Headaches suck - but we don't know why

A fascinating look into the knowns and unknowns of headaches. Spoiler alert ; there is a lot we don't know.

Migraine … real pain! 

I've been lucky enough to almost never suffer a serious headache.  

I can remember once in my early twenties, a few hours of debilitating pain, as someone inside my head tried to use a blunt spoon to tunnel their way out… through my eye.  

I was convinced my brain was erupting and death was a comin'. I almost welcomed it! "Don't worry," said my girlfriend, "It's just a migraine. It will pass." And pass it did.

Blessed as I am to live life headache free, I was captivated by Jerome Groopman's piece, "A Screaming Skull" in the New Yorker, which partly reviewed Tom Zeller Jr.'s book, The Headache, a highly personal memoir of a late-life migraineur. 

It made three fascinating points. 

1. The ultimate smart tax?

As far as we can tell, dogs, birds and elephants just don't get headaches. When your cat flashes that "I just can't get out of bed" look at you, that's just because they are a lazy cat.  

Might headaches be uniquely human, resulting from our evolved, hyper-sensitive nervous systems?  

Perhaps our "razor's edge" neural wiring, once valuable for survival on the prehistoric savanna, now misfires in our modern world. 

2. Can you at least tell me why?

You'd hope that for something affecting over a billion people globally, we would have a good idea what causes migraines. Nup!

The medical field remains split between two competing theories from the 1800s: are these headache horrors the result of blood vessel problems or are epilepsy-like electrical brainstorms the culprit?  

This fundamental uncertainty is one big reason why treatment remains frustratingly hit-or-miss for most sufferers. 

3. Pain free with CGRP?

The recent discovery of CGRP (calcitonin gene-related peptide) has led to breakthrough treatments that can completely eliminate migraines in about 20% of patients – the so-called "super responders."  

For the first time in history, some lifelong sufferers are experiencing complete freedom from their condition, though the effects can unfortunately wear off over time. 

Share your pain

If you would like to share your stories of living with headache – or, as cluster sufferer Zeller calls it, “the predatory creeping shadow” – I'd be fascinated to read them. Please do so at number@adamspencer.com.au

The book, again, was The Headache by Tom Zeller, Jr. The original New Yorker article appears here https://www.newyorker.com/magazine/2025/08/18/the-headache-tom-zeller-jr-book-review

Here's to a pain free day,

Adam S