Certainly our brains are unfathomably complex organs and difficult to study. But the dynamic that Dr. Kempner identified, almost certainly helped prolong the scientific ignorance of headache mechanics and treatment for decades and for everyone. Note that the Amgen / Novartis antibody was the first drug ever approved in the United States to specifically prevent migraines. The first – and that was just three years ago. (Side effects generally seem rare and mild so far, although the long-term picture remains to be seen.) Eli Lilly didn’t get approval for his version of a CGRP inhibitor for the treatment of cluster headaches until 2019, and new classes of CGRP drugs are still around existing arising. But since the dawn of drug regulation, every other pharmacological blob of preventing these diabolical headaches – a menagerie of beta-blockers, anti-epileptics, antidepressants, and other drugs – has been researched, developed, and developed for other diseases. They just seemed to help some people with headaches as a side effect, so the doctors gave them a try.
In my work as a journalist researching modern developments in headache science, I have spoken to many patients who have indicated that both clinical and cultural ignorance persists. As with so many other pain disorders, black patients are far less likely to get their headaches properly diagnosed than their white counterparts. And while the World Health Organization has identified headaches as one of the leading causes of disability and loss of productivity on the planet, our knowledge of headaches, as with so many other diseases, tends towards the rich world and leaves its incidence and impact in developing countries grossly underestimated.
At the same time, while remarkably effective for some people, the new drugs are yet another heartbreaking failure for others, suggesting that a more fundamental neural trigger or target remains elusive. These drugs are not cures, either, and many patients continue to need to take them regularly – although they can cost more than $ 600 for a single injection. Many headache sufferers find that their insurers refuse to cover them.
With all the recent advances, the National Institutes of Health’s funding for basic research on headache disorders is disproportionate to its enormous social cost, and far too few young doctors see headache specialization as fertile ground for careers. A young medical student interested in neurology told me that she was amazed that her studies were so focused on unusual brain disorders because headaches are so common – and still so mysterious. “We taught so much about other things that are also important but are much less common,” she said. “I was surprised by that.”
Look, I understand. In a world of disease and turmoil, complaining about a headache can seem absurd. But that too makes the path of a chronic headache sufferer – or really anyone with chronic pain – a singularly lonely one. The pain is sure not to kill us, but we can receive prolonged physical blows at any time without explanation – a ruthless cycle that some studies have shown can increase the risk of suicide. In fact, some headaches are believed to be capable of producing one of the most extraordinary sensations of pain in the human body, but they occur in a place that makes them completely invisible to confused viewers (and, for most of history, scientists, too) . . And all this pain has a name – “headache” – which is so common, so boring and so diluted by its resonance with other, lesser things that those affected are often ashamed to even mention it.