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Excerpt of All In My Head by Paula Kamen
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Drugs Are Inadequate for the Problem (chapters 1, 21)
Chronic daily headache, like the more chronic types of pain, is deceptively complex to treat. A result is that patients often feel guilty, that they are personally "unresponsive" to drugs, not realizing how inadequate present treatment really is for this problem. (This is true despite some breakthroughs in the past decade to treat those with episodic migraine, which happens once in a while. Many of these patients have been helped with the new group of "triptan" medications, such as Imitrex and Relpax—which have limited use and cannot treat someone with constant pain.) Many pain medications, when taken too frequently, can result in addiction or "rebound" or worse headache, as the body becomes sensitized to them over time. This is true with aspirin, anti-inflammatories, decongestants (that reduce swelling), and even the triptans. Other medications given daily as "preventives" for head pain commonly have severe side effects of lethargy and can help only a minority of the CDH population. This book reveals typical problems taking the drugs most commonly given "off-label" for pain (without FDA approval for that use), including antidepressants and anticonvulsants, which address common brain chemistry.


Society In Denial

• From American culture (preface): One reason why the media has barely covered chronic daily headache is because of overall cultural denial of chronic pain. According to American culture and alternative medicine, it's just a matter of "mind over matter" or thinking positively. While a positive attitude can obviously help, this standard is often unrealistic, leaving the patient feeling guilty that he or she can't cure the problem on their own.
• As an "invisible illness" (chapters 7 and 8): In addition, because chronic pain has been considered an "invisible" illness, psychologists have been central in the past 100 years in explaining it as primarily psychosomatic in nature. Freudians have influentially framed chronic pain a subconscious expression of the psyche, with results of "blaming the victim" and not providing adequate medical care. For example, for decades, migraines have been considered to be the result of "repressed anger," not neurological disease. And those with more chronic head pain (CDH) have been the most stigmatized as "using" their more disabling pain to avoid life.
• Women's movement's historical lack of response (chapter 13): Unfortunately, the women's health movement, a separate branch of the women's movement, has been very slow to respond to issues of pain and fatigue in women. Feminist activists have feared validating the enemy's accusation of "hysteria," which has justified centuries of discrimination against women and denied them access to jobs and education. In fact, in the late 19^th century, women's "hysteria" was used as a major argument against women's colleges and allowing women into traditionally male universities.
• The media's narrow focus (preface, throughout book): The more well-known popular self-help gurus often also compound the blame and guilt. While academic textbooks on pain often give a more nuanced perspective, most popular health books, including those on headache, are of the self-help variety, by a doctor or New Ager with a single limited agenda or practice to promote. They often sell a one-size-fits-all perspective of pain relief, a variation of "Ten EZ Steps to Total Health and Enlightenment." Many of the health stories that do exist from a patient's perspective, like in articles in women's magazines, follow a pre-ordained formula to recount the valor, and ultimate triumph, of rich and famous celebrities. And those with more invisible, yet still often disabling, chronic illnesses that characteristically hit young women, from fibromyalgia to rheumatoid arthritis, hardly see their problems even covered at all. Popular media reports on pain are often devoted to over-praising the latest so-called "wonder drug" (read: it's so new that we don't know its side effects yet) as pain patients' savior of the day. Testimonials are provided by a carefully selected group of patients, very often given to journalists by pharmaceutical companies and the doctors interviewed.

From the preface to All In My Head, pages ix - xvi. Copyright Paula Kamen 2005. All rights reserved. No part of this book maybe reproduced without written permission from the publisher, Da Capo Press.