Migraine Sufferers Of The World Deny It - You Have Nothing To Lose But Your Pain
“Migraine is the most common neurological condition in the developed world. It is more prevalent than diabetes, epilepsy and asthma combined – eight million people in the UK have migraine.” Migraine Trust of the UK
If you, or someone you know, suffer from migraines, then you probably know that the conventional medical profession can offer no cure. With one in eight of the UK populace already affected by migraines, there is every chance that the problem will only get worse.
Sometimes it takes a re-examination of the assumptions about mysterious illnesses in order to make a breakthrough. Doctor Arturo Goicoechea, chief neurologist at the Hospital de Santiago de Vitoria, Spain, has done just that. However, his views on migraines mock conventional medical wisdom and show a metaphorical middle finger to the pharmaceutical industry which feeds on the ignorance of both doctor and patient. So his ideas are not welcomed by the majority.
As a migraine sufferer myself for over twenty-five years, I have tried multiple remedies. To begin with my GP in the UK had me scanned for possible head trauma or cancerous growths. When that proved negative, he recommended painkillers like paracetamol, and later codiene. Over time, I tried assorted "alternative remedies" like homeopathy and aromatherapy, again with no effect. The migraines continued, and I moved overseas to Spain. Once here, I was recommended to one after another neurologist who recommended preventative medicines, like topamax, solgol (nadalol) and beta-blockers, among others. In most cases they did suppress the onset of migraine pain but, the side-effects of a migraine (like drowsiness and nausea) were still evident - I didn't get such severe headaches but it didn't make my life any easier.
After being prescribed one more preventative medicine - zonegran (for there was no other remedy available according to my latest neurologist) - I bought the first packet and was put off by the possible side-effects so that I threw them in the bin without commencing treatment. I preferred to take the zomig (zolmitriptan) remedy as and when the migraines struck, for they had become the only reliable "cure".
However, I was still getting about five migraines a month and so I went back to my GP to beg her for some alternative treatment. She had been reading up on the subject and suggested I try a completely alternative treatment, being promoted by a Spanish neurologist, yet not widely accepted. He has an online blog and has published several books, some in English, but naturally enough, mostly in Spanish.
Most notably, he had written a book entirely about migraines: Migraña, una pesadilla cerebral (Migraine, a cerebral nightmare), published in 2009. This is only available in Spanish, but I decided to give it a go. I can read Spanish semi-fluently, and ordered it from my local library.
The book is laid out in the form of dialogue between the neurologist and his patient (or student) in mostly simple language, so I was able to read it through in ten days, understand most of it and intuit the rest. At the first sign of a migraine (about seven days into the book) I tried to apply some of what I had learned and was amazed to find that it helped. I fought off the attack and didn’t need to take a painkiller, so I was making progress already.
Over the next few months my control weakened and I resorted to painkillers again (ibuprofen or aspirin). Perhaps I was naïve to expect a quick-fix, I thought, but there was the potential for a permanent fix in the medium- to long-term, for I was already free from strong painkillers like zomig. So I borrowed the book again with a view to translating what I felt were the important parts - there is no official translation out there - reinforcement of the ideas is imperative (according to the author) if one is going to beat migraines, so it made sense, not just for me, but in case I wanted to try to explain it to anyone else. I kept my translation to the bare bones, as much as possible, but it accounts for about 3,300 words, perhaps only 5% of the entire book.
Having gained approval from the author that my translation is close enough to what he intended to say, I choose to share it, not for any financial gain, but for anyone with an open mind unsatisfied with taking an endless cycle of drugs to combat an illness that no doctor has yet to properly explain. Like any medical theory it may not help everyone, so much depends on the individual.
Readers comments and any constructive criticism would be welcome.
Translated extracts from ”Migraña, una pesadilla cerebral” by Arturo Goicoechea - Editorial Desclée de Brouwer 2009, ISBN 978-84-330-2360-5
THE MYSTERIOUS SCIENCE OF MIGRAINES
[…] Some neurologists interested in migraines propose the theory that a crisis begins with meningeal inflammation. Danger sensors inside the head are situated in the meninges (membranes that cover and protect the head). They talk of a sterile meningitis or a neuralgic meningitis, implying that there are no germs in the meninges and that the process is ignited by a overexcited sense of danger in the meninges. When asked why the meningeal sensors are activated, they don’t know. They consider it a mystery and blame the genes, i.e, the migraine patient has some genes that generate anomalous signals (only in the meninges) which peculiarly ignite spontaneously or with little inducement.
They also suggest that the ignition comes from some intermediate level of centres, but that solves nothing. When we ask what these supposed centres do and how they activate the sensors, they say the sensors activate alone (being anomalous), confusing the spinal medulla, the brain stem and finally the brain (upwards from below). [They say] there is no information from the brain to the sensors (downwards), only information from below upwards. [By analogy …] a batch of defective danger sensors on the edge of town go off, giving the police a headache and a hot-headed journalist provokes panic in the town with exaggerated news of an extraterrestrial invasion.
Neurologists say nothing of the dialogue between the brain and the individual, they are scientists, trusting only chemistry. They advise the patient to protect themselves from the pain by shutting themselves in a dark room, putting up the Do Not Disturb sign and taking an analgesic a.s.a.p. Patients should lead a monastic life, even though this still does not free them from the migraines.
If they accept that the nucleus of a migraine has a phobic structure, the advice of neurologists corresponds with that for phobias – the avoidance of pain. But that only reinforces the problem that generated it. Most doctors believe only in molecules and in their advice and their nurses disseminate these beliefs widely. A disappointing percentage of doctors believe homeopathy and other alternative medicines contain a real therapeutic use, even if as a placebo. They have more faith in their tablets than in words to calm pain. […] Patients associations [for migraine sufferers], under the supervision of various experts, offer counselling, understanding, support and resources, but their combative defence of the theory of sickness (in the conventional sense) only spreads and consolidates the problem.
[…] The prevailing model of molecules and stress doesn’t allow for daily processes of the organism. At the core of Medicine they apply the dualistic model: we are formed by matter and spirit. The matter is the bones and ligaments moved by muscles and all the rest is vital spirits, mysterious energies that construct what we feel, say and do or, as the neurologists suggest for migraine, overactive circuits that mysteriously and without control, ignite and set off the nociceptive meningeal alarm.There are not [according to Medicine] previous thoughts, learning, cultural impregnation, predictions, senses of pain nor danger, errors etc. What they accept for the immune system is not for the nervous system and that is their basic, fundamental error.
The brain works, through the functions of the sense of danger, as a predictive system. … The awareness of danger always begins with parents, as they never lose sight of their offspring whilst at play. “Take care, you might fall!” “Come eat your lunch!” “Drink some water!” “You’ll get cold!” “Don’t leave things so dirty!” Come and wash your hands!” If they continue to infect their children with their fear, this makes them obedient and they will do as their parents ask: they will ask for lunch, clean their hands (including obsessively). Perceptions are invitations to a conduct.
From the embryonic state, we have muscular fibres which receive orders to contract and neurons with sensors of various types that detect the stimuli generated by the contractions. The central neurons keep a log that incorporates orders given to the muscles and the effects that it produces in the organism. This permits the brain to know beforehand what is going to happen when it gives an order. When you go down a flight of steps the brain knows what stimuli will be produced on the skin, the muscles, tendons and articulations when you execute the programmed action. This log of foreknowledge of the effects produced by actions is what we call the efferent copy. If you put on a CD to enjoy a favourite recording, you can anticipate what you’re going to hear. This anticipation helps you enjoy it more. If some other music comes on it will surprise you and you will begin to ask questions. The efferent copy is a plan of the motor orders to be given to the muscles based on the logs of known immediate effects that it will produce. Given an input, it is a template for its outcome.
To know ahead of time what is going to happen when it gives an order, the brain can take various decisions: if the effects are irrelevant, then it ignores them. The majority of stimuli that are produced when we move we don’t perceive if they are predictable and uninteresting. We only take notice of the relevant or that which is new. Each part of the organism is scattered with sensors that are constantly stimulated, we are restful or we are moving. All the signals they generate can anticipate and filter themselves (if uninteresting) and, in normal conditions (i.e. when there are no lesions), they produce no sensations. Contrarily, if what they perceive will happen is important, real or theoretical, their power is increased.
Regarding the music, we enjoy listening more to the recording: in this case, the efferent copy is well-reinforced. In a state of alert for the expectation of danger in the head, whatever action we take can have consequences and all the stimuli that are generated with our conduct are, therefore, potentially relevant, dangerous. The efferent copy in this case fails to filter. This can be frightening. In a migraine attack the brain checks the logs of previous attacks and forecasts a series of stimuli from the danger sensors in the head. With the lines that transport signals already at alert, dormant sensors are activated and false information of danger is received by the brain that aggravates the sense of pain. As you would expect, this creates a vicious circle and whatever movement of the head makes it worse.
[…] The brain rewards and punishes our actions, or even our intentions. There is a penal code that judges and evaluates, if we commit fouls against that which we want to protect. Falsity or foul play will activate punishment and if we correct our actions it will switch to that which seems like a reward. The reward of a drink of water relieves the punishing thirst. Generally, the sensation of wellbeing is limited to neutralising a sensation of illness that the brain places carefully so that we may do as it wants. The pleasure of a meal consists in freeing ourselves from the acute presence of hunger. It is pleasing to scratch if it relieves an itch… There is nothing like removing a tight shoe, or drinking a deep draught of water after an over-salty cod. If it seems to us that our head is in danger, it makes us feel bad and we don’t return to normality, wellbeing, until we do that which we consider which we ought to do: in the case of a migraine, to stop what we are doing, retire to a dark room, vomit and apply a “treatment”.
The recognition of the problem [of a migraine crisis] as an error of the organism [brain] and not as a mysterious illness is the first step towards the exit from the tunnel of suffering.
[…] To err is human. To correct errors is wise. The student is human and probably is or was wrong. It is not his fault. The dependence of his convictions of what the experts say drives him into a blind alley with only a migraine at the end of it. What can the brain do to detect and correct the error? The problem for us is not that we are wrong, but to not recognise the error. A migraine is an erroneous decision of the brain, it activates a select programme for necrotic emergencies (the violent death of cells) when all that has happened is that the sun is shining, or we have eaten chocolate. Even then, it is not enough that the individual detects the error. It is not enough to say to ourselves that pollen is inoffensive. That doesn’t open the road to the declassification of pollen as a dangerous agent. Migraine is not an inevitable effect of a genetically hyperactive brain triggered by some transgression or excess. We place the error in ourselves and close the door to correcting it.
BREAKING DOWN AND BUILDING UP
If the placebo effect has not had much press, than the nocebo effect has had none. At least, we don’t have to deny or argue down false concepts, it is a virgin concept. The information about pharmaceuticals contains certain interesting elements which twists things. For e.g. they teach us to think that the body adapts to drugs, and that after a time one needs something stronger, or at least one needs to change drugs every so often. This is the theory of soft drugs, strong drugs, drugs that go direct to the vein, etc. When a drug doesn’t work for one crisis it won’t work for any future crises. One abandons it and so ends that relation. These variations in the therapeutic effect don’t depend so much on the real actions of analgesics but in the evolution of ideas, beliefs, expectations or uncertainties. They have a nocebo effect. Therefore, if one uses a drug, it’s better to trust in that one forever.
Remember Dumbo, with his giant ears. His friends tried to convince him that he might be able to fly. Dumbo resisted, he was afraid, without feathers he could not fly. So his friends give him a feather to hold in his trunk. Dumbo is persuaded, falls for the con (the placebo) and launches himself into the air from a tree. All goes well with the feather until one time, he drops it, he panics and plummets to the ground. His friends gather round and try to convince him he doesn’t need the feather, that they conned him and that it was his enormous ears that made him fly. Dumbo eventually believes them, flaps his ears and flies again. He no longer needs the feather for he has discovered the true power of his ears.
[…] It is not necessary to know magic phrases or to recite litanies to avoid a migraine, but to carry convictions about the concepts. You should recognize the value and importance of a conviction. Don’t let your brain consider any other explanation. Once formed, convictions work automatically. When we drive we do it automatically, without continually wondering about how to do it. Concentration is only necessary to begin with. You have to arrange the change in your network of convictions so that they will modify the connections between the neurons. Ideas generate electric signals, sensors light up and go out, etc. Of course, they also produce chemical changes. You have to trust the power of your convictions. Respect them and construct solid arguments that keep a high level of confidence in that nothing is happening in your head except for your brain acting like there is.
Although you aren’t aware of it, in each migraine crisis the dialogue between you and your head is open. What usually happens is that it is automatic and always ends the same way. You shouldn’t encourage the alarmist tendencies of the brain’s memories. If you don’t modify your convictions, nothing will change.
[…] You have to maintain the contrary to what your head is suggesting. It is wrong. I had a student who suffered badly with migraines. As they were frequent they were often inconvenient, coming on when she had plans for the day. She liked to visit friends and go for walks in the mountains, but the idea did not appeal to her brain. Many times, she would wake up with a headache and have to postpone her day out. Other times, she would put on a brave face, say nothing to anyone and go anyway. In this case, the migraine always won and they all had to go back home, consoling the poor patient, suffering with vomiting and the pain and, if that wasn’t enough, enduring the embarrassment of ruining everyone’s day. After consulting me [the author] she understood the situation better and decided to stand firm against her brain if it tried to produce a conflict again. One day she woke up with a migraine warning, but said nothing to her friends and set out walking with more vigour than normal, which surprised them. As she went she kept thinking of about normality in her head and the nonsense of her brain. Little by little the pain disappeared and she finished the excursion without incident. If this patient had carried the fears with her she would have ended up back at home in a dark room, with pain and vomiting. By standing firm against the situation not only did she free herself from the migraine but also, her brain realised there was nothing wrong. The two of them learned from the experience.
Remember that we are talking about a process of learning. Exam results vary between students but generally the best are those that do their work well. Failure is assured if the student rejects and ignores the explanations of the teacher. Acquire knowledge and forget the result of the exams. Success doesn’t come with just effort – its necessary but not enough – the point is to clearly mark the objective.
In the case of migraine it should not be to get rid of the pain but to give your brain the adequate tools: knowledge. Don’t demand nothing from your brain, feed it with new ideas. Talk to it, use the imagination. Overall maintain your plans: go out on the balcony even though you feel dizzy, don’t hold onto the edge of the pool. Convince yourself that you can float – it is only a question of the fear of water. You don’t need tablets to float.
DON’T GIVE UP
[Following a discussion wherein the argument between the brain and individual is likened to a parliamentary debate between two closely matched parties …]
Student: I can’t see what’s going on inside my head, so I don’t know whether to believe, or not to believe, that something is happening. The party with the power, the fear circuits, tries to impose its opinion, I am the opposition and I have to refute their argument that the head is in danger with that which I already know. … Winner takes all. The key argument seems to be that the decision to activate the alarm in the head is not only unnecessary but is not acceptable to me and particularly prejudicial for the general interests of the organism.
A conviction isn’t in all the brain and it is not forever. The law of winner takes all is valid but it only applies to one battle at a time. In reality, the law should say, he that wins the battle, although it is only by a simple majority, takes the decision to defend their position to resolve the question. In the next episode they must resolve the question again and proclaim themselves winners that it doesn’t have to always be the same. In the neuronal parliament, one should not underestimate the force of the opposition, nor of course, yours.
If your brain wakes you up with the thesis that the head is in danger, you have to begin to oppose that thesis and settle the brain. Don’t give in to the voice nor its vote, don’t take painkillers and put yourself in a dark room after telling your workmates you have to stay home with a migraine. It is actually very difficult to work with the brain convinced in the theory of dark rooms, nausea and painkillers. You have to do something very distinct, oppose the decision defended by your brain. Do something, that is to say, logically, to think, reflect, argue, imagine the interior in order, not take analgesics. The option to take them shows that you accept the road laid out by the lie and all that it reinforces.
There exists a decision taker in your brain. It is the consequence of a complex process of learning influenced by culture. Pain is the brain’s decision, a wrong decision, unnecessary, unjustified, that causes absurd and costly suffering. There is no benefit in it, for you or for your body. One must detect the error urgently and start the debate. It is not the drug that returns chemical peace to the brain but the obedience of your brain to follow the convictions that you should take a painkiller and protect yourself from outside stimuli.
[…] It isn’t easy to undo the brain’s decision to take a painkiller and hide in a darkened room. The temptations form part of everyday life. They offer quick solutions without worrying about the medium and long term. We sell the future for a few breadcrumbs today.
Student: Using the music example: someone (my bad brain!) is playing an insufferable cover version of some music, music which I have liked before and my memory banks should know and that makes the suffering worse. What can I do to stop it?
Remember that you form part of this interpretation. You are a member of the orchestra, or if you like, the conductor, or you could be. Blocking your ears or singing loudly to drown it out doesn’t help, so you need to take up the baton and take control, to correct it. The musicians are your ideas, your convictions, your fears.
The brain starts the migraine crisis programme according to your values, your beliefs. Correct the ideas, the fears, the uncertainties, all that feeds the false interpretation of danger. Rationalise your fears. To receive the warming rays of the sun don’t destroy the brain… put biological sensitivity in the archives. Free yourself from virus-ideas. Confront the irrationality of the phobia.
There are schizophrenics that can tickle themselves – they don’t have a well-constructed sense of self, of that which succeeds from their own decisions and are confused by their own decisions. They don’t anticipate and filter the effects of them scratching on their own foot. The brain interprets some kind of parasite. But they know that’s not true, so it makes them laugh. When we know that a tragic story is false, it can make us smile. The start of a migraine crisis from your brain has to make one laugh too if one can previously convince oneself deep down that nothing is what it seems. The migraine-sufferer cannot tickle himself but he can produce pain without the need to make it dangerous: it’s enough to move the head, to hear, to see, to smell, whatever inoffensive stimulant causes pain. He has alodinia. In a way, it is equivalent to tickling. Alodinia is pain derived from an inoffensive stimulation, and the fear that it is dangerous.
[In the English book by] David Butler & Lorimer Moseley, Explain Pain, their vision and focus on the theme of pain without necrosis is similar to that which I [the author] sustain.
--end of translation--
Since translating the above text, I have ceased keeping a diary of when migraines affect me. I neglected to translate any part of the text which explicitly mentions the keeping of a diary, but it seems clear that the keeping of any record of one’s migraines is very much to be avoided. For the sufferer intent on ridding themselves of pain, it is very tempting to make a note of when migraines occur. By so doing, we, our family and friends, our doctor and even common sense gives us hope that we might detect a pattern and find that elusive trigger, that something which we need to eliminate from our diet or which indulgence to delete from our lifestyle. But if Dr Goicoechea is to be believed, this will only drag us down further into the vicious spiral of pain we want to be free of. Only by re-educating ourselves about migraines, by denying their hold on us, can we be free of them. In his own words, “Know pain, no pain.”
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