Making headaches history? The game-changing meds offering new hope
“I’ve never felt a pain like that at any other time,” says Tom Zeller. “I liken it to having your hand on a hot burner and not being able to take it off. It’s that level of intensity, that you must move. You’re highly agitated. You sometimes bang your head on things because the pain is that bad.”
The former New York Times journalist and author is describing the experience of a cluster headache, a rare form of headache causing pain so severe it’s been described as the “suicide headache”. In his book The Headache: The Science of a Most Confounding Affliction – and a Search for Relief, Zeller documents his own and others’ experience of debilitating pain from migraines and cluster headaches – collectively known as headache disorders – and the science behind the pain.
For something that’s thought to affect one in seven people, surprisingly little is known for certain about why these headaches happen. As Zeller writes, science can’t even really agree on what is hurting.
Asked if he can say for sure what a headache actually is – having researched and written a whole book on the subject – Zeller tells the Listener with a laugh: “I would say the short answer is no. Assuming we’re talking about primary headache disorder, like a migraine or a cluster headache … the top headache scientists in the US told me we know very little.
“We know some things, but it’s not very much. We know there are certain chemicals that are expressed when a headache is happening. We don’t know all of them, but we know some of them. We know that certain parts of the brain are lighting up during that pain event. And with migraine in particular, that there are associated neurological symptoms that can come hours or even days before. So there’s definitely a central nervous system activation going on.”
Beyond that, the experts can’t really even say which anatomical structures are hurting. “We can’t locate the pain in any particular place. It might in fact be nowhere at all.”
Root cause
Two competing theories have prevailed when it comes to headache pain over the years: that they are a vascular issue affecting the blood flow in the head, and that they are a central nervous system issue.
In most primary headache disorders, says Zeller, the pain is unilateral: almost always on one side of the head. “And that’s also a clear sign, if you think about it for even a minute, that the central nervous system is involved.”
If headaches were vascular, he points out, since the vasculature is everywhere, you’d expect the pain to be all around the head. The vascular theory is out of favour now, though not all headache scientists are ready to completely dismiss it.
For decades, it was assumed the brain itself was insensate – unable to feel pain, he says. There’s some debate about this now.