The morning after Eve was created, Adam had a question;
"God," he asked, "what is a headache?"
Dr. Seymour Diamond isn't verifying the quote, but he's fond of telling the story and, for those in the headache-treating business, it says two things: First, if headaches don't go all the way back to Eve, they certainly reach deep into the Stone Age -- if nothing else, as in early man clunking his fellow on the noggin. And second, specialists have found that, indeed, a headache can be a handy -- albeit unhealthy -- tool for some people at some times.
Probably somewhere close to 50 million Americans spend something like half a billion dollars a year to ease their aching heads. Perhaps as many as half of those -- estimates range from 12 to 25 million -- get some version of that meanest sick headache of all, the migraine.
Diamond is one of this country's leading headache specialists, and directs his own headache clinic in Chicago. He believes it is the largest in the country, with approximately 35 new patients a week, most of them "desperate, driven men and women . . . "
He has managed to codify more than 100 or so types of headaches into three large groups, writes and lectures extensively and maintains his active clinical practice.
George Bernard Shaw, who suffered terrible headaches, once asked Arctic explorer Fridtjof Nansen if he'd ever tried to find a cure for headaches. The surprised explorer, of course, said no. "Well," Shaw is said to have responded, "that is a most astonishing thing! You have spent your life trying to discover the North Pole which nobody on earth cares tuppence about, and you have never attempted to discover a cure for the headache, which every living person is crying aloud for."
The three basic headache groups Diamond describes are:
Vascular, including migraine and the exceptionally painful "cluster" headaches. The two are quite different, related only in that they involve the blood vessels in the head. Also, more women get migraines; more men get clusters.
Muscle contraction, sometimes called psychogenic, the tension headache, which is usually caused by anxiety or depression.
Traction headaches, which usually have their basis in some organic disease.
By the time the patients get to a clinic like Diamond's, he said recently, "they've really been all around, to 10 or 12 doctors, to all the big clinics . . . They're very resistant. You're dealing with a hard core patient."
But Diamond's approach to a headache is that of a Columbo-like detective to a knotty murder.
For example, he will leave a chair out of place in the examining room, or a gown laying rumpled across the table. If the patient, almost unconsciously, sets the chair straight or folds the gown, Diamond says that is a major clue pointing to migraine.
If a patient can't exactly remember when he got his headaches, it probably is not migraine. As he wrote in a 1977 paperback, "Patients with migraines know precisely when and how often and how long their headaches strike. They often come in with long lists. When you have a patient with lists, you have a patient with migraine."
Migraine, the one-sided headache, was first described, it is believed, in a medical papyrus from about 1500 B.C. The Greek healer Galen referred to the headache as hemicrania (half a head) from which the modern version of the name probably evolved.
Migraine sufferers included Lewis Carroll, whose pre-headache visual hallucinations were reflected in the Tenniel drawings of the weirdly distorted characters down the rabbit hole and through the looking glass. Not all migraines are preceded by auras or prodromes, but they can come in weird and bizarre forms ranging from the fairly common glittering zigzags to grotesque distortions of taste and smell.
A distinct migraine personality was first described in the 1960s. There are, of course, many exceptions. Dr. Diamond uses these personality traits as clues, no more. But the so-called migraine type is often a perfectionist, bright, ambitious, driving and self-demanding. Often compulsively neat, but sometimes, some experts say, just the opposite in a kind of if-I-can't-do -it-right-I-won't-do-it-at-all perversity.
As Dr. Diamond told colleagues at a recent conference on biofeedback techniques -- which he has found successful among certain resistant patients for whom nothing else worked -- "Migraine suffers are famous for building environments too great for them to handle. . ."
On the theory that misery loves company, headache doctors including Diamond and Michigan specialist Dr. Joel Saper, like to list notable sufferers, for example: Chopin, Cervantes, Charles Darwin, Thomas Jefferson, Tolstoy, Alfred Nobel, Karl Marx, Edgar Allen Poe, Tchaikovsky, Virginia Woolf, Ulysses S. Grant. Conventional wisdom holds that (Bloody) Mary Tudor was suffering from one at her coronation.
The constriction and then dilation of blood vessels that actually cause the aura (in a small percentage of sufferers) and then the pain are actually the result of a series of biochemical events in the body that can be set off by such diverse things as changes in atmospheric pressure, certain foods, stress, blood-sugar levels, smoking, menstrual cycles, birth-control pills and post menopausal estrogens.
Says Dr. Diamond, "I cure more migraines by stopping estrogens than anything else I do in the office."
Migraines, which often run in families, can be precipitated in some sufferers by any or all of these foods, Dr. Diamond says, which contain chemical substances that are believed to be the culprits:
Ripened cheeses; herring; chocolate; anything fermented, pickled or marinated or cured; sour cream and yogurt; nuts, peanut butter; hot fresh breads, raised coffeecakes and doughnuts; pods of broad beans; foods containing monosodium glutamate; onions, canned figs, citruses, bananas, pizza, pork, excessive tea, coffee, colas; avocado; chicken livers; all alcoholic beverages.
(If you must drink, he suggests sauterne, reisling, Seagram's VO, Cutty Sark or vodka, limited to two drinks.)
There are also many drugs that may or may not be useful in migraines such as those containing ergot or the just-approved propronalol (Inderal), which is virtually miraculous but cannot be used for everyone.
Diamond also uses biofeedback -- he was an early convert -- as well as relaxation, self-hypnotic and conditioning techniques, also useful for other headaches as well.
And does the doctor get headaches himself? "Not me," he says. "I'm a carrier."