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To the Editor:
Re “Why Don’t We Have Cures for Headaches?,” by Tom Zeller Jr. (Opinion guest essay, Sunday Review, July 25):
Finally, someone is shedding light on a traumatic disorder that wrecks relationships and careers, and makes you feel crazy and completely alone. At 47, just as I entered the prestigious Smith College School for Social Work, my migraines started.
Three years later, as my fellow students and our families cheered our graduation, my heart sank. My migraines had become so frequent and so painful that I couldn’t imagine how I could commit to being a therapist. How could I hold other people’s emotional pain when I was in such physical pain? How could I still be a decent mother and wife?
Nine neurologists and three psychiatrists later, I came away with a suitcase full of drugs and multiple analyses: Grad school had been too much, gluten was the trigger, or perhaps I had bipolar disorder! I cried, railed and contemplated suicide.
Ashamed, I shrunk into myself and retreated to a dark room. I also faced painful rejection from friends who didn’t like the new me who could no longer drink and laugh.
Thanks to one Houston neurologist who is a headache specialist, an extremely devoted partner and the new calcitonin gene-related peptide meds, I have emerged with some semblance of a life. But I remain vigilant at all times. A migraine is lurking, and the fear never really goes away.
Clare Casademont
Nantucket, Mass.
To the Editor:
Headaches are neurobiological, but stress and emotional tension are, too, and should not be dismissed.
As a physician who treats chronic pain, headaches and back pain, I often find that a focus on a patient’s emotional stressors, childhood traumas, personality style, etc. yields great success in pain relief.
I recently treated a 45-year-old health care worker. After learning how emotions can cause and trigger migraines, she was able to learn, through expressive journaling and brief psychotherapy, how to intercept the process. Not only have her headaches gone away, but she is off those powerful, injectable medications that Tom Zeller Jr. refers to.
I consider that a win for her and a huge cost savings for society. Being open to a biopsychosocial explanation and treatment is not weakness; it is strength and empowerment of the patient.
David Schechter
Culver City, Calif.
To the Editor:
I have suffered from cluster headaches since I was in medical school (I’m an orthopedic surgeon). I would get them every two or three years, have them every other or third day for a couple of months, and then they would go away. They were always in the same location, like an ice pick in my right eye, sometimes brutally painful — so bad I could only walk slowly in a darkened room, couldn’t even lie down. Medications were useless.
Around 25 years ago a neurologist friend suggested oxygen, so the next cluster I got, I used an oxygen tank and breathed oxygen, and in 10 minutes the headache would go away. Previously they would last two to four hours typically. This was awesome. Finally I had a treatment that worked.
The last couple of times I had them they weren’t so bad, and I haven’t had any for 10 years. Whew! I’m 69 now. It is conventional wisdom that migraines subside as we get older, true in my case.
James Loddengaard
Palos Verdes Estates, Calif.
To the Editor:
I am a family physician headache specialist. A little-known treatment for migraine, which I first published in the Journal of the American Medical Association in 1996, involves merely lying down on your side with the head extended and rotated, and squirting a gel of lidocaine into the nostril on the side of the headache (on both sides if the headache is on both sides). The procedure is referred to as a sphenopalatine ganglion block.
While the treatment is a bit inconvenient, and less reliably effective than the usual commercial products, it is very safe and inexpensive, and when effective, it acts almost immediately. More and more headache specialists are adopting this procedure, but it does not have widespread acceptance because it is not promoted by the pharmaceutical industry.
Morris Maizels
Everett, Wash.
To the Editor:
Re “Short on Doses, and Struggling to Deliver Them” (front page, Aug. 2):
It’s easy to find ways in which delivering vaccines to nearly every country in the world during a pandemic could be improved. Yet no one has been more vocal than Covax in calling out the governments that put national interest over the global one, or the vaccine manufacturers that cater to them.
The fact is that today, albeit at a rate slower than we would have liked, Covax is delivering: Within the first six weeks we had started delivering to 100 countries, and then, even though we faced supply bottlenecks because of export bans and vaccine nationalism, with dose donations we’re now close to being back to our original rate of deliveries. In a world without Covax, many of these countries would still be waiting for any vaccines at all.
But yes, for the sake of humanity, we need Covax to work. Because if it doesn’t, then the appalling global inequities in Covid-19 vaccine distribution would not only be much worse but would also inevitably persist for some time — meaning continued spread of new infections and new variants.
We are pleased that the pace of deliveries has now picked up. Ultimately, however, a global collaboration is only as strong as the level of partnership it receives.
Seth Berkley
Geneva
The writer is chief executive of Gavi, the Vaccine Alliance.
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