1
" You keep pressing me,” he said, “to say that the attacks start with this symptom or that symptom, this phenomenon or that phenomenon, but this is not the way I experience them. It doesn’t start with one symptom, it starts as a whole. You feel the whole thing, quite tiny at first, right from the start.… It’s like glimpsing a point, a familiar point, on the horizon, and gradually getting nearer, seeing it get larger and larger; or glimpsing your destination from far off, in a plane, having it get clearer and clearer as you descend through the clouds.” “The migraine looms,” he added, “but it’s just a change of scale—everything is already there from the start.” This business of “looming,” of huge changes of "
― Oliver Sacks , Migraine
3
" Du Bois Reymond spoke of “a general feeling of disorder” at the very start of his attacks, and other patients speak, simply, of feeling “unsettled.” In this unsettled state one may feel hot or cold, or both (see, for example, Case 9); bloated and tight, or loose and queasy; a peculiar tension, or languor, or both; there are head pains, or other pains, sundry strains and discomforts, which come and go. Everything comes and goes, nothing is settled, and if one could take a total thermogram, or scan, or inner photograph of the body, one would see vascular beds opening and closing, peristalsis accelerating or stopping, viscera squirming or tightening in spasms, secretions suddenly increasing or lessening—as if the nervous system itself was in a state of indecision. "
― Oliver Sacks , Migraine
4
" PERIODIC MOOD-CHANGES We have already spoken of the affective concomitants of common migraines—elated and irritable prodromal states, states of dread and depression associated with the main phase of the attack, and states of euphoric rebound. Any or all of these may be abstracted as isolated periodic symptoms of relatively short duration—some hours, or at most two or three days, and as such may present themselves as primary emotional disorders. The most acute of these mood-changes, generally no more than an hour in duration, usually represents concomitants or equivalents of migraine aura. We may confine our attention at this stage to attacks of depression, or truncated manic-depressive cycles, occurring at intervals in patients who have previously suffered from attacks of undoubted (classical, common, abdominal, etc.) migraine. "
― Oliver Sacks , Migraine
19
" We have seen that there are two forms of stimulus which are particularly prone to evoke migrainous reactions in predisposed individuals: inordinate excitations or arousals, and inordinate inhibitions or slumps. Within certain “allowable” limits (which vary greatly from person to person), the nervous system maintains itself in a region of equilibrium, homeostatically, by means of continuous, minor, insensible adjustments; beyond these limits, it may be forced to react by sudden, major, symptomatic adjustments. "
― Oliver Sacks , Migraine
20
" Transient states of depersonalisation are appreciably commoner during migraine auras. Freud reminds us that “… the ego is first and foremost a body-ego … the mental projection of the surface of the body.” The sense of “self” appears to be based, fundamentally, on a continuous inference from the stability of body-image, the stability of outward perceptions, and the stability of time-perception. Feelings of ego-dissolution readily and promptly occur if there is serious disorder or instability of body-image, external perception, or time-perception, and all of these, as we have seen, may occur during the course of a migraine aura. "
― Oliver Sacks , Migraine