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Chronic headaches are an unnerving and often debilitating condition experienced by more than a billion people worldwide. Why do we know so little about them? Jerome Groopman explores the lingering mystery of migraines. Plus:
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Hannah Jocelyn
Newsletter editor
Thirst, stiffness, nausea, flashing lights, blurry vision—the symptoms that come with a migraine can be almost as gnarly as the headache itself. Almost. What might be worse for sufferers, though, is the lack of a definitive treatment. Globally, more than a billion people get regular migraines—famous sufferers over the years have included Charles Darwin and Joan Didion—and yet there is little scientific consensus on why they happen or how to prevent them. This might be because its victims are mostly women. As Tom Zeller, Jr., points out in his new book, “The Headache,” female migraine patients outnumber their male counterparts at a ratio of about three to one. Zeller (who is afflicted with something generally acknowledged to be even worse: cluster headaches) chronicles the history of headaches and their treatment, the current science surrounding cranial pain, and why patients often struggle to have their symptoms taken seriously.
In a review of Zeller’s book for this week’s issue, Jerome Groopman, a physician who is himself prone to migraines, points out that “there is a kind of uneasy fellowship in this condition—a vast, involuntary community of people mapping out their lives between attacks, haunted by uncertainty but sustained in part by accounts like his.” Mapping my own migraines, I learned a lot from Groopman’s review; as he notes, “understanding, however incomplete, can offer its own form of relief.” Here are three key takeaways:
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Why migraines happen: There are two contradictory schools of thought, both of which can be traced back to the nineteenth century. The first is that migraine is primarily an abnormality of the blood vessels; the second is that migraine comes from the brain itself, like epilepsy. Without a conclusive explanation, solutions are hard to come by.
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The slow evolution of remedies: Around the second century C.E., one fix involved applying a torpedo fish—a member of the ray family—to the heads of sufferers, as a way to pull pain elsewhere. Treatments have improved since then, but only marginally. Today, many migraine sufferers take upward of four medications to try and stay ahead of the pain—and that doesn’t include home remedies or preventive superstitions. (I’m devoted to mustard-powder foot soaks and eating hunks of raw ginger.)
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The drugs available today: When scientists discovered a neurotransmitter called calcitonin gene-related peptide (CGRP), which is released in abundance during a migraine event, they finally had a target. A handful of drugs, taken orally or as injectables, have since 2018 been developed to block the effects of CGRP—but their potency often wanes over time. For Groopman and the rest of us who live in anticipation of an attack, what’s left is the delicate, indefinite balance of interventions. Might I recommend some coconut water?
