Book Review: The Headache by Tom Zeller Jr.
Book 33 of 2025
Tom Zeller Jr. suffers from cluster headaches which inspired him to write The Headache. Approximately 15% of people suffer from migraines, and approximately less than 1% suffer from cluster headaches. Overall, headache disorders are estimated to impact up to 3.1 billion people. Where are the research dollars for these disorders that not only cause debilitating pain but deeply impact a person’s ability to work, socialize and live their life?
To date, no one really knows what causes a headache of any kind, let alone the most disabling conditions noted above. I assumed they were caused by the dilation of blood vessels, but there is no definitive proof. It’s likely that there is a vascular component, but the meninges, brain chemicals and different neuropeptides are also part of the story. Some scientists posit the theory that headaches don’t even start in the brain and are instead initiated by some external stimulus.
Many neurologists are dissuaded from specializing in headache disorders as it isn’t “sexy” enough. A small amount of money is spent on headache research, especially by the NIH. The grantmaking process is not straightforward, but many well-intentioned researchers believe that some grants are intentionally quashed, despite meeting the necessary benchmarks. Interestingly, many promising avenues for treatment are discovered through R&D at pharmaceutical firms instead of public funding.
The available treatment options for migraine and cluster headaches are poor. A drug can work for 50% of people half the time, and that is considered a success. Many people turn to alternative methods of treatment such as psilocybin, LSD and dietary modifications. Many people find that drugs lose their efficacy over time and they have to try a new regimen, which may or may not be covered by insurance. I cannot imagine what it would be like to go months or years without an attack, only to be suddenly stricken again.
Highlights:
I most enjoyed the personal stories of headache sufferers. It was appalling to see how long it took some of them to even arrive at a diagnosis.
The camps supporting different theories of what causes headaches were surprisingly snippy with each other. It was fascinating and at times rather amusing.
Criticisms:
I swear I ended up with a headache each time I sat down to read this, so it took me longer than expected to finish. Clearly psychosomatic.
Zeller got a little lost in the technical weeds once the discussion turned to neuropeptides.
Rating: 3.5 stars out of 5. An excellent and well-balanced discussion, made especially vivid by the author's personal experience with cluster headaches.
Fascinating and informative at the same time!
Love it!