Gabriel Rose Nichol

Gabriel Rose Nichol, Self-portrait, gouache on paper, 1991. © 1991 Gabriel Rose Nichol

MIGRAINE

By Gabriel Rose Nichol

Migraine probably began in early childhood, with a collection of apparently disparate symptoms: vomiting attacks, severe headaches, motion sickness and occasional episodes of an unnerving sense of unreality. I was a solitary child, preferring to paint, play the piano or guitar, write poetry and stories than to play with other children. Both my parents were migraineurs: my mother had been diagnosed with atypical common migraine and my father with classical migraine. Later my father's migraine headache disappeared, leaving him with occasional aura symptoms such as visual and intestinal disturbances. Both parents' migraines were cyclical. Migraine was widespread on both sides of the family, almost always occurring with mood fluctuations. I later discovered that at least one member of my father's family had also suffered seizures, and my mother's sister's migraine had caused powerful visual disturbances or hallucinations.

Migraine was diagnosed in my twenties. I took various oral contraceptives for ten years but it did appear that these worsened the headache component. After this time it began to be obvious that the migraines were always linked to menstruation. The headache would begin on the fifth day of the cycle. Headache was always, although frequently severe, a welcome sign. Duration would be 7-10 days. Aura symptoms, occurring pre-menstrually, included gut disturbances, mood lability, disturbance of taste and touch, facial numbness, fatigue. At the time they were thought to be symptoms of PMS and treated accordingly. Treatments significantly worsened aura/PMS symptoms. After thorough gynaecological investigations showed nothing amiss, symptoms were treated as those of depression 'possibly a reflection on her fertility and the biological clock' (Dr Michael Pawson, gync.)

I had married in 1982, a television producer in News & Current Affairs at the BBC. I was then a researcher in BBC tv Documentaries. We lived a busy (childless-by-choice) life in London with many friends and many shared interests. I gave up my job in 1986 in order to concentrate on painting. At the same time I made some profitable property investments. We moved to the suburbs in 1989, to a comfortable home not far from Richmond Park. I then had a separate painting studio.

In 1990 my father had a major heart attack which he survived; as a precaution however I was advised to keep my own cholesterol levels well monitored. My levels were in fact low but my husband Mick's were high, and in January 1991 he was prescribed a rigorous excluding diet, which we shared for convenience. We both walked and exercised a great deal, drank moderately, and were now eating apparently healthily also. We took no drugs legal or illegal. We could both have been described at this time as happy and very fit.

My migraine headaches virtually disappeared in March 1991. I was less troubled also by menstrual cramping. My mood was steady. In February I had begun visiting a priest in order to examine the state of my virtually non-existent 'faith'. He had recommended meditation, and I had followed his advice, meditating for increasingly long periods during the mornings and evenings. In the middle of February I had had the most severe headache I ever had in my life. It did not last very long, not much more than a day, but it was truly horrible. Afterwards I told myself that if I had another one like that I would have to insist that my GP referred me to a specialist. But I never did have another one like that, or even slightly like it.

On 11 March I returned from the studio as usual at about 6 or 6.30pm. After attending to one or two household chores I sat down in the warm and comfortable surroundings of the sitting room. I had lit the fire and one or two lamps. I did not feel at all sleepy but my eyelids suddenly felt heavy and it was hard to keep my eyes open. This clear and precise, then unprecedented, symptom later became routinely familiar to me. Directly I closed my eyes I began to 'see' a series of images. The images were cinematic, apparently perfectly normal, that is to say they were not images of anything weird or frightening. I heard nothing, no voices certainly, but words came to me and on reflection I could describe this process as like a memory - as if I were remembering something that had once been said. There were also a series of wordless thoughts which arrived in my mind without apparent effort on my behalf. Again these thoughts were not weird or frightening, but at the same time they did not exactly feel like my own. I did not really understand what I seemed to be thinking. But I knew the content as if recently instructed or told. The narrative content of the 'cinema' was touching, peaceful, interesting and even, for me, rather remarkable.

It was very suddenly over and I opened my eyes. The curious thing is that I did not reflect on what had happened nor even think about it. The episode appears to have lasted between 20 - 60 minutes. Mick came home a few moments after I'd opened my eyes. I heard his key in the door. He came into the room and I felt instantly extremely irritable; indeed we began bickering about something almost immediately. I felt oddly tired, ragged, and 'dry' as if I had been sleeping in nylon sheets. My head felt tight as it frequently did just before a headache, but no headache of any consequence followed.

It wasn't until the next morning when I was painting in my studio that I seemed suddenly to wake up and to recognise that something very odd had happened the night before. It was literally as if I had gone to sleep at 6.30 or so the previous evening, and had been sleepwalking since, until 11 or so the following morning. I felt really shocked. The suddenness of 'waking' when I was in fact already awake was quite shocking in itself. Also the 'pictures' I had seen, what were they?

I thought immediately that I was going mad. It did occur to me that, as the man had been so exceptional in his bearing and had also seemed so benign, that the pictures might have had some genuine mystical significance. But in the main I thought that I must be going mad quite simply because I was not the kind of person who would have religious experiences.

I told no-one about the hallucinations, except Peter, the priest I had been visiting. He was, unexpectedly, quite convinced that the experience was 'a vision' a 'gift from God', a 'spiritual nosegay' for which I should rightly be grateful. I had already decided that I must visit my GP, but Peter counselled strongly against this. He also counselled strongly against discussion with anyone but himself. He said that other people were 'unlikely to understand'. As he had been a priest for over thirty years and was locally well respected, I thought I should perhaps follow his advice. I did not feel ill, and nothing had changed in my life apparently. I did not therefore visit my GP.

I have recorded the above in detail in order to try to show background, health, state of mind, etc. Subsequent episodes are shown in less detail, for brevity's sake.

2 April 1991: I was sitting at the back of a church. It was extremely cold. I had been there for a minute or so when a series of extraordinary sensations began to roll through my body rather like waves. I had never experienced anything like it before. The waves came roughly at one or two second intervals; each was followed by a trough (ie lessening of feeling) and then the sensation would build again. This sensation was one of exceptional physical bliss or ecstasy which it is beyond my ability to describe. I have heard descriptions from various drug-users who appear to be describing something similar, but of course I cannot say whether or not what they describe is the same thing.

The ecstasy engulfed all my body. There was a marked sexual response, but the sensation was by no means confined to nor generated from sexual organs. Physical duration was of about twenty minutes, but the physical experience left a sense of emotional well-being. In addition my limbs were entirely relaxed throughout the rest of the day. It seemed that no physical effort was required in order to walk, to lift, to carry, and my body felt light as air.

The following day I felt ill. I had gastrointestinal disturbances, fatigue, disturbances of touch and taste, mild facial numbness - symptoms similar to those preceding menstruation/migraine headache. I felt also irritable, with the same odd sense of dehydration caused usually by nylon clothes or sheets. Drinking did not seem to do much to help. I was also extremely cold all day, and nothing I did seemed to make me warm.

22 April 1991: Symptoms as 3 April. The previous day (21) we had driven back to London from Brussels via Calais.

The following morning at 10.00 the same symptoms as 2 April. This time I was painting in my studio at home. By 11.00am I was unable to stand. I lay on the floor until the waves began to decline a little. However, for the next four days, until Saturday 27 April, there was a succession of such episodes, with no real break except when I slept. My sleep at this time was periodically deep and heavy like unconsciousness and this had often previously been associated with migraine headache. Over the four days the episodes gained in intensity. I thought it would be impossible to withstand such ecstasy, I felt that something must surely physically give way or break, but it did not. I was frequently unable to stand. Once, in the Park, I collapsed. My husband was away and at no time did it occur to me to tell anyone what was happening. I was in a state of considerable confusion. I would anyway not have known what to say, even had I been clear. It did not occur to me that a doctor would be the relevant person to deal with fits of bliss, because doctors are normally there to deal with pain. I was not in pain. I was somewhere akin to heaven. No-one could really complain about that, could they?

On Friday there were hallucinations of the man I had seen in the cinematic-like experience. There were a few words, not many. During a very intense period in the middle of the day I feel my consciousness must have been affected, for I was only vaguely aware of my surroundings. Later on that night, alone in the sitting room, I lost consciousness completely. When I came round I found that my body was in a condition similar to post-coital and I was lying on the floor with my limbs flung at unusual angles. I went to bed and slept heavily. I woke at dawn, and the same 'wave-like' experience was occurring again, this time it appeared to have begun in my sleep. There was another long episode that morning (Saturday) and in the afternoon the experience began to fade out.

On Sunday I thought I was dying or perhaps had already died. I felt so weak I could hardly breathe. By this time my husband had come home, but still I said nothing to him. I'm not sure why. I lay all day in the garden, in the unseasonal sunshine, feigning some 'normal' illness. I felt terrible.

On Monday 29 I felt much better. I went in to the church where the original 'ecstasy' had occurred. I should say at this time I had no real religious belief, but a great interest in things religious. I was also agnostic about what was happening to me, and 50/50 about whether it might be madness or mysticism.

I sat down and my eyelids suddenly felt heavy. I closed my eyes. Gradually I began to see that the dark reddish-brown that one normally sees when ones eyes are closed turned to a very beautiful deep dark blue, almost but not quite indigo. I never saw a colour like it before or since. Not the sea, not the sky, not anywhere have I seen such a blue. Then, also gradually, it seemed that I could see myself, as if from above, sitting in this blueness as I sat in the church. And I saw that I was surrounded by little orangey flames, like candle flames or flames on a gas-cooker. On my head there was a scarlet plume. As I watched the flames shifted a little, as if in a slight draught. It was so beautiful I almost felt I should hold my breath. It was a scene of the utmost exquisite peace. As I watched, the flames slowly faded away and then to my surprise, they reappeared. This time I seemed to be holding something in my hands, something white, netted perhaps, about the size of a football or a pigeon. Then again the flames disappeared. I opened my eyes. I went outside. I thought I had been in there about twenty minutes but I saw from the church clock that an hour and a half had passed. I checked my watch, the clock was right. I was astounded as much by this as by anything because my sense of time had been famously perfect until then.

The following day I went into my studio to paint. I had not been in there since the first of the 'four days'. I had no headache and no other apparent symptoms. I felt well. I had been painting a self-portrait when the episodes began, and returned to it that morning, Tuesday 30 April. Although I knew roughly what I wanted to do to the work, I found I could do nothing at all. It sounds odd but I felt that I could not 'see' the painting properly, although my vision was still functioning perfectly. And I could not co-ordinate myself therefore sufficiently to make controlled or meaningful marks on the surface.

Thinking that I must be simply tired I abandoned attempts and went out to lunch with a friend. When I returned I felt suddenly very cold again, a sudden drop in temperature, and fugitive physical discomfort. I went into the studio, but knew as soon as I looked at the painting that I would not be able to continue. I went down to my desk and began writing. I wrote about everything that had happened, from the beginning. My husband was again away in Geneva, and I wrote from 2.30pm to 2.00am more or less without stopping. It was when I read what I had written that I realised that something very odd had happened or was happening to me. I didn't really want to think about it. The only obvious answer was that I was going mad. I suppose it was because I didn't want anyone to tell me that I was going mad that I didn't go to see a doctor.

I told Peter about all this and he again confirmed his opinion that the experiences were 'mystical'. We spoke at length about 'other mystics', of whom until then I had not heard. He mentioned Terese of Avila, John of the Cross, Catherine of Sienna, even Francis of Assisi and Bernard of Clairvaux. I was nonplussed at the time, but now having read and reflected it seems that these characters might all join Hildegard of Bingen as very possible migraineurs. Their experiences were indeed similar to mine, sometimes strikingly so, but they were religious and I was not. And sheer common sense suggests they were more likely to have been like me than I like them.

I was not ever able to paint again, so I wrote instead. I kept a full and detailed account of everything that happened during those weeks and months. I found as I wrote that I was increasingly preoccupied with philosophical or religious questions of a very simple nature. I found that I did not know what I really believed, about anything at all. I was increasingly absorbed by the question of how much one believes and trusts unthinkingly, and how far and how surprisingly this uncritically rules one's daily life.

On the morning of 7 May 1991 at around 10.00 I was walking in the park when out of the blue something very extraordinary occurred. I felt a significant pressure inside my chest under my heart and further pressure in my groin and pelvis. The direction of the pressure was upwards, as if I were being lifted. Suddenly it was as if a bolt of lightning crashed down through the centre of my skull, through the centre of my torso following the route of my spine, hit the pelvic floor and shot front to back with a burning sensation. All the fluids in my body felt as if they were boiling. So powerful was this attack that I lost complete control of my bladder and collapsed. But it was over in seconds, with no aftermath save the sodden state of my clothing and the fact that I felt very cold. There was no headache until the afternoon, and the headache was mild.

On the evening of Saturday 11 May 1991 on the first day of a heavy menstrual bleed I experienced an acutely psychotic episode, involving the distinct impression of a presence at my side. The presence was not frightening. There was a long 'conversation' with a 'voice' which again did not have a particularly frightening content, but I was petrified. The episode, of abrupt onset, was of about three or four hours duration. During this time I found that I was physically clumsy and uncoordinated, with the same feeling of being unable to 'see' properly which occurred when I tried to paint, even though I could see perfectly well and knew that I could see perfectly well.

The next morning there was a brief recurrence at around 10.00am. Afterwards I felt extremely weak, although not ill.

A long drive around France, mainly in the south, in June/July of that year (1991) seemed to provoke a number of dream-like hallucinatory episodes, and problems with time, but there were no further physical symptoms beyond sensitivity to cold until Tuesday 6 August 1991 when I was lying on our bed after lunch. My eyes were closed, I was lying on my back with my head resting on three pillows. I had the impression that my head was beginning to tilt down and backwards and my feet to lift into the air. A point at the base of my skull seemed to begin to spin like a propeller. I opened my eyes in alarm and found that my eyes were rolling. I could not keep them still. It was like being very very drunk. I closed my eyes again; again the impression of tilting backwards etc. Opened my eyes again; again they were rolling. There was an odd babbling noise somewhere. For some reason I tried to get off the bed, to stand, perhaps I thought I was dreaming. I fell because I could not see where the floor was. I crawled about, very frightened, my eyes still out of control. I cannot remember what happened then until I was in the dressing room changing my clothes. Later I discovered there had been a thunderstorm, presumably this had been the source of what had seemed to me like 'an odd babbling noise'.

By September I had become depressed. I had lost a significant percentage of my original weight; having been slim to begin with this was not good. I was now frankly thin and not eating well. I did not sleep much. I cried a lot. I was depressed because I still could not paint, and depressed because I did not know how to tell anyone what was happening to me. I was depressed because of what was happening to me. I was depressed because I could not work out what it was. The priest had given up trying to convince me there was God and was now himself convinced that I was perhaps 'possessed' by some 'being' or 'power' (he did mention the devil en passant) which was 'not exactly wholesome'. He recommended exorcism, an invitation I declined. I did not think that I was possessed by the devil or by anything or anyone else.

I went away for a holiday in the South of France but, feeling no better on return, decided that I must tell my husband what was happening. Apart from anything else I was now at times freezing cold and there were as a consequence disagreements about the central heating. I showed Nick some of the stuff I'd been writing. He said immediately that I must see a doctor, preferably a psychiatrist.

I was diagnosed with schizophrenia and admitted to hospital on 30 October 1991, two days after a cousin had committed suicide. He had electrocuted himself, which seemed to me especially violent and especially unequivocal. I had been unable to stop crying because of this, and was therefore not strikingly coherent at consultation. My physical symptoms were graded as 'somatic delusions' and the diet I had been following for my husband's health reasons was ignored: I was treated also for anorexia. I was given a starter dose of 300 mg of chlorpromazine and 225 mg dothiepin. I was mildly anaemic on admission, but this was not investigated. This was a pity as tests much later showed significant B12 deficiency, and this may well have been a contributing factor to the psychotic states: I see that the deficiency is also currently being researched in the context of migraine.

This drug regimen remained in place for thirteen years, with occasional dose fluctuations. The symptoms were not ameliorated by these drugs. They instead became less episodic.

I was given ECT in 1994/95.

In 1995 I began to experience left-sided weakness, tingling, vertigo, tachycardia, visual disturbances (ie snowstorm-effect). These symptoms were of differing duration, but typically they would occur over a period of 5-10 days in episodes of an hour followed by half an hour remission, then another hour of symptoms etc. In 1996 gut disturbances increased and there were in addition episodes of severe abdominal cramping. All symptoms were treated as those of anxiety.

My marriage had broken down in 1993, since which time I had lived alone. Family relations were strained to breaking and friendships had gradually vapourised. I was divorced in 2000, too sick to attend the hearings; menopause began in June of that year. In 2001 I moved out of London. I found I was now unable to write creatively, although I wrote a number of extremely long letters. There is no doubt that I was extremely depressed, but in the letters there is no sign of this. On the contrary the content is frequently humorous and takes the form of a discourse on emotionally neutral subjects. I was aware whilst I was writing these letters that the activity was a form of flight. Whilst I wrote I lived 'elsewhere', removed from myself perhaps as I had been in the 'blue' hallucination in the church in 1991.

In 2002 I left England for Europe, intending to take a holiday and then to end my life with an overdose. I continued to write as I travelled. I always wrote to the same person, the one friend who remained. I am again surprised re-reading these letters at the lively tone and level of observation, for my sense of being alive was now virtually annihilated. So feelingless was I that I began a long debate with myself about whether or not I was actually dead. I discussed internally the notion that perhaps the long broken sometimes apparently aimless journey was a metaphor for death, I played with the old idea of the flight of the soul, the notion that perhaps consciousness may outlive physicality and that, if so, it may well result in such a sense of unreality as my own.

Real or not real, dead or undead, however, I continued to be plagued by serial and sometimes severe abdominal cramping. Thus it turned out that instead of a taking an overdose I made what turned out to be a fateful decision: I withdrew the chlorpromazine. This because I thought that it may have been responsible for the abdominal pain. I thought that anyway if I were to end my life I might as well finish it pain-free. I withdrew the drug slowly beginning November 2002, finally finishing February 2003. I did this without medical supervision. The results were startling. The cramping certainly disappeared, over a period of several weeks. Much more suprisingly for me, my mental state returned to somewhere near normal.

I had become I think profoundly psychotic, and any doctor who during those latter years took me for a schizophrenic would probably have been largely correct. I had a thin operational ability, which is clear from the fact that I was actually able to get myself from hotel to hotel in the countries I visited, feed myself, and behave more or less appropriately. I ate properly, I slept adequately, I dressed reasonably. Having said that, one would have said everything. The rest of my life had gone out of control. It did not come back under control overnight, but the first li