Defeating Pain

One Person's Battle Against Chronic Pain


Pepper, The King of Spices

Migraines, migraines, migraines! Ugh, they sure slow me down¬†but, never stop me ūüôā¬†Luckily, there is black pepper to help with migraines, and it is great for other uses with a long, long history behind it.

I am sure if you went to an American public school that you learned that Columbus sailed the ocean blue, back in 1492, and he did so to find Spices. (If you didn’t I am sure you got a different story, and possibly more, or less, accurate depending on where you are.) Spices¬†were¬†that mystical substance found in the “East,” that were used to cover up rancid meat. Since apparently our “crude” European ancestors didn’t care if their food was off as long as it was coated in spices. Every country must have it’s creation myth, and this is the one taught here.¬†‘Murica!

Depiction of actual historical event, brought to you by American Public Schooling

But in all seriousness, spices are important. Important enough to attempt dangerous voyages, or commit horrible crimes upon the native owners of the fabled spice plants. I am looking at you VOC.¬†Spices may mask some of the early stages of food turning rotten, but would not cover them all once it has turned, or make it alright to eat without severe consequences later. Also rotted food is gross, really gross. (Which if that stuff is your fancy,¬†interesting stuff is being learned on disgust now and why we have it) Generally this myth about spices is not believed by actual historians, so while they weren’t used to make gross, inedible things edible, it did make edible things a lot more exciting. In the immortal words of¬†Emeril, they let you kick food up a notch. BAM! It was that excitement of the palate, the way they activate the senses, and rarity, that made spices so desirable. Spices make the meal, it adds complexity, depth, and helps us avoid the monotony of blandness. Even just adding salt and pepper can take a meal from¬†meh, to wow! But we, as a culture, hardly ever notice it as we dump massive amounts of both on our food, before even tasting it.

Spices usually¬†traveled great distances, and because of this commanded great prices, and were first used in small amounts. Sometimes used as precious medicine, and many of them were, even if they were not necessarily used in the right way all of the time. Of course some of them weren’t medicinal, or magical, but were still used as medicine since rare things are often claimed to have powers to add to its price. Also used in cooking, but sparingly and it makes the dishes from Richard II’s kitchen more luxurious when you realize that a small piece of ginger was not only crazy expensive so only nobility could afford it but it made it all the way to England, over possibly months or even years. A lot of these spices that traveled far and were known in the historical eras dried easily and were easy to transport. Some of the most important were cloves,¬†ginger, cinnamon, turmeric, cardamom, in later years nutmeg, and of course¬†black pepper. Black pepper and cloves take the distinction of being the oldest traded, and most important of them all.

Pepper, most well known in its hard, small, bead-like black pepper form, is made from the berries of the Piper nigrum vine. This vine that grows native in India, but is a global crop now, and it is the little berries that are harvested to make what we know and recognize as peppercorns.¬†The berries (drupes to be precise, but I will use berries since most people understand what berries are ūüôā ) hang in long clusters, and turn redish orange when ripe. They are sort of like harder, larger seeded grapes, or coffee berries.


Hard to believe those shriveled little black things we know, started life like this

Harvesting at various stages of ripeness, and its preservation method, determines the color of the end product. The vines are quite beautiful, and they like to grow in tropical areas where there are lots of trees and things to support its vine-y growth. Since pepper and cloves were so easy to transport, they were some of the first spices to travel and make it over great distances. Pepper was once the sign of great wealth, and was extremely expensive, hence its epitaphs of the King of Spices, or the Master Spice. Even thought its price has diminished to allow it to be more accessible, it is still the most used and most traded spice in the world. It has even kept its name Black Gold, though it now shares that moniker with crude oil.

“Wait!? Pepper!? That common thing that we pay as little attention to as salt? That is on every table, be it fast food or fancy.¬†That pepper¬†was crazy expensive?!?” You are probably thinking to yourself.

You betcha.

It was not only expensive, it was used as a form of money it was so precious. Many sayings come from this use of pepper, like in England¬†¬†“peppercorn rent” came to be used for a token payment, or for extremely discounted rents. The Dutch phrase “peperduur” translates to “as expensive as peppercorns.” In the Middle Ages pepper was used to pay dowries, and even taxes. Now we have pepper everywhere, to the point we expect it and take it, and its low price, for granted. People purchase and use pre-ground pepper which is dry and bland, never getting to experience the complexity of white, or green pepper. Or¬†the wonderful taste of black pepper when freshly crushed. Next to water and salt (which we really under appreciate), black pepper is the most common ingredient in cooking. But, considering we have used pepper since 1000 BCE, it is sort of easy to see how it may have become common, and lost its luster and air of exoticism. Americans consume about .25 lbs (.11 kg) a year and Tunisia is the highest consumption at .5 lbs (.23 kg) a year, and most of it is the most common black pepper.

Pepper has a long history with humans, it has been around since at least 2000 BCE in India where it has been known to have been used by Indian cooking for generations. It was found dried and stuffed into the nostrils of Ramses II, most likely placed there during the embalming of his body. Pepper is native to India but only in a very small place in the region of Kerala, and pepper had to travel great distances to get to Egypt. It is still not known exactly how pepper got to Egypt from India, since there is no documentation of it prior to 600 BCE. The most likely suspect would be by dhow, a type of boat that has plied the seas between Africa, the Middle East and India for longer than humans have documentation for, leading to a lot of debate on how early they could have been used just in general. Using the cycle of the Monsoon winds, as is done now, it would have been fairly easy journey from India to the Middle East or the Horn of Africa with spices for trade. After the Kon-Tiki, it is very plausible that these trips were going on for many years before someone happened to write it down. This trip is still made today by the same type of boats, and it is an easier route than the over land, later known as the Silk Road.

By¬†about 400 BCE Greece was very familiar with black pepper, even if they could not always afford, or find it. They first¬†called black pepper peperi. Black pepper was not as popular as Long Pepper, in Greece and was not a huge feature in their foods.¬†The Romans later caught on to pepper and called it piper.¬†Once Rome conquered Egypt and a sea route to Malabar was possible, and as it became more available Romans grew to use black pepper more frequently in their cuisine. In fact, they almost became pepper fanatics. Pliny the Elder complained that vast amounts of Rome’s income was flowing to the East. Brennus, the original Hells Angel, after laying siege to Rome demanded as ransom for the city 1000’s of pounds of gold and silver, and 3,000 pounds of peppercorns. Vae victis indeed.

Pepper traveled more and more widely and gained popularity in every country it traveled to. Up to the Middle Ages, all black pepper in Europe, the Middle East and North Africa came from Malabar. As Europe grew a taste for pepper its popularity there quickly increased. There is folklore that Indian monks used them for energy, and the term pepper came to mean energy or energetic, and it is where the term “pep” came from. Like with Tea, when it was scare and valuable, many people kept their precious pepper supply under lock and key. People considered poor were the ones with “no pepper” and in Germany a term for the rich was “pepper sacks.” Pepper is what made the wealth of the merchants of Venice, and was what helped to drive the Age of Exploration. Pepper was one of ¬†the spices people sought to find a direct trade route to that started all those expeditions. If you were a merchant in Venice one of the ways to bribe a tax collector was with a pound of pepper. The oldest guild in London is the Guild of Pepperers, started in 1328 CE. Soldiers were given it as payment after battle, and when a wreck of a boat originating from England dating to about 1545 CE was found, all the sailors bodies recovered were found to have peppercorns on them. Not only was pepper wealth, it was easily portable wealth, which made it easy to carry during travel or trade. It was so highly prized, along with salt that you have fantastic items like the Cellini Salt Cellar being made. Which pretty much screams luxury at you, telling you how highly regarded pepper was, displayed in a golden and enameled chest next to a possible Earth goddess who faces her counterpart the Sea god and his boat¬†of salt.


The very definition of 16th Century table bling

If you have ever been to a spice store, you know there are more types of pepper than just black. And to make things more confusing there are different types of black pepper. So it is important to understand what is out there, what it is, and what is important for cooking and/or medicine.


6 of the different types of peppers. Red (orange) pepper is not shown

All of the below listed versions are made from Piper nigrum, which produces most of the well known peppers.

Red Peppercorns –¬†(not to be confused with Pink (Rose) Peppercorns)¬†these are pickled in brine or vinegar, and sometimes called orange pepper. These are not imported into many countries, and¬†if they are, they are pretty expensive. Maybe I will get to try them eventually. The taste of these is said to be more mellow and similar to dried Tellicherry black pepper.

Green Peppercorns  much more affordable, than Red, but still expensive due to the amount of processing and all that work gives a small yield. These are made from the unripe berries from the pepper vine. They are then sometimes treated with chemicals to preserve their color and freeze dried, dehydrated, or canned. A more traditional processing means they are pickled in brine or vinegar. If you are making peppercorn sauce, this is the version traditionally required to make it.

White Peppercorns this is actually just the seed of the pepper berry with the fleshy outer coating removed. The berries are soaked in water until the outer fruit loosens around the seeds. They are then rubbed to rid them of the remaining fruit and dried. White pepper is often used in white sauces, to prevent marring the color where black pepper would stand out. White pepper since it lacks the fruit, does have a slightly different taste than black pepper since it retains its fruit coating. When I lived in Australia, this was commonly used in restaurants as the pre-ground pepper on the tables. I wonder if that is still done there? Muntok white pepper is grown in Indonesia, and generally hand harvested, soaked, and hand processed as well as sun-dried. It is the most common and best known white pepper, and is generally harvested well after ripening and then processed. It has a mild heat and almost wine flavor, it goes best with poultry, cream, and shellfish. Sarawak white pepper is from Malaysia and has more licorice or musk-like flavors, and is considered the better white pepper of the two. It is processed mostly the same as Muntok, except they are soaked in running water sometimes in jute bags which improves the taste. Again this is great for softer dishes and recommended for fish as well as all the things Muntok goes well with. Juila Child always said you should always use white pepper in a béchamel sauce to prevent unsightly specks.

Black¬†Peppercorns –¬†the still unripe berries are harvested and cooked briefly in hot water, they are then dried usually in the sun since the heat helps to change the color as well as dry the berries. These are what most of you fill your pepper mill with, or if you buy the pre-ground stuff your pepper shaker. ¬†Tellicherry (which is a city in Kerala) black pepper is from the same vine as other black peppers, but it is allowed to stay on the vine longer until it is just about to ripen before it is harvested, giving it a more fruity or floral characteristic. Malabar peppercorns are from the famed Malabar coast in Kerala, and are basically the most well known black pepper taste, it is more bitter than Tellicherry more citrus and pine flavors. Black pepper can be used in anything from ice cream. the crust of your finely grilled steak, or just a¬†sprinkle on your mashed potatoes. There are other types than just the two listed, usually based on what country they are grown in.¬†Black¬†pepper is the most valuable medicinally, since they still contain the black peppercorn oil, and this is the oil used for medicinal purposes.

ProTip:¬†It is¬†highly suggested that when buying a pepper mill one should invest in preferably of plastic or metal models, since wooden ones can actually suck the oil from the berries causing them to be less fragrant and potent over time. I have to admit though I have a wooden one myself that I don’t have the heart to get rid of since it was a gift, and since I use pepper a lot I haven’t noticed that much degradation.

Pepper has some sometimes impostors, useful cousins, and replacements – if pepper isn’t available. They have their own uses, and names should be noted if you are looking for medicinal items, to prevent confusion, since these do not have the same characteristics as black pepper and shouldn’t be substituted in medicinal preparations.

All of the below listed plants carry a common name of pepper, but are a different species from black pepper.

Long Pepper – made famous more recently by Sam Adams if you are a beer nerd, since it was used along with grains of paradise in a beer he made that brought back some old fashioned beer spices. Long pepper is usually tied (or confused) with black pepper and seems to have been used interchangeably or preferred over black pepper for its similar taste but slightly hotter kick than normal black pepper

Grains of Paradise – also made famous with long pepper in Sam Adam’s beers, this is not actual of the same genus as black pepper. This plant is more closely related to ginger and is sometimes known as African pepper, or alligator pepper. While it has a peppery flavor the chemicals in it are more closely related to the same chemicals produced by cardamom. Common in West and North African cooking, it is used in brewing as well as flavoring gin and sometimes¬†akavit (a Norwegian alcohol).

Pink (Rose) Pepper – this can be one of two species Schinus terebinthifolus or Schinus molle, both of these are native to South America and is generally the pink-red peppercorns you can buy in peppercorn blends. This is a great culinary spice and I highly recommend keeping a black pepper, and a black, green, pink, and white peppercorn mix on hand for cooking. I love the taste of this mix on eggs the most. Pink peppercorns are antiseptic, and good for wounds but we will not be discussing its uses in depth in this post.

Jamaican Pepper – (aka allspice) I am including this one here since it was thought, when first discovered by Europeans, to be black pepper or some near relative of it. It is used in a variety of cuisines in savory and sweet dishes. Its current name allspice comes from its flavor which the English when first experiencing it thought it smelled of cloves, cinnamon and nutmeg combined.

Adulteration & Substitutions

Peppers have been adulterated for pretty much as long as people were figuring out how to cheat others. Sometimes dried juniper berries were used, sometimes papaya seeds, which sounds a bit better than wooden faux nutmegs. If it was already ground, there are horror stories of people using dust from floor sweepings to adulterate pepper.

Some places use pepper substitutes because pepper either does not grow there, or it is too expensive to import. The desire to use plants that have this spicy effect to jazz up food, almost seems to be universal.It should also be noted that chilies are called peppers some places but are completely different, we will go over them in the future.

Because I love cooking, and these are all interesting substitutes. Not to mention possibly useful to people who have a pepper allergy. So here are some alternatives to pepper:

Why are they called corns though? 

They aren’t made of corn! Just like corned beef, or corned gunpowder, corn is a term for any small seed-like item that originates from Old English, and possibly proto-German. So since pepper berries once dried look like small seeds or beads, corn was applied to them and the term stuck.

So, OK, pepper is awesome, but also way more complicated than it looks.

How do you use it medicinally?

In the Ayurvedic tradition it was used to treat migraines, using a paste made from crushed black pepper cooked in milk and then smeared on the forehead. Ayurveda used it as a digestive, and for gastrointestinal distress, which the Europeans found the same uses for it too. It is also great for colds, since it increases mucus flow and can help get things moving again. It was also used in other traditions as a skin treatment to relieve hives and other skin issues. Black pepper is a natural antiseptic and is actually a great source of vitamin C. It should help to strengthen the immune system and is why its included in the turmeric tea recipe. You can always add a pinch of pepper to your turmeric teas, or ginger teas to help with pain and inflammation.

Black pepper has¬†analgesic properties as well as anti-inflammatory and anti-spasmodics, its warming effect on the skin also feels lovely on sore achy muscles. Black pepper oils carry a lot of the same chemicals we have discussed with previous plants, camphene, őĪ-pinene, linalool and other sesquiterpines are present which account for its medicinal versatility. It can also irritate the gut in larger doses, aiding with¬†slow digestion or constipation, but small amounts help with digestion and “prevent wind.”

Pepper Oil for Sore Muscles and Migraines

  • 1 oz Carrier oils (any good quality oil will do)
  • 15-20 drops Black Pepper essential oil

Mix well, store in a dark bottle. Massage into a spasmed muscle, or just exhausted ones after a workout. It works great for areas of neurological pain, and massaged into the temples or a spasmed neck to ease the pain of migraines. The warmth and drawing blood to the area helps heal muscles, as well as ease pain. It works great for inflamed joints as well. You can always reduce the amount of pepper to 10 drops and include 10 drops of other oils like eucalyptus, lavender, copaiba, juniper, clary sage, clove, ginger, fennel and frankincense not to mention many others. Most scents smell nice with pepper (a good bet for a mix is floral or citrus) but will provide additional relief.

Black pepper is also good in a salve, which makes it easy to use on the go. So these are great to keep in your gym bag, or near where you work out.

Black Pepper Salve

  • 1/3 cup Oil (Sunflower, Almond, Apricot, just should be of vegetable origin)
  • 1/3 ounce Bees Wax, granulated, or grated
  • 5-10 drops of Black pepper¬†oil

Heat oil in a double boiler, and slowly add bees wax. Stir constantly until fully melted and everything is combined. Remove from heat, and slowly stir in, by hand, the essential oils. Pour into small, preferably glass, seal-able containers and store in a cool dry place. This is great for arthritic pains, rheumatoid or otherwise, and good for muscle pains on the go.

You can always make the cheater version by whipping 2 oz of solid at room temperature coconut oil in a stand mixer with a whisk attachment, and adding 10-20 drops of the black pepper essential oils. You can also make a chai spice version which smells fantastic as well as helps with pain, and with the addition of raw honey is good wound healing and for your skin too.

Chai Raw Honey Salve

  • 1/3 cup Oil (same as above, just make sure it is good quality)
  • 1/3 ounce of Bees Wax
  • 1/3 ounce Raw Honey
  • 2-3¬†drops ginger
  • 2-3¬†drops cloves (start with 2 and add more if you like since clove can over power things)
  • 2-3¬†drops of nutmeg
  • 3-5 drops cardamom
  • 3-5 drops cinnamon
  • 2-3¬†drops black pepper

First heat oil in a double boiler, and slowly add bees wax, like above then add raw honey. Stir mixture until fully melted and all ingredients are thoroughly combined. Remove from heat and stir in by hand the essential oils. Pour into small, preferably glass, seal-able containers and store in a cool dry place. This is a great salve for painful cracked skin to help it heal, to put on a wound before bandaging, and is great massaging into painful joints and muscles. Also a great gift idea!

Home made chai tea is also fantastic, and there is a great recipe here you should definitely try, and I have more fast and loose recipe I like to use.

Chai Tea from Scratch

  • 1/2 inch to inch piece of ginger peeled and crushed
  • 2-5 peppercorns, cracked but not ground to powder (start small and increase to get it to where you like)
  • 2 green cardamom pods, slightly crushed
  • 2-3 cloves, slightly crushed
  • 1/3 cup water
  • 2/3 cup milk (or milk substitute, coconut cream goes well here, go for the full fat options if you are bold)
  • 1 teaspoon of Black tea (others are fine, and if you don’t have loose 1 teabag will do, Earl Grey will work in a pinch too)
  • Honey or sugar to taste

You don’t want the ingredients completely broken apart but crushed enough to allow maximum surface area for the flavor to disperse into the liquids. Throw it all in a saucepan cold, let it heat up slowly until just before the boil, making sure to stir or swirl the pan constantly. Strain and serve. This is great on a cold morning to warm the hands and ease stiffness and pain. But frankly it is good any time, and well worth the effort ūüôā

Black pepper oil is also good, in my opinion, rubbed directly on the skin. Just a drop or two into one of my painful spasmed muscles brings soothing warmth as well as a smell that helps keep me alert. I enjoy it the most massaged straight, with no carrier oils, into my neck and spasms in my face when migraines are an issue. Which if you have sensitive skin this may not be the application method for you.¬†I also don’t recommend using this near bed time as I have found the smell isn’t so great when you are trying to sleep. It is also good for the hair and a drop with rosemary on the hairbrush and brushed into the hair smells quite nice.

If you know anything about Italian food, or if you are an Anthony Bourdain fan, you probably have heard of Spaghetti Cacio e Pepe. A dish that’s deceptive simplicity can highlight ingredients, or mistakes. You can never go wrong with Lidia’s recipes so I have provided her’s. This is my sort of simple comfort food, and reminds me of home since Mom would make this often. It also is a good way to get a good dose of pepper in your diet that isn’t a beverage.

Lidia’s Spaghetti Cacio e Pepe

  • 2 tablespoons whole black peppercorns, or more to taste
  • 1 pound spaghetti
  • salt for the pasta water
  • 1¬Ĺ cups Pecorino-Romano, freshly grated, or more to taste¬†

Bring a big pot of salted water to the boil. 

Grind the peppercorns very coarsely, preferably crushing them in a mortar with a pestle or in a spice grinder. 

Warm up a big bowl for mixing and serving the pasta-use some of the pasta water to heat the bowl, if you like. 

Cook the spaghetti until al dente. Quickly lift it from the pot with tongs, let it drain for an instant then drop it into the warm bowl. 

Immediately scatter a cup of the grated cheese and most of the ground pepper on the pasta and toss in quickly. As you mix, sprinkle over spoonfuls of hot water from the cooking pot to moisten and amalgamate the pasta and condiments-add more pepper or cheese to taste. 

Serve right away while the spaghetti is very hot.

There are also some great recipes for Black Pepper Ice Cream, or a more advanced Black Pepper and Strawberry Swirl Ice Cream you should try.

All this time that little humble pepper shaker on your table has held all of these secrets, you may not take it for granted the next time you shake, or now hopefully grind, it.

Remember, do your own research and educate yourself before trying anything, and everybody’s body is different. Make sure this won’t have interactions with your medications by checking sites like WebMD, and if you have any doubts at all if this is for you, ask a professional!¬†



What is a Migraine?

This new year has been a bit rough, we are only in the second month of 2014, and I have had about 10 days where I have not had some form of migraine pain. Which is, needless to say, making me a wee bit grumpy. These continuous sort of migraines over a span of days, or as of now weeks, I like to describe as being similar to a North Korean radio, you can turn it down but you can never turn it off.¬†*rim-shot* Ha! Thank you!¬†You’re a lovely audience,¬†I’ll be here all week folks! Try the veal!

He knows what I’m talkin’ about

Migraine pain can really ruin your day (or weeks!) it can be crippling pain that makes it hard to think, or do anything really. The pain can cause nausea, issues with your vision (I get bright spots of light as a precursor, sometimes I have “tunnel vision”), plus the fun muscle spasms in your head, neck and shoulders. In its worst stages the pain reduces me to a feeble, trembling being, only able to beg for water, and the pain to end. You feel like your mind has fractured, and it is hard to think. It feels like your head has exploded and then has grown too small. Any sort of movement or light can increase the pain, and the pain can be so extreme you start vomiting. For me, the pain can be soul crushing at times, you hurt so much it hurts to even think. The best image I can find to convey how I feel when I suffer an attack is this.

Yup, pretty much like that.

Yup, pretty much like that.

On the good days, it is just background pain, which thankfully allows me to still function, and even if I really don’t feel like doing anything, I can force myself into living life like pain isn’t there, as much as I can. That pain though, it doesn’t leave it only turns down. It lurks behind your eye, sometimes it sneaks around in the back or side of your head. Always there, waiting. Reminding you that things could get worse at any time it would like it to. The fear of that sort of pain can stop your life completely. It can also make you stop your normal routine, and frankly it can be hard to fight the thoughts of “if I go do X, will it all get so much worse?” And this is where you have to say to yourself, “Well self, it could come back, and I could spend all my time avoiding everything because it might hurt, but where is the fun in that?” Sometimes it even helps to keep the charade of routine, distraction from the pain by focusing on other things can help a lot. The biggest help is keeping a pain diary, writing down things that are outside of routine, or just normal routine (if there are no changes) should be noted. Doing this helps a lot in finding patterns that will help you deal with your migraines possibly ahead of time, as well as allowing yourself and your doctors treat your pain more effectively.

Migraines have been studied by doctors for thousands of years, even the ancient medical Eber’s Papyrus mentions some of the symptoms, and the school of Hippocratic medicine knew of migraines and symptoms¬†like visual disturbances with possible relief from vomiting. Galen referred to them as hemicrania (half-head), which lead to the term migraine – which has evolved from a corruption of the original Greek term he applied to the syndrome. In historical times trephination¬†was frequently used to treat migraines, thinking that there was pressure in the head that needed to be released, or in some cases “evil spirits.” Even though these surgeries occurred as far as 7,000 BCE, they did not always end in death, as there is evidence of bone mending around a large percentage of the skulls.

Looks like it would be fun, right?

What is a Migraine?

So really, what makes the difference between a headache and a migraine? Migraines are so well known, we probably have all heard the term, and it is because of this notoriety it becomes easy to fall into the self diagnosis trap of any extreme headache must be a migraine. ¬†But, what is a migraine? Migraines are defined as an attack lasting from 4 to 72 hours,¬†characterized by throbbing pain in the head on one, or both sides of the head. The throbbing headache is accompanied by other symptoms which are usually diagnosed by doctors using the “5, 4, 3, 2, 1 criteria“:

  • 5 or more attacks fulfilling the next two below listed requirements, apparently if you suffer from migraines with aura 2 is enough to diagnose. Episodic is less than 15 days a month and chronic is more than 15 days.
  • 4 to 72 hour duration of the migraine untreated or treated.
  • 3 at best or at least 2 of the following symptoms – unilateral (sometimes bilateral) location of pain, pulsating or throbbing pain, “moderate to severe pain intensity” (that means near crippling where everything just seems to suck , to crippling pain where everything does suck , especially movement). Finally if movement aggravates the pain – this is the sort of pain that if you make any sort of movement you get an increase in pain, that means something as simple as sitting up or moving makes you wish you didn’t and it causes you to avoid movement or normal tasks.
  • 2 symptoms listed, but you need just one of them to be diagnosed- nausea and/or vomiting, or light and/or sound sensitivity (sometimes you get just one, sometimes 2 sometimes all 4, depends on the sufferer and that days migraine)
  • 1 there is only 1 thing it could be, that means all other possible issues are ruled out and all that is left is a migraine.

If you don’t meet these qualifiers, you may want to look into tension headaches since that is the most common painful headache that is not as extreme as a migraine. Tension headaches can become migraines sometimes, so it is always best to discuss symptoms with a doctor to be sure you are being treated correctly. It is really important not to self diagnose with migraines, if you are suffering from extreme headaches there could be other, and possibly life-threatening causes. It is best to get an official doctor’s diagnosis, than find out too late you have a brain tumor.

Migraine Phases

So now we know what sort of symptoms manifest with actual migraines, and what criteria a doctor would use to diagnose your headaches. If you have all of these symptoms, you should know how a migraine works so that you can note things in your pain diary that are precursors or even possible triggers (we will go over triggers further on). To make it easy, we will look at how migraines work broken out into the four medically recognized stages:

  1. the prodrome¬†phase – this is a fancy medical term, but what it basically means is the pre-symptoms. Everything that happens before you get a migraine that makes you go, “oh wait, this might be a migraine.” That is the prodrome. This can include mood swings, depression, mania (extreme happiness), fatigue, food cravings, neck spasms, bowel issues, or even sensitivity to sounds and light. Usually for each person what they get is different, no one sufferer has the exact same precursors as another. These warning symptoms can be noted and acted upon to reduce migraine pain once it hits. Careful notation of your mood and other things daily will help you to find out what your prodrome symptoms are, and then you can work out how best to fend off your migraine.
  2. the aura¬†phase – put your Stevie Nicks outfits away, this is not what you’re probably thinking. Auras are a visual disturbance (ie. hallucination of sorts see examples here). Not all migraines have visual disturbances, but if you are going to have it, it comes after the precursor symptoms of the prodrome. It can be small points of dancing light like I have, or could be blurriness, squiggly lines, blind patches, all sorts of visual issues. Other symptoms that may occur in this phase are “pins and needles” feeling in arms or legs, and some experience speech issues.
  3. the pain phase – my least favorite phase. This is the migraine rubber meeting the migraine road, this is when you have that pain in your head. That throbbing with every heartbeat, that pain that makes it difficult to move and sometimes triggers vomiting, and sensitivity to light for me. Others may also experience sensitivity to smells, general nausea, and fatigue. There are a few more symptoms listed, and I find a lot of sites list irritability as a symptom, but really who isn’t a bit grumpy when they hurt? Classically this is pain only on one side, or unilateral, but some migraine sufferers of “no aura” migraines will have bilateral pain (that means both sides of the head hurt).
  4. the postdrome phase – these are the after affects, lingering pain, and that headache hangover feeling are what I tend to see after mine. You can also experience, mood swings still, cognitive issues, stomach upset, and even weakness. You may not get any of these or you may have all of them, some people even feel even better than before the migraine afterwards, so every body and its post-migraine reactions are all different for everyone.

Different Types of Migraines

There are also different types of migraines, not just one! Just like there isn’t just one type of headache!¬†They are grouped by symptoms to help differentiate between the types. These terms are set by¬†International Classification of Headache Disorders¬†which is the group that releases the official classification of headache as used by the World Health Organization. The ICHD is published by the¬†International Headache Society, which is a charity organization for headache sufferers of all sorts that has formed to advance the cause of headache sufferers.

Because headaches of all sorts suck.

The ICHD lists the different types of migraines one can have, they are grouped together based on the symptoms one experiences:

  • Common Migraine¬†– This is the most common form of migraine, and was previously known as¬†hermicrania simplex.¬†It is a neurological disorder and is characterized by a “throbbing” headache usually only affecting one side of the head (in fancy science terms that is called unilateral) but mostly centering on the right side of the head. This is classified as a moderate intensity type of migraine and can cause nausea, sensitivity to sound and light (that is¬†phonophobia¬†and¬†photophobia¬†in fancy science terms), but does not cause the seeing of¬†auras. This is a visual disturbance that can be caused by other migraines, and is different to the spiritual auras that most are probably thinking of when auras is mentioned. These can be like lights, blobs, lines, all sorts of things and they are not present in this sort of migraine. Menstrual migraines are a subset of this group.
  • Classic Migraine¬†– this sort of migraine has the symptoms like the one above, except it can manifest with auras, but it doesn’t always have them. Along with visual disturbances more severe symptoms could include neuropathy, motor weakness, difficulty speaking and other symptoms. This sort has two subgroups of migraine types. Basilar type migraines are thought to be caused due to spasms in the basilar artery (that supplies the brainstem) and this type manifests some of the more extreme symptoms like difficulty speaking, vertigo, and other brain stem related symptoms. The other type of migraine subgroup is familial or sporadic hemiplegic migraine, sporadic if you have them occasionally and familial if someone in your family also has them. Both of these manifest with normal pain and auras, but only the classic type of migraine is also accompanied by possible motor weakness.
  • Childhood Periodic Migraines¬†– also like or sometimes referred to abdominal migraine. This one is debated and it generally causes a lot of migraine symptoms, sometimes without an actual migraine. Some think these could be a herald of migraines later in life.
  • Retinal Migraine¬†– ocular migraine is another name you may have heard of, there are visual disturbances, a patch of vision loss, or there will be loss of vision in one eye. These also tend to include symptoms of light sensitivity, the throbbing headache, and nausea.
  • Chronic Migraines,¬†status migrainosus¬†& everything else¬†– If your migraines last for more than 15 days a month for 3 months, those are chronic migraines. If they last more than 72 hours that is what is known as¬†status migrainosus,¬†which is just a fancy science term for never ending migraines. Then there is everything else that doesn’t fit in these groups lumped in here.

What causes a migraine? What are Triggers?

Migraines are a bit like other neurological and pain disorders in that there are a lot of theories as to what causes a lot of them but no one really knows fully why they happen. They are a neurological syndrome, but all of the details of them still elude us. There are a few theories on what causes them, some think there is a lot to do with genetics, since some can run in families but this doesn’t hold true for everyone. Also women are more likely than men to experience migraines, and there are even menstrual migraines that specifically occur around a cycle. There also seems to be ties with facial nerve compression,¬†TMJ issues, muscle spasms in the neck and head (which is not just a cause but a symptom too), diet, exercise, weight, hormones, mental disorders (such as depression, anxiety etc), strong smells, changes in the weather/barometric pressure, and even change in routine are some of the things thought to “trigger” migraines.

Triggers are what seems to cause your migraine attacks, everyone’s are going to be different. To find out easily what your triggers are, you should keep a pain dairy of what occurs when you do and don’t have migraines and eventually you will be able to zero in on what is triggering your headaches. A fellow student in my Tai Chi school told me her’s were just triggered by excitement mixed with a change in routine. This meant birthdays for her could be extremely challenging. She has been able to listen to her body enough to where she now can regulate her migraines through controlling things that trigger them, as well as medications. It is so important to listen to your body, it will always tell you when something is going wrong. Be observant, notice patterns in changes with activities, changes in weather or foods, and you will find what triggers your attacks, and hopefully help avoid pain for yourself. For myself changes in weather always triggers pain and migraines, so I watch the weather closely, and when a large front is headed my way, I know I am going to be more likely to have an attack. So I try to minimize stress, and keep my routines in the time leading up to a weather shift, and this seems to help reduce severity of attacks.

Treatment of Migraines

Back in the old days they used everything from Coca-Cola, to pretty much straight cocaine, and laudanum (alcohol and opium), to treat pain and migraines. As well as a plethora of other “snake oil” cures that you could find in the local pharmacists. Some of them made some crazy claims on how effective they were.

Seems legit.

Now treatments are becoming more advanced as we learn more and more about how the brain and nervous system work. So how do you treat these nasty migraines in the modern day, if we still don’t know what causes them? Well are finding newer better drugs, or therapies, on the market but as of now there are three main ways of treating migraines – analgesics and/or NSAIDS, triptans and/or ergotamines, and migraine medications.

Analgesics – you’ve probably seen this word before pop up on this blog, Analgesia means “relief from pain.” Anything that can relieve pain can be lumped into this group. Specifically for migraines some narcotic analgesics are used as well as NSAIDS (we will go over next). Narcotic drugs can be taken orally and intravenously, depending on severity of the pain and can be administered by an ER doctor or your pain doctor. For me, I find the injections to relieve the pain a lot faster than a tablet but should also be only used in a real pain emergency. Personally due to my extended migraines, and pain levels I was prescribed hydromorphone (most commonly known as Diluadid) which is like morphine, and a very powerful opiate painkiller. This is a rescue pill that I only take in extreme situations, I find that my normal a pain medication sometimes works, and have had success with my¬†herbal¬†remedies. But sometimes even that isn’t enough, and when you would consider selling your own soul to end the pain, it is a welcome relief to have handy. One should always use narcotics of any strength with caution, they are not only highly addictive but rough on your body.

ProTip: Try using an anti-nausea medication or an herbal remedy to help keep those pesky pills down during severe attacks. Things like peppermint, chamomile, ginger or fennel can help settle things.

NSAIDS – this stands for Non-steroidal Anti-inflammatory Drugs, that means things other than narcotics or corticosteroids to treat pain. Aspirin and Ibuprofen (commercially known as Advil) are the most commonly known of these, Naproxen (commercially known as¬†Aleve) is another one that you will find in most stores. Paracetamol (commercially known as Tylenol) isn’t in this group since it also includes a mild anti-inflammatory aspect. These are all much less addictive than any narcotic medications, though they can have side effects like blood thinning, they can have an effect on your liver, and they are rough on the stomach. Overall though, these are a great choice due to their lack of addictive substances, and are over the counter medications that anyone can obtain.

ProTip: Excedrin Migraine was not listed up there since it is sort of a blend of things, it contains the same chemicals as Tylenol and Aspirin, but also has caffeine. If you are sensitive to things like that you may want to avoid this option, but you may want to opt for it though if you regularly consume caffeine and get headaches from lack of your daily does since this can also be a cause of migraines.

Triptans РThese are specific migraine drugs, there are a few that are common on the market one well known one is Sumatriptan (Imatrex), there are many others, but this seems to be the most common one I run into, and also take it. How these work is they cause the serotonin receptors to constrict and this means that chemicals that cause inflammation are not able to be released, they seem to have an effect on nerve cells and blood vessels as well. These you need to take early in the attack to have these work, and are not as effective if you take it later in the attack. They are also not as effective for long term migraine attacks (attacks that span over a few days). These can be in tablet form, inhaler form and in injections, so this is a drug that can be administered even if there is vomiting with the migraine pain.

Ergotamines Рthis is an older medication and not as frequently prescribed these days, you may have heard of ergot before as well. Ergot is a type of fungus that grows on grain plants that humans consume (rye, wheat, barley, etc). This type of fungus can cause hallucinations, and is suspected for being a driving factor in inexplicable behavior in humans in history, like the Salem witch trials. It is a pretty complex chemical so unless you are familiar with brain chemistry, just know it causes a lot of chemical reactions that are pretty complex but end up relieving migraines effectively (and if you are read the wiki on it, pretty interesting stuff). The possible reason it is still so effective is the lysergic acid in the ergot, and could explain why the fungus psilocybin has been so effective in treating painful cluster headaches and for some migraine sufferers. This is an older medication as mentioned previously but it is still being prescribed for those with migraines that last more than a normal attack, like with status migrainosus. Like the triptans they also need to be taken early in the attack, when taken at the first signs of attack they prove to be most effective.

Anti-migraine Medications – this is sort of a lump all the rest here group. There is all sorts of other medications that has been used to treat, and hopefully prevent, chronic migraines. Botox is one I am intimately familiar with, I have had this procedure twice and hope to have a third soon. Botox is a “watered down” form of the Botulinum toxin, best known for ruining canned foods in the early days of canning (after cans, but before can-openers). This is a neurotoxin that is injected for therapeutic purposes in spots around the head and neck, this then pretty much paralyses them into relaxation and hopefully reduces or completely prevents migraines. I have found this to be an effective treatment, the only down sides are it is expensive, and it only lasts a few months before you need to be “topped up.” Besides botox there are a few other sorts of medications that have been used, anti-depressants, especially¬†tricyclic antidepressants, have proven to be effective in treating some sorts of migraines. Another would be anti-convulsants, example like topiramate (commercial name¬†Topamax), that is used to treat migraines and seizures. Finally Calcium and beta blockers have also proven effective for relaxing the blood vessels, and hopefully preventing migraines. These are more extreme measures to treat the more vicious and frequent attacks, and generally are considered some of the last lines of defense in combating migraines.

Alternate Treatments – Acupuncture is a great option, as well as massage, Graston, and just focused relaxation exercises work as well. I recently was inspired by a fellow sufferer, and new information on placebos, to try to “trick” my brain into thinking that a bandanna tied on my head would “hold” my head together (since frequently it feels like it has exploded, or soon will. The pressure of the fabric helps make that area feel like it is held together, and was in a recent attack the difference between pain to where I vomit and pain, but no vomiting. It is now the “magic bandanna” for migraines. I have also used cold and heat, I tend to prefer heat but sometimes cold works better. And of course there are always herbal options I have listed, and tried, for preventing or assisting with relieving your migraines and headaches.

So, now you know more than you probably ever wanted to know about migraines! And hopefully will be a bit more understanding, if you weren’t already, of any suffer of a migraine. They are not the run of the mill type of headache as you can see. The best thing as always though is to stay positive about your treatments and keep searching with your doctors to find what works best for you and then stick with it.

If you would like to read more information on migraines here are some good resources: