there was no explanation. You know, it could’ve been stress or the exacerbating factors that come with stress at a certain period of time. It could’ve been some medication overuse. I started to get a fair amount of migraines so I started to take a fair amount of migraine medicine and that can lead to prescription overuse headaches. But, of course, you don’t take a lot of medicine unless you’re getting a lot of headaches in the first place.

CAVANAUGH: Right.

LEVY: So it’s kind of a, you know, it’s a circle that goes round and round. The weather was weird that year. I could just be growing older. Migraines change over time. The same person can have migraines their whole life but have three or four different syndromes, so to speak. They transform, which is one of the fascinating things about them.

CAVANAUGH: So when you started to get these headaches every single day, what kind of a – how did you live your life?

LEVY: Well, I think that a lot of people are out there living their lives with frequent disabling migraines. I’m struck by the number of people who drive with them, for instance, especially given the number of people who have migraines that cause some partial visual blindness. I once talked to someone who said that they would drive and a stop sign would become an ‘op’ sign and it never occurred to him to stop driving the way that someone, you know, who was, you know, drunk might.

CAVANAUGH: Sure.

LEVY: I think people tough it out. I think people look for compromises. They edge through the day. They are often not nearly as good husbands, wives, parents as they would like to be, or as good at their work as they’d like to be. They take off days. I think it’s a long, unending series of compromises with the life you want to have.

CAVANAUGH: Now, you know, what people who don’t get migraines often ask is, what do they feel like? I, indeed, have had migraine headaches myself and so I know how difficult it is to describe it. But you have written a book about this and you do sort of attempt to describe what the migraine feels like, so if you could do that for us now, what does one of your migraines feel like?

LEVY: It’s a good question, Maureen. And I think the – for me, the most interesting thing about the migraine first is that disorientation. You know, it’s often a – there – most migraines have a premonitory symptoms so they start with premonitory symptoms, maybe at ten or eleven in the morning. I might feel almost like my nose was melting or I feel a certain very specific kind of tiredness, a really sharp yawn. It’s taken me years to distinguish that sharp yawn from other kinds of yawns. Then maybe a little dizziness. Thick-tonguedness. I might say the wrong thing; I might something I had no intention of saying at all. I might be typing on the computer and be unable to type the ‘p’ and the ‘s’ for some peculiar reason. It’s things that are that arcane. And then the headache comes and, for me, the headache is – tends to be about a six to eight hour event that goes from, you know, early afternoon to dusk, sometimes late morning to dusk. And for me, it’s an incredibly sort of sharp, uncontrollable throbbing, usually over the left temple. Migraine means half a head in French and Latin so most people’s migraines tend to be half a head, although many’s are not. And, you know, for me, it’s just this throb. It’s like, you know, in the book, I write it’s like God punches you in the side of the face. Pow. Then quiet, calm, almost like the zen calm. Then pow. And sometimes it’ll race a little bit faster. The pows will be faster. Pow, pow, pow, then they’ll slow down. I might almost think they’re going away. I’ll feel calm. Then a big pow. And like that for six or eight hours.

CAVANAUGH: We are talking about migraine headaches with the author of a book, "A Brain Wider Than the Sky: A Migraine Diary,” Andrew Levy. And we’re taking your calls at 1-888-895-5727. What is actually happening in the brain when we have a migraine? Do we even know that, Andrew?

LEVY: There are different but converging theories about that. And, again, I’m not a neurologist, I just sort of summarize…

CAVANAUGH: Right.

LEVY: …you know, like an English professor would, what neurologists say. But a 19th century doctor named Edward Liveing called them nerve storms. And a lot of contemporary neurologists are very fond of this terminology, that it’s cascades of electricity triggering pain receptors in your head. Often the pain receptors which are supposed to be triggering for a good reason, like the way that, for instance…

CAVANAUGH: Ah, you’re getting a call.

LEVY: I know. I’m getting a call. I can’t – I have to take this, Maureen. I’ll be right back.

CAVANAUGH: We’re actually getting a few calls for you as well.

LEVY: It’s, you know, like the way when you sneeze in bright sunlight, that’s your brain making a mistake. And in many ways a migraine is just an awful mistake your brain makes in response to, you know, it’s a wrong stimuli. It sets off your pain receptors and it’s usually a cascade of electricity or change in electrical differential.

CAVANAUGH: Yeah. That – I think that explains it pretty well. Let’s go to the phones and take a phone call. We are taking your calls at 1-888-895-5727. And Nitsan in San Diego is calling us. Good morning, Nitsan. Welcome to These Days.

NITSAN (Caller, San Diego): Good morning.

LEVY: Good morning.

NITSAN: How are you?

LEVY: Good. How are you?

NITSAN: I’m good. I don’t have a migraine today.

CAVANAUGH: Excellent.

LEVY: Oh, excellent.

NITSAN: My question is one of my symptoms is a sensitivity to smell and all my friends are – relatives who’ve ever had a migraine have never had that symptom. I’m wondering if other people get it, if it’s common?

CAVANAUGH: Well, thank you for that. And, Andrew?

LEVY: Yeah, the three ways you know a migraine is a migraine and not another kind of headache is nausea, hatred of light, and hatred of sound. That’s the stuff that people usually identify. But smell sensitivity is in the game, too. And for some people it’s often a very specific smell which will trigger a migraine. It could be, you know, the cleanser that your company uses on the carpets at night before you come in to work in the morning or a certain food. And then, in general, I think a lot of people just experience – they just become hypersensitive or hyper-excitable. Some stimuli that other people think is normal, they hate. It’s not often smell but it is smell sometimes.

CAVANAUGH: Or a skunk. That can do it, too.

LEVY: Yeah, I’ll bet.

CAVANAUGH: How common are migraines? How many people get migraine headaches?

LEVY: About 35 million Americans, sort of one in eight, one in nine, seems to be the number, and about half of those have what you would call disabling conditions, which is a few days a month where they simply can’t function because of them.

CAVANAUGH: Now in your book, you talk about some symptoms that, frankly, I had not heard about. I hadn’t heard about the aura that basically sort of like makes you see things that aren’t there or, you know, you’re talking to someone and their head disappears. Tell us a little bit more about that and how common they are.

LEVY: Well, I interviewed someone once who said that their first migraine, the aura was that they were turning the pages of a book and the pages were completely clear and the book was completely clear but the words had disappeared. It’s that kind – those kinds of – or someone is talking to someone and their head disappears like the Cheshire Cat’s head disappears in “Alice In Wonderland”…

CAVANAUGH: Yeah.

LEVY: …but their shirt is still there. Their tie is still there. They can see the wallpaper where the head should be. These are aura symptoms. These are the kinds of hallucinations that, you know, it’s a minority of people who have migraines who experience this kind of stuff but they are absolutely, you know, routine, diagnosable migraine symptoms.

CAVANAUGH: I won – Do we know the things that trigger migraines? As you said, you know, it can be sound. Well, I don’t know. You are sensitive to sound but what is it? Every time I do any reading on migraines, it’s always like chocolate and caffeine and…

LEVY: Yeah.

CAVANAUGH: …but I was so happy to read what you had to say because you are weather sensitive and I think that has a lot to do – I mean, just, you know, being selfish, I think that has to do with my migraines, too. Tell us about being weather sensitive. I mean, there’s nothing you can do to control that.

LEVY: No, there isn’t because weather is, you know, you kind of have to live with it. Yeah, actually there’s a passage in the book. I’m speaking from Indianapolis here but there’s a passage in the book talking about my San Diego migraines, for what it’s worth…

CAVANAUGH: Uh-huh.

LEVY: …which I got, you know, in the Torrey Pines State Reserve looking over toward the ocean, absolutely beautiful with the light glimmering off the ocean. I did not want to turn my eyes away but the dry air combined with that sort of bright sparkling light is completely migraine inducing.

CAVANAUGH: Umm-hmm.

LEVY: For me here in the Midwest, it’s barometric pressure changes, if a storm is coming, if the air gets hot and humid, and you can almost feel that electricity in the air, the migraine mounts inside my head almost in coordination with it and tends to sort of become quite severe in the hours before the storm and then tends to break with the storm. If you go through – there’s some – there are some neurologists who think that this is, you know, arguably the reason that most people get migraines, the number one reason, or number two. But there are also other neurologists who think it’s actually a fraudulent reason, that there’s something else going on.

CAVANAUGH: Let’s take another call. Laura is calling from San Diego. Good morning, Laura, and welcome to These Days.

LAURA (Caller, San Diego): Good morning. Thank you for taking my call. This is so timely to hear from you guys this morning because I woke up this morning with another migraine in my 38 years of migraines that I’ve been suffering, so I’m really glad to hear about this. And I just wanted to make a comment on how difficult it is for migraine sufferers out there, that maybe you’re in a relationship, you know, with a family that doesn’t suffer from migraines. You can feel very alone and maybe not understood when you’re going through that pain but I’m lucky to have a family that does understand what’s going on and just wanted to comment on the, you know, that the support of people around you can really make a difference when you’re going through this trauma of migraines, especially when they’re frequent like mine are on a couple times a month basis. So…

CAVANAUGH: Laura, thank you for the call.

LEVY: Thank you, Laura.

CAVANAUGH: You talk about that a great deal, Andrew, in your book, how it affects the family members.

LEVY: Yeah, and I think it’s – it might be the most important thing to talk about because if 35 million Americans have migraines, it’s one out of every five families that has a husband or a wife or a child with a migraine condition and a lot of those are quite severe. So it really is an incredibly common situation and, as Laura describes, if your family doesn’t get it, if your husband or wife thinks that you’re faking it, or doesn’t understand the symptoms or doesn’t respect them, it can be a phenomenally difficult experience for both people, as well. You know, by the same standard, I also say that the husband or wife or the child who has to, you know, to sort of accept the sudden disappearances of the person with the migraine, that’s also difficult. And I think, you know, understanding that it’s really the pain’s fault, that it’s not any individual’s fault, coming up with, you know, an accurate, honest understanding of what a migraine is so that your spouse knows and understands and sees what it is, these things really help.

CAVANAUGH: I’m speaking with Andrew Levy and we’re talking about migraines and about his book, "A Brain Wider Than the Sky: A Migraine Diary." We’re taking your calls and we will continue to take your calls when we return from a very short break. You’re listening to These Days on KPBS.

# # #

CAVANAUGH: Welcome back. I'm Maureen Cavanaugh, and you're listening to These Days on KPBS. My guest is Andrew Levy. He’s written a book called "A Brain Wider Than the Sky: A Migraine Diary." And we are talking about migraines, not only how people live with them, how Andrew is coping with his, but also migraines in history and the famous people who’ve suffered from these terrible headache conditions. And we’re taking your calls at 1-888-895-5727. You know, we have heard from some fellow migraineurs, what – I’ve always been intrigued by that name, migraineur. Where does that come from? People who have other illnesses don’t get to call themselves something.

LEVY: I know. I got a paragraph about that, how, you know, depressive it makes it sound, like something that, you know, acts upon you but migraineur makes it sound like something you practice on some racquet court somewhere.

CAVANAUGH: Yes. Indeed. Now how long in history have people been having migraines? Or do we have evidence?

LEVY: Well, there – they’ve diagnosed them in ancient Egypt, 1500 years before the birth of Christ. They called them gestep (sp). The ancient Samaria had them about 750 BC. Hippocrates was working with them. Galen, Claudius Galen, a famous Roman, a surgeon about 200 years before Christ. And these aren’t just headaches, these are one-sided headaches with the very specific diagnoses that match what modern doctors look at.

CAVANAUGH: Well, someone in ancient Rome or – What did they do when they got a migraine headache?

LEVY: Well, they had all – they had – they understood at a very early time that rest and quiet were very helpful. Even the Talmud has some headache advice where it says that if someone has a headache, you leave them alone. You don’t force them to engage in society. I think it’s very good advice. But they also – they did something called trepanning which was surgery, kind of just, you know, scourging the forehead with a knife. They had – Galen recommended using an electric torpedo fish attached to your head, basically kind of an early form of electroshock. A lot of prayer. A lot of, you know, stuff using surrogates and effigies. The Samarians would create a clay version of your own head and then transfer the pain from your head to the clay head and then break the clay head, that kind of stuff.

CAVANAUGH: I like the fish one, though. Maybe that worked.

LEVY: I like it, too. Yeah.

CAVANAUGH: We’re taking your calls at 1-888-895-5727. And let’s talk to Jean in San Diego. Good morning, Jean. Welcome to These Days.

JEAN (Caller, San Diego): Good morning. I’ve had migraines since I was about eight and I’m now in my mid-forties. And in the last year, I’ve been getting vertigo and nausea and some of the other symptoms of a migraine but not the pain in the head.

LEVY: Umm-hmm.

JEAN: I’m having the disorientation and the severe vertigo, and I was just wondering if you had heard other women who’ve talked about that?

LEVY: First of all, I’ll just say that if you’ve had a change in your symptoms, that I hope you will go to a doctor, preferably a neurologist and preferably a headache specialist, Jean. But, yeah, and those are all symptoms. It’s certainly – You can have a migraine without the headache, and vertigo, dizziness, nausea are absolutely within that constellation of neurological symptoms. If you’ve had a pattern in the past of having headaches with migraines, it just seems like, you know, it’s sort of another turn of the kaleidoscope of the disease but you should still absolutely go talk to someone, double check it. You know, make sure that that’s, you know, you know, that it’s not anything more serious. And, as well, just get a diagnosis period. It might be that a different drug might work for you now that wasn’t working before.

CAVANAUGH: I’ve always been interested, speaking of the history of migraines, if the sick headaches we always used to hear about…

LEVY: Right.

CAVANAUGH: …in the 19th century were, indeed, migraine headaches.

LEVY: I think so. They had a bunch of names for them and one of the names was ‘sick headache.’ Lewis Carroll, who was a tremendous hypochondriac, called them bilious headaches. So did Jefferson, who also had them. When – Most of the times when you hear of a woman in Victorian literature complaining of a headache, it’s a migraine syndrome. It could be cluster headaches or some other major headache syndrome but it’s that kind of condition.

CAVANAUGH: You know, Andrew, you write at length about Lewis Carroll and his “Alice In Wonderland.” Why? Why do you do that in this book?

LEVY: Well, what really hung me up is that if you go through the book, first off, I mean, Carroll identified himself as having migraines and he wrote about them. He drew sketches which indicate the exact kind of partial blindness issues, so that he was a famous migraineur interested me. But “Alice In Wonderland” is almost an encyclopedia of migraine symptoms. I mean, you can just go right through it, so much so that it’s almost suspicious if like any one person could have all those migraine symptoms. And, you know, in some ways it’s a lesson of over analysis. It’s also a lesson in what a very smart man is probably capable of producing, a smart man with a medical textbook. The interesting thing, in fact, is that most of the symptoms experienced in “Alice In Wonderland,” you know, things like feeling nine feet tall or nine inches high, crying gallons of tears, becoming incoherent, not being able to remember your name, you know, it goes on and on, they tend to be more associated with children’s migraines. And given his interest, you know, his general interest in children, the possibility that he had heard children complaining of their headaches and their migraine conditions and sort of turned it into a fantastical children’s story is one you shouldn’t disregard.

CAVANAUGH: Something like a migraine fantasy, that’s very interesting.

LEVY: Yeah, sort of like Alice had headaches, she complained about them, he turned it into a children’s story.

CAVANAUGH: Right, right.

LEVY: Yeah.

CAVANAUGH: Let’s go to Kim in San Marcos. Good morning, Kim. Welcome to These Days.

KIM (Caller, San Marcos): Hi. I’m really enjoying the show. I have really strong auras, the kind that are like a halo of light…

LEVY: Yeah.

KIM: …around my field of vision.

LEVY: Umm-hmm.

KIM: And I’m interested to know whether he went – the more intense the aura I have and the longer it lasts, the milder my headache is, and I wonder if that’s common?

LEVY: Umm-hmm, that’s great. I don’t know. You know, I think that’s – I love that question and your description of it as well. I think that there is – doctors – right on those two bodies of thought about what auras are and the reason that some people get auras without headaches. And to some extent, it’s the idea is some people think that the aura is – there always is a headache afterwards the aura but sometimes the headache just doesn’t gin up enough amps in the rheostat, so to speak, doesn’t have enough electrical pulse to matter. So it’s possible that what is happening, again, is kind of a – just, as we said to Jean, a transformation of your migraine condition from one phase of your life to the next, which is now going to be more aura featured and less headache featured which is, of course, the one you want.

CAVANAUGH: Yes.

LEVY: And that, you know, that’s – that happens. I don’t know that it’s – that the exact ratio that you described, which fascinates me, happens. That’s the first I’ve heard of it.

CAVANAUGH: And we’re to – I’m speaking with Andrew Levy and his book is called "A Brain Wider Than the Sky: A Migraine Diary." We’re taking your calls at 1-888-895-5727. And, Andrew, you’ve already dropped some names of some famous migraine sufferers, Lewis Carroll and Thomas Jefferson. Who else? What were you able to piece together in your compilation of the people, the great and the famous, who have also had this debilitating problem?

LEVY: There’s quite a few. And I want to stress, I don’t want anyone to think I’m romanticizing this disease.

CAVANAUGH: Right, right.

LEVY: But what was interesting because there’s a lot more people who’ve had such bad headaches that they’ve not been able to lead as fulfilling lives as they’d like.

CAVANAUGH: Yeah.

LEVY: I don’t want to make it seem like it’s a fun, great thing to have. But there’s great stuff from Sigmund Freud about his migraines which took place during, you know, early creative fugues in his life. Charles Darwin, there absolutely seems to be links between headaches he reported as migraine. Lewis Carroll. Virginia Woolf wrote brilliantly about migraines. I don’t think anyone has written better than she wrote about them. Ulysses S. Grant said that his migraines went away the day he got the letter of surrender from Lee at Appomattox, which is one of my favorite lines about migraines. A lot of composers, Tchaikovsky, Mahler, Georgia O’Keefe during the phase where she became Georgia O’Keefe where her paintings became more experimental. They asked her where she saw this stuff and she said, I saw it in a headache. Over and over again, I saw it in a headache. The list is pretty extensive. One of my favorites is actually right now Jeff Tweedy of Wilco…

CAVANAUGH: Ohh…

LEVY: …one of my favorite bands.

CAVANAUGH: Uh-huh.

LEVY: Yeah.

CAVANAUGH: So up to the present day.

LEVY: Yeah.

CAVANAUGH: That’s very interesting because that brings us to another point that you make in the book and, indeed, without romanticizing migraines and anybody who has them knows that that really can’t be done, you talk about the kinds of insights that some people find as they manage through these attacks. Tell us more about that.

LEVY: I think the – you know, the best person for this is Sigmund Freud because, of course, he kept ridiculously complete records of every change in his psychological state. And from in the 1890s, when he was making the decision to become a psychoanalyst, actually to invent psychoanalysis, when he was coming up with the key concepts, he was having frequent migraines. In fact, he was going to become a migraine doctor first and after – you know, he often described how frustrating the migraines felt, how dumb they made him feel, how words would go out of his head, but then he would also leave diary entries which said, you know, that after the migraine receded, from 3:00 to 6:00 a.m., he wrote several famous concepts of psychoanalysis. That often the migraine, in Virginia Woolf’s words, sometimes a migraine leaves you feeling like sand that a wave has uncovered. You feel fresh, renewed, humbled. Some of these – You know, a lot of people also report periods of elation and unusual clarity before the headaches begin, during the sort of premonitory period. Now to other people, these periods of clarity often look ridiculous. I mean, there’s frequent records of a husband walking around the house, pacing, muttering to himself and he thinks he’s brilliant and his wife thinks that he’s insane. He thinks he’s having a fugue of clarity and that’s migraine, too.

CAVANAUGH: And another thing that’s migraine is when – is how you feel after the attack has subsided. Quite often people report that they are fatigued and they feel as if, you know, they’ve fallen down a flight of stairs but every once in a while people also report that they also experience a sense of euphoria. Have you heard both?

LEVY: I have heard both. I’ve heard people say, you know, the migraine takes a day and then they need another day to recover from it. They say they feel completely depleted, exhausted. But I’ve heard other people describe it almost like a computer reboot. You know, it’s like it just clears the slate and they feel fresh and relieved and rejuvenated. So it kind of cuts both ways.

CAVANAUGH: Let’s take another call. Craig is calling in San Diego. Good morning, Craig. Thanks for waiting and welcome to These Days.

CRAIG (Caller, San Diego): Hi there. My name is Craig Ditzler and I’m a chiropractor in University City. And I find in my practice that migraines, I can help them a great deal by the chiropractic adjustments in the neck area and also treating their liver, gallbladder.

LEVY: Hmm…

CRAIG: A lot of times I find hormonal involved with the liver, gallbladder and one remedy that can work very well at times on people is literally sucking on choline. Choline is a B vitamin you can find it at most any drugstore.

LEVY: Umm-hmm.

CRAIG: And generally depending, we can get rid of migraines and I guess, in a way, I’ve never met a migraine I haven’t been able to help and/or get rid of if we can change their lifestyle and their dietary type pattern.

CAVANAUGH: Well, thank you for that call very much, Craig, which, of course, Andrew, brings us to remedies.

LEVY: Yeah.

CAVANAUGH: And major strides were made in the 1990s with prescription drugs, not to say that chiropractic won’t work…

LEVY: Umm-hmm.

CAVANAUGH: …but there’ve been all sorts of remedies. What’s available these days?

LEVY: An amazing amount of stuff, including chiropractic and B vitamins as well. The breakthrough in the ‘90s was a class of drugs called the triptans, which was the first drug created for migraines that actually helps with migraines. But up until then it was accidental drugs basically. Beta blockers work for a lot of people, for instance, but they take them for hypertension or blood pressure issues. There – So there’s – triptans are meaningful. But there is just a host of other remedies that people are using. Biofeedback and acupuncture, for instance, for some people. A lot of herbal remedies ranging from lavender to feverfew. A lot of, you know, alternate drugs, anti-epileptic medicine works for some people, anti-depressants works for other people. As I said before, anti-hypertensive works in some cases. Some people are using Botox now; it freezes the muscles, you know, it paralyzes the muscles and nerve endings where the headache is supposed to happen. For other people it’s dietary and lifestyle changes. You mentioned it before, caffeine is probably causing millions of headaches…

CAVANAUGH: Umm-hmm.

LEVY: …in America. And because it also stops a migraine, people often get caught in these cycles of, you know, I have to have a cup of coffee a day and the cup of coffee is making the migraine, it’s also relieving the migraine.

CAVANAUGH: Right.

LEVY: And if they raise or lower their caffeine level then they fall into like this migrainous disaster zone.

CAVANAUGH: Yeah.

LEVY: I think chocolate, I think more research has found that chocolate is actually pretty innocent. Bad sleep, bad diet, sometimes it’s just very basic stress factors in your life. A lot of people get them at the start of a holiday or the end of a holiday just to ruin the holidays, it’s called like the Maui migraine and because it’s often the case that, you know, just a major change in the stress level of your life. Women are two or three times more likely to get migraines than men and that’s usually because of hormonal changes, onset of menstruation when they’re teenagers, pregnancy, menopause, those usually all signal a change in migraine conditions, too.

CAVANAUGH: Let’s take another call. Mike is calling from San Diego. Good morning, Mike. Welcome to These Days.

MIKE (Caller, San Diego): Yeah, good morning. I just wanted to share real quick that with me, I think you kind of touched on it just now, is that for me my migraines have been going on since I was probably, you know, I can – as far back as I can remember. I’m in my mid-twenties now. And for me, it was always my – it was my diet. It was the food I was eating, especially foods that were high in content of like monosodium glutamate and Yellow 5 and all that kind of stuff. So, I mean, a lot of people just suffer from this just like me and if they would just kind of look to, you know, their diet and eat more pure foods, you know, they would – they wouldn’t see so many migraines, so…

CAVANAUGH: Well, thank you for that. Thanks for adding that. You know, I think a lot of migraine sufferers get pretty cynical when it comes to remedies because, you know, you try one and it really doesn’t work and then you try another one and that really doesn’t work. And…

LEVY: Yeah.

CAVANAUGH: …so how are you coping with your migraines now, Andrew?

LEVY: Well, I think that you have to – You know, you have to really get to know your own body and have to take some risks, I think. I – you know, for me, I get them pretty regularly but I’m much smarter at recognizing them than I used to be. That I can recognize them at 11:00 a.m. makes a huge difference taking almost any migraine drug. If you recognize it early, you catch it. If you recognize it late, it’s too late. It’s galloping and you’re done. That makes a difference, I think. You know, if you get lucky, you find changes in lifestyle such as cutting out MSG, as your last caller said.

CAVANAUGH: Right.

LEVY: Sometimes one of those clicks, you know, and you just have to be patient with it because it takes a few days or a week, you know, to make the change. You can’t give up. You have to keep a good diary and figure out what patterns you might detect and then stick with a change for a little while. And it’s very hard to sort out, you know, one food from another, you know, do you cut out the caffeine? Do you cut out the MSG? Do you cut out the chocolate? Or do you cut out the alcohol? If you cut out all of them and just eat toast for a month and then see what happens to you. And it is so frustrating because they are so enigmatic in their causes and their triggers. And some people never – you’re right, some people never get a cure. And some people get a cure and then they tell everyone about their cure as if they think their cure is going to work on everybody, and most people are in between. For me, I take a couple of pills. I take a beta blocker, I take Imitrex, which is a generic sumatriptan. I catch them early. I excuse myself from events whenever I can. But I try not to add any stress to it or any stress to my family’s life. And not adding stress to anyone’s life on account of my migraines or stress to my own life, makes them just pain, you know? And just pain is a whole lot easier than pain with panic, pain with despair, pain with guilt.

CAVANAUGH: Exactly right.

LEVY: Yeah.

CAVANAUGH: And finally, Andrew, you say that people who have migraines can have an extraordinary outlook on the world, a kind of a special zen. Could you tell us what you mean by that? Because I think that’s a very hopeful note.

LEVY: Yeah, I mean, in my personal experience, you know, with eight hours of that throb and the quiet, that throb and the quiet, you know, there’s a Buddhist metaphor of using – you know, of a broom that sweeps your mind clean and flat. And the migraine kind of works that way. I don’t – I’m not proud that I have it but if I have to spend six or eight hours every once in awhile just lying there in this almost unthinking state, it does reset me to zero in a way which I know to take advantage of because another thing about the migraine is like you’re getting something good out of this amid the bad. And to not take that good thing, to not cherish that nugget and make something of it, I think makes a difference.

CAVANAUGH: I want to thank you so much for talking with us today.

LEVY: Thank you for having me here, Maureen.

CAVANAUGH: Andrew Levy’s book is called "A Brain Wider Than the Sky: A Migraine Diary." I want to thank everyone who called in. Those people that we couldn’t get to, please do post your comments at KPBS.org/TheseDays. Now coming up, the story of a Mexican cultural theme park that almost was. That’s ahead as we continue on These Days here on KPBS.

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