Pain Is - Carol D. Marsh

Pain is an animal waiting.

I suppose this is a poor metaphor, and should you ask me to draw a representation of migraine pain I may not produce anything remotely mammalian. Yet its affect has a sentient quality. Its reluctant host imagines it alive and breathing, just out of sight. And maybe it’s true that, to a certain extent, I’ve grown accustomed to the pain that began as occasional migraines when I was thirteen and morphed to chronic some few decades later. I can now work or be social through a migraine that would have had me flattened fifteen years ago. But is that a good thing? I’m not sure. Do I want to have become so accepting of pain? Should I be so willing to push myself into the spiky regions of just-barely-managing? 

Pain is an entity.

Migraine is not a headache. It’s a neurological event. 

As such, it makes itself known everywhere in the body from the pain above one eye, to olfactory hallucinations, to brain fog, to flu-like muscle aches, to a metallic taste in the mouth. Nausea, dizziness. Light sensitivity. To name a few.

Pain is a ghost.

Maybe not so much an animal or entity, perhaps it’s a wisp, the hind end of chiaroscuro. Here again, my fogged brain struggles with the task of helping non-migraineurs understand us migraineurs. (I’ve always liked that word, migraineur. There’s an elegant sound to it, a quality sorely lacking in any other aspect of this disease.)

The easily described part of chronic migraine is how it reduces one’s options. For example, I had to stop working thirteen years ago. It’s that simple: one day I had a full-time job in a career I loved, the next day I didn’t. Or this: Six years ago, I was driving when a migraine started and scared me so thoroughly—it’s hard to think and see with a migraine’s visual disturbances and I feared I’d cause an accident—I haven’t driven a car since. Or this: the worst of the migraines lays me flat on the bed in a dark room for a day or more, only getting up to make another cup of tea or to pee. 

Are these examples clear enough for non-migraineurs to understand?

Pain is a coiled snake, poised and attentive. 

So here we have a snake metaphor. You know it’s a snake even without the noun. Coiled, as in ready to strike. Poised, as in self-assured. Attentive, as in always alert. Don’t imagine pain disappears. Imagine, instead, rattles on one end. Always you hear the menacing clatter and you quail despite yourself.

It seems everything worsens migraine pain: changes in barometric pressure, high winds and storms, bright sunlight, reading a book, looking at the computer screen or the television, too much exercise, too little exercise, standing up too quickly, bending over, talking with too much animation or too long, laughing too hard, crying, smiling too much. I calibrate my actions and tone of voice to ease or prevent worsening pain, in part because I can’t medicate all the migraines I have during the week. Taking meds more than three times a week causes rebound headaches. This leaves four days during which pain must go unmedicated. It also means we agonize over when to medicate. We call it analysis paralysis, and it’s a fixture of the chronic migraineur’s life: if I take meds for this migraine that means I can’t tomorrow night, so although the pain is bad and I need relief now, if I medicate this pain I won’t be able to take meds for another 48 hours so what about the day after tomorrow when I have something important scheduled for which I’d like to be pain-free? What’s most helpful, treating this pain now, or waiting and taking the meds tomorrow night to make sure I’ll be ok the next morning? 

Snake, ghost, entity. Pain defies my metaphoric abilities. 

Pain is a lion roaring. 

I know I cannot trust this particular lion. Even so, I make plans—always with a wary eye on the beast—to go out with friends, or attend an evening book reading, or travel for family visits. If I don’t make plans to be out, pain or no pain, I’ll be indoors and alone most of the time. This is why I’m willing to enter the spiky regions of just-barely-managing. The alternative is untenable. 

During moments of hope—or maybe they’re of delusion—I schedule an evening event or a busy Saturday, ignoring a fanged snarl. As often as not, I must cancel or postpone these plans. Or I might choose to attend in pain, holding on for the moment I’m home with a cup of tea, ensconced on my bed under my weighted blanket, eye mask blocking all light.

Pain is my best teacher. 

I have become a lion tamer. I am a snake-charmer, a ghost-buster. I live with and beside the beast.

Within the chronic pain experience are deep ironies: its patience isn’t benevolent, but the fortitude it has taught me is; its sleepless activity isn’t benign, but the inner peace to which it has led me is.

It’s an intuitive flip-turn in this world where we’re taught to fight for change, to refuse to accept difficulties. The brave thing, it seems, is to act, to have agency, to make things happen. To fight. Yet anger, fight, and making things happen only make migraine pain worse, and this is pain’s most difficult lesson: patience and acceptance are my best allies. 

The reason lies in our brains. Amygdalae, small but powerful, evolved early to ensure humankind’s long-term endurance by sending urgent, pre-thought, signals to neurological receptors. Saber-tooth tiger over there. Run! We no longer encounter saber-toothed tigers, but our brains still go into survival mode before we have time to think. 

Pain is experienced first in the amygdalae as a threat, and they send run! signals coursing throughout the body. All this has a sure effect on migraines: it makes the pain worse. Ages after it first sent my ancestors scuttling across the savannah in pre-thought terror, the amygdala is pressing its advantage over my much-prized reasoning abilities, and migraines still represent an existential threat to my primitive brain.

Thus, pain itself has taught me that patient acceptance is the one way to manage these physical and emotional responses even as they’re already galloping toward full strength. 

Pain is my spiritual guide.

Pain has brought me to a certain wisdom, to gifts of forbearance and equanimity. I can’t be sure I’d have developed these qualities had chronic migraine not made itself part of my life. And although I’d gladly give up any similar, future gain for the migraines to stop tomorrow, though I still have moments of anger and frustration, I feel grateful for what is mine now that I’ve made my peace with the beast. 

For this is pain’s gift: spaciousness, depth, a place of quiet so profound that somehow it seems all boundaries have dissolved. Into the void made by the banishment of futile emotion and fruitless tension, into the broad place of my depths comes—on lithe, padded feet—peace. 

Breathe. Breathe. And breathe. 

It matters not whether pain is an animal or a snake or some malignant thing. It matters that you choose, that you choose in this moment, and this, and this, not to permit it to toy with you. Place it gently in your cupped palm and let it be cocooned in the silken webbing of your awareness. See? Its edges begin to soften. Breathe. Breathe. And breathe. Smile, only a tiny movement of your lips. Open your hand ever so slightly and see how some space around your pain makes it, ever so slightly, smaller. See? Its edges are blurring, its presence diminished. Breathe. Breathe. And breathe.

There is within you a pathway unscrolling to your depths. Follow. Deeper within you is the serenity you seek. Where is deeper? It is within. All you need find is what’s within. All you need do is inhabit its peace. Breathe. Breathe. And breathe.

Carol D. Marsh earned her MFA from Goucher College. She's won essay awards from Soundings Review, New Millennium Writings, Under the Gum Tree, Solstice Literary Magazine, and Tucson Book Festival. Other essays have appeared in Los Angeles Review’s Best of Annual print edition, River Teeth, Chautauqua Journal, and The Vassar Review, among many others. Marsh’s book, Nowhere Else I Want to Be: A Memoir, was a Finalist in the Sarton Women’s Book Award 2018, and the Finalist in National Indie Excellence Awards 2017. Her chapbook, Border/Between: A Symphony in Essays, released by Bamboo Dart Press, 2022.