Chapter 2
1 Usually my class was in January, the same month as Maya did most of her data collection. There is a theory that you can only experience ice cream headache if it is warm. Well, Ontario, Canada, isn’t the warmest place on the planet in January (Maya said it rarely gets above 0 degrees centigrade, which is freezing to me, who grew up in a temperate climate warmed by the Gulf Stream) but Maya didn’t do her experiments outside so presumably room temperature negates this argument as a point of contrast. So both Maya and I would have run our experiments in relatively warm environments, making ice cream headache more likely.
2 Dublin-born, like myself, Robert Smith studied at the medical school of my alma mater, Trinity College Dublin, during World War II, graduating in 1946. He subsequently moved to Surrey in the UK to practise there, and following a stint tending to the medical needs of the British Army and their families in post-war Germany, he became one of the first trainees in general practice when the National Health Service (NHS) was created. He went on to set up schools of family medicine in Guy’s Hospital in London, Chapel Hill in North Carolina and finally, the University of Cincinnati, where he also set up the Cincinnati Headache Center. In the middle of all of this, he was researching various aspects of pain. Hence the ice chips.
Chapter 3
1 White-water kayaking is a winter sport. In a kayak, I would wear a rash vest, swim shorts, a wetsuit, a cagoule with watertight seals at the neck and wrists, a buoyancy aid and dry pants with watertight seals at the ankle and waist, wetsuit boots, a skull cap and a helmet, in addition to a spray deck that attached to the cockpit in the kayak to keep my legs relatively dry. If I had my way, that’s what I would have worn to the waterpark (which was indoors, incidentally) but I have only so much resilience to people staring.
2 I had cause to be very glad that chlorine had been used in the pool when the little boy beside me in the wave pool later that day shouted to his mum: ‘I need a wee... Never mind…’ as a look of sheer relief overtook his features. I couldn’t move away fast enough. I actually couldn’t as I had torn my watershorts and underlying swimsuit when I had got stuck on that slide and was concerned for my modesty.
3 Pneumococcus was discovered independently in 1881 by both well-known chemist Louis Pasteur in France and a US Army physician, George Sternberg. It is a Gram-positive bacteria and looks like little blades made up of elongated spheres or ‘cocci’ (singular: coccus) and will often pair up to become ‘diplococci’, by which name it was known until 1920. They are particularly beautiful in three dimensions, where they look like chains of spheres.
4 A number of cases have been documented whereby certain people develop a triad whereby they get asthma, sinus and polyps with aspirin sensitivity. Thirty per cent of people with asthma and polyps have a sensitivity to aspirin (but also ibuprofen). This combined response probably has something to do with the aspirin’s activity blocking the prostaglandin immune response but the exact causes are not yet known.
Chapter 4
1 Social psychologists like Mario Weick call this ‘the planning fallacy’. People in positions of power, or those who need things done by other people, tend to underestimate how long it will take to get things done. It’s not because they are inept, it’s because they view their task at hand as unique and think that whatever may have happened in similar circumstances previously, things will be better this time around. It’s also related to the fact that they just don’t think about all the other things that people have on their plates to do as well as what they have asked for. They are more focused on the intended outcome and not all of the steps and cogs in the wheel to get to that outcome. So, timescales slip. Unless they are surrounded by superhumans, which simply feeds the fallacy.
2 You might also take beta-blockers if your heart is beating too fast because of a different underlying condition such as an overactive thyroid gland. Your thyroid hormone is important in how fast your metabolism goes and is usually tightly controlled through communication between the hypothalamus, pituitary and thyroid gland. The most common thyroid condition is autoimmune, where your own immune system attacks the gland, which rather counter intuitively makes it bigger, producing more thyroid hormone. Patients with this condition have really high resting heart rates, sometimes well in excess of 100 beats per minute. They breathe quickly and talk fast and have the energy of an entire under-10s football team. Cognitively, they feel rushed and stressed and find it hard to grasp a thought before it flies out of their head. Part of this is because of the interpretation of that beating heart and fast breathing as threat by the brain. Beta-blockers calm this down as they do for the emotional causes of stress in the body by dealing with the bodily effect, but not the emotional causes.
Chapter 5
1 It wasn’t actually recognised as its own class of headache until 1998, having been lumped in with migraine up until then. However, it was first extensively described centuries before in 1694 by a Dutch physician called Nicolaas Tulp.
2 It’s probably clear by now that I am no fan of non-descriptive terms, preferring ‘apoplexy’, ‘subarachnoid haemorrhage’ or ‘ischemia’ to ‘stroke’, for example. The reason we call it stroke today is due to the influence of religion. Because it changes your life quickly and often irrevocably, it was seen as ‘the stroke of the hand of God’. Stroke, as a term, stuck.
3 Perhaps my preference for the term cluster is determined by this rather groovy nominative.
4 Interestingly, there are HCRTR2 receptors all over the brain that ensure these complex behaviours are carried out, and so orexin has a reputation for integrating multiple physiological functions.
5 It is too early to tell what effect vaping will have on nicotine dosing as this is a habit that is not as easy to keep track of, because it is not packaged in the same way as cigarettes.
6 Schools that have reset their timetables accordingly have reported dramatic decreases in truancy and improvements in student well-being and mental health. There is no point in telling a teenager to go to bed; their body just isn’t ready. They live in a different time zone.
7 Of course, we didn’t know this in Horton’s time; back then it was thought that they were caused by stress and bad diet. It took until 1982 for Barry Marshall and Robin Warren, two Australian physicians, to prove that stomach ulcers were caused by bacteria, and the scientific and medical establishment only started listening in 1984. But listen they did when finally, in an act of complete and utter frustration, Robin drank a solution swimming with the bacteria Barry and he had painstakingly isolated. Lo and behold, he developed a stomach ulcer! He then treated himself with antibiotics and made a full recovery. Part of the medical community didn’t believe it (‘if it is caused by bacteria then why haven’t we seen this before?’ being a common complaint) and part of it was utterly agog. For this reason, it was the early 1990s before the pharmaceutical industry and clinical practice started to treat ulcers systemically in this way, with the first targeted antibiotic coming on the market in 1995. In 2005, Barry Marshall and Robin Warren accepted their Nobel Prize in Physiology or Medicine for work that had started with the observation under the microscope of a high load of bacteria in the gut of an ulcer sufferer and their ability to draw the correct conclusion.
8 A biologist herself, Lisa Kudrow published a paper with her dad in 1994 debunking the idea, at least in California, that more left-handed people suffered from cluster headaches than right-handers.
9 In his spare time, Lance also likes to spot the neurobiology lessons in the works of Shakespeare, such as the description of Othello’s epilepsy by the treacherous Iago in Act 4 Scene 1!
Chapter 6
1 The myelin sheath is what is attacked and destroyed in multiple sclerosis (MS), thus demonstrating its enormous value to us. In people who suffer from MS, movement and eventually thought and breathing become impossible over time.
2 A term preferred by radiologists to describe this low blood volume; oligaemia is borrowed from the Greek for ‘uncountable’.
3 Ti’u was the specific evil spirit of the headache, represented in the Mesopotamian pictorial language or logography by sag-gig, or head illness. It depicted Ti’u pointing to a person’s head, suggesting horrendous headaches with after-effects of dry lips, loss of appetite and urination.
4 The thalamus is my second-favourite area of the brain after the hypothalamus (which sits below the thalamus, as the name suggests). Thalamus is Latin for ‘inner chamber’ or ‘bedroom’, which is apt given that the thalamus in our brain sets the activity, or firing, rate of the rest of the brain. It literally slows everything down when we want to go to sleep and starts it all up again to wake up.
5 These migraineurs can’t suppress their grins when they tell me about this – they know they are the lucky ones. For example, 62-year-old Mary told me: ‘I don’t generally talk about it in my group of friends. They all get headaches, we’re accountants! But people get so jealous. I see it as my reward for coming out the other side!’ Since dopamine is the neurotransmitter that mediates the reward centres of the brain, her choice of words couldn’t have been more prescient.
Chapter 7
1 Hippocrates was born on the island of Kos, Greece, in 460 BCE and reached the ripe old age of 85, living through the Classical Greek period. A philosopher and a physician, he and his followers turned away from the idea that illness was caused by spirits or gods and other superstitions, believing instead that patients must be individually and closely observed in order to come up with a rational treatment plan. The whole patient should be considered, and their diet, sleep, exercise and work should be monitored as these were deemed important factors in causing and therefore reversing imbalances in the humours. This approach is very much reflected in our modern interdisciplinary enquiry, although through the ages humanity subsequently fell into a one-size-fits-all category.
2 At least for people who like to think about the evolution of our thoughts about how anything happens in our body, how we experience it and how it guides our behaviour.
3 As Hippocrates is accepted as the father of medicine, Thomas is the father of neurology, being the first to coin the term in the first textbook of clinical neurology, which he wrote. He discovered the nature of our reflexes and also described the Circle of Willis, a central and indeed vital cross-connection of arteries that serves the brain and all of its structures. Thomas imagined that the vague, occult-like communication that served the Greek ‘sympathy’ was actually based in a neurophysiological framework, leading him to predict many of the findings that proved his theories at late as the 19th century.
4 Psychological study of the migrainous syndrome, Herman Selinsky, Bulletin of the New York Academy of Medicine, 1939, Vol. 15, pp.757–763.
5 This role was to be the reason why Gregor’s experiments had to stop; the administrative burden of running the monastery was too great to allow anything else. It was ever thus in the academic career. He had chosen to become a friar at least in part because it meant his education was paid for and his living expenses were taken care of, letting him carry out his scientific enquiries, but his fast-track promotion made sure his plan backfired somewhat.
6 Do I need to explain why? I once reached out to the legend that is Dolly Parton over Twitter to ask her if she knew this. She didn’t respond of course, but somebody told me she did in fact know, and that she wanted to get a jumper made from Dolly’s wool. Dollywool! I don’t know if she ever got it.
7 The word Jaagsiekte is Afrikaans for ‘chase’ (jaag) and ‘sickness’ (siekte) because affected sheep are constantly out of breath, as if they had been chased.
8 A Chinese team, lead by Yiqing Huang, gave it a bash in 2017, but it is not usually the norm; one gene tends to be followed in one family.
9 Three weeks later I walked into the house and immediately clapped eyes on that stripy top again. A wave of nausea instantly ensued (pretty sure it was in reaction to the shirt). So, if spousal sartorial choices are not grounds for divorce (they are not, I checked), perhaps throwing up on your spouse is.
10 Sometimes two are released, leading to fraternal twins if both are fertilised by a visiting sperm cell over the next 24 hours, and even multiples beyond two (those are called ‘the motherload’).