All in My Head

All in My Head is a black comedy, a candid memoir and an informed journalistic report. It's about my often absurd struggles to try to cure one long 15-year migraine (now diagnosed as "chronic daily headache"), through odysseys through the extremes of both Western and alternative medicine.

The book stops to address different "big picture" issues involved, such as framing chronic pain as a "women's issue." This book is the first one written on my specific disorder, "chronic daily headache," a constant or near-constant headache, that affects about 4-5 percent of the population (and about 10 percent of women of childbearing age).

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Chapter Summaries

The book's narrative is based on my own journey through Western and alternative medicine, stopping to report on relevant bigger themes when they naturally arise.

Following are the themes explored in each chapter:

PREFACE: Why I'm writing on topic, pain as a major under-reported public health issue.

Chapter ONE: Basics on chronic daily headache and critique of common pain medications. Wacky history of migraine drugs, such as the popular Sansert derived from LSD.

Chapter TWO: Nightmare of pain clinics, with over-use of drugs (Cuckoo’s Nest chapter). Follows my hospitalization for two weeks in a famous Chicago headache clinic.

Chapter THREE: Living with medication side effects (weight gain as a major one).

Chapter FOUR: Daily challenges of a life with pain: financial, emotional.

Chapter FIVE: How friendships are affected.

Chapter SIX: “Yes, tonight dear, please.” Reveals studies how sex can help migraine. Dating with chronic pain.

Chapter SEVEN: Current doctor and therapist views of pain as psychosomatic, new research to make it less invisible with brain scans.

Chapter EIGHT: History of sexism in pain and headache fields -- investigating Freud, Silas Weir Mitchell, Harold Wolff and even Oliver Sacks.

Chapter NINE: Alternative medicine on pain, including massage and acupuncture.

Chapter TEN-TWELVE: Limits of alternative medicine, including strange diet advice, over inflated promises, pseudo-science, and the mind/wallet connection.

Chapter THIRTEEN: Pain as a women’s issue, and the invisible population of “Tired Girls.”

Chapter FOURTEEN: Wacky alternative medicine for the desperate, from magnets to vibrating hat.

CHAPTER FIFTEEN: Surgery and its dangers as chronic-pain treatment.

Chapter SIXTEEN: Red herrings involved with treating migraine and CDH, such as diagnosing symptoms (muscle tension, sinus inflammation, neck pain) as the cause. Explanation of differences between causes (neurological wiring) and triggers (weather changes, food, stress). This chapter also discusses the trippy stages involved in migraine, with and without aura.

Chapter SEVENTEEN: Simple ways to get temporary relief without drugs. Methods used since ancient times, such as a band around the head.

Chapter EIGHTEEN: Botox treatment, new “wonder drugs” critiqued.

Chapter NINETEEN: Anxiety and depression as common accompaniments to pain. The risk of addiction with tranquilizers, most commonly prescribed to women pain patients.

Chapter TWENTY: Beginning of emotional recovery with chronic pain, insight into how drugs become more effective with doctor attention and care.

Chapter TWENTY-ONE: Conclusion One: Framing chronic pain as a real disability. What patients can do to cope. Explores concepts of acceptance and pace. Features interviews with chronic daily heachache patients across the country.

Chapter TWENTY-TWO: Conclusion Two: What society, doctors, media can do to more effectively treat pain. Hopeful about new generation of uppity women speaking out.

Q and A with Paula Kamen

Your book is about a headache that you’ve had, continuously, for over a decade. How did it start?

Well, my Headache and I are actually celebrating our 15-year anniversary together soon. I think it’s the paper anniversary, or the crystal one, I’m not sure.

I have what has been officially classified by doctors in the last decade as “chronic daily headache,” or headache that happens at least 15 days/month for at least four hours at a time. (In past decades, this has been called a “mixed headache,” meaning a mixture of migraine and tension headache.) Recent studies show that this afflicts 4 percent of the population. I am “lucky” to have the type that is CONSTANT, hitting about .5 percent (about the same numbers that have epilepsy) of the population. But since chronic headaches are mainly experienced by women of reproductive age, chronic daily headache is thought to happen to 10 percent of them.

How did it start? I got my first real bad one in the spring of 1991 as I was putting in a contact lens, and the left one seemed to set off a mother of a headache in the left eye and behind it. I stopped wearing the lenses, but then the pain just started happening on its own. Over the course of about six months, it became continuous. But knowing what I know now about chronic pain, I think it had been building up and gaining steam behind the scenes for a while, but it wasn’t bad enough to really notice.
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Headache and chronic pain statistics

HEADACHES:

At least 28 million Americans battle chronic headaches.
About 18 percent of women experience migraine, compared to 6 percent of men. (However, until puberty, the rates of headaches in boys and girls are about even, with boys experiencing slightly more by some accounts.)
Up to one-third of women between the ages of 25 and 55 have migraine (with hormones exacerbating the problem during reproductive years).
However, hormone fluctuations do not fully explain migraine as a “women’s issue,” as 14 percent of post-menopausal women have migraine.

Reviews

KIRKUS REVIEWS (1-1-05): "A darkly witty account…creates a clear picture of the poor state of pain care today…sharp, entertaining, informative, and blessedly free of poor-me-see-how-I-suffered-ism." Read More

PUBLISHERS WEEKLY (1-17-05): "Undeniably funny. Kamen's irreverent sense of humor about her pain and herself makes the book a delight to read as she unabashedly pokes fun at the corporate pharmaceutical industry (even while she hopes for a test-tube cure), doctors and other caregivers. Kamen makes the reader understand what it is like to be happy even while one is in pain." Read More

LIBRARY JOURNAL (2-15-05): "...her story documents the failures of our medical system to deal with chronic pain or any other illness that is difficult to measure objectively while also offering insight into the desperation experienced by chronic illness sufferers." Read More

Blurbs

Part confessional memoir, part raucous stand-up comedy routine, part-antidote to self-help literature, part incendiary call to action, All in My Head is a painfully funny descent into the woefully underreported topic of chronic pain. Kamen writes with the dedication of a muckraking journalist, the comic flair of Woody Allen, and the obsessive attention to detail of Spalding Gray. Tragically for the author, yet blessedly for readers, All in my Head is clearly a book that Paula Kamen was born to write.
-----Adam Langer, author of Crossing California

This deeply human, witty and courageous book tells us the story of Paula Kamen's headache, and much more. During her lengthy, determined odyssey for relief of headache pain (during which the "personal becomes political" time and time again), Kamen addresses the broader issue of chronic pain in all its complexity, especially as it affects women. She challenges a broad range of western and "alternative" medical practitioners, as well as politicians and drug companies -- indeed all of society -- to develop compassionate and scientifically knowledgeable healing practices, useful remedies and improved health policies for the large number of people who suffer chronic pain. Drawing on her own experiences, historical and medical books and articles, and the testimony of many others, Kamen makes visible what has been all too invisible up until now. This wonderful book should be required reading for everyone.
-----Jane Pincus and Judy Norsigian, for The Boston Women's Health Book
Collective. See the companion website for book, with new parts on chronic pain and fatigue

Not since Norman Cousins' ANATOMY OF AN ILLNESS has there been a medical memoir of such depth and compelling fascination. The detail, the beautiful writing, the triumph of this young author's will over paralyzing pain will make you cry for her and adore her on the selfsame page.
----- Barbara Seaman, author and
co-founder of The National Women’s Health Network

Paula Kamen combines a sharp journalistic intelligence with a very welcome flair for the absurd.
-----Dave Eggers

Paula Kamen's comic gifts are the best prescription for protecting us against the insane realities of our pharmaceuctically-obsessed health-care system.
-----Neal Pollack, author of Nevermind the Pollacks

As a longtime fan of Paula Kamen and a fellow sufferer of constant, chronic, and misdiagnosed pain, I dove right into "All in My Head." As with her prior works, and pardon the painful pun, Kamen hits the nail right on the head in this book, this time investigating not only her headache but the metaphorical headaches one can easily get contemplating a spectrum of questionable pharmaceuticals and a parade of doctors, not a few of them unsympathetic. Best of all though, despite the sobering topic, Kamen manages to magically bring in a dose of levity- perhaps laughter is the best medicine after all- letting her keen wit and hilarious eye for bizarre detail shine through right from the start.
-----Spike Gillespie, author Surrender (But Don't Give Yourself Away): Old Cars, Found Hope and Other Cheap Tricks"

Interviews

Not All In Your Head

A new book illumines the way we think of women and chronic pain

By Silja J.A. Talvi
Evergreen Monthly July 2005

The way I saw it was as a weakness.

I certainly didn’t want anyone to think of me as weak, having learned the valuable lessons of the feminist movement.

Little did I realize that I had internalized this lesson to an arguably damaging extent. That is, until I came across Paula Kamen’s new book, “All in My Head: An Epic Quest to Cure an Unrelenting, Totally Unreasonable, and Only Slightly Enlightening Headache” (Da Capo/Perseus).
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