Not Tonight: Migraine and the Politics of Gender and Health

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 frequently dismissed, ignored, and delegitimized.

In Not Tonight, 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 make policies for people in pain. Because the symptoms that accompany headache disorders—like head pain, visual auras, and sensitivity to sound—lack an objective marker of distress that can confirm their existence, doctors rely on the perceived moral character of their patients to gauge how serious their complaints are. Kempner shows how this problem plays out in the history of migraine, from nineteenth-century formulations of migraine as a disorder of upper-class intellectual men and hysterical women to the influential concept of “migraine personality” in the 1940s, in which women with migraine were described as uptight neurotics who withheld sex, to contemporary 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.