Headaches and Head Coverings received an inordinate amount of attention when we posted it last week. On Torah Musing, the blog where the story was originally posted, the following fascinating exchange took place between Dr. Tovia Berk, a Headache Medicine Fellow, and the post’s original author, Rabbi Alex Ozar.
My name is Tovia Berk – I am currently a Headache Medicine Fellow at the Jefferson Headache Center in Philadelphia, a graduate of Ner Israel and the NYU School of Medicine. I have had the pleasure of following your website for years (the Daily Reyd and Audio Roundup are never missed by me or my wife). I read the article this morning entitled “Headcovernigs [sic] and Headaches” and was interested in giving you feedback regarding this article – both regarding my interest in headaches and as an avid reader of your website.
Regarding the topic of headaches addressed in the article – as the author mentioned, the scope of the article could not include the intricate pathophysiology that cause headache in general, however, the author does not even describe the characteristics of the headache pain that he refers to. It is also not clear where he received his information regarding these headaches – he simply refers to “testimony from the front lines”. Headache medicine takes great pride in describing and differentiating headache syndromes and although the latest classification of headaches does not describe the phenomenon of “Head Covering Headache” in my personal experience there are two general categories: people who have a primary headache syndrome, such as migraine, who develop a painful sensation of the scalp called allodynia which can be exacerbated by any pressure on the hair, and those who aren’t prone to other types of headache but develop a kind of scalp fatigue when they either balance a loose fitting covering or have a very tight fitting covering on their head for extended periods of time. It is essential to make this distinction as there are treatments for both of these conditions which vary greatly – the first category describes an underlying medical condition that needs to be appropriately addressed, the other may benefit from more practical solutions such as alternating head covering and giving the scalp ample rest time when appropriate and necessary.
In extreme situations I am aware of individual heterim after exhaustion of medical and practical solutions and after discussion with relevant medical professionals . The author states that “this is not an epidemic, the threat isn’t cataclysmic, and the response shouldn’t be over-dramatic” – the relevant discussion should not be about those in the extreme circumstances who can’t tolerate head coverings at all, rather the “hamon am” – the typical woman on the street who finds head coverings uncomfortable at the end of a long day and at the end of a long week. Rabonim who get these shailos and women who have these problems should know that in most circumstances there are treatment options available.
Thomas Berk, MD
Rabbi Alex Ozar responded:
Thanks so much for the info and analysis. Consulting with medical professionals on these kinds things is certainly something I’d wholeheartedly recommend, for what it’s worth.
One interesting hypothetical, and you can tell us if it’s a real possibility: What would we do, halakhically speaking, if someone (1) had an underlying condition, (2) that condition was not severe enough to require medical treatment, (3) medical treatment becomes necessary as a result of head covering. Is such a person obligated to add a course of medical treatment (possibly perpetual?)? I don’t know.
I should also say that I was in fact intending to address the more mundane, “hamon am” case of women who just need some pragmatic adjustment to their routine. The hope was just to allow those kinds of adjustments a little more space. So, for another hypothetical: Someone, afternoon on a long day in a long series of long days, considers uncovering their hair for an hour or two at their desk in a quiet office, thereby keeping everything contained and making sure the stuffy August subway commute doesn’t compound the day’s effects.
More generally — this is no longer directed at you, good Dr. Berk — I do want to say that I don’t think a regime of suspicion, or even more than rudimentary skepticism, is appropriate here, given the nature of the obligation. People shouldn’t feel they’re going to need to plead their case, certainly not withstand interrogation, before a team of rabbis, doctors, psychologists etc. before reaching the conclusion that this is an issue to be addressed.
Looking for another story about head coverings? Check out our story on Wrapunzel.
The words of this author reflect his/her own opinions and do not necessarily represent the official position of the Orthodox Union.