It announces itself in the most contrary way, given what it is about to inflict. First, his fingers go numb. Then that same sensation—or lack of it—advances up his arm, always on the left side. His lips and nose go numb, and he can feel it in his mouth. Just to be sure, he will move his left hand to his face. The image will be blurry.
Milwaukee Bucks Center Andrew Bogut—all 7 feet and 245 pounds—is about to get a migraine.
Bogut is a strong, big man who pushes and shoves other big men for limited space at either end of a basketball court. It's a test of manhood, 82 times a year, and Bogut revels in it. But as the early symptoms give way to his advancing migraine, he knows he is in for one of his toughest challenges yet.
And Bogut has never been one to sit out challenges—not at any time during his meteoric, historic rise up through the National Basketball Association. He was head of the NBA draft class of 2005, the first Australian ever to be chosen number one.
In his second and final year with the Utes of Salt Lake City, Bogut carried all before him, winning the Associated Press Player of the Year, and the Naismith and Wooden Awards as the best college player in the country. Utah reached the round of 16 in the National Collegiate Athletic Association championships, draped around their center's broad shoulders.
This season he has been the rock of an injury-stricken Milwaukee Bucks team that lies in last place in the NBA's Central Division.
On the day after a game in Seattle last March, the Bucks were at practice and Bogut began to feel the dreaded symptoms. By the time the team boarded its charter to L.A., Bogut was in the grip of a full-blown migraine. “It didn't kick in until we got on the plane and then it was terrible,” he says.
There were no beds on the plane, so Bogut was sitting uncomfortably, his 7-foot frame sprawled in a seat, his body a throbbing Do Not Disturb sign. His teammate Toni Kukoc, saw this, grabbed a blanket, and rolled it into a pillow. Then he guided Bogut to the exit row and helped him lie down. Finally, he commandeered a curtain from the baggage compartment and hung it over Bogut to give him a degree of darkness and quiet.
Bogut played against the Lakers the following night—just 14 minutes, half his season average—scoring nine points. He was drained and still recovering, but he put in his time on the court.
Usually, with the onset of symptoms, Bogut will take Imitrex (sumatriptan), one of a class of drugs called triptans, which are believed to work by binding to serotonoin receptors in the brain, inhibiting inflammation and causing constriction of cranial blood vessels
If he can't get it early enough, he follows that up with an anti-nausea medication and then a prescription sleeping pill. The anti-nausea medication prevents him from vomiting as he tries to sleep off the pain.
Timing is everything in this situation, says migraine expert Gretchen E. Tietjen, M.D., professor and chair of neurology at the University of Toledo in Ohio. “Some reports suggest that if you take a migraine-specific medicine when you first experience the symptoms of aura—like those described by Bogut—that it won't help prevent the ensuing headache. You have to wait until the migraine starts. But many patients have found that that's not necessarily true for them, that they can take the medications during or at the beginning of the aura, and it prevents the migraine.”
What warning signs should you be looking for? It's different for different people,” says Dr. Tietjen. Some people have the feeling that something is coming on, even the day before the migraine, a stage of migraine referred to as the prodrome. About 20 to 40 percent experience the aura. They're still alert but they have the feeling that something is coming on. An aura can occur with or without a headache, she explains, but typically it comes up to an hour before the headache starts.
“Bogut's symptoms sound like typical sensory aura. It can last for 15 to 20 minutes, and then usually goes away before the headache starts.”
Many people will take a triptan at that point, she says, and if that works for them, that's good. The earlier you take triptans in the course of the headache, the more likely they will be effective. Triptans can be taken in different forms—in a pill, a nasal spray, or a shot—but most people prefer the pill.
Sleep can be a good thing for migraine to stop the process, Dr. Tietjen says. We tend to suggest an antihistamine, like Benadryl, rather than a sleeping pill, because it also helps treat the process causing the migraine.
Finally, drinking a lot of fluids can be very helpful, as is keeping an icepack on your head. Sleep, ice, relaxation, and fluids can all help ameliorate the pain, Dr. Tietjen says.
Bogut has won many awards in his short career. These awards saluted strength, ambidextrous shooting touch, and visionary passing, but there were intangible qualities that were recognized as well: namely a passion for the game.
“I don't like to miss games from injuries. I try to find a way to play,” Bogut says. “I loved the game so much as a kid growing up; basketball was the highlight of my week. …My reward for going to school, in my head, was playing on a Friday night and Saturday morning so that no matter what happened, I would always be ready. No matter how hurt I was, I'd always play.”
Bogut is a rare mix of characteristics, at once talkative, yet heedless of what, if any impact his words will have on public opinion. That includes talking about his migraines. His hope, he says, is that increased public awareness of his plight may lead to some breakthrough in migraine treatment.
“I don't mind talking about it. Most people know that I get them. … I'm kind of thankful that it's just a migraine and not something more dramatic.”
The pain runs in the family. Bogut's elder sister Michelle suffers from more frequent migraines, as did their paternal grandmother. His earliest migraine memory dates back to when he was 12 or 13. By then, Bogut had begun to devour anything about basketball, his favorite sport even at that early age. And not even migraines can keep him off the court for long.
“Once you make the NBA, for some guys, their love's not basketball anymore,” says Bogut. “Their love's whatever it may be off the court. My number one love's basketball. Anything else I'm doing between that is just to fill time.”
NBA's #1 Draft Pick Rebounds from Migraines with a Passion for the Game©2007 American Academy of Neurology
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