Home Again

Back from Cleveland

Very tired, legs are protesting, but made it through the trip without too much trauma.  The Headache tried to throw a fit but I managed to stomp it back into it's hidey hole.  The legs have had it, with the cane being totally necessary yesterday and today.

Never try to travel when you have a bad headache trying to worm its way out.  I got on the train system in Cleveland and totally missed my stop.  I got out where I thought I should be, and a very nice young girl directed me down the street where I could catch the bus to the Cleveland Clinic.  The plane schedules were very hectic as some storm had hit the northeast - I never thought I would get on a flight to Milwaukee to get back to KC.  People were very grouchy as flight after flight was delayed or cancelled.  One flight got cancelled because there were no flight attendants for the flight.  Thinking I will drive next time if I can get someone to ride with me.

I actually saw Dr. Mekhail this time, he examined my incisions (which have all healed well) and asked how my headache control was doing.  I told him that once or twice a month The Headache escapes and I was thinking perhaps if I had a pulsating program on the stimulator it might do better for those bad days.  Lilly, the study coordinator, found an ANS rep there at the clinic and she came in and added a couple of programs for me.   I haven't tried them yet, but will if The Headache keeps getting worse.

I am very discouraged about The Legs.  With the therapy and the epidural and the new muscle relaxers I was thinking that I would have less pain with travel and standing, but unfortunately it wasn't so.  Feet and legs are hurting and weak, and the pelvic pain is making me tremble when I try to stand.  I'm OK once I get on my pins, but the action is hard to do.

The client I was going to have to go to for the next install has decided to delay everything for two weeks.  I'm glad I don't have to go so I can maybe try more therapy and get myself in better shape.  Unfortunately I don't think damaged nerves are going to respond to therapy.  Damaged muscle: yes.  Dysfunctional movement: yes.  Nerves that aren't transmitting correctly: no.

I have to go back to Cleveland on July 22nd.  I tried to get out of it, but I have to be there to finish more surveys on their computer system and to have another physical review and to turn in the palm pilot headache diary I picked up this time.  Hoping they are able to publish soon.  Don't know what I will do if the clients try to reschedule to this week.  I have never turned down going to a client even at the worst of times healthwise, but this might be the one time I cannot go.  Hoping luck is with me and the client will delay further.  Not so good for my company, but I am being selfish today.

Maybe I will get to stay home over the 4th of July holiday.  It's my favorite holiday of the year.  I have two nieces born in July and one great nephew born in July, and a step great niece born in July.  A happy time for everyone!  Woo Hoo!!!  I am sure my legs will be better by then and I will be able to enjoy the day.

I Think I Still Have My Marbles

But They've Shifted Lately

Bad day yesterday, bad day today.  The Legs are not happy, and today The Headache was making itself know as I tried to work.  Sometimes I can tell when The Headache is not happy because I don't make sense.  I call people named Annie Angie, I can't remember words or just stop in the middle of a sentence, and I have to recheck work three or four times.  My typing and spelling goes downhill.  Hoping it's better the rest of the week.  I have recalibrated my head buzzer so should be good to go!

One of the guys at work thought I was better today because I wasn't using my cane to walk everywhere.  I just let him think that, but it actually was more weight I had to pick up to walk and it wasn't worth the effort.  I don't use the thing so I won't fall down, I use it so I can lean on it to stand or walk and have less pain in my nerves in my legs  - when the pain is maxing out I really don't see the purpose. 

I'll use my cane to walk with as I travel this week. I have some new muscle relaxers from Dr. SassyPants called Skelaxin which I am afraid to try until this weekend, so I guess I'll just have to tough it out this week because I have to drive.  I don't take anything that messes with judgement when I drive - The Headache is bad enough!

The epidural was a bust.  Not working for me.  Pretty sure that there will be no more in my future.  The benefit lasted for less than two days, and I think that was the anesthetic they use with the steroid.  Plexopathy must be a tough thing to treat. The physical therapists gave me more exercises to do since I won't be having anymore therapy for a few weeks, maybe more than a month since apparently summertime is their vacation time too.

Wishing I had some time for a real vacation where I could escape everything INCLUDING The Headache, The Belly, and The Legs.  They just seem to follow me around everywhere, the skunks. I guess my luxurious economy flight from Kansas City to Cleveland will be my only escape this summer.  I'm gonna try to skin out of doing the last trip to Cleveland in July, because I think I am going to have to be in Arizona at that time.

Burning Foots

Red Hot Nails

No sleep tonight, even with maximum medication.  The Headache is not happy, and The Feet are not happy.  The Belly was unhappy, but settled down, and The Legs are just grumpy.

Getting red hot spikes of pain, like claws tearing through the bottoms of my feet up to the tops of my feet.  Guess the epidural didn't quite fix this.  I have been "flossing" my nerves like the therapists suggested but really don't think it is working  or just not working fast enough.

The pudendal nerve pain picked up yesterday because I was doing laundry, where you pick up and transfer loads of laundry.  Any weight lifted that has downward pressure seems to bother this, not sure why.

My epidural had some positive effect for a couple of days, but seems to be wearing off rather than making everything better.  Maybe I just need to be more patient and positive.  I will send good vibes down to my legs to make them better.  I have my doubts that it will work, but why not give it a try??

I'm told I'm anemic now, perhaps why I feel so very very tired.  Maybe not sleeping might have something to do with the tired feeling too.  I have worked on a project for work most of the evening, probably putting in an eight hour day already because I need the distraction.  Because of the lack of sleep (it's 3 AM and no sleep in site) I may call in late to work tomorrow.  I have several things to do, but can compress them into the afternoon and stay late to further make up.

Wishing the foot problem gets better, as it is starting to radiate UP my legs.  I have been trying hard to remain positive about the physical therapy.  Inaction hasn't helped the pain any, so I am hoping some directed reaction to pain might be the ticket to wellness.  The pain is lessened by the injections, so can't tell if the additional pain was there, but masked by worse pain, or if the injections just weren't that effective.

Going to Cleveland Thursday, will stop at a client on the way to the airport on Wednesday, and if they feel the need may stop back for a short while on Friday.  Hoping they don't have a big list of little problems for me.  Sigh.  Gonna email my boss and update the "time off" calendar after signing off.

Ouchy Epidural

Hoping this does the job

Received a spinal epidural steroid injection today.  This is supposed to eventually help my lower spine pain and relieve muscle spasms. Am hoping for the best!  Left work early as it started hurting a couple of hours after the injection.

The back is hurting tonight, and The Legs are not so well either.  Not as bad as yesterday or the day before, but still hurting from the injection.  The butt numbness is wearing off, so the soreness is settling in.  This is anticipated, so hoping it will be better tomorrow.

Will be back tomorrow for more physical therapy.  Trying to get my body ready BEFORE the next client installation starts.  Going to bed and going to sleep!  Night all!

Blog Carnival at Somebody Heal Me

Theme this Month : Food!!!

At last a theme dear to my heart, food!!  Diana Lee at Somebody Heal Me has done a marvelous job again editing her monthly Headache Blog Carnival.  This month's entries are about Food, Glorious Food!!  I recycled an older entry about brewer's yeast allergies, and there are some wonderful entries that cover the spectrum of food and its relation to headache.

I especially liked the link to Natural Pain Relievers: 20 Herbs that Work.  Found a few I didn't know about! 

If you are a Facebook fan, hook up to Diana Lee on Facebook - she posts some bonus articles that are great to share!

I Love It When A Plan Comes Together

New Headache Clinic: The A Team

Saw my new headache specialist this week, I think he's gonna be a keeper.  Long interview process for the first visit with both the nurse and my new doctor.  I think I'm going to call him Dr. Hannibal Smith, after the A-Team leader, because he definitely has a plan for treatment.  Instead of giving me the Mission Impossible speech or the One Flew Over the Cuckoo's Nest song and dance he came up with not one, but four different strategies for us to look at!

He knew about my condition (hemicrania continua). He didn't have to look it up in a book or tell me it didn't exist or that isn't what I have.  He said the pain is on the very severe scale of headache pain (which I already knew) and there aren't a lot of medications that work with it, and that it was doubtful that any new ones would be developed because there just aren't enough of hemicrania continua patients to make it profitable.  However, he is going to some big headache conference in a couple of weeks, and he is going to ask some other headache specialists that deal with more hemicrania continua patients to see if there are other treatments that might work, and check on how effective a couple of his ideas might be for HC.  He also said he would check to see if there were any clinical trials I could participate in that might be of help.

A medication change, the addition of Klonopin (clonazepam) at night, is already helping my sleep.  I did wake up at 2 AM like always, but I was able to go right back to sleep - a big improvement over most nights. Hoping I won't have many adverse side effects from it.  I am also going to try taking phenergan/benedryl on a schedule proactively before The Headache gets out of hand.  I have a headache diary to keep, and will start checking to make sure The Headache is still in the three to four day pattern it has had for the last three years.  If so, I will take my phenergan/benedryl combo on the projected bad days not waiting for The Headache to wake up and ruin my day.

The Headache tried to get worse last night, and between taking the phenergan/benedryl pretty quickly and then the Konopin I was able to keep it at a distance.  Hoping that it will stay that way for a while!  Not so good this evening, but maybe tomorrow will be better!  The Legs are better tonight and are not hurting quite as much.  Hoping they will be even better next week.

A couple of the strategies he spoke of I am not so sure I want to try - one was getting Botox injections in my supraorbital nerve, and in my forehead and neck.  Another was getting another stimulator installed in the supraorbital nerve; if I got that I would so electrical I think I would need to get a direct feed from the Hoover Dam to keep going!  He said that Botox helps headaches not only by numbing the nerve, but also prevents the nerves from exuding an enzyme/chemical messenger that tells your brain to have a headache.   Didn't know that, but I don't really want to have a limber neck like Stephanie at Head Wise ended up with!  My Bone Head is too heavy for my wimpy neck already without the help of Botox to make it worse!

They gave me all kinds of information about migraines (even though I no longer have them) which was nice.  I was told to avoid all artificial sweeteners except Stevia, as they all seem to contribute to headache pain.  I don't use artificial sweeteners so I think I am OK on that score. I am sure about 98% of the patients they see are migraine sufferers and they sure give you a lot of really good literature to take home about migraines.  It was very interesting reading, and I learned a few new things about migraines from their booklet.

I give this practice an A+ (so far) and hope that I will be going there for my headache care well into the future.  No perfumed magazines in the waiting room, no perfumed personnel, and no perfumed patients to ruin my morning.  A very quiet and orderly place to go.

I am up late tonight because I delayed taking my medication because I was busy.  Time gets away from me when I am doing something that requires concentration.  Must be my Bone Head at work again!

The Spanish Inquisition

PT Visit #2

The therapy evaluation I had Monday put me in a world of hurt Tuesday.  It didn't help that I had a 14 hour day of work counting travel on Tuesday, and that I drove myself, and that I stood for almost nine hours.  The last half hour of the drive home I was actually in so much pain I didn't know if I could make it home.  After getting home I took a Soma and benedryl, and then curled up around a pillow and cried silently for a couple of hours until the pain started to dissipate a bit.  About as bad as it can get so it must be uphill from here!  I know my face must have reflected the pain at the client as I was asked two or three times if I was OK.  I try very hard not to show it, but I can't help the "hollow eye" look I get.

The therapy visit I had today hopefully won't leave me in as much pain.  I hurt quite a bit this evening, but it is basically what I started with this morning, so far no additional pain.  Whew!

The therapists had researched radiation induced lumbosacral plexopathy to see how to treat me.  Bless their hearts!  They told me what I already knew - there is not a lot of research or literature out there on this condition.  They did find some tips in therapy websites on what has worked and what has not worked for this type of problem.  Unfortunately there wasn't a lot that had worked.

They decided to try a technique called myofascial release which involves pressure and stretching of connective tissue (fascia) that has become restricted by the therapy and the body's reaction to pain.  I am sure my inability to exercise much in the last three years has not helped any either.  They said their research said that they would need to work in a band from my ribs down to my knees, and will work from the outer edges inward to "trick" the nerves out of their hypersensitivity.  I felt some scar tissue release today in the radiation field, so am hoping this might actually help.  They are trying very hard not to hurt me too much.  They said this works really well with fibromyalgia too.  I have a niece with this condition, so thought of her.

I was put in traction for a while to allow my lower back to relax.  I have more exercises to add to my list and will practice until my next appointment next week.   I feel as if I have been tortured with soft cushions and made to sit in a comfy chair for a while today, much better than the bed of nails and the rack I was tortured with on Monday.  Hoping the next session will go well.  The therapists said I will need at least hour long sessions or more for a while, so I will have long days at work making up the time the next couple of weeks.  They have some techniques to work on the pudendal nerve issues also, but said we need to wait for some of the pain to subside before trying these.  Yeah!

My therapist said she teaches a class on pain and how the body perceives pain.  The next session is in July and I would love to attend if my travel schedule permits.  Understanding the mechanism takes some of the mystery out of the "why me" part of my whiney brain.  She said if I can't attend she will try and include it in my therapy sessions.

Go to see the new headache specialist tomorrow.  Have hopefully gotten all my records sent to them already, and have faxed them all the evaluations they asked me to fill out.  Good news for all of us "scent sensitive" people out there - they specifically say not to wear perfume or strongly scented powders deodorants or soaps.  They said the first visit might take a couple of hours.  Not sure if it will for me, since I already have a diagnosis.  Hoping they are not weird, or flakey, or rude, or incompetent.  I have a friend who went there and now has control over devastating migraines that haunted her for years, so I hope this practice will work for me too!

Bent Like A Pretzel

PT Evaluation Day

Had my physical therapy evaluation today.  I had two therapists do the eval, one a student and one an experienced therapist.  I certainly hope I didn't scare the student away!  Physical occupational and speech therapists are generally quite jolly people, so we are sympatico in our approach to life.  Or maybe they are just closet sadists that really are jolly about hurting people, but I don't think so.  They are generally upbeat all the time, whether they are increasing your range of motion or talking about the weather.

I had some pain during the eval, a few times I actually shed a few tears [thank heavens I was face down at the time] but I am in general stupidly stoic.  Must be my stubborn German ancestry coming out.  The experienced therapist told me she thought I had a great deal of pain tolerance (nice of her to notice since she was trying to see where it ended) but my toes gave me away - good poker face, but apparently my toes were curling when the pain started getting bad.  Drat those toes!  They are almost always in shoes where no one can see them.

I still have no reflexes from the knees down.  My right leg is weaker than my left leg - which is no surprise.  My left leg is a quarter inch longer than my right leg, which was a surprise - but apparently there is an exercise that can help with that.  Some moves made my feet more tingly, and a couple of positions they pretzelled me into were quite painful not only on my sciatic nerves and hamstrings, but my pudendal nerve area also.  They mentioned a femoral nerve problem, but am not sure if the test was positive or negative for that.

I came out of the session with a couple of exercises to do, one to "glide" my sciatic nerve through the muscle structure of my legs and hips, and another to help correct my leg length difference.  Neither are hard, but I feel very weak in my lower legs, so it will be a challenge.  I was so afraid there would be nothing they could do so am glad I have something to work on.

The Headache is behaving itself, The Belly is grumbling and trying to put out feelers of pain (it got a little scrunched today), and The Legs are having a fit.  I started getting extreme spasms of pain starting at 45 minutes to midnight, and am still having them although they are dying down a bit.  The pelvic pain started at the same time, so hoping tomorrow I will be able to drive.  I have a two hour drive to a client, several hours of training and walking to do when I get there, and a two hour drive home.  I don't have anything for the pain except the Soma, and 1) the physiatrist took me off that medication and 2) I have to drive tomorrow so I don't want to take any risks for alertness.  I am just buckling down, gritting my teeth, and riding it out.  I certainly hope it quits soon, as the pain has started radiating down my legs in addition to the spasms.  Sigh...BIG sigh...

I have another physical therapy session Wednesday so I will be giving them some feedback about the pain.  This is what happened to me several years ago when I tried PT before.  I experience some pain during the sessions, but later is when it gets extreme.  The therapists suggested I get with a pelvic floor therapy specialist for the pudendal nerve pain, but my fear is that agressive treatment of that will end up with me laid up for a week or two unable to walk and I simply have no time for that right now.

The area of the radiation field from years ago is very sensitive to touch and perceives even light touch as pain so I am supposed to try to desensitize my skin and retrain it as to what is normal sensation.  Didn't know you had to train your skin!  The therapists said that I need to have deep tissue massage and myofacial release done but I won't be able to tolerate it until I am able to get this overreaction under control.  They want to do a case study of me because they don't see many people with my type of problem - not related to a spine issue or an accident.  Glad to be an object of interest I guess!

Gonna try to go to bed, hot needles are being poked in the bottom of my feet and up my shins now.  Starting to jiggle the legs in the dance of pain.  Hoping that this will be the end of the pain for a few hours.  The therapists acted surprised I was still working.   I told them I just want to improve my ability to work - pain I can handle but loss of function I can't. 

I was so excited about getting the PT done because I want so much to do better at being able to stand and walk for work.  We are such a small company I feel like I'm not being a good team member because I can't carry my share of the "go-live" support like I used to.  Travel is becoming such an issue - carrying luggage is a problem, stairs are problems, driving is a problem, standing in line at airports is a problem.  I just want to do my job and it is frustrating to keep hitting limits I have no control over. Looking forward to a better day tomorrow!   Will try to stretch the pain out tonight - using the cat in this video as a model of relaxation!!!

Cherry Jam Weekend

Luv My Cherry Trees

My cherry tree, which is 10 years old this year, finally had a crop of pie (tart) cherries that I could do something with.  In years past, I have been lucky to get a handfull of tiny little red cherries off it, but this year I have gotten almost two gallons of cherries from it!  I just love picking shiny red cherries and then cooking them up into rubilicious cherry jam!

Saturday almost all day I picked cherries.  My Mom, and Beanie and Augie helped pick, although the puppies mostly nosed around on the ground where we dropped a few.  The Legs held out, even with me climbing a ladder to pick the cherries at the top of the tree.  I cheated, because regular step ladders are hard on The Legs I had an old above ground pool ladder and used that instead.  The steps were wider, and the entire structure was much more stable  - plus I had the pool ladder platform to hold my cherry picking bowls!

I love pie cherries - one of my best memories of my childhood is sitting high in our cherry tree during the summer, eating fresh picked cherries while reading a book.  Living in southern Missouri there are plenty of orchards, but none that I have found with pie cherries.  I think it is too warm down here for cherry trees to thrive - they like cold weather in the winter.  Mine haven't done so well in the past but this was a good year for cherry trees I guess.

Mom decided she wanted to make cherry preserves or cherry jam, so today I bought sugar and pectin and we made several pints of cherry jam.  Now making jellies or jams is a fairly expensive proposition - it is probably cheaper to buy ready made products at the grocery store - but nothing tastes better than homemade cherry jam!  I still have more to make, but will make it tomorrow night - wore out tonight before the cherry supply was used.

What's the difference between a jelly and a jam?  Jelly is made just from the processed juice of the fruit, while jam has parts of the fruit and pulp in it.  A preserve has whole fruit in it as opposed to the more chopped up mishmash used in jam.

I survived the weekend without The Headache, The Belly, or The Legs ruining it all for me.  The Hives were behaving, but I re-challenged my system with Flexeril again this evening so I'm a bit hivey at the moment.  Pretty sure Flexeril is now off the preferred drug list for me!

I go tomorrow for my physical therapy eval, Tuesday I go for a day trip to a client, and Thursday I try out the new headache doc to see if this practice will be a match for me.  We also have clients from out of town in the office all week, so it looks to be a busy week!

Self Assessment

Reality Check

A list I go through periodically (just my own questions) to remind myself that life does not sucketh as badeth as I thinketh at times.  These are my June responses:

1. Do you have a life threatening illness? No
2. This year to last year, health improved, worsened, same?  Improved
3. This year to last year, finances improved, worsened, same? Improved
4. Is your family life stable?  Yes   
5. Is your work life stable?   Yes
6. Are you not stressed, slightly stressed, really stressed?  slightly stressed
7. Are you feeling hopeless?  No
8. Are you tired? Yes
9. Have health problems affected your interaction with others?   At times
10. Do you take yourself too seriously? Don't think so!
11. Do you have trouble concentrating? At times
12. Do your illnesses intefere with your ADLs? Yes
13. Do you feel sorry for yourself?  No
14. Are you able to relax? Yes
15. Are you able to sleep? With Difficulty
16. When you sleep is it quality sleep, leaving you rested? No
17. Are there people worse off than you are? Yes
18. Do you feel you are acting appropriately concerning your illness?  Yes
19. Do you still have a sense of humor? Definitely
20. Despite your own issues do you have concern for other people's welfare? Yes
21. Do you misuse or abuse medications given to you?  No
22. Do you project your feelings about your illness into your interactions with others?  I hope not
23. Have you put life plans on hold due to illness?  Yes
24. Do you feel illness has cheated you out of a life you deserved?  No
25. Are you happy/content?  Most of the time

Hoping I stay this side of what is normal for me!  Guess I'm doing pretty OK, except on the sleep score.

Mast Cell Degranulation

Mastocytosis and Other Hive Disorders

One of the problems I have been tentatively diagnosed with in the last few years is mastocytosis, or a mast cell activation disorder (MCAD).  My gastroenterologist and my original immunologist thought it might be a possiblity, since the symptoms include headache AND digestive disorders AND skin reactions.  The immunologist thought I have a mastocytoma on my nose (I call it my permanent hive!) in addition to some of my permanent hive spots.

My Kansas City immunologist was not so sure.  She didn't rule out mastocytosis, and pushing on my red spots did induce hives elsewhere, but decided to treat the autoimmune component of my hives first to see if that was the cure all I needed.  I definitely showed autoimmune issues in my blood tests there, but the tryptase levels (used to measure the leakiness of the immature mast cells) were in normal range.

I started thinking about this again partly because I am changing immunologists if I like the new local guy (my original local doc died of an aneurysm at a very young age) and partly because I think the flexeril Dr. SassyPants prescribed is making me break out in hives and blisters.  This evening even my lips are little puffy and the inside of my nose and ears is itchy - generally not a good sign.  Unfavorable reactions to muscle relaxers can be a characteristic of mastocytosis, but I get so many unfavorable reactions to so many medications it gets hard to figure what is causing it!

One of the talented members (Lisa Sterling) of  The Mastocytosis Society web group I belong to thought my description of my spotted appearance would make a good story, and wrote a children's book about mastocytosis using my psuedonym for the web (Winny Ninny PooPoo) as the name of the lead character,  who is a child with spots.  There are many children afflicted with this disease and it can be disfiguring and painful, and this book was written to be used by doctors and families to explain the disease to a striken child and perhaps to the child's classmates/friends.  There is even a spotted Winny Ninny PooPoo doll that can be purchased with the book, and a companion coloring book!

Like some headache patients, many masto sufferers have spent years trying to get a diagnosis for their condition.  The symptoms are varied and differ in intensity from one person to another.  Some just have the cutaneous version (hives, red spots, Urticaria Pigmentosa, and /or Telangiectasia Macularis Eruptiva Perstans), some have the systemic version which can include all the cutaneous problems and also involves more than one body system (skin, liver, intestines, etc.).  Children seldom have the systemic version; it is more common among adults with this syndrome.  The systemic version can evolve into more agressive and possibly cancerous versions that involve blood cell production.  "Brain fog" and fatigue are often symptoms but are difficult to diagnose.

A mastocytoma is an abnormal collection of mast cells in one place, and rubbing that spot can cause hives to pop up and the mastocytoma to flare up also.  The histamine released by the constantly degranulating mast cells is thought to be the cause of the headaches associated with these disorders.  Still considered a rare disease, experts believe it may be underdiagnosed in the general population.  Bone marrow testing and biopsies of my lesions could definitely confirm the diagnosis or rule it out, but I'm not keen on having the top of my nose removed or getting my pelvic bone pinched.

I will discontinue the flexeril for a few days and re-challenge myself to make sure that it is the cause of my hive exacerbation.  Just call me itchy until then!!!  Am on the road tomorrow, back to a client for followup!  Sigh....

Interesting Theory About Migraine

Is Migraine a Disease or a Syndrome?

In the May 2010 issue of Neurological Sciences there is an interesting article entitled "Is Migraine A Disease?" by Cortelli, Pierangeli, and Montagna.  This article theorizes that migraines themselves are normal functions of the body to what the primitive brains of our ancestors saw as threats.  When these threats (or triggers) are experienced a cascade of chemical and neurological changes occur as the body attempts to negate the effects of the threat. 

One area directly stimulated by these responses is the hypothalamic region of the brain, which is closely related to the "Fight or flight" response.  In sensitive individuals if the threats/triggers are detected too frequently, the body starts to anticipate the threat, increasing the reaction and shortening the response time.  After many repetitions the condition becomes chronic, resulting in migraine as a malfunction, rather than migraine as a defense mechanism.

Cortelli, et.al., make the point that many of the common triggers for migraine (hunger, lack of sleep or too much sleep, alcohol consumption, light, noise, smell, and stress p. s30) could be seen as threats to brain function.  The brain desires to mitigate these threats, and when overwhelmed creates what Cortelli, et. al., describe as excessive allostatic load.  Allostasis is the body's active response to restore and maintain homeostasis (normal levels of stress hormones and energy), and allostatic overload results in continued heightened response to stimulus, often in excess to the threat offered.

"Four types of allostatic states leading to allostatic load have been identified
(1) repeated challenges,
(2) failure to habituate with repeated challenges,
(3) failure to shut off the response after the challenge is past, and
(4) failure to mount an adequate response." (p. s30)

The theory put forth is that migraine pain, nausea, photophobia, phonophobia, and sensitivity to odors is a normal defense mechanism of the brain.  The abnormal behavior in the migraineur's brain happens when allostatic load is increased frequently and the brain becomes habituated to it and starts to "short circuit".  Perhaps that is why many migraineurs find solace in a dark quiet room, lying very still - all threats are minimized and the overactive circuits are able to stop firing.

The authors speculate that "Migraine attack may not be considered a disease itself but in presence of a failure of the mechanisms controlling an excessive allostatic load, the repeating of migraine attacks may lead to a morbid state (chronic migraine)." Cortellis, et. al state that the migraine spectrum is a syndrome not a disease or dysfunction, and that more research needs to be done to find the exact mechanism that turns the primitive midbrain response into a chronic pain condition. (p. s30- s31).

In a post I did entitled "Does Anyone Really Know What Causes Migraines?"  I wrote "I wonder if what we call "migraine" is actually a catch all for several disparate diseases which all cause similar symptoms by different mechanisms. Perhaps that is why it is so difficult to manage, because there is no real "it"...rather migraine is a loose definition of a entire spectrum of disorders."  I guess I could modify this thought with this caveat "or a syndrome with varying causes masquerading as a disease".

My headache disorder, hemicrania continua, is mediated by the hypothalamus.  Perhaps my primitive midbrain/hindbrain is in constant alarm state, not able to turn itself off - that could explain the bone weary fatigue that goes with it.  I think I must have hit myself in the head too many times in past lives with a rock and am paying the penalty now.  Guess my primitive bonehead needs more space for the brain!  After all this scientific hoohah babble I have been writing, I think perhaps what brain I have is shriveled up like a raisin.