Not Tonight: Migraine and the Politics of Gender and Health

260 Pages·2014·1.315 MB·English

by  Joanna Kempner

Not Tonight

Not Tonight
Migraine and the Politics
of Gender and Health
joanna kempner
the university of chicago press chicago and london
joanna kempner is assistant professor of sociology and an affiliate of the Institute for
Health, Health Care Policy, and Aging Research at Rutgers University.
The University of Chicago Press, Chicago 60637
The University of Chicago Press, Ltd., London
© 2014 by The University of Chicago
All rights reserved. Published 2014.
Printed in the United States of America
23 22 21 20 19 18 17 16 15 14 1 2 3 4 5
isbn-13: 978-0-226-17901-8 (cloth)
isbn-13: 978-0-226-17915-5 (paper)
isbn-13: 978-0-226-17929-2 (e-book)
doi: 10.7208/chicago/9780226179292.001.0001
Library of Congress Cataloging-in-Publication Data
Kempner, Joanna Leslie, author.
Not tonight : migraine and the politics of gender and health / Joanna Kempner.
pages cm
Includes bibliographical references and index.
isbn 978-0-226-17901-8 (cloth : alk. paper) — isbn 978-0-226-17915-5 (pbk. : alk. paper) —
isbn 978-0-226-17929-2 (e-book) 1. Migraine. 2. Migraine—Social aspects. 3. Headache—
Social aspects. I. Title.
rc392.k45 2014
616.8'4912—dc23
2014004075
a This paper meets the requirements of ansi/niso z39.48–1992 (Permanence of Paper).
to my parents
Were headaches known in the Age of Gold; or, when the millennium shall
prevail, will they cease to be? Certain it is, that in any state where there
are secrets to conceal or pangs to dissemble, this convenient malady could
no more be dispensed with than the most necessary article of attire. How
could society possibly go on without the trite but inexhaustible excuse
that—better than any soft answer—turns away wrath, and, for a while, at
least, closes the mouth of the accuser, so that the accused, whether inno-
cent or guilty, have time to breathe and brace themselves for the question,
if it must needs ensue? There are people, I believe, who discourse quite
eloquently on the advantages of gout; surely as many could be found ready
to cry Vive la migraine!
george a. lawrence, Harper’s New Monthly Magazine, 1870
For the person in pain, so incontestably and unnegotiably present is it that
“having pain” may come to be thought of as the most vibrant example of
what it is to “have certainty,” while for the other person it is so elusive that
“hearing about pain” may exist as the primary model of what it is “to have
doubt.”
elaine scarry, The Body in Pain, 1985
Contents
List of Illustrations viii
Preface ix
Acknowledgments xvii
List of Abbreviations xxi
Introduction 1
chapter 1. All in Her Mind 24
chapter 2. All in Her Brain 51
chapter 3. Embracing the Migraine Brain 75
chapter 4. Gendering the Migraine Market 106
chapter 5. Men in Pain 134
Conclusion 158
Appendix A—International Classification of Headache Disorders 171
Appendix B—Methods 175
Notes 185
Bibliography 207
Index 229
Illustrations
Figure I.1 2007 NIH funding per DALY (Disability-Adjusted Life
Years) / 9
Figure I.2 New Yorker cartoon / 19
Figure 1.1 Wolff’s experiment / 36
Figure 1.2 “Headaches Are a Luxury” / 39
Figure 1.3 1960s pharmaceutical advertisement / 42
Figure 4.1a–f Imitrex advertisement / 124
Figure 4.2 Zomig advertisement “Escape from Migraine” / 127
Figure 5.1 “Women with Cluster Headache” / 144
Figure 5.2 Persistence of cluster headache profile in
textbooks / 148
Figure 5.3 Percent of textbooks that support or reject cluster
profile / 149
Figure 5.4 Typical representation of a cluster man / 150
Preface
My headaches began when I was five years old. A pediatrician diag-
nosed me with a “type A personality” and assured my parents that
nothing could be done. My mother, herself debilitated by migraine, re-
jected his diagnosis. Thus began a long and frustrating quest for headache
relief. By high school graduation, we had consulted at least a dozen or
more health care providers, a group that included several general practi-
tioners, a well-respected headache specialist, his clinic’s psychiatrist, an
acupuncturist, a massage therapist, an herbalist, as well as several chiro-
practors and physical therapists. Each relied on different diagnostic pro-
cedures, which were frustrating at best (a misread CAT scan indicated a
rather alarming enlarged pituitary gland) and sometimes offensive (how of-
ten do patients get asked explicitly or otherwise whether their pain is real?
Since pain is a sensation, isn’t it always real?). Each had new treatments
for me to try—anti-inflammatories and antidepressants, beta-blockers,
muscle relaxants, painkillers, acupuncture, teas, diets, and homeopathic
pills. I had needles embedded in my ears. I learned to meditate. I laid
with my neck in traction. And I wished that one of my doctors would find
a clear-cut biological abnormality that could explain my pain. A tumor
might be removed, I reasoned.
In college, I managed these headaches with a firm commitment to de-
nial and a cocktail of prescription painkillers and muscle relaxants. The
medications never relieved the pain, but they helped me sleep or, some-
times, just laugh it off. Needless to say, plans were canceled and classes
missed. Eventually, I learned that my headaches were migraines. Like so
many other people with migraine (a disorder that experts always refer
to in the singular), I would find myself vomiting in an emergency room,
hoping that nobody would treat me like a drug addict who invents pain in