The dura, with its nociceptive fibers, is sensitive to traction, and traction can translate into pain. When I was leaking, when I experienced a headache upon standing, theoretically part of the reason for this was the decrease in my already low intracranial cerebrospinal fluid volume due to the new gravity of being upright, plus the stretching or traction of the dura as it responded to the contents of my skull shifting downward, however slightly. As I’m recovering from this leak, my dura is still hypersensitive, all its nociceptors on high alert, ever at the ready, waiting for the smallest of signals, and so my pain now is from the volume of cerebrospinal fluid reaching full capacity, from the traction on the dura caused by tilting my chin, from the way it is stretched simply by my sitting down. All of this stimuli, which previously, in my non-leaking life, was merely interpreted by my body as stimuli—not danger, not threat, not pain—is now transmitted as signals of peril. My brain is sensitized, my pain pathways are sensitized, and so the pain cycle continues.
Sensitization is an important component of pain. It is an increased response to stimuli, which results in both increased sensitivity to pain and the experience of previously non-painful things now being experienced as painful. As I recover from my leak, with my sensitized dura, I am painfully sensitive to the pulsation and circulation of spinal fluid as I never have been before, despite the fact that my spinal fluid has been pulsating and circulating my whole life. And while I was leaking, I became sensitized to that pain as well: After a while it took longer and longer for the pain brought on by being upright to subside once I lay flat. My pain was continuous, even in the absence of painful input. This kind of sensitization is in part why techniques like the infusion treatments I had at the headache center are prescribed: Those several days of concentrated exposure to medications, some to constrict blood vessels, some to induce relaxation, all to decrease pain, help to interrupt the pain cycle, to reset things so that these sensitive receptors can recalibrate, and return to their normal levels of sensitivity.
The main difference between the pain I had while leaking and the pain I have now is that the pain I have now changes over time. It is intermittent, and variable in intensity. I can answer the headache center questionnaire questions like Have you had any headache-free periods? because now that answer, incredibly, is yes. I can quantify the number of headache hours I have each day, because now my headache is not continuous, it is not intractable; it has a cycle to it that is no longer dependent upon whether or not I am standing. The questions of scale that confounded me with my leak headache—On a scale of 0-10, how severe are your headaches? __/10 Mild ones __/10 Severe ones __/10 Average ones—are fathomable now that my headache (singular, unceasing) has become headaches (plural, limited in duration), now that I have moments when my head hurts less than it does in other moments. This is progress, and I note it, tracking each day on an app on my phone, so that eventually I can see that what feels like stasis is in fact an evolution, my pain waxing and waning, ebbing and flowing, my fast and slow nerve fibers recalibrating themselves, until eventually, one day, it might even be gone.
33
It’s happened again: I’ve forgotten something crucial—the prophylactic medication, an antidote, a cure—and now we are all at risk. I sit up in bed, but it’s already too late. I can see the laser beams cutting through the ceiling, brilliant sparks penetrating the darkness, and then the poison gas begins seeping in through the floor. Soon the house will shake and collapse upon us. It’s only a matter of time. My throat burns. I clutch at my neck, gagging, choking, as I search fruitlessly on the dresser, the nightstand, for the thing that surely must be there to protect me, the mask or the pill or the whatever it was I was supposed to have prepared in order to save us. But it’s not there, of course it’s not there, nothing’s there, I’ve failed as I always fail, as I’m destined to do every time, and so I run to the hallway, screaming as I throw open my bedroom door, the panic propelling me, my heart a rapid staccato in my throat. I’ve got to get the kids before it’s too late, I’ve got to save them, I’ve got to get them out.
Suddenly, standing in the harsh light of the hallway, I feel myself beginning to wake up, the pain in the back of my head dawning, and the truth slowly returns to me: There is no disaster. There are no deadly lasers cutting through my roof and destroying my house, no deadly gas flowing through the vents. This is a nightmare. A night
