“All pain is simple” reads the opening sentence of this unusual and striking book. The next sentence reads, “And all pain is complex.” These two sentences foreshadow many puzzles to come: how do we live between chaos and control? Why can’t doctors figure migraines out? Why don’t they agree on a treatment for a particular patient? Olstein is a poet and long-term migraine sufferer. Her book offers many observations about pain, and her attempts to define it, describe it, and plumb its nature through language. There is no linear narrative or argument, rather 38 very brief chapters—usually three to five pages—and many of these could be read in a different order. 

Olstein uses the terms “studies” and “research” for her efforts to capture pain, to explain it, and to understand the cause(s) of her disease. Her mother had migraines; women have three times the rate of men; she had a childhood head injury. Do any of these factors explain her disease? No. And what treatments work? She lists some 50 drugs/supplements/activities she has tried to deal with her illness. None of these have worked in a definitive way. Further, she lists some 30 side-effects she has experienced from these various treatments (pp. 74-75). She has had multiple migraines, one lasting three months, but she also says drugs keep pain at bay: “mostly the medication does work” (p 90).

Some disparate figures help her focus her inquiry: Joan of Arc (possibly a migraine sufferer), the TV character Dr. Gregory House (racked with chronic pain, he is an opioid addict), Virginia Woolf, and Hildegard of Bingen (possibly a migraine sufferer). Also ancient writers such as Lucretius, Pliny the Elder, and Antiphon the Sophist, and contemporaries from different fields, such as mathematics and neurology. Also she refers to poems by Emily Dickinson, Elizabeth Bishop, and C. D. Wright, as well as to an article on gendered literature by Siri Hustvedt. 

Largely written during a writing residency, these are incisive notes plus associations as she plumbs not only her illness but also her responses—as poet, as thinker, as searcher for healing—to the bizarre, long, difficult path of her migraines. (We have only brief mentions of her personal and family life.) While she refers to some scientific literature, it is more often that her insights come from artistic fields such a literature, sculpture, drama, and popular music. She writes that her work with a therapist over a dozen years has been helpful to her.

There is no conclusion…nor can there be. Her illness, treatment, and writing are all works in progress. Patients are different; doctors are different; science evolves. In their many forms and presentations, migraines are mysterious and complex, as this book creatively and powerfully shows. Olstein writes, “The beauty, the love, is in what we perceive” (p. 144). We may take this observation as the guiding principle for the book.   


This is a book to read slowly, reflectively: peruse and muse. The short chapters, the brief paragraphs are like Zen riddles, haiku that give us perspectives on various topics and, centrally, pain. With her poet’s eye and ear, Olstein offers us vivid images and insights: “I’ve written with migraine as with a jagged star stuck in my eye” (p, 132); “What if migraine is the gorilla pounding at the glass, breaking patterns, breaching expectations?” (p. 154), and pain “removes your armor” (p. 89).

The book feels stroboscopic, flashes of illumination on various subjects and, certainly, pain. We’ve all felt physical pain, emotional pain, perhaps even intellectual or esthetic pain. This book is a series of invitations for readers to compare their perceptions about pain with hers. 

In my case, I recall a serious pneumonia vividly from 45 years ago, also a badly sprained ankle; effective medical treatments healed both. Closer to Olstein’s illness, visual migraines come upon me out of nowhere and whenever, one a year or two in a week. These are strange, even beautiful disruptions in my visual field. For me, there is no pain, and they resolve in 30 minutes or less. The connection I see to her migraines is the randomness, the absurdity, the brief chaos that my migraines bring, in pale parallel with her extensive and painful experiences. No doctor has given me an explanation for their origin. Late in the book she writes, “I find myself wrestling with the riddle of causality” (p. 174). Rings true for me.

Her wide experience of various texts, works of art, scientific concepts, and more all provide many interesting, even startling perspectives. She refers briefly to Hildegard of Bingen, the medieval nun whose visions have been called “migrainous” but gives no links to religious or spiritual experience even for Hildegard, who wrote extensively on medicine and religion. While love is implied in much of the book, there are no religious or spiritual linkages; this is a secular book…humanistic, we might say. Pain Studies is dazzling, puzzling, ornate, arcane, and deeply intelligent as it moves from perception to perception, always seeking some order or understanding. It will join the literature of books attempting to fathom the many complexities of migraines. 


Bellevue Literary Press

Place Published

New York



Page Count