It can start as a dull throb, but for more than a billion people, it can escalate into agony. "Childbirth in your skull," is how some sufferers have described it. But for most the headache is an unremarkable annoyance that is relieved with an aspirin.
However, for a large portion of the global population, the headache is a profoundly misunderstood, debilitating, and lonely affliction. Migraines, cluster headaches and other forms of severe disabling head pain cause loss of work, burden relationships and have been blamed for some suicides.
In his book, “The Headache: The Science of a Most Confounding Affliction—and a Search for Relief,” Tom Zeller Jr. plunges into the mystery and the history of the headache.
After centuries of research, experiments and investigation, top researchers still fiercely disagree about the fundamental cause of headache pain. This scientific conflict is often framed as a "Blood vs. Brains" debate.
For much of the 20th century, the dominant "vascular theory" of headaches was seen as the key to understanding the malady. This is the explanation most people instinctively believe. They attribute the pain to constricting blood vessels, and the intense pain that follows is from their expansion or swelling into the sensitive tissues around the brain.
The counter-theory argues that a headache is a primary neurobiological disorder—a "nerve storm" that originates in the brain or central nervous system. In this view, the changes in blood vessels are merely a side effect of the underlying neurological event.
A major breakthrough in fighting headaches has come with a new class of drugs that target a neuropeptide called Calcitonin Gene-Related Peptide (CGRP). This is a key chemical messenger in the nervous system's pain communication pathway. The new CGRP-inhibiting drugs (like Aimovig and Emgality) are the first new therapies to prevent migraines in nearly 60 years.
While they are not miracle cures for everyone, they represent a monumental shift in headache science and treatment.
Guest:
Tom Zeller Jr. is the author of “The Headache: The Science of a Most Confounding Affliction—and a Search for Relief.”
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This episode will be recorded on Tuesday, December 2, 2025.
