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Wednesday, October 20, 2021

Opinion | There Has Never Been a Better Time to Have a Headache

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To be sure, our brains are unfathomably complex organs, and they are difficult to study. But the dynamics that Dr. Kempner identifies almost certainly helped to prolong scientific ignorance of headache mechanics and treatment for decades, and for everyone. Consider, after all, that the Amgen/Novartis antibody was the first drug ever approved in the United States to specifically prevent migraines. The first — and that was a mere three years ago. (Side effects so far generally appear uncommon and mild, though the long-term picture remains to be seen.) Eli Lilly secured approval for its version of a CGRP inhibitor to treat cluster headaches only in 2019, and new classes of CGRP drugs are still emerging. But since the dawn of drug regulation, every other pharmacological dollop aimed at preventing these diabolical headaches — a menagerie of beta blockers, anti-epileptics, anti-depressants and other drugs — were researched, developed and designed for other diseases. They simply seemed to help some people with headaches as a side effect, and so doctors just gave them a go.

In my work as a journalist exploring the modern evolution in headache science, I’ve spoken to many patients who suggested that ignorance, both clinical and cultural, persists. As with so many other pain disorders, Black patients are far less likely to have their head pain properly diagnosed than their white counterparts. And while the World Health Organization places headaches among the leading causes of disability and lost productivity on the planet, our knowledge of headaches, like that of so many other diseases, skews toward the rich world, leaving incidence and impact in the developing world vastly understudied.

At the same time, the new drugs, while remarkably effective for some people, are yet another heartbreaking failure for others, suggesting that a more fundamental neural trigger or target remains elusive. These medications are also not cures, and many patients must continue to take them periodically — even though they can cost more than $600 for a single injection. Many headache sufferers are finding that their insurers will refuse to cover them.

For all the recent progress, funding from the National Institutes of Health for basic research into headache disorders remains incommensurate with their enormous social costs, and far too few young doctors see headache specialization as fertile ground for a career. One young medical student with an interest in neurology told me she was taken aback that her studies focused so heavily on unusual brain disorders, given that headaches are so common — and still so mysterious. “We got so much teaching about other things, which are important too, but way less common,” she said. “I was surprised by that.”

Look, I get it. In a world troubled by all manner of disease and unrest, it can seem absurd to complain about headaches. But this, too, is what makes the path of a chronic headache sufferer — or really anyone with any sort of chronic pain — a uniquely lonely one. The pain won’t kill us, sure, but we can receive prolonged physical beatings, without explanation, at any moment — a merciless cycle that some studies have shown can increase suicide risk. Some headaches are even thought to be capable of administering one of the most extraordinary sensations of pain known to the human body, but they occur in a location that makes them entirely invisible to puzzled onlookers (and for most of history, to scientists, too). And all such pain bears a name — “headache” — so common, so boring and so utterly diluted by its resonance with other, lesser things, that sufferers are often too ashamed to even mention it.

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