There was a yellow ring glowing gently around my Alexa Dot this morning. It indicated a notification. Hazily, I slapped the screen as I tried to shake off my sleepiness. “Dense Fog Advisory”. I rubbed my eyes and chuckled, that sounds about right, I thought to myself. Over the past several days, I had been struggling with a thick cloud of brain fog.

What is brain fog? First, if you don’t already know, I am legit happy for you. That being said, there isn’t actually a strict definition on it. However, it usually refers to a host of issues in the cognitive realm. For me, difficulty concentrating, focusing, or paying attention. It can also feel like dissociating easily or as if everything you are experiencing is just a little further away mentally – like a lucid dream state. It can make it more difficult for you to go about your day especially when your day includes technical work tasks but even just talking to co-workers and remembering what they just said can be challenging.

I also suffer from migraines and that can also have lasting effects on the brain and may contribute to making brain fog worse. Migraines are another one of those symptoms that fall into the chicken and egg category for me. When my therapist and I talk about depression, migraines often come up. Did the migraine cause the depression or did the depression cause the migraine?

So, if you’re not familiar with migraines you might think they are ‘just headaches’. Let me assure you, if you use that phrase around a migraineur, you may end up with a swift slap to the face. Migraines can be far more impactful than an occasional headache. Not to downplay the suffering headaches can cause but they are often easily treated with some ibuprofen, water, and rest.

Migraines on the other hand, can range from a moderate headache, usually with other physical symptoms like nausea, to completely debilitating a person. Some of the symptoms mimic having a stroke and can intensify to being temporarily blind or unable to speak. This Timeline of an Attack graphic is the tool I most often use to explain migraines to people. I especially like the creativity in describing one of the symptoms as simply, “Icepick in the head” (it’s accurate).

Not every migraine will incapacitate a migraineur (isn’t that a fun word?). However, I have gone to urgent care on more than one occasion and once to the ER due to the intensity. When a migraine refuses to back down to conventional or prescribed meds at home, you may need a stronger treatment that can only be administered by medical professionals.

Apart from migraines, most chronic mental or physical health issues can be frustrating and confusing. Brain fog, fatigue, inattention, depression, increased anxiety are some of the most common symptoms, so it can be difficult to know where your symptoms are originating. Not only is this frustrating for individuals, it’s especially challenging for medical professionals to treat.

The goal in good quality healthcare (mental or physical) is always to find the root cause and address that. However, when the root cause is unclear, or if the symptoms are actually exacerbated by multiple conditions, clinicians are stuck just treating the symptoms directly. As a patient, this means participating in a kind of trial and error with medications and treatments until something sticks. Easier said than done. Not only can this be costly from a health insurance perspective (I’m in America here folks, can you tell?), but it’s costly from a quality of life perspective.

When you’re trying out new treatments, you can get better or worse, sometimes a lot worse. Even after you find a treatment that works at least 80% of the time, it doesn’t always address the root cause; so you may be stuck in a sort-of-healed state. And I don’t know about you, but does anyone really want to be chained to a medication for the rest of their life? Of course, that’s better than the alternative in may instances but what happens if your circumstances change and you’re no longer able to obtain that medication? And sometimes, medications lose their potency over time, or your physiology just changes. It’s an ongoing battle in trying to live a healthy life isn’t it?

I will say one of the things that improved my health is several lifestyle changes. Actually, let me back up. I kind of hate that phrase “lifestyle changes”. For some reason it feels like it’s society’s way of putting the blame on the person. A lifestyle is something one chooses right? So, if you’re suffering as a result of your own lifestyle then it’s your own fault. But that is a horribly simplistic view. Most of us don’t choose to lead unhealthy lives. Several factors can contribute to that, that aren’t always under our immediate control, socioeconomic status being a big one.

However, we can try to choose healthier options when we have the available resources (internally and externally) to make those changes and keep up with them. I think the key here is progress, not perfection – and being kind to yourself. It’s hard enough to maintain your own health when you don’t have chronic conditions. When you do, that mountain can feel impossible to climb some days. Know that, many people are struggling in the same way, even if you don’t always see it on the surface.

I have a clear view of the world outside my office window and while I was writing this post, I can see that the weather cleared up quite a bit. I can see the blue of the sky slowly saturating the atmosphere like watercolor across a textured paper. The sun is making it’s debut for the day, peeking out from behind a fluffy white cloud in the shape of a boat. Does this mean there will never be another foggy day? I know there will be. But today, I’m going to enjoy the sun while I can.