What comedian hasn't joked "not tonight honey, I have a headache," to describe the scenario of a cold, neurotic wife who will do anything it takes to avoid sex.
Still used to elicit a chuckle, the punchline is so universal that Rutgers sociologist Joanna Kempner used it as a title for her new book, Not Tonight, Migraine and the Politics of Gender and Health to shed light on how the severity of migraines have been diminished because of this longstanding cliche.
In her book, Kempner, whose own migraines began when she was only 5, examines how migraines disrupt so many lives yet still continue to be trivialized by so many. She asks why migraines aren't taken seriously by doctors, policymakers or society at large.
Her answer: over the past 150 years migraines have been and still are plagued by gendered images, metaphors and stereotypes. Even though neurologists have determined that migraines are a brain and not a personality disorder, the condition is still seen through a feminized looking glass.
"In the 19th century we looked at those with migraine as men and women with nervous temperaments, who were excitable and sensitive," says Kempner, who spent the past decade doing research and interviews for the book, recently published by the University of Chicago Press. "In contemporary medicine, even though we know it is a brain disorder, we still describe those who have it as being hypersensitive and demanding, except now we're talking about their migraine brain instead of their personality."
These beliefs, Kempner argues, shape the way migraines are viewed by doctors, the pharmaceutical industry and government and have had a profound effect not only on how medicine has been practiced but also how information about a disorder that affects 36 million Americans has been shared and research programs funded.
Kempner, whose own journey to find relief from these devastating headaches has been extensive, began her research for "Not Tonight" in New York in 2001 at the International Headache Congress. Over the next 10 years she traveled across the United States and around the world interviewing leading headache specialists and advocates at conferences where the latest research in headache medicine was being presented.
While the disorder has been transformed over the past two decades from a personality disorder that affects mainly depressed, whiny women to a brain disorder that can disable men, women and children, Kempner says longstanding cultural beliefs about gender and pain still exist and have made it difficult to change the face of the migraine sufferer.
"My suggestion is to create a new public face of migraine that is not just that of a white middle class woman having problems taking care of the kids. Let them see the football players, the soldiers coming back from Iraq and Afghanistan, all these very masculine men suffering from what many think is still a female problem," says Kempner, an assistant sociology professor in the School of Arts and Sciences.
Instead of asking patients how many migraines they have had, doctors should ask them how many days of work they have missed, Kempner says. Migraines cost American employers more than $13 billion each year as a result of 113 million lost work days, according to the Migraine Research Foundation.
New language needs to be developed, she argues, to talk about the excruciating pain and the hours - or in some cases days - spent lying in a darkened room waiting for relief.
"There are different ways to talk about pain that make it sound like this is serious and really matters," says Kempner. "We don't have to resort to highly feminized weak language that makes people think migraine is not important or is an excuse."
What started out as intellectual curiosity for Kempner has turned into a mission to educate the public about a disorder that affects three times as many women as men and is an underfunded public health issue that needs to be taken seriously.
The mother of a 4-year-old son and 6-month old daughter says it is even more important to her now that effective treatments for those suffering with migraines be developed. Studies indicate that if one parent is a migraine sufferer, their children have a 40 percent chance of having the same condition. And girls are even more susceptible than boys.
"It's very scary for me to think about the day when one of my kids comes to me and says that they have a headache," says Kempner. "I do have some hope, though, that in their lives, they won't be as disabled because of migraines and there will be better treatments than we have today."