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Sam is twenty-one when it first hits him.
Later, he’ll learn that they say it tends to come after a virus, but Sam has no memory of being sick, just of waking up one day with a splitting headache that never again goes away. He knows the exact date, the exact hour when it started.
He puts up with it silently, then turns to over the counter medication. Eventually, Jess notices, and gets the truth out of him. Four weeks of headaches makes her panic, so he makes an appointment with a doctor just to ease her worry.
After that, it’s blood tests, and a dental exam, an eye exam, an ear, nose, and throat exam. His sinuses are checked. His neck and spine are examined. When all simple things are ruled out, even Sam is starting to panic a little bit. He has student insurance but not everything is covered and bills are starting to stack up. Ten weeks with a non-stop headache varying from mild but present to head-splitting excruciating pain are not normal. And Jess’ panic hasn’t abated.
The night before his first appointment with a neurologist—three and a half months after the headache began, and he’s been told he’s lucky to get an appointment so fast—Jess holds him through the night, stroking his back, keeping their bedroom absolutely silent as Sam rides out the waves of pain. He sleeps a bit, fitfully, trying not to disturb Jess through the night.
He sees the neurologist, who wants more blood work and an MRI. At least the MRI is good news, something to offer Jess and ease her worries a little bit. Sam doesn’t have a brain tumor.
At that point they become convinced that the headache is the problem, not a symptom. They haven’t gotten anywhere, really, but Sam figures it’s good to know he’s not dying of any invisible disease hiding in his body.
They run through chronic headache disorders, but Sam really doesn’t meet the criteria for any of them. It’s not migraines, not a tension headache, not a cluster headache. They call it a migraine anyway and give him a prescription.
Sam fills it. It’s meant to be taken as needed. It takes him months to work out what “as needed” means. It’s hard, to negotiate when the pain is severe enough to justify a drug, especially because the pain is always there. He feels like he’s being judged, like there’s criteria for taking it or not and he’s breaking some rule, somewhere.
It works mediocrely while he has it, but he doesn’t bother to refill it when he runs out. It’s too expensive and doesn’t do much more than the Tylenol, to be honest. He never goes back to the neurologist, either, and decides, now that he knows he’s not dying, he’ll hack this alone. He’ll just have to figure it out.
He becomes good at hiding it, until the only person who can tell is Jess, and only on the bad days. He goes to class, goes to work, helps out around the house, is there for Jess and never slows down his friends any. He makes it work.
There are days where he just wants to lie in a hole somewhere, curl up and pray for it to recede once more. Other people complaining about headaches makes him alternate between gritting his teeth and wanting to laugh. He learns to work with the constant pain.
He’s had his headache fifteen months when Dean shows up one night.
Thankfully, he’s had a good week, so there’s not much for Dean to notice. But the stress of hearing about Dad and seeing his brother and being dragged away from college and back to hunting builds behind his eyes, and Sam wants to shout. The headache an get bad all on its own, without Sam doing a single thing, but stress and so many other little things can certainly help it along. It’s all about balance, Sam’s discovered, keeping his body in balance and keeping it all in as much control as possible. And the last thing hunting is, is balanced.
Jess dies and Sam grieves, the nightmares and sleepless nights and grief and stress and lack of apatite and depression setting off a whole new round of headaches. Dean thinks Sam is grieving, and he is, but he’s also trying to get back on his feet, bent double in pain.
He finally levels out, and it’s back to a life of hunting that Sam has to adapt to suit him best he can. Salads are a good start, the nutrients his body needs, a meal it’s used to, something it will almost always tolerate. He adds a certain amount of physical activity in, too. He doesn’t know what to do about his sleep, or his stress, or the pit inside of him that seems to just make it all worse.
He doesn’t tell Dean. There’s nothing to tell. He deals with it, just keeps dealing with it. Dean thinks he gets migraines, calls him a nerd and tells him to read less and leaves him alone for a few hours, on the rare occasions where it’s so much even Sam can’t hide it anymore.
The headaches that come with being psychic are completely different, more like the cluster headaches the neurologist explained to him so long ago, bouts of stabbing pain behind his eyes. The double layering—the stabbing on top of the ever-present throbbing ache—makes him dizzy and makes it impossible to focus on anything at all other than how much pain he’s in.
When Dean is in hell, there’s the hunt, and Ruby, and the bood, and his always-present, loyal headache at his side. Demon blood makes it abate for a few minutes, fade down to an almost unnoticeable level but it never disappears entirely. Still, he remembers being unable to move with the pain of it all, and Ruby tenderly dripping blood into his mouth and him lapping it up, knowing the sweet—if temporary—relief it offers.
It’s worse the entire year leading up to stopping the Apocalypse. Of course it is. He’s not sleeping, and he’s more stressed than he’s ever been in his life. It’s his own fault, adding complications to the already growing fire, making everything worse. But, he figures, he deserves it. It’s just a taste of what he deserves, really.
Even soulless, Sam gets headaches. He doesn’t get them in hell, but then again, the only thing he gets in hell is what Lucifer and Michael give him, and even the painful familiarity of his headache seems too much to ask for.
There’s a wall in his mind, dividing it, and then it falls and Sam’s seeing hallucinations and for once, his headache is far from the worst thing his brain is doing to him. Lack of sleep turns the headache into a brutal punishment, and by the time he’s hospitalized, he thinks falling asleep and never waking up—never seeing Lucifer, never feeling his headache again—would be the best possible conclusion.
Dean sees him sleep more and grow weak and cough up blood during the Trials. What he doesn’t know is the headache reaches consistently high new heights, his new normal completely jacked from what it was before. Some days, he can barely see, for all the pain.
Gadreel heals a lot in Sam, but it doesn’t take a genius to see he leaves Sam’s mind alone. Sam hates Gadreel ever being inside of him, hates what Gadreel did with his body and hates how Dean and Gadreel conspired to let Gadreel in. He hates himself for thinking it, but some days he hates Gadreel for promising Dean he’d fix Sam and leaving behind the headache, strong and damning as ever.
Hunting down his brother and, later, hunting down information about the Mark of Cain is incredibly difficult. He wonders if his headache really used to go as almost-quiet if he remembers, or if he’s romanticizing the past. Whatever it once did, it certainly doesn’t anymore. But he has something to focus on, something to do, so he keeps pushing forward.
Sam is thirty-one when he’s looking around on the internet one day and discovers there’s now a word for what he has. A word, a diagnosis, even if it’s one neurologists still seem to be arguing over. He reads the lists and the articles and decides that, even if it isn’t perfect, it’s closer than anything he’s heard before. Daily persistent headache. The name is enough to convince him.
Of course, he keeps reading, only to be disappointed. There’s no discovered cures, or even treatments. There’s lists of things that might work, everything from out there cures to homeopathic remedies to drugs like the one he took so many years ago. Nothing guaranteed, nothing people can agree on, nothing that offers surefire success. Nothing, in short, that will help him.
Because it’s a chronic condition. Because it’s been there for decade now and it will be there until the day he dies, whenever that may be. He’s been well used to that fact, and knowing there’re words for what’s wrong with his brain shouldn’t change that.
He closes the computer and shakes his head. What a waste of a half hour. Meanwhile, there’s actual work to be done. Research to be done, a primitive skin marking associated with murder to be erased. He pushes past the lingering—and growing—pain in his head and gets to work.