In September 2009, Cindy McCain was a keynote speaker at the 14th Congress of the International Headache Society (IHS) in Philadelphia. IHS is a charity-based organization for people from all professions who treat headache disorders, and it publishes a respected journal, Cephalalgia. McCain, the wife of former presidential candidate John McCain, spoke in the lead-up to the Congress, describing the journey she had travelled since she had first developed migraine (after a hysterectomy at the age of 38). One doctor had described her as neurotic, but she had gone to important events ‘throwing up out the car window’. Headaches had caused her to miss a lot of significant events in her children’s lives. And it did not take much to set them off — just a sudden drop in barometric pressure (a thunderstorm), odours from cooking, perfume, and wine, or foods such as red meat, chicken, and chocolate.
Then there were the food additives, such as MSG and sulphites. Imagine what such a life would be like if you have a role where you must eat out and deal with people every day. Among the remedies McCain had tried were acupuncture, acupressure, massage, biofeedback, analgesics, tricyclic antidepressants, and botox. On an island in Micronesia, a medicine man gave her some crushed guava leaves that seemed to help. Either the doctor who called her neurotic was right, or this was one very desperate lady.
And were her headaches a warning sign of other health issues she might face? She had endured a miscarriage and a stroke, unexplained weight loss, and drug addiction. Was she just unlucky, or was some cause-and-effect going on here? McCain aimed to raise funds to find a satisfactory treatment for migraine. In her attempts to get help, she said, ‘I’ll do anything, including chew broken glass, if it would help me get rid of this.’
Her treatment journey, the triggers for her headaches, her related health issues, and — not least — her desperate claim that she would be prepared to chew broken glass to fix the problem do, I think, echo the situations and feeling of many migraine and chronic-headache sufferers.
If the life of public figures such as McCain requires an imaginative leap, we can look closer to home. You don’t have to be a would-be-presidential wife to be affected. In a recent radio report, a headache sufferer, Alison, said: ‘As a single parent, it was rather challenging … I remember there were times when I had to get my older son to make dinner for his younger brother, and I was trying to give him instructions as to how to make the lunches, and get friends to come and collect the kids to take them to school because I knew that I couldn’t move or I would be sick.’
Alison’s neurologist diagnosed migraine. Her story was typical of a migraine sufferer. Headache symptoms vary according to the type of headache, and we will look at some of these categories shortly. Yet even within a category — say, ‘tension headache’ or ‘migraine’ — every person will be different.
Of course, pain is the key feature of headache, as demonstrated in the names it is given in various languages. In French, it’s mal à la tête; in Japanese, atama ga itai desu; in Norwegian, hodepine; in Catalan, mal de cap; in Welsh, cur pen; in Italian, mal di testa; and of course in English, headache. One does not need to be a linguist to get the message; the head is hurting. But headache is more than just pain. Nausea, fatigue, insomnia, loss of confidence, and depression are just some of the symptoms that may accompany it. It can affect your work and your whole life, as the following patients of mine show.
It was not hard to give Catherine a label: she was a classic migraineur. Her headaches came regularly each month with her period. She had aura (an uneasy feeling accompanied by visual disturbance), nausea, and vomiting. She had a penchant for chocolate, and because she sometimes got away with eating it, had managed to convince herself that — despite evidence to the contrary — chocolate was not one of the factors in her headaches.
However, Catherine was also a professional classical musician. Time off work was not always an option. Even drugged to the eyeballs with every preventive medicine and treatment you could imagine, she found that her career was in jeopardy.
David was a lawyer in his mid-fifties. He came to me on his wife’s insistence that he ‘try another approach’. His headaches always began with work stress, and he could feel his jaw clench and his neck stiffen. Sleep could sometimes abort an attack, but if the headache hit, the pain was ‘excruciating’ and responded poorly to analgesics. Once the headache was established, he would become very nauseous, could not tolerate light, and often ended up vomiting.
Sometimes one headache was followed almost immediately by another. At other times, he could go months without headaches at all. He was a non-smoker on a healthy diet. He could identify no obvious food triggers. He knew that he was sensitive to alcohol and so drank minimally and rarely. David had been to a headache clinic; he had been provisionally diagnosed with cluster headaches. However, it would be easy to make a case for tension headache or cluster headache or migraine. (These classifications are discussed in detail shortly).
Ari was a young builder with a supportive wife, and he had been diagnosed with cluster headaches. He was taking a lot of time off work with headaches he described as ‘blinding’. His daily regime of preventive medication was formidable. He worried about the effects of this on his judgement and balance when up on a roof.
Ari had seen a series of neurologists but favoured his current one, who had prescribed oxygen for the attacks. He found that oxygen had helped him more than anything else. The problem was, what would happen if he was on the roof and needed to grab his oxygen cylinder? What would the welder think when he walked past carrying this thing? Would his boss allow it under occupational health and safety rules? How else could he earn his living without expensive retraining?