ALL OF IT Podcast Summary: "Why Are So Many People Plagued by Headaches?"

Episode Release Date: July 21, 2025
Host: Alison Stewart
Guest: Tom Zeller, Jr., Author of "The Science of a Most Confounding Affliction and A Search for Relief"

Introduction

In this engaging episode of ALL OF IT, host Alison Stewart delves into the pervasive issue of headaches, exploring their various types, underlying causes, and the significant impact they have on individuals and public health. Joined by Tom Zeller, Jr., a seasoned journalist and author, the conversation blends personal experiences with scientific insights to shed light on why headaches remain a challenging medical ailment.

Understanding Headaches: Types and Differences

Tom Zeller introduces the audience to the different categories of headaches, emphasizing that not all headaches are created equal:

• Cluster Headaches: Affecting less than 1% of the population, these are characterized by sudden, intense pain without warning signs. "The pain is debilitating. You can't do anything when a cluster headache is firing at its peak," explains Zeller (02:08).

• Migraines: The most familiar primary headache disorder, migraines involve recurring headaches that can be severe but are generally more manageable with over-the-counter medications.

• Tension-Type Headaches: More common and often less debilitating, these headaches respond well to simple treatments and lifestyle adjustments.

Zeller elaborates on the complexity of distinguishing between these types, highlighting the unique physiological processes each entails.

The Personal and Public Health Impact of Headaches

Headaches are not merely personal nuisances; they pose a significant public health challenge. Zeller references his book to discuss the staggering prevalence of headache disorders, affecting approximately 3 billion people worldwide. He emphasizes that migraines, cluster headaches, and related conditions are among the most harmful to public health when measured by disability-adjusted life years (DALYs).

"It's a way of comparing all these things and ideally giving funders and scientists some idea of where the greatest needs are, where money maybe should be spent." (08:39) – Tom Zeller

Zeller expresses surprise at the relatively low funding headache disorders receive compared to their impact, underscoring the need for increased research and resources.

Challenges in Diagnosing and Treating Headaches

The episode explores the difficulties patients face in obtaining accurate diagnoses and effective treatments. Zeller discusses the skepticism patients often encounter from healthcare providers, especially since headaches like migraines predominantly affect women—a fact that has historically led to their trivialization.

"Doctors have not always been great at taking us seriously," Zeller notes, highlighting the gender bias in medical treatment of headache disorders (11:08).

Listeners share their struggles with finding effective medications. For instance, caller Robin from SoHo recounts the trial-and-error process with various drugs, culminating in the discovery of effective but side-effect-laden medications like Imitrex and Hewilipta.

Advances and Future Directions in Headache Treatment

Despite the challenges, there have been significant advancements in headache treatment. Zeller discusses the emergence of CGRP (Calcitonin Gene-Related Peptide) medications introduced in 2018, which have been life-changing for many sufferers.

"If a drug helps half the people, half the time, you're sort of on a winner," Zeller explains, acknowledging both the promise and the limitations of current treatments (17:42).

He also touches upon ongoing research into other neurotransmitters and potential therapies, offering hope for more effective solutions in the future.

Listener Stories and Experiences

The episode features heartfelt accounts from listeners dealing with chronic headaches:

• Meryl from Port Washington shares her journey through misdiagnoses and ineffective treatments before finding some relief through serotonin-related therapies (13:04).

• Robin from SoHo describes decades-long battles with migraines, highlighting the emotional and physical toll they take despite finding some effective medications (14:29).

• Ben from Brooklyn discusses his struggle with vestibular migraines and the surprising efficacy of antihistamines like Zyrtec in reducing his migraine frequency (20:10).

• Cheryl from the Berkshires opens up about childhood-onset headaches and her strategy of using motion sickness medication to alleviate nausea during severe episodes (22:46).

These stories underscore the diverse experiences of headache sufferers and the urgent need for personalized treatment approaches.

Historical Perspectives on Headache Research

Zeller delves into the history of headache research, particularly focusing on Dr. Harold Wolf, a pioneer in the field. Wolf's emphasis on the brain's vasculature as the primary culprit in headaches has shaped much of the scientific understanding, though contemporary research suggests this may have led scientists down a "blind alley" (25:28).

Impact of Environmental Factors

The conversation also touches upon how environmental conditions, such as barometric pressure and elevation, can trigger headache attacks. While acknowledging anecdotal evidence, Zeller emphasizes the multifactorial nature of headaches, making it difficult to pinpoint exact causes (22:42).

Conclusion

As the episode wraps up, Zeller reflects on his personal experiences with headaches and the gradual improvement he's observed over the years, attributing it to a combination of aging and effective treatments like CGRP injections (29:33). He underscores the importance of ongoing research and the evolving landscape of headache treatment, offering hope to millions affected by these debilitating disorders.

"We haven't hit a wall, but we've definitely taken a long time to start taking them seriously scientifically." (27:44) – Tom Zeller

ALL OF IT effectively combines expert insights, historical context, and personal narratives to provide a comprehensive exploration of headaches, their impact, and the journey toward better understanding and treatment.

For more episodes and to join the conversation, visit WNYC's ALL OF IT. Share your experiences with chronic headaches by calling 212-433-9922 or texting the provided number.