I don't remember my first headache. I don't even recall when I first started getting headaches. But many of the headaches themselves are burned indelibly into my memory.
I remember driving to Missouri on vacation and arriving with a blockbuster that put me into bed for two days. I remember driving to Los Angeles every month when I was in graduate school in Santa Barbara and starting to feel the pain as soon as we hit the smog in the San Fernando Valley.
I remember drinking two glasses of burgundy and paying for it with two days of agony.
And we are not talking Excedrin headache No. 23 here, the run-of-the-mill annoyance where you take two painkillers and in half an hour your pain is gone. We're talking anvils pounding in your forehead, room lights that feel like the noonday sun in the Sahara Desert, ticking clocks that sound like triphammers.
We're talking about refusing to speak, huddling inside a self-imposed shell separate from the rest of the world. We're talking nausea that makes you feel like your last meal came from the city's garbage truck.
We're talking about pain that has driven my son, who also suffers migraines, to pound his head against the wall in frustration and anger, pain that leads people to contemplate or even attempt suicide.
We're talking migraine.
And, increasingly, we're talking about something it is no longer necessary to endure.
A small band of scientists, unorganized and without government research funds but united in their commitment to headaches--which many of them suffer themselves--have been making great strides in treating migraines, as well as other types of disabling headaches.
They have developed widely used drugs and therapies that can abort migraines in the majority of people and devised others that, used regularly, can prevent migraines from occurring in the first place. Other drugs, now entering clinical trials, promise to be even more effective and to help a higher percentage of victims.
At least 75% of patients can eliminate or greatly alleviate their headaches with drugs and biofeedback, according to Dr. Joel R. Saper of the Michigan Headache and Neurological Institute in Ann Arbor. Another 15% are not helped by drugs as much but can be taught to cope with their headaches--through relaxation techniques--enabling them to return to work. "The other 10% are simply not helpable, and we're not sure why," Saper says.
But many physicians believe even that last 10% eventually will be helped. "We're very close to some big breakthroughs," for that group, says Dr. Seymour Diamond, who operates the Diamond Headache Clinic in Chicago.
VIRTUALLY EVERYONE gets headaches. By some estimates, as many as 95% of Americans have an occasional tension headache, triggered by stress and fatigue, that requires a couple of aspirin or a short nap. In a study published in April, Dr. Walter Stewart and his colleagues at the Johns Hopkins School of Hygiene and Public Health in Baltimore reported that most Americans suffer 10 to 12 headaches a year.
The direct and indirect costs of headaches to society, for medical care and lost workdays, total as much as $10 billion annually, according to the National Headache Foundation in Chicago. Each year, Americans spend more than $400 million on aspirin and other over-the-counter pain relievers, primarily to counter headaches.
But a remarkably high number of individuals--an estimated 45 million, according to the National Headache Foundation--have more serious chronic or disabling headaches.
Even though headaches are the seventh most common complaint patients bring to physicians' offices, according to Stewart, they receive little attention from researchers. "Headaches are not fatal and (often) aren't chronic, so they don't grab attention like other, more dramatic illnesses," Stewart says.
It's not easy to study headaches. There are no animal models. Dogs, cats and laboratory mice do not get headaches--or, at least, if they do, they are not able to tell researchers about them. So there is nowhere to study the physiology of headaches or to test new drugs except in humans themselves.
Even in humans, headaches are difficult to study. There are few objective measures by which to get a handle on them. You can't take a picture of a headache with an X-ray machine or a CT scanner; you can't track it with an electroencephalograph; you can't find its traces in a blood assay or urinalysis.
Few physicians are knowledgeable about headaches, whether for diagnosing them, for treating them or simply for knowing where to send a headache victim for help. "It's not taught anywhere," says Dr. Lee Kudrow of the California Medical Clinic for Headache in Encino. The majority of headache sufferers who seek medical help report that they tried doctor after doctor with no success.