Book Excerpt
“I believe your headaches are due
to tension,” the doctor reported
to him. But once the belief was
stated, the relief did not follow.
Dr. Seymour Diamond
He was convinced that he had migraine.
That was understandable, but I began to look
elsewhere, for his headaches were not focused
on one side or the other. They came daily,
not occasionally. He was troubled by sleep
disturbances – he customarily awakened early
in the morning. All these were signs of a deep
depression that was exhibiting itself in a persistent
and intense headache.
Actually, I felt he was getting chronic daily
headaches. For though the depression was
prominent, some of the headaches he suffered,
on occasion, to me sounded very much as if they
were migraine. So I chose the monoamine oxidase
inhibitor (MAOI) – phenelzine (Nardil). I had two
reasons for choosing phenelzine: It is one of those
rare medications which seem to work against
depression as well as against migraine; and I did
not want to use the common antidepressants,
amitriptyline (Elavil), for example, because I felt it
might cause complications with his diabetes.
It turned out that the choice was a good one.
His headaches were greatly reduced right from the
start. As time went by, he seemed to overcome
them altogether. He saw other benefits from the
medication. “I no longer lose my temper over
sloppy work and my patience quota has risen
sharply,” he said.
But the second phase of treatment failed
somewhat. I was, of course, curious professionally
and personally at what might be causing the
depression. For here was a man who had endured
combat and politics without any headache
problems or sleep disturbance. And suddenly in his
thirties and forties he fell prey to both.
I thought it might have to do with his married
life. There were indications that he was not getting
on well with his wife and some of the headache
patterns – their increase during vacations and
weekends – suggested an effort to maintain calm
in a situation which he found difficult. But when I
asked him about it, he was quite blunt. He didn’t
want to talk about it. He told me he didn’t consult
me as a psychiatrist. Thus, the barriers were high
and formidable. When somebody tells me that, I
leave him alone.
We’d conquered the pain, and that was his top
concern. He was aware, I’m sure, of the conflict
that brought about depression. And he was
learning to live with it or to live apart from it: he
separated from his wife. He was not a weak man;
his whole life showed that, and once he was freed
from pain, he was also free to tackle, by himself,
the problem behind it.
In subsequent years, whenever my name
appeared in relation to headache he would send
me a note and a copy of the article and tell me in
his note how well he was doing. He died recently
of other causes than his headache but donated
a very substantial amount of his fortune to the
National Headache Foundation. HW
www.headaches.org
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National Headache Foundation
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