Not Tonight: Migraine and the Politics of Gender and Health

by Joanna Kempner

“[An] insightful and eloquent account of our evolving understandings of migraine, from a condition of weak-nerved women, to a ‘real’…disease” (Elizabeth Mitchell Armstrong Princeton University).   Pain. Vomiting. Hours and days spent lying in the dark. Migraine is an extraordinarily common, disabling, and painful disorder that affects over 36 million Americans and costs the US economy at least $32 billion per year. Nevertheless, it is a frequently dismissed, ignored, and delegitimized condition. In Not Tonight, sociologist Joanna Kempner argues that this general dismissal of migraine can be traced back to the gendered social values embedded in the way we talk about, understand, and care for people in pain.   The symptoms that accompany headache disorders—like head pain, visual auras, and sensitivity to sound—lack objective markers of distress that can confirm their existence. Therefore, doctors must rely on the perceived moral character of their patients to gauge how serious their complaints are. Kempner shows how this subjective dimension of diagnosis has shaped the history of migraine. In the nineteenth-century, migraine was seen as a disorder of upper-class intellectual men and hysterical women. In the 1940s, the concept of “migraine personality” developed, in which women with migraine were described as uptight neurotics who withheld sex. Even today, we see depictions of people with highly sensitive “migraine brains.”   Not Tonight casts new light on how cultural beliefs about gender, pain, and the distinction between mind and body influence not only whose suffering we legitimate, but which remedies are marketed, how medicine is practiced, and how knowledge about disease is produced.

Genres: Nonfiction, Health, Science, Sociology, Disability Studies, Feminism, Disability

262 pages, Kindle Edition

First published January 1, 2014

Reviews

[Anna · Rating 5 out of 5]

The only book of its kind, Not Tonight: Migraine and the Politics of Gender and Health provides a thoroughly researched overview of historical approaches to migraine in Western medicine through a sorely needed feminist lens, calling b.s. on the gamut of insulting assumptions about women with migraine. From hysterical Victorian women to 20th century psychosomatics and every “migraine personality” in between, these observations are informative, fascinating, and appalling.

But Kempner doesn’t stop there. She effectively demonstrates how the paradigm shift from migraine as a psychosomatic illness of delicate, uptight women to a disease of the brain has done little to legitimize the experiences of people with migraine and the work of headache specialists. It seems that old tropes have easily found their way into the new neurobiological framework of the high maintenance, hypersensitive “migraine brain” as many specialists, advocates, and advertisers are actively “reifying gendered stereotypes about people with migraine by attributing unflattering feminized characteristics to their brains.” (102)

A chapter on the powerful world of pharmaceutical advertising serves to show how homogenous (white, upperclass, female, feminized) depictions of people with migraine perpetuate stereotypes, and contribute to the “legitimacy deficit” of migraine. These economically-driven advertisements suggest migraine is easy to treat, and do nothing to garner awareness of the very real disability caused by migraine in diverse populations. Worse still, she shows us how the work of pharma and headache doctors is inseparably intertwined so that the very industry that supports headache research simultaneously undermines it.

What Kempner does not offer in Not Tonight is a suggestion of how we might reframe migraine in a way that serves to accurately spread awareness of the devastating individual and far-reaching societal burdens it causes.

That part is up to us.

Let us use this information as a launch pad for new conversations about migraine to convey a more accurate depiction of people with migraine: a group that is large, diverse, strong, resilient, misunderstood, stigmatized, sometimes severely disabled, and often without access to effective care. Let it serve as a reminder that in order to change public perceptions of migraine, we must be willing to do the hard work it takes to become more self-aware through a better understanding of the ways history has shaped our perception of migraine and ongoing analyses of the language we use to discuss it.

Without question, this book is a must read for all headache specialists, advocates, and any pharmaceutical advertisers who have even one moral bone in their body.

Thank you Joanna Kempner for an eye-opening and timely read.

[Adrian · Rating 4 out of 5]

Clear, effective and well-researched study that highlights how masculinity and femininity alter medical treatment, public attitudes toward disease, and thus health outcomes.

[Michelle · Rating 4 out of 5]

This book is fantastic for anyone who has migraines, knows someone who has migraines, or is interested in gender in medicine and society. Kempner does an excellent job at not only tracing the history of migraine treatment in medicine, but in the way migraine has been constructed in society, and how it gained validation in the medical community once it was determined to be neurobiological in origin.

Through the lens of one illness, Kempner illustrates the ways clinicians and patients are dependent on each other for validation in their respective communities, and how those narratives can both helpful and harmful.

[Kris Hansen · Rating 5 out of 5]

A must read for anyone with migraine. An amazing presentation of feminist research. I found myself experiencing both feelings of vindication and disbelief. This is a work that I expect to be transformative in my life as a person with chronic migraine disease.

[Oskar · Rating 4 out of 5]

I read this book for a politics of women's health course and I absolutely loved it. I've experienced migraines since I was a child and have often faced difficulties in finding adequate treatment for them. This throughly resourced book traces how the sexist origins of migraine research has become embedded in modern medicine and impacted treatment options for everyone. While much has changed, there is still work to be done. Reading this book helped me understand my own experiences at the doctor's office while also contextualizing how gender greatly impacts treatment outcomes.

[Wenjing Fan · Rating 3 out of 5]

完整地读了前言/简介/结论章，尝试读了1/2/3/4章的开头都有点没劲就没读下去。本书出版于2014年，讲述的是当时（及之前）对偏头痛的轻视、误解、女性化倾向。前四章分别从偏头痛的生物学发展、现代科学研究、民间组织的宣传、制药公司的影响方面来写，虽然都提到了“性别”因素造成的阻碍和偏见，但并非从女性视角展开的解读，读起来有点难受。而且作者还拿丛集头痛（男性患者较多）来和偏头痛（女性患者较多）来对比，甚至有一章专门写男性，真是非常没有必要。还是希望看到更新的研究吧。

[Ginger Essink · Rating 5 out of 5]

This was a fascinating look at how a complex brain disease has been associated with hysterical, sensitive women and how that has impacted research and legitimacy of the physicians who study it.

[Chrissie · Rating 3 out of 5]

Excellent portrayal of how gender impacts the research around, and treatment of migraines.

[David Bradshaw · Rating 4 out of 5]

migraine a gendered viewing

[Amber · Rating 4 out of 5]

Interesting dissection of the cultural landscape of migraine.

[Joanna Theriault · Rating 5 out of 5]

Excellent, and a classic in the making. An academic and stunning indictment of the medical establishment's dismissive attitudes and practices towards its migraine and cluster headache patients, millions of whom live with chronic pain and other neurological symptoms every day. Also of the marketing campaigns of migraine medications by pharmaceutical companies, which trivialize migraine and rely on gendered stereotypes that do not reflect the realities of the disease.

I wish I had the means to put this book on the required reading list of every medical school, GP, neurologist, and pharmaceutical company executive.

One particularly entertaining bit - how physical appearance characteristics of cluster headache patients that continue to be referenced in a majority of medical literature began with the non-scientific observations of just 16 patients by one doctor many decades ago. Hilarious! Except not, when you consider how many countless sufferers have probably been denied care because they did not meet the "physical appearance" criteria for cluster headache.

[Mills College Library]

616.84912 K328 2014

[Zuska · Rating 4 out of 5]

Comprehensive analysis of the sociocultural history of, as the subtitle has it, migraine and the politics of gender and health. Although an academic book, it is VERY readable. At turns astonishing, amusing, and frustrating, the history and evolution of how migraine and migraine patients have been understood and portrayed - by clinicians, the media, and the patient community itself - was a fascinating read. The author advises in the preface that the book is not a "how-to guide of life in pain" but rather she hopes to "clarify the cultural landscape that colors our collective experience of living with pain." I would say she has achieved that goal. Furthermore, I would also agree with the author that while this book does not "provide any relief to pain", it does indeed help to "alleviate the greater suffering of those in pain." Those who have migraine (or cluster headache) will find much illumination of their lived experience in these pages.

Kempner describes the shift from a focus on "the migraine personality", a more psychosomatic view of migraine disease, to "the migraine brain", a neurobiological-based view. This shift was facilitated in large part by the development of triptan drugs to treat migraine. Paradoxically, this shift has not served to entirely "legitimate" migraine as a disease nor to erase the stigma of gender attached to it - to the patients who have migraine and the clinicians who treat it. Kempner's analysis of pharmaceutical advertising is particularly strong in showing how gendered categories of personhood are bound up in the narrative of not just who it is that has migraine, but what it means for them to experience it, and to find "relief" from it via the pharmaceutical solution being advertised: e.g., women having migraines are not able to meet their duties as nurturing caregivers, even to the point of endangering their children; pharmaceutical solutions can restore the proper caregiving/nurturing roles; taking a pill fixes everything and "gives back" the white middle class woman her "lost day" shopping or socializing. The pharmaceutical ads create a specific narrative of gender and class that helps sell medicine but obscures the true makeup of the patient population, and simultaneously undermines the narrative that migraine is a serious illness that is "not just a headache".

There is so much more in Kempner's intricate analysis than I can easily summarize here. I strongly recommend this very readable and fascinating study of the politics of migraine to anyone who enjoys books about history of medicine, sociology, gender and science; who has migraine; and to any clinicians, psychologists, or psychiatrists who treat people with migraine.