My head aches.  Not with the “good ache” in your biceps the day after lifting weights, that dull feeling of warm achievement that signals the regenerative growth of torn muscle fibers.  Like a sore bicep, my aching head is also a muscle over-flexed from hours of heavy lifting (read: reading). But this particular hurt is not regenerative.  It is damaging.  And it is anything but dull. When I have a migraine, it is a sharp, pulsing knock-knock-knocking on my brain’s door.

It was at the National Archaeology Museum in Lima where I first discovered trephination.  The museum is the home of the largest extant collection of trephined skulls, removed from burial grounds in the highland and coastland areas of Peru.  For a range of conditions including severe and recurrent migraines, holes were once bored into the skull to reduce intracranial pressure, to allow the brain to “breathe” or “pulsate,” and in some cases, to allow demons to escape.  Staring at these curated specimens in their temperature-controlled cases, I felt an uncanny and sad connection.  Somehow, deep in the bone, I understood that desire for cranial pressure relieved.  The human skull – that perfect house for the fragile brain – this time with a skylight.

The museum docent called trephination the oldest form of neurosurgery.  I call it mythological.  Think of Zeus’s splitting headache.  When Metis warned the Greek god that if she bore him a boy child, the child would be greater than him, stubborn Zeus swallowed her whole.  He then suffered a headache so violent that Hephaestus had to break open his cranium with an axe.  Out of his head, Athena was born.  This proliferative breaking open reminds me of the cranial bump at the top of the Buddha’s head.  Often stylized in sculpture as an elegant topknot, the bony protuberance symbolizes the expanded wisdom the Buddha attained at the time of Enlightenment, wisdom breaking through the roof of the world.  True mind fullness.

But the ache is not all in my head.  The migraine is mobile. Sometimes it appears before my eyes as dancing stringy neon spirochetes.  Sometimes it’s in my nose as the cloying sweetness of decayed fruit, or in the vessels by my ear as whooshing sounds, like waves crashing gently against my tympanum.  Sometimes it’s the thick wooly socks balled up in the dark locker of my brain during the days of mental sluggishness that linger after an episode.  For a few days last year, it was the diminished hearing on my left side.  Often times, it’s in my speech as I switch the first letters of adjacent words and slur my language like I’m drightly slunk.

These days, the ache has traveled back to my head, now as perseverative thoughts about small strokes and brain lesions.  Recent studies using imaging technology have suggested new theories relating migraines to structural changes in the brain.  A few months ago, I heard a radio interview with a neurologist who described migraines as small incidences of brain damage.  A 2012 study in JAMA reports that women with migraines are more likely to develop a higher prevalence of MRI-measured ischemic lesions in the brain, raising questions about deep white matter brain changes and their possible relation to ischemia and ischemic stroke.[i]  Fortunately, this heady revelation comes with somewhat heartening news for us female migraine sufferers.  Another study published by the British Medical Journal suggests that migraines, while painful, are “not strongly linked” to faster rates of cognitive decline among women.[ii] “Good news,” celebrates one press report on the study.  “Migraines hurt your head but not your brain.”[iii]  The headache, it seems, is all in my head.

Or is it?  Centuries ago, trephination opened a window into the skull and onto this curious ache.  Today we continue to peer in, exchanging the auger for magnetic fields and radio waves.  Yet for all our recent discoveries and emerging theories, the locus of this mobile malady remains perpetually elusive.  All we find are dropped hints, signs of the headache’s absent presence.  For the ailment that has plagued gods and human alike, there is no straightforward story to tell.  What I continue to learn of this slippery malady layers onto what I already know to be true: my headache lives in the first person plural.  For me, its existence is multiple, all at once the wooly socks in my ears, the escaped demons from a trephined skull, and the illumined spots on an MRI.[iv]  It is the spiritual strain to break free of the world, my stilted words, and hours lost to quiet darkness.


Jocelyn Chua teaches anthropology at the University of North Carolina-Chapel Hill.  Her first book, In Pursuit of the Good Life: Aspiration and Suicide in Globalizing South India, will be released next year with the University of California Press.

[i] IH Palm-Meinders, H Koppen, GM Terwindt, LJ Launder, J Konishi, JM Moonen, JT Bakkers, PA Hofman, B van Lew, HA Middelkoop, MA van Buchmen, MD Ferrari, and MC Kruit. 2012. Structural Brain Changes in Migraines. Journal of the American Medical Association 308(18):1889-97.

[ii] Pamela Reist, Jae Kang, Julie Buring, N Maria Glymour, Fran Grodsetin, and Tobias Kurth. 2012. Migraine and Cognitive Decline Among Women: Prospective Cohort Study. British Medical Journal 345:e5027.

[iii] Accessed February 12, 2013.

[iv] Annemarie Mol. 2002. The Body Multiple: Ontology in Medical Practice. Durham: Duke University Press.

Image: “Plasmodium falciparum.” Dr. Osaro Erhabor.