This cluster of headaches continues. Often I feel like they’re the result of the buildup of something, some pointless store, deep in my body’s metabolism. The excitation of some wonky, long disused component of the nervous system, freely discarded by evolution and no longer of much value to the rest of the body. Every now and then some autonomic appendix gets full of stuff and has to empty itself: hence a cluster headache.
While the practicable medicine is obviously not simple, different neurophysiological oddities can often sit well side by side. Cluster headaches and migraines; sympathetic- and parasympathetic-autonomic; melatonin deficiency and serotonin deficiency. Most interestingly, both of these exhibit a kind of self-irritation or symptomatic feedback.
During my early twenties, I spent around a year either limping or walking with a stick. The cartilage in my left knee crackled and itched, usually painfully and often with an intense heat. By the time I had an MRI scan, all that could be seen was inflammation. The original damage, the chip in the cartilage, whatever the speck of grit in my knee’s oyster had been: that had entirely disappeared, leaving a huge, inflated pearl of bursitis. So great was the inflammation of my knee joint, that merely flexing the joint caused all its moving parts to rub against each other, inflaming itself still further. Over time, and with physiotherapy, the inflammation gradually disappeared, leaving nothing at all.
Cluster headaches are odder still. If I take Migraleve an hour or so before I know one is going to start – yes, they’re that accurate – then I don’t notice the headache: unsurprising, given enough codeine. More than that, though: even though codeine has little anti-inflammatory effect, I also avoid having a light, almost forgettable headache for much of the next day. A traditional theory of pain would say that: at night, although I could not feel the pain, the underlying mechanisms causing it – excessive vasodilation near my trigeminal nerve, say – would still be going on. I just wouldn’t notice at the time, but any subsequent inflammation caused by those mechanisms would still cause me pain once the medication had worn off. Yet a painkiller at half past midnight, that wears off by four a.m, is still affecting my perception of pain some twelve hours later.
Migraines react so strongly to external stimuli early in their formation that they feel like they’re entirely symptomatic, all the way down. A friend still suffers, and he finds that: if he can neck enough painkillers and anti-emetics within the first two hours of a forty-eight hour cycle of auras, nausea, headaches and the rest; then only four hours later the medication and migraine have both worn off. If he waits for the migraine to become established, then no amount of painkillers (within the bounds of safety) will do anything other than ameliorate the pain. Treating the symptoms only, and treating them early, treats the underlying cause.
Cluster headaches and migraines are symptoms built on symptoms, themselves built on themselves. They’re evolutionary artifacts, weird excitations, ghosts in our machines. They co-habit our nerves, live alongside us, flicking switches like gremlins living in our attics. They’re the hooting feedback in our body’s PA system, drowning out the normal telegraphy from limb to brain. They’re the strange loops, not of our consciousness or subconsciousness, but of our body itself; proprioceptive Tourette’s, our nervous system firing off swear words at us when we’re trying to sleep; for goodness’ sake.