Sylvia Plath at 2:30 A.M.

Usually there first occurs a mysterious and beautiful introduction, sometimes as brief and soft as a French Baroque unmeasured harpsichord prelude, but sometimes as passionate and driving as Tristan and Isolde. These are actually quite enjoyable, but for the dread of the impending pain, if I am awake to savor it.

Unfortunately, these attacks often come in the darkest night hours. Typically, about 2:30 in the morning. I hate that because then I miss the good part. I don't much notice the aura if I am dozing during it. It becomes interwoven in the loose dream-fabric of my usually fitful attempts at sleep.

Just now I am realizing how the glowing waves of the Encinitas red tides very much resemble the visual light-storms of my auras. The beauty of these is beyond description.

Then comes the discomfort. Often other sufferers employ the term "vise-like" to describe the grip in which the pain squeezes the head; or rather, a good half of it. Throbbing, scintillating, pounding, hammering, the God of Ache arches through the hemisphere with the dull tenacity of an hydraulic lift upon which an auto rises for inspection.

Then all work stops. Other stars in the constellation begin to shine. The bladder calls. For me, a round of explosive sneezes numbering in the teens passes before the wet-sock leprechauns stuff my nose adroitly. At least that stops the nasal runniness. The tour includes a halt for the lower digestive tract, and often an episode of emesis.

Emesis with or without nausea. It depends, like so many things, on nothing. Interesting, that.

I've had hospital patients who get "abdominal migraines" without headache; frequently these are young males. Sorry, those. One was misdiagnosed with porphyria, of all things, for years, becoming addicted to opiates and getting a PortaCath in the process. But that's another story. One of the few times we called the local police to help us with a patient. They all knew him and his mother.

Life before Imitrex: caffeine. With a healthy ibuprofen dose. Not good in the middle of all-precious sleeping time. NSAIDs and vomiting do the esophagus no good, no good at all, and lead to other concerns. I would then be up. and as the migraine leaked out of my head, I could catch up on a little reading or studying.

So as not to disturb the others, headphones are nice, and when the headache fades I am still awake but a little music becomes tolerable and passes the time until drowsiness recurs.

My introduction to Imitrex (sumatriptan succinate,) the first of a subsequent whole family of vasoconstricting triptans, (I think Relpax, or eletriptan, is the latest newcomer,) came after a span of three days of intense sleepless pain. I had missed work, and finally my spouse took me to the local ER at the hospital in which I was then newly employed, in the middle of their night shift. My oral temperature was 94-something degrees from putting ice on my head. Useless, that.

Don, the nurse supervisor who I came to know later (marathoner and demerol thief, another story,) administered a subcutaneous dose of Imitrex, then a brand-spanking-new drug, and within five minutes the leaden fog on my head lifted and I was free at last.

Well not free free. I was uninsured, having just started that job. The ER bill was about $650 which I had payroll-deducted over the next few months, harmlessly.

I was the only patient in that rural ER.

A 3 a.m. code was called on the floor where I worked the day shift.

While lying on an ER gurney, time passes by at the rate of continental drift.

We finished the lovely paperwork and went home.

At that time Imitrex came only in an injectable form, still the best route in my opinion, as then one's probable emesis will not cause one to "waste" a dose (an oral dose, anyways,) away. For a mere $75 you got two doses. I quickly learned that about a half-dose would work for me, and research showed that worked with a good number of other migrainers. Still, it added up over those periods in which the migraines came a few times a week.

Now there are nasal sprays and tablets, and I have insurance so I do not need a $37.50 headache to justify a dose of Imitrex.

Lucky ducky me.

Like an elephant not wishing to confront the mouse in his path, the migraine turns and lumbers away, leaving only the dark quiet peacefulness that slowly succumbs to the dawn.