Head case

Paula Kamen has had a headache for 14 years. Her unlikely and often hilarious memoir explores the secret history of women and pain, and introduces us to a new (but very old) social phenomenon: The Tired Girls.

By Andrew O'Hehir

Apr 15, 2005 | Paula Kamen has a headache. On the day I call her in Madison, Wis., where she's made a stop to promote her new book, "All in My Head," which is a memoir and a cultural history and a comic odyssey through the licensed and unlicensed health professions and a lot of other things besides, she rates the headache a 3 or 4 on a scale of 10. For most of us that would be a pretty bad day, possibly requiring three or four ibuprofens, a couple of grande Starbucks concoctions, dark sunglasses and a lot of grumbling.

But Kamen says she's feeling great. See, she got this headache when she was putting in her contacts in a Chicago hotel bathroom -- in 1991. Over the last 14 years it's been her constant companion, waxing and waning like the phases of the moon -- sometimes so intense she can't function at all, sometimes barely noticeable -- but never completely going away.

On one level, this is ludicrous: A woman gets a headache and writes a book about it. Kamen is able to appreciate the joke, up to a point. (She's not so delighted that a New York Times critic cited her book, without reading it, as an example of the glut of self-indulgent memoirs.) But Kamen's headache is enough to make you suspect there might be a God. If Jehovah chose Job to persecute because he knew that upright man's faith would never waver, maybe he had his own reasons for afflicting Paula Kamen with a never-ending headache. She was already a first-rate reporter on feminist issues as well as an aspiring humorist with a wry, sardonic tone.

That combination of elements has produced an improbable book, indeed almost an impossible one. "All in My Head" dramatizes Kamen's suffering without wallowing unduly in self-pity, and her journey along the highways and back roads of both Western and alternative medicine, while often hilariously rendered, will provoke anguished cries of recognition from anyone who's dealt with chronic pain (and the medical establishment's general befuddlement by it). More than that, as a reporter Kamen marshals most of what is now known or suspected about headaches and related disorders, and as a feminist she drags into daylight a half-hidden social phenomenon we all recognize but rarely talk about: the Tired Girls.

If you're one of the Tired Girls, you already know what I'm talking about (although you may not have known you belonged to a newly founded identity group). If you're not, then there's probably one or more T.G.'s somewhere in your life -- in your family or your circle of friends. A Tired Girl is that youngish woman, probably in her 20s or 30s, stuck in a cycle of pain and fatigue she may not talk about openly, even with her closest friends. She is known to cancel long-planned social engagements at the last minute, to disappear early in the evening, to oversleep, to spend beautiful Saturdays alone in bed. Like Kamen, she's constantly trying some new drug, some new massage or chiropractic technique, some new combination of Chinese herbs, some new diet.

A Tired Girl may suffer from migraines or depression or chronic fatigue syndrome (now called CFIDS) or fibromyalgia or bipolar disorder or the persistent, mixed-headache syndrome called chronic daily headache (CDH), which is Kamen's diagnosis. It's quite possible she has more than one of these conditions; scientists are now inclined to believe that these ailments (along with epilepsy and other seizure disorders) are related at the neurological level, and people who suffer from one are exceptionally likely to have the others.

Tired Girls are nothing new, and if you view the phenomenon with some suspicion, that's understandable. Victorian women fainted and had the "vapors"; the desperate housewives of the '60s self-medicated with Chardonnay and Valium. Medical testing couldn't "see" any organic source for these diseases, so they were often regarded as psychological in origin -- the result of female "hysteria" or sexual repression. These cut-rate Freudian theories found their way into the postmodern age, too: Feminists defined these female-coded illnesses as a form of political resistance to patriarchal oppression, while deconstructionists saw a cultural virus bred of millennial angst and spread by media overload.

I probably shared that skepticism myself, a dozen or so years ago. I never get headaches unless I drink too much or have a sinus infection. But for more than a decade I've lived with a woman who has 10 to 20 severe migraines in a typical month. In general terms, Leslie's diagnosis is similar to Kamen's, if less severe; she has CDH, but headaches are sporadic rather than constant. Like many other women, Leslie got significant but probably temporary relief from the massive hormone surges associated with pregnancy and breast-feeding (our twins were born a year ago). Leslie has taken many of the same prescription medications as Kamen -- mostly powerful psychiatric drugs with whopping side effects -- and been subjected to a lot of the same goofball psychologizing. (My favorite was the shrink who thought that because I was giving Leslie massages at night to relieve her pain-induced insomnia, I was a controlling boyfriend who was causing her headaches.)

Along the way, I've had to question my own preconceptions about these stereotypically female ailments, especially as I've learned that new, more sensitive brain scans now seem able to pinpoint their neurological source. As Kamen explains, it now appears that disorders like migraine and CDH result from a kind of wiring malfunction deep in the brain stem. Migraine, for instance, was recently described by one medical researcher as "a chronic-progressive disorder that may cause permanent changes in the brain."

Of course men suffer from chronic pain and fatigue as well; millions of sports fans got an instant education in this issue when Denver Broncos running back Terrell Davis had to leave the 1998 Super Bowl game with a severe migraine. (After an intranasal dose of a drug called DHE and a locker-room nap, he returned to score the winning touchdown.) But for reasons that aren't entirely clear, women are several times more likely to have these diseases, which has clearly contributed to the centuries-old perception that they're fragile and untrustworthy creatures, both physically and emotionally.

Paula Kamen thinks it's time for the Tired Girls to come out of the closet (or the darkened bedroom, as the case may be). Individual women can admit to pain and fatigue, she argues, without stigmatizing their entire sex. Hardly anyone argues that men should be excluded from the workplace as a group, despite their pronounced tendency to schizophrenic breakdown and random shooting sprees.

As I know very well, Tired Girls can be tough -- and Kamen has the scars to prove it. In her medical odyssey she's endured painful and useless surgery, gained and lost an enormous amount of weight, beaten a dependency on Xanax with large doses of "Antiques Roadshow." She's tried Botox, fig tea, a burlap sack from Peru (purported to retain energy from the baby who was born on it), "healing stones," a Russian masseuse who "beat the living crap out of me" and a vibrating hat from a TV infomercial.

In the long run, Kamen, 37, actually found the mental and emotional pain associated with her endless headache harder to deal with than the physical discomfort, as bad as that has sometimes been. She writes about the details of her personal life with considerable restraint (an example more memoirists should follow), but it's clear that her ordeal has made her love life very difficult. She's had boyfriends over this 15-year stretch, but none stays in the story for long. It has also strained and fractured friendships, made her financially dependent on her parents for a time (a humiliation for any adult), and rendered her unfit for any normal workplace.

Perhaps that last part was a backhanded blessing. If the headache literally disabled her, it also liberated her to research and write "All in My Head" as well as her previous volume, "Her Way: Young Women Remake the Sexual Revolution." (On that subject, Kamen reports that for many women, including herself, a headache is not an impediment to sex; if anything, the endorphin rush associated with a good romp tends to provide some relief.)

Next Page: Why do women suffer from so much pain and fatigue?

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