Thursday 8th October 1992   Lunchtime 13:10

“I am afraid Dr Lewis is away today so I’ll have to do the tutorial for you.” My Dad had come into the staff room. We looked apprehensively at each other.
“What were you going to discuss?” he asked.
“Dr Lewis was going to go over psychosomatic illness.”
“Mmm . . .” my Dad said. He rubbed his chin thoughtfully. “Psychosomatic illness is a very interesting topic. It needs some preparation though. I am not sure that I can do it now. I know what I’ll do, I’ll tell you about my migraine.”
We looked at each other again. Dylan sighed.
My Dad sat down and loosened his tie. “We’ll start from the beginning: when I was in junior school. I am a bit embarrassed to say so now but I was one of the cleverest children in the school. I was very competitive and took great pride is being at the top of the class.” He smiled knowingly at Dylan.
“My parents were very glad to see me doing well and they encouraged me. I passed the 11 plus without too much difficulty. I ended up going to a very good grammar school with an excellent reputation for getting students into university. That’s all I wanted then, to go to university.”
“Why was that, Dr Dennis?” Dilys asked.
“I am not sure, really. It might have been because my uncle went to Cambridge. He had a big influence on me.”
“Did you always want to study Medicine?”
“No, not then. I hadn’t thought about what I wanted to do. I just wanted to go to University.”
My Dad paused and took a sip of his coffee.
“Things were very different in the grammar school. In the first year, I was really struggling. My homework was always carelessly done. I never seemed to have time to check anything over before handing it in. I was soon near the bottom of the class. I started to get fed up and lose confidence. My work got even worse. I felt quite despondent.”
Dylan shifted impatiently in his chair.
“I remember my form teacher talking to me just before Easter. He knew that I was finding things difficult. He said that the school based almost everything on examination results. If I worked hard for my exams, I could get into a good stream. I realised that this was my opportunity and I studied every night for 2 months. I got my Mum to test me regularly until I knew my work inside out.”
Dylan yawned loudly. Dilys looked at her feet. I blushed. I always found Dad’s tutorials embarrassing.
“I ended up doing very well in the exams and I managed to get into the B stream. No one wanted to be in the A stream because it was full of odd characters.”
“Dylan was in the A stream.” Dilys laughed. Dylan glared at her.
“For the next two years,” my Dad continued, “I did exactly the same. My course work was terrible but I was near the top of the class for all tests and exams. I felt pretty pleased with myself and my old confidence returned.”
“I thought you were going to tell us about your migraine.” Dylan asked. He was getting annoyed.
“I am just coming to that. It was towards the end of the fourth year when I had my first migraine. I didn’t know it was a migraine at the time. In fact, I didn’t diagnose it until I was in the second year of medical school. It happened in the middle of a maths test. It started almost imperceptibly, a slight distortion of my vision that I couldn’t quite put my finger on. This gradually became worse with jagged, coloured lines, shimmering and blank areas where I couldn’t see anything. It was a bit like the pattern you see when you look directly at a bright light bulb. As this ‘visual aura’ progressed, it became harder to see the test paper. I had to move my eyes around to utilise the clearer areas of vision. Even then, some of the fractions and equations were distorted and difficult to see. It was tricky to do the work but not impossible and took longer than usual. I was pleased that I still managed to complete all the questions. The symptoms lasted for about 30 minutes. I was left with a dull headache. I have never had severe headaches with my migraines.”
“I thought everyone got really bad headaches with migraine.”
“Not really, Dilys. Some patients don’t get a headache at all. What other symptoms can you get with migraine?”
“Nausea and vomiting . . .”
“Yes, I do occasionally feel sick but I’ve never vomited.”
“Anything else?”
“Dizziness . . . photophobia . . .”
“Very good.”
“Can’t you get tingling and numbness or even paralysis?”
“Excellent, Dylan. Tingling often starts in the hand and spreads up to the face. You usually get weakness rather than complete paralysis, though. Only a small proportion of patients get numbness or weakness.”
“Isn’t migraine more common in women?”
“Yes it is, Dilys. Anyway, we’ll carry on with the story. At the time, I was quite worried about the symptoms but felt reassured when they disappeared completely. I guessed that the episode might have been a consequence of all those weeks spent staring at books. But, I was worried. What would happen if I had these episodes during examinations in future? It would have been impossible to complete a difficult paper. I was relying on my exams results. I knew that my course work would never be good enough. I thought about doing less revision but it would be too risky. I was in a quandary and anxious for weeks. Some mornings, I woke up with a horrible feeling of dread. I couldn’t bear the thought of not doing well at school.”
My Dad looked at us and took another sip of his coffee.
“Of course, as it turned out, I ended up doing progressively more revision over subsequent years. I did my O-levels, A-levels and, then, spent 5 years at medical school in Cardiff. That was when I had to work the hardest. During this time, I continued to have regular migraines. Sometimes they were caused by tiredness or bright lights. Sunshine or car headlights could set them off, particularly if it was wet. However, the majority were related to studying.”
“How did you manage to pass everything?” Dilys asked anxiously.
“Well,” my Dad said, “In all that time, I have never had another migraine during an examination. They have always occurred, very conveniently, a day or two after one exam or a similar time before the next. They never even disturbed my revision. I have always thought that that was a remarkable coincidence.”
“It was a coincidence, wasn’t it?” Dilys said. “You were very lucky, really.”
“Yes, I was. Gradually, as I have got older, my migraines have occurred less and less. I only get one or two a year now.”

My migraine.