The California Cure Head Case: Paco McCauley

as told to Sally Horchow

September 3, 2007: The Headache

On Labor Day in Nantucket, the morning after a sunset beach picnic, I woke up with a typical hangover headache: a dull, tight pain in my forehead, behind my eyes and spanning the temples. Wait, I thought. I can’t be hung over—I didn’t drink last night. In fact, I hadn’t had a drink in almost two years. I was a healthy 35-year-old guy in good physical shape. I had run the same five miles I’d been running all summer. It was the end of a stress-free vacation; if anything, I was more relaxed than usual. I must be coming down with something, I thought, popping a couple of Advil. Something...

September 14, 2007: It’s Still There

Back home in Los Angeles, after a 10-day cross-country drive with my dogs, the headache remained camped out stubbornly in my forehead. It wasn’t an all-out migraine, but it stayed at a consistent level all day, in the night and when I woke—ranging in intensity from 1 to 10.

October 10, 2007: The Tests

Dr. Daniel Rovner at Cedars-Sinai was a nice enough guy, but no amount of cool rock photography on the walls could help during those cacophonous body scans or while gigantic needles were being jammed into my spine. Thankfully, my MRI was negative: no brain tumor. The MRA and MRV, which examine blood flow to and from the brain, were negative. The spinal-fluid tests were negative, too. There was Dr. Stephen Uman (an infectious-disease guy, like the one on House), who did a full blood workup to test for obscure strains of illnesses that had never been detected outside of Africa. An allergist found nothing. Nor did an ophthalmologist, a rheumatologist and an endocrinologist. According to Rovner, Uman and Dr. Ron Benbassat, there was nothing wrong with me. No one had a diagnosis, and yet I still had a headache.

November 26, 2007: Desperate Measures

My pain had completely taken over my life. I was spending 75 percent of the time in bed (hard when you run a men’s clothing company—Franklin + Gower). To alleviate growing stress on our marriage, my wife and I tried everything—switching to organic products, filtering our tap water, expunging our house of mold. We considered “remediating” our dogs but decided I’d rather have a headache than live without them. Decapitation was ruled out. After unsuccessful trials with migraine medicines and antibiotics, the only thing that helped was Vicodin, which the doctors reluctantly prescribed, worrying that I might develop a “rebound” headache that could exacerbate the problem. I used it as infrequently as possible, feeling guilty even as it eased the pain. Medicinal marijuana worked, too, but it had a funny way of making me stoned, so I couldn’t rely on it for work or social situations. I now had to deal with a growing depression.

January 10, 2008: The Diagnosis

Steven Graff-Radford, DDS (yep, a dentist) is the director of the Headache and Orofacial Pain Program at the Cedars-Sinai Pain Center. He’s a friendly but no-nonsense South African. He answers his direct line. He faxes prescriptions to the pharmacy from the exam room. He delivers his proclamations with confidence. So, despite the one Graff-Radford was about to hand down, I was immediately taken with him and his exceptional practice. Dealing with the inefficiencies of so many medical offices had truly made my headache worse.

But he had a diagnosis for me: “You have what is called ‘new daily persistent headache.’ ” No shit. “The good news is that it usually goes away in three to five years.”

And with that, he prescribed an antidepressant.

December 2, 2008: The Hope

This year, I would avoid those dreaded holiday-party “how-is-your-headache?” conversations by spending the month at the Michigan Headache & Neurological Institute, where I was put in the Trendelenburg position (flat, with my feet higher than my head—also used for water boarding), and this temporarily alleviated my headache. I also got a possible new diagnosis: cerebrospinal-fluid (CSF) pressure, caused by a leak in the spinal cord. With newfound hope, they released me into the care of the world’s expert in spinal issues, Dr. Wouter Schievink, a neurologist back at Cedars. Of course, by this point, I’d learned that hope is not a strategy.

January 8, 2009: The Incident

Happy New Year: Dr. Schievink ordered a CT myelogram to X-ray my spinal fluid, which precipitated my most torturous experience: being splayed out on a table at the Cedars-Sinai Imaging Center, writhing in excruciating pain as a second-year resident made five failed attempts at a lumbar puncture. A few weeks later, I would try again, with an attending doctor and overall anesthesia. They didn’t find a leak, and I still had a headache. Dr. Schievink threw up his hands and suggested I “go back home to Michigan.” I reminded him we lived in Los Angeles.

August 9, 2009: The Fight Continues...

Almost two years, 24 doctors, 35 prescriptions, 11 spinal procedures and zero holiday parties later, my battle wears on. However frustrated I am, I’ve also learned how to cope: by not maintaining false hope that we’ll find some miracle cure but not giving up the quest for one, either. Every few weeks, I test a new radical medication. On my own, I test more L.A.-ish therapies—a gluten-free diet one day, hypnotism the next. But today, like every day, I woke up with a headache that just wouldn’t go away.