By skyforbes 
Two decades ago, I was leaving my morning clinic at the hospital where I work when I suddenly felt an excruciating pain in my head. It was as if my skull were exploding while simultaneously being gripped in a vise that was getting tighter and tighter. I became nauseated and dizzy, and made my way unsteadily to the emergency room. I was in my early fifties, and my first thought was that this could be a burst aneurysm, known to some physicians as “the worst headache of your life.” To my relief, a CAT scan showed no sign of bleeding in the brain; then came the bad news. A neurologist arrived, examined me, and said he thought that I was suffering from a migraine. I had never had one before, but his diagnosis turned out to be correct, and, since that time, migraines have been an indelible feature of my life. Their frequency and severity have varied over the years, but once you become a migraineur, as doctors sometimes call us, you are always wondering when your next attack will be, planning how you might strategize around it, scrutinizing your life for possible triggers, and looking for some new treatment that might curb the agony.
As Tom Zeller, Jr., writes in “The Headache” (Mariner), the unpredictability of chronic headache conditions is particularly unnerving for those who suffer from them: “You may be delivering a speech before a large crowd, cooking dinner for a friend, or simply lazing alone on a hammock staring at the sky. You may even be sound asleep when it happens. At any moment it can appear, creeping in like a shadow in some cases, ambushing like a predator in others.”
Zeller, a science journalist, does not get migraines. He suffers from something generally acknowledged to be even worse: cluster headaches. Often featuring in lists of the most painful conditions in medicine—along with trigeminal neuralgia, sciatica, and gout—cluster headaches are named for the way that they descend in clusters, several times a day. The intensity of the pain is reflected in another name for the condition: suicide headache. Zeller describes the pain as “white-hot, blinding but invisible, frantic but elephantine” and writes of “writhing on the bathroom floor; of spittle and drool; of fingertips ground furiously into the scalp in a futile attempt to soothe whatever shrieking complex of anatomy is tearing at the right side of my head.”
Cluster headaches are relatively rare, affecting less than one per cent of the population, whereas migraine is among the most common serious maladies. Globally, some 1.2 billion people suffer from it, some forty million of them in the United States. Men are more likely to experience cluster headaches, whereas female migraine patients outnumber their male counterparts at a ratio of about three to one. The two conditions provide the focus of Zeller’s book, which weaves together history, biology, a survey of current research, testimony from patients, and an agonizing account of Zeller’s own suffering, which began when he was in his twenties. Readers with migraine or cluster headaches will find themselves, as I did, comparing their own experiences with the rich material in the book, which is both a survey of the field and a great cry of pain.
Migraines vary widely from person to person—in terms of how they are experienced, what seems to trigger them, and how responsive they are to various drugs. They may begin in adulthood, as they did in my case, but they can also afflict children. More than half of women with migraine suffer attacks during menstruation, suggesting hormonal fluctuation as a trigger. Migraines may be preceded by a variety of subtle symptoms; Zeller lists “constipation, food cravings, frequent yawning, stiffness in the neck, or increased thirst and urination.” There is also the phenomenon known as aura, an array of sensory or motor symptoms that often portend the onset of pain, nausea, and a heightened sensitivity to light.
Aura is one of the most striking features of a migraine, but only about a third of sufferers experience it. I am one of them, and my experience is intensely visual. Before my headache arrives, there’s a kind of flashing light in the shape of a crescent moon with sawlike teeth, and this apparition gradually expands until it blocks the vision in my right eye. Oliver Sacks, in his masterly first book, “Migraine,” from 1970, includes paintings by various migraine patients of their auras. One that looks very much like mine bears the caption “A classical zigzag fortification pattern—its brilliance, in life, is as dazzling as a white surface in the noonday sun, and the edge is in continual scintillation.” Some relatively lucky migraineurs get aura but no pain following it. But for most, both with and without aura, the attacks are debilitating. During and after, I need to rest in a dark room. Even a glimmer of light is painful, and I feel physically and mentally spent, unable to function for the rest of the day.
Migraines typically affect one side of the head. (Indeed, etymologically, the term comes, via Latin, from a Greek word referring to this, hēmikrania, which lost its initial syllable as it passed from language to language.) The condition has been recognized through most of recorded history. Hippocrates described what appears to be an aura. “He seemed to see something shining before him like a light, usually in part of the right eye,” he wrote of a patient. “A violent pain supervened in the right temple, then in all the head and neck.” Aretaeus of Cappadocia, thought to have lived in the second century C.E., possibly at the same time as Galen, described a headache disorder similar to my experience: “These were bouts of head pain involving much torpor, heaviness of the head, anxiety, and weariness. . . . Patients fled light because the darkness soothes their disease.” A remedy recommended by Galen involved applying a torpedo fish—a member of the ray family—to the heads of sufferers, a treatment that Zeller speculates may have served as a counter-irritant. Aretaeus favored bloodletting, cupping, blistering, and, if all else failed, a gruesome cauterization of the scalp.