Excerpt from The Migraine Diaries
- nervetowrite
- Mar 14
- 6 min read
Updated: Mar 20
by Zach Powers
The Migraine Diaries is a novel that follows a migraineur for the year following the death of his best friend, KJ. While fully fictionalized, it draws heavily from my real life circa 2005, when I had migraines several times a week and always felt as if one were about to occur. I’ve never not had migraines as an adult, but this year-long period was far worse than anything I’ve experienced before or since. Overall, the novel is an investigation of how chronic illness can unmake a life, and how so much of what we live through—such as grief—can become comorbid with our illnesses.
The scene below is the narrator’s second visit to his primary care doctor for the migraines. It mostly needs no explanation, except to note that the character Dolores was KJ’s fiancee, and in an earlier scene, the narrator was punched in the side of his head after leaving a bar. I think a doctor’s office visit, for someone with a chronic condition, is such a recognizable and, perhaps, ultimately absurd thing, that I hope the setting resonates for readers. Slight spoiler: I swear I’ve never stolen anything from a doctor.
April 23
…
I go to the doctor today. There have been more migraines, and even when they don’t come, it feels as if one will. I’ve lost whole days waiting. I finished re-watching all seven hundred episodes of Naruto. My muscles have softened to sponges from disuse.
I sit in the lobby as far away from coughing people as possible, but everybody’s coughing, including the friendly receptionist.
The National Geographic on the table intrigues me, but not enough to touch its diseased surface. I stare at the cover photo of a glacier. It’s broken free from the arctic and begun an impossible journey. I wonder where it’s going and if it’ll melt before it gets there.
An older guy, prime dad material, descends on the seat next to me. He clears his throat. One cough, and I’ll move.
He points to the glacier. “Mind if I take that?”
As if it’s my magazine I brought with me and happened to set down on this grimy table.
“Please,” I say, “go ahead,”
He thumbs through the magazine. He licks his thumb between pages.
“Global warming, huh?” he says.
“Right?” I say.
I lean back to look at the pictures. Melting glacier after melting glacier. A map shows how much the world’s ice has shrunk, how much shrinking is yet to come.
The man slaps the magazine shut as if to say enough of this global warming bullshit. He puts the magazine back on the table, face down. The glacier is gone. Global warming, indeed.
“What’re you in for?” asks the man.
“Murder,” I say.
He chuckles. “These places will drive you to that.” He assesses me. “The older you get, the more often you’ll visit.”
I nod because what do you say to that?
“I had cancer,” says the man, “but it’s in remission now. Remission is the doc’s word for needing monthly bloodwork”
“Sorry about that,” I say.
“Better than having cancer.”
I ponder the profundity of that. It’s a philosophy that can only have meaning for someone who’s made it to the other side of illness. I try to remember what causes cancer. Bad genes or bad cells or bad blood. Cancer is a betrayal by one’s own body.
The nurse cracks open the door and calls my name.
“Happy bloodwork,” I say to the man and leave the lobby.
I’m back sitting on the paper-covered examination table. The room is frigid. This can’t be conducive to good health. Maybe it prevents germs from multiplying on the room’s surfaces. I work with that hypothesis for a while.
The nurse checks my vitals. I’ve lost a little weight, which I didn’t have much of to lose. The nurse says the doctor will be in shortly. The doctor’s version of shortly and mine don’t align.
I shift my butt back and forth to make the paper crinkle.
Whenever I visit the doctor, I’m an imposter. I can’t be sufficiently sick to justify taking up her time. Especially today, with no particular pain. What am I doing here? Every doctor’s visit is an existential crisis.
The doctor comes in and introduces herself. I was here less than a month ago. She squirts antibacterial goop onto her hands and rubs it in. I notice how dry her hands are, how notably older they look than the rest of her.
She reads one page of my chart, turns to the next page, and then flips back to the first.
“How are the migraines?” she asks.
“They kinda suck,” I say.
She smiles. I keep amusing people today.
“How often are they coming on?”
“Two or three times a week,” I say. “And one always feels ready to pop up.”
She jots a note on the chart. “And are you still treating them with ibuprofen?”
“Yeah. If I take it immediately, it can help stop the pain from escalating.”
She nods and jots.
“Have you been keeping a migraine diary?”
“Of a sort.”
“Have you noticed any patterns to your headaches? Any activities that might be triggering them?”
“It seems like every activity might be triggering them.”
She nods and jots. She sets the chart on the counter.
“I guess the news is both good and bad. You’ve found a treatment that’s helping you cope with migraines. Because of that, and because you’re having fewer than fifteen a month, my recommendation is to continue using ibuprofen at the first sign of migraine or as soon as possible after that. However, you need to make sure you don’t take too much. If you start taking it daily, it can actually have the opposite effect.”
“Got it,” I say. “Take ibuprofen, but not too much.”
“And keep up with the diary. You never know when a pattern might emerge. We don’t know exactly what’s happening with migraines, but there are patterns. Knowing those can help us treat them. Anything else?”
“I guess not.”
I can’t believe I’m about to pay a doctor to tell me keep on truckin’.
The doctor leaves and later the nurse directs me back to the front desk. I make a wrong turn. The office is a maze of similar rooms and fluorescent lights. Lost patients wander the halls for years.
I find myself by an emergency exit. There’s a coat rack in the corner, so I guess the exit isn’t only for emergencies. I snatch a white doctor coat from the rack and drape it over my arm. I check out. The receptionist doesn’t mention the coat. I guess that means it’s mine.
Outside, I stand in the sun. My office is directly across the street. The broadcast tower is a backlit lattice. I could go in and finish a couple edits this afternoon, but I already took sick leave. I turn around and head to Forsyth Park. I text Dolores to meet me by the fountain.
Steady pedestrian traffic streams through the wide walkway bisecting the length of the park. Mostly tourists. They circle the fountain like a roundabout. Pausing for photos, posing in front of the statues of water-spitting geese.
I select a spot of shade and put on the white coat. I angle myself into the breeze so the coat flutters around me.
Dolores comes up from behind and says, “Doctor?”
That’s as far as she’ll acknowledge the coat. A person living with KJ had to tolerate mischief.
It’s significantly springtime today. Too hot for the coat. We walk south past the cafe and the playground. In the open fields art school kids play a pick-up game of Ultimate.
Dolores asks what the doctor had to say.
“She told me that my headaches aren’t bad enough for additional treatment.”
“They seem pretty bad to me,” says Dolores.
“I’m not arguing with you.”
“But the doctor isn’t worried?”
She evens her voice, but I see the concern on her face.
“This is a textbook case,” I say.
“There’s a book?”
Two of the Frisbee kids run into each other full steam. Their bodies produce an audible thump. They get up and dust off and seem okay, but I hasten our pace before somebody calls for a doctor. What a disappointment I’d be to them.
We step out of the shade of an oak tree. Dolores inspects my head where the bro punched it.
“The bruise is gone,” she says.
But we both know that’s not how bruises work.
Zach Powers is the author of the novel The Migraine Diaries (JackLeg 2026), the novel First Cosmic Velocity, and the story collection Gravity Changes. He serves as Executive & Artistic
Director for The Writer’s Center and Poet Lore. Originally from Savannah, Georgia, he now lives in Arlington, Virginia.