Joan Didion and Migraine Headaches

No matter what, I will always love Joan Didion because of her essay on migraine headaches. “Three, four, sometimes five times a month,” she wrote, “I spend the day in bed with a migraine headache, insensible to the world around me.” So do I–a bit less frequently, but sometimes for a few days at a time.

When I found her essay, it was the first time I’d found someone whose work I admired admitting to suffering from migraine. I had always assumed that my particular problem was somehow illegitimate. In part this is because migraine headaches are hard for people who don’t have them to take seriously. When everybody around you thinks your debilitating pain is your own fault, or else made up to excuse laziness and a desire to lay without moving in dark rooms, you can start to doubt your own experience, to wonder if the unavoidable factuality of your pain is actually some kind of psychosomatic illusion. In college and graduate school, for example, many a teacher would take to me, and then decide I was lazy or untrustworthy after the second or third time one of my regular headaches prevented me from coming to class or keeping a scheduled meeting. I began to internalize their opinions about me. (When I was teaching philosophy at Boston College, therefore, I was always exceedingly lenient about health-based absences, and I never made attendance part of the grades I gave.) Didion addresses this social dimension of migraine, the consequences of its invisibility, and when I read it the first time, I felt like someone had tossed me a lifeline:

[P]erhaps nothing so tends to prolong an attack as the accusing eye of someone who has never had a headache. “Why not take a couple of aspirin,” the unafflicted will say from the doorway, or “I’d have a headache, too, spending a beautiful day like this inside with all the shades drawn.” All of us who have migraine suffer not only from the attacks themselves but from this common conviction that we are perversely refusing to cure ourselves by taking a couple of aspirin, that we are making ourselves sick, that we “bring it on ourselves.” And in the most immediate sense, the sense of why we have a headache this Tuesday and not last Thursday, of course we often do.

It’s true that there’s a kind of vicious circle that I—and other migraine-afflicted persons of my acquaintance—tend to get into, which looks like “bringing it on myself.” For me the cycle usually takes the following shape: dwelling on the knowledge that sooner or later I’m going to fall behind on whatever I’m trying to do, because migraine will interrupt me, I will seize on a good day with a sort of panicked intensity, and I will work and play so hard that day that I somehow bring on the migraine I was dreading. Or that’s what it feels like. I did that yesterday, writing 5000 words in various forms, tramping all over the city, visiting friends, reading as fast as I could with intense concentration; and today, I’m paying for it in bed. Am I at fault for today’s lack of doing? Partly, but then the next migraine was coming at some point, and at least I did a lot of valuable things yesterday… It’s also possible that the borderline manic days that precede a migraine are themselves symptoms of its approach rather than the cause. I don’t know.

According to Didion, there is a migraine personality: “ambitious, inward, intolerant of error, rather rigidly organized, perfectionist.” I’m not sure if this describes me. Maybe it does.

One other bit of Didion’s essay expressed something I had known but never stated to myself before I read it:

We have reached a certain understanding, my migraine and I. It never comes when I am in real trouble. Tell me that my house is burned down, my husband has left me, that there is gunfighting in the streets and panic in the banks, and I will not respond by getting a headache. It comes instead when I am fighting not an open but a guerrilla war with my own life, during weeks of small household confusions, lost laundry, unhappy help, canceled appointments, on days when the telephone rings too much and I get no work done and the wind is coming up. On days like that my friend comes uninvited.

This is also true of me. For some reason I have always been sure that on a day of great importance and intense stress—when I defended my dissertation, for example, or on every occasion I have had an oral exam, or faced a personal interaction of great importance—I would not get a headache. And I never have. But it’s always a possibility on an ordinary day. This is part of the moral ambiguity of the condition, in my opinion: somehow the fact that I have to cancel or reschedule something is a sign of how unimportant it must be to me, in my heart of hearts. Because if it was crucial to me, then “my friend” would know to stay out of my head. What does it say, then, when I have to cancel on an actual, human friend? I can never quite blame the people who’ve decided I’m lazy or a liar because of my headaches, because even if they are directing their judgment at the wrong thing, I have a sneaking suspicion that they’re right and I am insufficiently committed to them on some level.

Didion’s essay reveals that she gets her headaches more frequently than I do, and uses medications to lessen their frequency. My parents and I experimented with various medications as well, when I was younger, and something about how some of those medications changed my experience of being in my own head—making me feel exhausted all the time, or impairing my verbal intelligence—made me unwilling to experiment any further in that direction. If I got as many headaches as Didion does without medication, I would probably have to be on something. But as it stands, I just accept migraine’s occasional appearance. I’ve found it easier to do so—I accept them with less guilt—ever since reading Didion’s essay. Her essay was the medication I needed.

Joan Didion.

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