— BOOK AND MEDIA REVIEWS —

So Much More Than a Headache: Understanding Migraine Through Literature

Arindam Sarkar, MD

Fam Med. 2020;52(10):-.

DOI: 10.22454/FamMed.2020.956966

Book Title: So Much More Than a Headache: Understanding Migraine Through Literature

Author: Kathleen J. O’Shea, Editor

Publication Information: Kent, OH, Kent State University Press, 2020, 232 pp., $34.95, paperback

The rarity of versatile storytelling is perhaps best exemplified by the animation prowess of Pixar and the entertainment magic of Disney. Together, these studios garner audience appeal unbounded by age, education, or social status. While So Much More Than a Headache aims to compel a similarly wide readership, the editor most effectively speaks to migraineurs themselves. “Migraineur” is the all-encompassing and peculiarly romantic term presented throughout the book to identify those who experience migraine headaches. To the book’s credit, any reader will quickly recognize the devastation, marginalization, and isolation that headaches inflict upon our loved ones.

From the book’s opening, two things are clear about editor Kathleen O’Shea: she deeply loves literature in all its artforms, and she is a longtime, personal sufferer of migraines. O’Shea presents a smorgasbord of excerpts, poetry, essays, diary entries, and a play in this anthology aimed at improving the world’s understanding of migraines. Unlike medical textbooks, this collection heavily features the frustratingly invisible and catastrophically debilitating symptoms that headaches produce.

This collection of literary works is neatly organized into five parts ranging from disease physiology and living with disability to cherishing headache-free periods. The opening section is the strongest. It offers multifaceted glimpses into examples of aura, headache, and hangover. Having personally experienced ocular migraine variants, I found the passages describing insidious and unsettling preheadache symptoms to be the most riveting. Through poetry, Linda Pastan depicts feeling “ambushed by pins and needles of light” and afraid that her “eggshell skull won’t hold” (p 8). In a New York Times editorial, Oliver Sacks recounts “shimmer zigzagging borders” and “brilliant brightness, blindness, and emptiness” (p 10). Although such imaginative words might feel superfluous in a clinic progress note, these bizarre portrayals can offer camaraderie for fellow migraineurs.

O’Shea chronicles her personal journey with neurologists and coworkers who seemingly ignore or misconstrue her struggle. One physician kindly reassures her she lacked a “migraine personality,” clarified to mean ambitious, perfectionist, or inward (p xxv). O’Shea shares gratitude that her husband also has migraine so there’s less belittlement when social activities have to be canceled or medications have to be constantly adjusted. These passages can offer health professions students glimpses into the lived-in experiences of patients beyond their diagnosis. I had never considered that patients might experience guilt over “chemical inferiority.” Despite having “no brain tumor, no high blood pressure and nothing wrong with me at all,” Joan Didion writes she struggled to reconcile her chronic illness with the accompanying loneliness and helplessness (p xxiii).

Several included literary works might narrowly cater to avid playgoers or literary historians. The fictionalized rendering of Friedrich Nietzsche and the eccentric reimagining of Virginia Woolf, for example, fall short of advancing universal understanding of headache. Even for a busy clinician or medical educator, one outstanding excerpt should not be skipped. Sallie Tisdale’s memoir entitled, “An Uncommon Pain,” was originally published in Harper’s magazine in 2013. Her essay reviews the pathophysiology of migraine, highlights the pharmacology of common remedies, and outlines a framework for obtaining a migraineur’s medical history (p 72). Furthermore, Tisdale expertly underscores the “unsharability” of pain, the frustration of reaching for fourth-line medications and the glee of feeling “twenty years younger” when a headache finally subsides (p 82).

Unlike the innumerable self-help books written to remedy migraines through diet and behavioral changes, this text redirects our attention to patient-centered holistic care. After finishing this book, the reader appreciates that the simple act of gathering a history can be inherently therapeutic. While the text is unlikely to alter a physician’s approach to headaches, we are reminded of the powerful value in hearing with a silent ear. Perhaps by completing a book that provoked a constant need to criticize, correct, and interrupt, I practiced the most valuable skill for treating migraines—listening.

Lead Author

Arindam Sarkar, MD

Affiliations: Baylor College of Medicine, Houston, TX

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