THE HEADACHE

It’s not just in his head.

Zeller, a former New York Times journalist, dives into a topic whose central feature is, in the words of author Elaine Scarry’s description of all pain, its “unsharability…its resistance to language.” Zeller’s excellent debut book is largely about migraines, an affliction that plagues millions, derails careers, threatens lives, and yet is largely overlooked by the vast biomedical research community. Zeller recounts the long history of migraines, from ancient Egyptians to Darwin, and the often brutal measures applied to relieve the pain. The most disturbing part of the book is his personal story, and the stories of dozens of sufferers, who all pay the price of a life diminished by sudden, unrelenting, excruciating pain. The author reports that there are roughly 700 headache specialists with diplomas in the world. “In Montana, where I now live,” he writes, “there is one.” Yet the affected population is estimated to be 50 million people. Direct and indirect costs, according to a 2018 estimate, is about $28 billion annually. Even with such enormous health and economic consequences, federal research investments fall far short of matching the burden of the disorder. Zeller reviews the available treatments, some prescribed, most not, and a few illegal. His personal experience with many of them and his investigation leave him with the view that most don’t work, some work in the short term, and a handful of newly approved (and expensive) medications don’t have a track record of effectiveness. Headache patients, he writes, must often endure a “long, zigzagging journey through a pharmacological forest.” Zeller’s search to explore the frontiers of headache research takes him to a few leaders in the field who are pursuing tantalizing new findings. While they are engaged in intense competition, their numbers are few, their resources comparatively meager, and their progress uncertain.

A sharp—and funny—account of one man’s attempt to understand why so many of us suffer head pain.