Once upon a time there was a drunkard looking for his keys under a lamppost. A fellow countryman who was passing by went to look for them with him, and after a while he asked him:
- Hey, are you sure you lost them here?
To which the drunk replied:
- No, I’ve lost them over there, but it's too dark to look for them.
It's exactly the same with chronic headaches: you look for the cause where there seems to be more light, in neuroscience, but it's really beyond that.
We don't know everything about pain, but we do have some certainties. For example, we all agree that the capacity to feel pain is neurophysiological: for a person to feel pain, there has to be a neurophysiological activation; without that activation there is no pain. What we do not agree on is why that capacity is triggered.
There are many different approaches, each with its own why; depending on the approach you choose to treat your headache, you will have a treatment that will have nothing to do with what you would have done if you had chosen another approach
For example, the medical model, based on the assumption that every health problem has a biochemical or anatomical substrate, searches the organism for what causes the neurophysiological activation that results in headache pain (genes, peptides, proteins, neurons...). However, when we look at what pain is, it becomes clear that this is an absurd hypothesis.
Pain is the organism's way of inducing us to do something to deal with what it has perceived as dangerous.
For example, if you touch a burning radiator, it wants you to move your hand away because it has perceived that tissue is being destroyed; conversely, if you break your arm, it wants you not to move it so that it can heal.
This means that pain does not exist at all, as something that can spring from a gene, a peptide, a protein or a neuron; it is born of a perception without which it cannot exist.
Perceiving is a mental process through which the organism gives meaning to an internal or external event.
Behind every pain there is an opinion, and a gene, a peptide, a protein or a neuron cannot have an opinion. Only a person (with genes, peptides, proteins, neurons...) situated in an environment with which it interacts, can perceive. To think that the nervous system perceives is like thinking that a guitar plays by itself, without anyone playing it.
Having genes, peptides, proteins, neurons... that is, an organism, is necessary to be able to perceive, but it is not enough; because an organism does not perceive by itself as an independent computer, it needs an environment and behavior. Perceiving is necessarily linked to action: there is no action without perception and no perception without action, what Merleau Ponty called motor intentionality. What appears in the person's consciousness, what he feels, is determined by his behavior, not by a peptide.
Let's look at how fear, which has many similarities with pain, works:
Fear is our organism's way of inducing us to avoid what it has perceived as dangerous.
The ability to feel fear, like the ability to feel pain, is a neurophysiological ability that we all have. As in pain, the fear response involves genes, neurons, proteins, peptides... but they are not the cause, they are correlates, because fear does not exist at all, either, as something that can sprout from a neuron or a protein; fear is also born from a perception, it is always fear of something.
Its chronification doesn’t depend on a gene, a peptide, a protein or a neuron, it depends on the person's behavior: the more he avoids what he fears, the more the perception of fear increases, and with it the neurophysiological activation and the fear he feels. Conversely, if you face the thing you fear, the perception of danger decreases, and with it the neurophysiological activation and the fear you feel.
It is exactly the same with headaches: it is one thing to have the capacity to feel a headache, which we all have (93% of people have some kind of headache during their lives, Rizzoli et al, 2018), and another to have it become chronic, something that depends on the behavior of the person, on the relationship they establish with the headache; not on neurophysiology, which is the guarantor of the sensation, never the cause.
However, neuroscience twists reality to make it fit its theory, and looks for the origin of chronic headache pain in some structure or process of the organism, leaving aside one of the few certainties we have: all pain has its origin in a perception.
There is not a single proof of disease in the organism of a person with chronic headache (nor will there ever be), and from a logical point of view, it makes no sense; nevertheless, with an eagerness that has much more to do with faith than with science, this path continues to be insisted upon. In the words of Hegel, if the facts do not agree with the theory, so much the worse for the facts.
The history of medical research into headache pain is a long history of confusion between correlates and causes: just because genes, proteins, peptides or neurons are involved in pain does not mean that they are the cause.
It is no coincidence that despite being the most widespread model, it is the least successful: no one has ever overcome migraine with a drug and no one ever will. Because the drug, at best, blocks the neurophysiological activation that triggers the perception, but as it cannot change the perception itself, the headache returns without remedy. The person thinks that thanks to the drug they can manage the outbreaks, when the reality is that due to the drug they are stuck in a loop of headaches, by delegating to the drug a task that only the person can do: change a perception.
We know that all pain is linked to a perception, and that all perception is irremediably linked to behavior. Therefore, to change perception we must change behavior:
It is no coincidence that there are so many different remedies for headaches (botox, dietary changes, sport, piercing, acupuncture...), which work for some people but not for others.
If one works, how can another totally different one work?, why can't they be systematized for use with all patients,? what do they have in common?
What works is not the remedy itself; it is the fact of doing something different, which by chance and without premeditation, changes the perception in that person, being impossible to replicate it in another, because a perception is a particular opinion of reality.
Few disciplines have not yet fallen into the fashion of justifying themselves through neurons (neuromarketing, neuroeconomics, neuropsychoanalysis, neurorobotics, neuropsychology, neurolinguistics...), because the light radiated by neuroscience and the brain, today covers everything. However, the key to overcoming headaches lies beyond neurons, and beyond neuroscience, which, in this case, far from illuminating, dazzles us with its light.
Based on the knowledge we have today about pain, there is no scientific reason to consider neurology as the right discipline to treat chronic headache. Neurology should deal with the biological problems of the nervous system, with that which is strictly medical (brain hemorrhages, paralysis, cerebral infarcts...), not with that which is felt by the person, because there is no pattern of connection between brain states (what happens in the brain) and mental states (what the person feels), and there will not be because they are different epistemological levels.
For example, the brain areas activated in an experience of pain, in the same person in the same painful stimulus, are not even always the same. Therefore, even if we manage to totally control what happens in the nervous system, we will not control the pain. What appears in the person's consciousness, what they feel, is determined by behavior, not by what happens in the nervous system. Trying to overcome chronic headache by studying neurons is like learning to dance by studying muscle fibers.
Medicine is a model based on physics, in a closed system. An ideal method of analysis for studying things that can be isolated, such as the kidney, the liver or a knee, but inappropriate for studying the brain, because its essential characteristic is the continuous interaction with the environment. Studying migraine by isolating the brain is like studying tidal phenomena by analyzing water molecules, leaving aside the relationship between the Earth and the Moon.
Chronic headache is infinitely more similar to a phobic disorder than to a neuronal disease. In fact, there is no evidence of disease in the organism of a headache sufferer. And just because it is not a disease does not mean that it is not a serious problem; it means that it is a serious problem that requires a different approach.
If you want to know more about this approach, take a look at my blog, the book or write to me.