Explosions
in My Skull
The first one went off a month after I turned nineteen. I was on the FDR Drive at 106th Street in Manhattan, inching along in traffic when I became aware of a dull pain behind my left eye that within a few minutes turned into a burning sensation. Over the next eleven years, the pattern would repeat itself without variation hundreds of times: the ache, followed by the burning, followed by mounting pressure. Back on the FDR, I soon began to moan out loud and twist in my seat. I remember stomping on the floorboard, massaging my temples. Tears flowed from my left eye. On a scale of one to ten, I’d put the pain at nine. (By comparison, I once had a live cigarette shoved into my eyeball and had to wait fifteen hours to get to a doctor. I’d rank that pain—which was memorable—at six.)
After three-quarters of an hour, the pain suddenly vanished. What the hell was that about? I wondered.
It happened again the next day, and again, and again, totaling as many as ten one-hour headaches in a single day, every day for a period lasting anywhere from a couple of days to 6 months. I was diagnosed as having cluster headaches, a variety of vascular headache in which the blood vessels inside the head constrict and then dilate.
At first the doctors I saw pretty much shrugged and prescribed various vasoconstrictive drugs, as well as painkillers. But the relief they provided was minimal. By the time the Percodan or Fiorinal did their work, the headache would have abated, only to return in a few hours, just as the painkiller was wearing off. I could not have been a very stimulating conversationalist during that time of my life.
Frustrated, I turned to alternative medicine, which promised not only relief, but even a cure. I spent two months of mornings in the lab of one alternative guru while his assistants squirted extracts of corn, dust mites and chocolate under my tongue and logged my reactions. I ended up with my very own allergy serum and a supply of disposable hypodermics. Every Friday morning for weeks I shot myself in the bottom. The headaches got fiercer; the guru got richer.
I had tests: regular X rays, tomographic X rays, electroencephalograms, a CT scan. Friends, relatives and coworkers all had suggestions: a clinic in Switzerland, biofeedback, psychoanalysis, homeopathy, more gurus.
I read deeply on the subject. There was consolation in finding out that some of the great writers had had migraines (if not clusters). Lewis Carroll is said to have gotten the idea for Alice in Wonderland during the hallucinatory aura that preceded one of his migraines. Alexander Pope would call for steaming pots of coffee in the middle of the night so that he could inhale the vapors. (I’ll say this for my headaches: I’ve never since wished that I had been born in the romantic past. Give me the latter twentieth century with its abundant pharmacopoeia any day.)
It was my father who, after witnessing a particularly bad spell of my attacks, finally found Dr. Frank Petito, a Manhattan neurologist. I think of him the way some people think of Elvis or Mother Teresa.
Dr. Petito did two things. First he prescribed, in addition to the vasoconstrictors, Elavil (amitriptyline), an antidepressant with sedative effects. I chafed at the notion of being tranquilized until he explained that there was something in Elavil—they didn’t know what, exactly—that blocked headaches. Instead of getting ten a day, Dr. Petito said, I might get only two. Then he told me to stop smoking. “If you quit,” he said, “you probably won’t have these in five years. There’s a higher correspondence between smoking and cluster headaches than there is between smoking and lung cancer.” This was news. “There’s no data yet to support the idea that stopping smoking stops clusters,” he went on, “but I believe it, and several experts agree.” I was left to wonder why none of the half-dozen or so doctors I had been to before had told me this. I guess they were no Frank Petitos.
So I gave up smoking. More or less.
The Elavil worked wonders. Two headaches a day definitely beat ten. But they did remain a fact of life. By then I was working in the White House as a speechwriter, a job that can have its stressful moments. I remember one day trying to bang out an arrival statement aboard Air Force Two—my drugs were in the cargo hold, an error never again to be repeated—and pleading with then Vice President Bush’s doctor to shoot me up with morphine, or something, so I could finish the speech. The most he would offer was Tylenol with codeine. It was a mark of what an analgesic snob I had become that I spurned his wimpy white tablets.
A few days later, back in Washington, I found myself laid out on an acupuncturist’s table, my skull bristling with 20 needles. (“It won’t do you any harm,” Dr. Petito had said, “but I’ve seen no evidence to suggest that it will do you any good.”) I went through the mandatory ten treatments, each one increasingly painful since they insert needles into the exact same spot.
The headaches never came back. I tease Dr. Petito about Western Med being aced by a Chinese lady with needles, but nice as it would be to think of myself as living proof of a medical breakthrough, the truth is that Dr. Petito was probably as responsible as Dr. Wong. The headaches disappeared almost exactly five years after I more or less stopped smoking. They had lasted eleven years, about a quarter of my life at the time. I don’t miss them much.
—American Health, 1994