Reading Through the History of Migraines

Migraines are a debilitating condition that can often be overlooked by society, or hidden by sufferers for fear of stigmatisation. Hardly surprising when migraines can be thought of as “just a bad headache” by the unenlightened. Migraines can also be seen by some as a problem of the modern age; we now have such busy and stressful lives that stress migraines are a by-product of that. This despite the fact that it has been proven that migraines can be a result of brain chemical imbalances, neurotransmitter problems, hormonal changes, and also genetics; and so they must have been in existence long before our 24-hour society. Hormones and genes are not a modern invention.

Reading a book

This “modern problem” idea is partly because we just don’t hear about historical migraines. In school we’re taught about the damage smallpox and tuberculosis did to society, but there’s no big mention of the impact migraine had, despite the fact that some hugely important historical figures suffered from migraines and had to fight against migraine attacks in order to make their amazing achievements. Thomas Jefferson is one sufferer who had to struggle through his attacks. He did so while trying to find a permanent home for the White House while he was acting as First Secretary of State for George Washington, and while toiling to develop the new system of measures and weights that America would use within its new independent nation. To name only a couple of other key historical figures, Napoleon Bonaparte and Charles Darwin are also thought to have been migraine sufferers. So while migraines may be seen as a modern issue, actually migraines are as old as civilisation itself, and if you look through enough old texts there are plenty of references made to them.

One of the first mentions of migraine in writing dates back to 1200 B.C. when the Ancient Egyptians noted down descriptions of migraine in their medical documents. Though before this, skulls from over 9,000 years ago show evidence of trepanation (the drilling of holes in the head to allow evil spirits to escape), and this is generally accepted as being an early response to migraines and headaches. Cave paintings, although not writing as such, back up this hypothesis.

The next milestone for migraine in writing was in 400 B.C., when the famous Greek physician Hipprocrates (from whom we get the origin of the Hippocratic oath) wrote about the visual disturbances of aura which can precede a migraine; flashing lights or blurred vision. He also described the relief which sufferers can feel after vomiting.

Then a good while later we travel from Egypt and Greece and come to Persia to find our next big migraine mention. In the 9th century, Avicenna, an Islamic philosopher, also wrote about migraines being a serious medical condition. In his medical textbook “El Qanoon fel teb” (also known under the title of The Canon of Medicine) he writes about eating, drinking, noise and light all worsening migraine pain. He wrote that these patients needed to be left to rest in a dark room until the attack had passed. Around the same time another Persian philosopher and physician named Abu Bakr Muhammad Ibn Zakariya Razi, known in the West as Rhazes, made a link between migraine and hormone changes when he wrote that women could often experience migraines following childbirth, during the menopause, or during painful menstruation.

Fast forward through a few more centuries and in the 12th century text “Causae et Curae” (which has been generally accepted as being written by the German abbess Hildegard of Bingen who we have to thank for many medicinal, botanical and theological texts which are still being explored by scholars today) there is a wonderful explanation of why migraine only affects one half of the brain at a time. Although not medically accurate migraine sufferers today will appreciate the idea. She proposed that migraine was a force so powerful that if it was to take hold of the whole head at once the pain would simply be unbearable.

Then, going from this conclusion to observations from case notes, not long after Hildegard’s supposition you can find a particularly accurate description of migraine in a 13th century encyclopaedia which was compiled by a Franciscan monk named Bartholomaeus Anglicus. He describes migraine like this; “It feels as if there is hammering and pounding in the head. Sound or talking is unbearable, as is light or glare. The pain arises from hot, choleric fumes, together with windiness. And so one feels piercing, burning and ringing.” While the cause being attributed to choleric fumes isn’t right, the description of migraine certainly matches up to modern ideas.

As writing and publishing became easier to do and not just an activity for the likes of monastic scholars, more and more instances of migraine appear in writing. There are far too many to contain them all in one article, but suffice to say that there are some which helped to advance the understanding of migraine more than others. One of these key texts was published in London in 1712; the “Bibliotheca Anatomica, Medic, Chirurgica”. It described five major types of headache, including the megrim which is recognised today as that of classic migraine with aura. And, one other key text has to be the paper published in 1938 by Graham and Wolff. Their paper, advocating ergotamine tart to relieve migraines, went into detail about the pain-inducing effect of dilation of the brain’s blood vessels. It also began the vascular theory of migraine and helped to develop the study of migraines.

So, given all of these references through history, it’s clear that migraine has been around and making its presence felt for a while!

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