All pain is simple. And all pain is complex. You're in it and you want to get out. How can the ocean be not beautiful? The ocean is not beautiful today.

Pain is pain: vivid even in its opacity, vague even in its precision. Pain reduces and expands, diminishes and amplifies, bears down upon us, wells up within us, goes by the as often as by my, and only rarely by our.

"Fuck-fuck-fuck-fuck," was when, circa hour seventeen, the doula knew I was fighting the pain rather than moving through, going deep, riding it, whatever when she knew I would disappoint her. "I want to talk about an epidural now." My birth plan included something along the lines of: please-don't-offer-me-pain-medication-I-know-my-options-and-will-avail-myself-of-them-if-I-choose. My mother always claimed she enjoyed giving birth and fought to do it naturally three times before it was the fashion. "How about we try the tub?" she asked. "Get me the anesthesiologist," I answered.

For nine months, I'd been migraine-free every day but two, a couple of hours really, and mild, which was akin to a personal version of shattering the headache-free-heavyweight-world-championship-record. Colonized by plenty of other symptoms, my head left frontal quadrant: check; right frontal quadrant: check; base of skull, top of scalp, lateral plane 1.5 inches down: check; eyes and eyebrows, temples: check had been pain-free. Now labor pain was all pain was all me. "Get me the anesthesiologist, please."

Later, I'd worry this is characterological, that I flee too quickly, too desperately into the arms of an immediate solution, be it Advil for cramps, migraine meds for migraine, epidural for this. I worry this tendency weakness, fear, lack of imagination? might infect my parenting, as well. I wonder if it's bred by the countless hours I've spent in uncontrollable or barely controlled pain, a specter always shifting. Not if. More like how much (a lot) and how (so many ways)?

Perhaps you'll be relieved to learn, or maybe you've already guessed, that labor pain is not the pain I wish to discuss. The truth is, I couldn't. Seventeen hours and done not the labor, but the pain, neatly ended by a spinal block the blink of an eye, really; a memory, certainly, but one that draws dusky only a rickety bridge from here to there. Labor pain is like all pain, unknowable except while being lived. Fundamentally a creature of the present, physical pain remembered is by definition pain divorced. The difference between recalling the flu and having it between expecting a child and having one is like the difference between hearing a description of waves and drowning.

Drowning is one of the words we use to describe pain when we're desperately in it, though often it's used for other things, too: heartbreak, overwhelm. I've never experienced anything close to drowning, but I imagine that like pain it has a way of flooding you with the present. Yes, it makes you hazy, it fogs up memory's edges, but in the moment it is the moment and you are nowhere else except and only exactly where it puts you.

In some ways like any acute pain and in some ways possibly unlike any other, migraine is a particular version of the present. What happens when its present becomes yours for extended periods of time, for a significant portion of your life? This is the pain, or, the present, I wish to discuss.


Does the dark, early morning skull shatter by the light of waking or does the shattering wake the skull to dark, early morning? Either way, it's like an iceberg cracking but within the cramped confines of a dumpy container ship. Today? No, not today. Rather, yes, today, again. "Small streams may become raging currents without warning," the National Weather Service's alert flashes on repeat. No shit. In other words, despite all the information at your disposal, you're not going to see this coming. (I never do.)

Whatever pain you're in is the worst kind and when it's bad it's untranslatable, but that doesn't keep you from having to try.

Masturbate forever, chanting "I am alone" in Middle Persian
Dig through a hill with your breasts, wearing a millstone for a cap
Be thou a deathless thorn-tree in the suicidal woods

These are some of the forms of suffering listed on an altered version of the Wong-Baker Faces pain scale to be ranked by the patient (that is, reader; that is, you) in a poem about the underworld by Srikanth Reddy. Hearing him read it a finished section of an incomplete epic shortly before leaving town for a residency that will give me uninterrupted time to write, I'm struck by how ingenious as varieties of pain, they're equally apt as descriptions of what it's like to try to describe pain at all.

Pain as black-box, lock-box, substitute safe hoarding vital data. Pain as memory's shrapnel. Pain as vehicle. Pain as avenue (spiritual, sexual, other). Pain as evidence of God's love. Pain as evidence of God's wrath. Pain as healthy. Pain as diseased. Pain as hollow attachment. Pain as deepest bond. Pain as symptom. Pain as cause. Pain as passing. Pain as lasting. Pain as telling, as smoke screen, as distraction's pesky fly. Pain as phantom. Pain as proof.

Dull, sharp, throbbing, burning, aching, stabbing, concentrated, diffuse. Infrequent, occasional, intermittent, frequent, constant, mild, moderate, severe, tie me a noose. Despite or perhaps because of the dizzyingly various ways we categorize and conceptualize (let alone experience) pain, we're notoriously bad at talking about it, even literally, as in, do you have it, how much, where, what kind?

"The sensations of my own body may be the only subject on which I am qualified to claim expertise. Sad and terrible, then, how little I know," writes Eula Biss in the The Pain Scale. Before coming across the essay, I'd spent years hating the standard numerical scale rank your pain from 1-10, 1 being no pain and 10 being the worst pain you can imagine and hating myself when confronted by it, ricocheting as I did between indignation, shame, and confusion. So finding the essay was a kind of reprieve, the validation of a frustration that had long confounded me.

Looking for better systems of measurement, Biss points us toward the Beaufort wind scale. Developed in 1805 by Sir Francis Beaufort of the U.K. Royal Navy (undoubtedly along with many unnamed others) to categorize the speed of wind, it runs from 0-12, but the numbers are the least important part. They read as shorthand, really, for exquisitely tuned, twinned descriptions of the physical world by land and by sea. Biss quotes several of the on-land descriptions "wind felt on face; leaves rustle" but I find it's what happens at sea that reads eerily like a mounting migraine:

Sea surface smooth and mirror-like
Scaly ripples, no foam crests
Small wavelets, crests glassy, no breaking
Large wavelets, crests begin to break, scattered whitecaps
Small waves becoming longer, numerous whitecaps
Moderate waves taking longer form, many whitecaps, some spray
Larger waves, whitecaps common, more spray
Sea heaps up, white foam streaks off breakers
Moderately high waves of greater length, edges of crests begin to break into spindrift, foam blown
in streaks
High waves, sea begins to roll, dense streaks of foam, spray may reduce visibility
Very high waves with overhanging crests, sea white with densely blown foam, heavy rolling,
lowered visibility
Exceptionally high waves, foam patches cover sea, visibility more reduced
Air filled with foam, sea completely white with driving spray, visibility greatly reduced


"Was it cathartic to write that?" a well-intentioned audience member asks after I read an excerpt from an early draft.

Catharsis (n): from the Greek to cleanse, to purge

1: Purgation of the excrements of the body; esp. evacuation of the bowels

2: Purification of the emotions by vicarious experience, esp. through drama

3: The process of relieving an abnormal excitement by reestablishing the association of the emotions with the memory or idea of the event which was the first cause of it, and of eliminating it by abreaction

Later, Dot and I discuss whether the question is a gendered onewould a man be asked the same?  Consider: women and the body, women and emotions, the so-called Confessional poets, women and their creative hobbies, isn't that nice. Consider: female = emotion; male = intellect. See also: hysteria and other "female pathologies." And: conditions once attributed to "maternal failure" including: anorexia, autism, homosexuality, schizophrenia, and sexual deviance. Consider, too:

One in four women has had a migraine. (NPR)

For every man with a migraine, three women are struck. (UCLA Newsroom)

Of the more than 36 million Americans afflicted with migraine, 27 million are women. (Migraine Research Foundation)

Why? Historically far worse, the rangeand, in some cases, the contentof reasons still bandied about are sometimes maddening. Let's go with this one, relatively neutral and seemingly grounded in our best current understanding:

Dr. Andrew Charles directs the Headache Research and Treatment Program in the UCLA Department of Neurology. He describes what occurs during a migraine as a "spectacular neuro-physiological event" that involves bursts of electrical activity that start in the vision center of the brain... The brain activity then travels like a wave across the landscape of the brain. What triggers a migraine is nearly as complicated as the migraine itself. There are environmental changes like sounds, light, smells and movement. There are genes; migraine risk is hereditary. But there is one major trigger, and this is why women have so many more migraines than men. Neurologist Jan Lewis Brandes, founder of the Nashville Neuroscience Group, says migraines can be triggered by hormonal fluctuation. (NPR)

(But we knew that.)

"Ask me in a six-months to a year," I answer, trying to be generous while I deflect. "No," I might more honestly have said. Or, "I don't understand the question."

Denial and compartmentalization have long been my primary means of coping, and as far as I can tell they've mostly served me well. That is, they have delivered me reasonably close to my desired ends: a life that accommodates as necessary but does not orient itself around migraine. In other words, a life.

I've written on migraine as on a drug. I've written through migraine as through fog or storm. I've written with migraine as with a jagged star stuck in my eye. Sometimes I've knowingly imported the sensibilities of migraine-mind into the poems I write. Other times, I assume, I've done so unknowingly. In any given moment my relationship to language may be actively metabolizing migraine, and when migraine isn't currently present, that relationship is still shaped, like anyone's, by my accumulated experience its form as much as its content. I gave a version of my affliction to a character once, a displaced traveler studying moths, obsessed with seeing and stricken by pain, dissembling in the process. Some readers have praised what they see as the book's foray into science-fiction, and I'm not ungrateful, but no, this strangeness is ours it comes from inside, not from out there.

The brain has corridorssurpassing
Material Place
Ourself behind ourself concealed
Should startle most

Mostly, though, uninterested in personal revelation, unwilling to yield even more precious time and attention, and inchoately flustered or dismayed by nearly everything I read on the subject, I've avoided it. For years, my policy was a kind of zero-tolerance vigilantly pursued: give the monster nothing, not one minute more than what by stealth or by force it took. Accommodate what must be accommodated, but volunteer for nothing: not deep research, not support group esprit de corps, not even, really, a moment's reflection. Another form of magical thinking, a felt superstition: don't let the gods mistake your intent. So why am I writing this?

Excerpt from Pain Studies. Copyright © 2020 by Lisa Olstein. Forthcoming March 4, 2020 from Bellevue Literary Press: www.blpress.org. Reprinted by permission of the publisher. All rights reserved.

Lisa Olstein is the author of PAIN STUDIES, a book-length lyric essay exploring the intersection of pain, perception, and language, and four poetry collections published by Copper Canyon Press, most recently LATE EMPIRE. She teaches in the MFA programs at the University of Texas at Austin.