\n<\/p>\n
Rachel Feltman: For Scientific American\u2019s Science Quickly, I\u2019m Rachel Feltman.<\/p>\n
Headaches are incredibly common, but they\u2019ve gotten surprisingly little attention from scientists.<\/p>\n
Here to walk us through what we know\u2014and don\u2019t know\u2014about headache science is Tom Zeller Jr. He\u2019s a former New York Times reporter and editor and the current editor in chief of Undark. He\u2019s also the author of a new book called The Headache.<\/p>\n
If you’re enjoying this article, consider supporting our award-winning journalism by subscribing. By purchasing a subscription you are helping to ensure the future of impactful stories about the discoveries and ideas shaping our world today.<\/p>\n
Thanks so much for coming on to chat with us today.<\/p>\n
Tom Zeller Jr.: Oh, it\u2019s great to be here. Thanks for having me.<\/p>\n
Feltman: So I would love to start with a little bit about what inspired you to write a book about headaches.<\/p>\n
Zeller: Sure, well, you probably could guess that I have headaches myself. And not just the ordinary sort of headaches that we all get, but I have something called cluster headache, which is one of the three primary headache disorders\u2014I mean, there are other primary headache disorders, but these are the three main ones: tension-type headache being the most common, migraine being probably the most familiar and most debilitating\u2014and predominantly among women. Cluster headache is far more rare and more common among men, and that\u2019s what I have.<\/p>\n
So, you know, it\u2019s an issue that I\u2019ve sort of grappled with for most of my adult life. It\u2019s not something that I ever wrote about as a journalist, or thought that I ever would. But when I started thinking about a book I realized that I\u2019d kind of been researching this topic for most of my life for other reasons, and so it seemed like a natural fit.<\/p>\n
Feltman: And what is the research landscape like when it comes to these, you know, three major headache types?<\/p>\n
Zeller: Yeah, it\u2019s surprisingly bleak. I mean, in the book I focus mostly on migraine because if there is any research being done, it tends to be on that. And to some extent I think it\u2019s fair to assume that what we learn about migraine will shed light on other headache disorders, too, because there\u2019s sure to be some underlying biology that they all share.<\/p>\n
But in general the surprising thing to me that I discovered was how little we actually know about what\u2019s actually going on inside, like what bits of anatomy are being pulled into the choreography of a migraine attack, what bits of anatomy are more important than others.<\/p>\n
And we know some. I mean, the research suggests\u2014there are a lot of good imaging studies that show certain parts of the brain lighting up. There are more recent studies that indicate that certain neurochemicals are in abundant supply in the blood when someone is undergoing an attack. And we also know that the blood vessels may or may not play a role in all of this. But that\u2019s the extent of our knowledge of what\u2019s happening in migraine headache.<\/p>\n
Feltman: Yeah, and how is it that we know so little when headaches are so ubiquitous?<\/p>\n
Zeller: I think there\u2019s a lot going on. I think one of the most obvious things is that migraine mostly affects women, and I don\u2019t think I\u2019m saying anything that you don\u2019t already know: that women\u2019s health in general has gotten short shrift over the decades. And so to the extent that women were more often presenting in clinicians\u2019 [offices] with migraine over the course of the 20th century, it was not taken very seriously …<\/p>\n
Feltman: Mm.<\/p>\n
Zeller: And I think that that, in a lot of ways, it bled into decision-making at institutions like the [National Institutes of Health], which is the biggest funder of basic science in the U.S. So I think that\u2019s part of it.<\/p>\n
I also think that there\u2019s something sort of cultural about the word \u201cheadache.\u201d I mean, we use this word as a metaphor for a mere annoyance: You know, \u201cDoing your taxes is a headache.\u201d \u201cSitting in traffic is a headache.\u201d And it\u2019s unfortunate that we often have the same word to describe real neurobiological disorders. So that\u2019s at play, too.<\/p>\n
And I think a third leg of it is the fact that we all get this thing called headache. If you don\u2019t have enough water, or you\u2019ve skipped lunch, you have a little too much to drink the night before, you get a bit of a headache. So we all sort of think that we know what a headache is, and yet there is this sort of subset of people who have headaches, in a disorder sense …<\/p>\n
Feltman: Yeah.<\/p>\n
Zeller: That are excruciating. And yet we use the same word to describe it. So I think all of those things sort of combined slowed the science on headache.<\/p>\n
Feltman: Yeah, no, I think there\u2019s a real sort of definition problem. I, for years, thought I didn\u2019t get migraines but would kind of use the word for when I was feeling a particular kind of bad way. And then in the midst of having long COVID my migraines got more frequent and worse, and the increase in degree made me be like, \u201cOh, no, this is what people are talking about [laughs] when they say they have a migraine,\u201d which is just\u2014it was so funny to me.<\/p>\n
Zeller: Do you get the whole suite of symptoms? Like, you get the aura and all that, too, or just?<\/p>\n
Feltman: It\u2019s really interesting, during the period where they got very bad and frequent I did have, like, the aura, the blurred vision, so that was really what made it like, \u201cOh, this kind of weird, bad feeling I sometimes get that comes with a headache …\u201d<\/p>\n
Zeller: Yeah.<\/p>\n
Feltman: \u201cIs a migraine.\u201d And now it\u2019s much less common that I have this sort of whole suite, but yeah, they\u2019re wild, and it\u2014you know, I have a friend who gets migraines that honestly present as kind of, like, strokelike …<\/p>\n
Zeller: Mm-hmm.<\/p>\n
Feltman: Have, have, like, really intense\u2014though brief and, you know, passing\u2014neurological effects. And the fact that she can go to her neurologist and they\u2019re like, \u201cLooks all good. It\u2019s a migraine. [Laughs.] What can we tell you?\u201d …<\/p>\n
Zeller: Yeah.<\/p>\n
Feltman: Is, is pretty wild to me.<\/p>\n
Zeller: It\u2019s also interesting to me that, you know, for a lot of years, I mean, it was considered somewhat of a psychosomatic condition, or it was considered a vascular condition and just, \u201cIf we address the blood vessel tone, we might address this thing,\u201d when, in fact, there\u2019s all these clear indicators that it\u2019s a neurological event.<\/p>\n
I mean, you\u2019re getting blurred vision. You\u2019re getting\u2014some people get sleepy. Some people\u2014I mean, obviously, there\u2019s a lot of nausea involved. The pain itself occurs on one side of the head. And yet it just was sort of overlooked for so many years. It\u2019s fascinating to me.<\/p>\n
Feltman: And for listeners who don\u2019t know and maybe, like me a few years ago, are sort of blissfully ignorant of what it is we actually mean when we say migraine, could you tell us about those three big headache types and how they differ?<\/p>\n
Zeller: Sure. So I think most people will experience a tension-type headache. That\u2019s sort of the biggest class of primary headache disorders. The thinking, I think, is that a large part of them are much more involved in sort of muscle tone and maybe even posture, and it tends to be sort of all around the head rather than on one side, which suggests that maybe it\u2019s not strictly an\u2014a neurological disorder in the same way that migraine is.<\/p>\n
I\u2019ve had scientists tell me that they think a lot of tension-type headaches might actually be [a] migraine, so it\u2019s hard to draw these lines, but that would be the big category. And in most cases, not all\u2014it can be incredibly debilitating\u2014but in most cases tension-type headaches can be addressed with over-the-counter analgesics and maybe some lifestyle changes. Again, I don\u2019t want to, to belittle it because some people are really sort of bedeviled by these things, too.<\/p>\n
But the next sort of most common primary headache is migraine. It affects women by an order of [about] three to one. It\u2019s typically one-sided. The word \u201cmigraine\u201d itself comes from the Greek, which means \u201chalf the skull,\u201d and so that\u2019s where we get that word from. We can trace migraine\u2019s history back to the, you know, Egyptian papyri where we see it written about.<\/p>\n
Not everyone experiences the other neurological symptoms that we just talked about, but definitely the pain, and it\u2019s almost always one-sided. And it\u2019s broken down by chronic or episodic. So they\u2014if you get 15 of these headaches a month, you\u2019re considered chronic. If you get less\u2014it\u2019s sort of arbitrary, but that\u2019s how they break it down.<\/p>\n
But it can be really upending for people who have this, and whole seasons of their lives can be disrupted. It\u2019s often\u2014there\u2019s high sensitivity to light and sound. People experiencing a migraine typically retreat to a dark room, put a pillow over their head and ride it out for however many hours, or sometimes days, that it might last.<\/p>\n
The kind of headache that I have, cluster headache, is far more rare. Migraine affects about 15 percent of the population; cluster is less than 1 [percent]. It\u2019s rather rare. It\u2019s incredibly painful and much more, I think, sort of attenuated than, then migraine.<\/p>\n
The pain comes on incredibly fast. The severity of it is such that I couldn\u2019t even think of lying down; I mean, you, you sort of have to run around the room because it\u2019s almost like\u2014the intensity is, like, akin to having your hand on a hot burner but not being able to take it off. [The pain is] much more short-lived. That pain will last\u2014it\u2019ll come on in seconds and then last\u2014almost like a stroke\u2014and last for about an hour or two if you don\u2019t have an intervention and then go away.<\/p>\n
It tends to come multiple times a day, and you\u2019ll have those attacks for one, two, maybe three months out of the year, and then they [makes vanishing noise] disappear. They just completely vanish, and you might not get them again for many months or even years in between. So unlike migraine, which I think people who have it sort of deal with it all the time, clusters come in clusters, and they come and go in ways that we don\u2019t understand and also are kind of fascinating if you can back up enough to look at it.<\/p>\n
But those are the three main categories, yeah.<\/p>\n
Feltman: And what surprised you the most in terms of things you learned while researching for the book?<\/p>\n
Zeller: Well, I think the first thing that surprised me the most was just how little we know and it\u2019s as understudied as it is.<\/p>\n
One thing that we didn\u2019t talk about is that, for as common as headache disorders are, med students get very little education in headache science at all. I talked to med students for the book who said, \u201cYou know, it came up in med school for about a half an hour once,\u201d and that was sort of all, despite there being [roughly] 50 million people in the United States alone with these things.<\/p>\n
And I also talked to a lot of scientists who devote their lives to studying headache. I would say almost all of them were told as they were coming through school, \u201cDon\u2019t focus your life on that. Don\u2019t focus your career on headache. There\u2019s no money in it. You can\u2019t help these people. It\u2019s not a very sexy thing to study. You should go into, like, movement disorders or Alzheimer\u2019s.\u201d So I was just sort of shocked that there\u2019s this ambient sort of bias against headache science even within the sciences. So that was pretty surprising to me.<\/p>\n
Feltman: I mean, I find that disheartening [laughs] as somebody who deals with migraines. I imagine that was a little disheartening for you, too. But is there anything that you learned or came away from writing this book with that made you hopeful about, you know, the future of headache research?<\/p>\n
Zeller: Yeah. I think the main thing is that there are people who are devoting their lives to studying these things, and, you know, I actually thought that anyone who was doing it probably had these disorders themselves, but that\u2019s not necessarily true. There are a lot of scientists around the world who are just really fascinated by this as a neurological disorder, who reckoned that if we could figure this out, it would really sort of, like, change people\u2019s lives. And in fact, I think that\u2019s true.<\/p>\n
So there\u2019s a lot of nifty veins of science that are happening now. You probably have heard of the CGRP medications that came out. I think they hit the U.S. market in 2018. That came at the end of, like, 30 years of pretty intense and swashbuckling science that discovered these neurotransmitters. We talked about, like, neurochemicals sort of being elevated in the blood of people who are experiencing migraine\u2014CGRP is one of those neurotransmitters, and we figured that out only in the 1990s. And then, you know, it took about 30 years to figure out, \u201cWhat would happen if we produced a drug that blocked this neurotransmitter?\u201d And in fact, in some large portion of trial patients it worked; it seemed to have a really great effect.<\/p>\n
Now, when you sort of distribute those effects now on the market and look at it in aggregate, it\u2019s probably a lot like other medications in that it helps about half the people experience about half the number of headaches that they usually get, which, you know, that was another surprising thing to me in the book is to learn that, you know, 50 percent is, like, a home run when it comes to drug development [laughs]. If you\u2019re helping half the people, which for any particular person taking it is a roll of the dice, but as far as drug development goes it\u2019s a home run.<\/p>\n
So the fact that those drugs are now on the market, and I spoke to a lot of people who are genuinely helped\u2014and sometimes in a very, like, transformative way. Like, they spent decades just miserable and suddenly are sort of waking up into a life that\u2019s pain-free. It\u2019s sort of miraculous. It doesn\u2019t work for everyone, but I\u2019m aware and know of lots of studies that are now looking at other neurotransmitters and other potential targets for new drugs.<\/p>\n
So that\u2019s happening, and in a lot of ways this is a great time to be a headache suffer [laughs] because there\u2019s, there\u2019s a lot of exciting science going on.<\/p>\n
Feltman: Well, thank you so much for coming on to chat with us. I\u2019m sure a lot of listeners will be running out to check out the book.<\/p>\n
Zeller: [Laughs.] Thanks for having me. I really appreciate it.<\/p>\n
Feltman: That\u2019s all for today\u2019s episode. We\u2019re doing something a little different on Monday. I\u2019m about to take a break from Science Quickly to go on parental leave, so I\u2019m going to sit down and chat with our awesome interim host so you can get to know her. It\u2019s going to be a lot of fun!<\/p>\n
Science Quickly is produced by me, Rachel Feltman, along with Fonda Mwangi and Jeff DelViscio. This episode was edited by Alex Sugiura. Shayna Posses and Aaron Shattuck fact-check our show. Our theme music was composed by Dominic Smith. Subscribe to Scientific American for more up-to-date and in-depth science news.<\/p>\n
For Scientific American, this is Rachel Feltman. Have a great weekend!<\/p>\n","protected":false},"excerpt":{"rendered":"
Rachel Feltman: For Scientific American\u2019s Science Quickly, I\u2019m Rachel Feltman. Headaches are incredibly common, but they\u2019ve gotten surprisingly little attention from scientists. Here to walk us through what we know\u2014and don\u2019t know\u2014about headache science is Tom Zeller Jr. He\u2019s a former New York Times reporter and editor and the current editor in chief of Undark.<\/p>\n","protected":false},"author":1,"featured_media":32562,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[50],"tags":[15935,4667,4170,3333,18774,3141,15672,2286,18773],"class_list":{"0":"post-32561","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-environment","8":"tag-bias","9":"tag-cultural","10":"tag-gender","11":"tag-headaches","12":"tag-migraine","13":"tag-research","14":"tag-stigma","15":"tag-tom","16":"tag-zeller"},"_links":{"self":[{"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/posts\/32561","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=32561"}],"version-history":[{"count":0,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/posts\/32561\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/media\/32562"}],"wp:attachment":[{"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=32561"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=32561"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=32561"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}