The myth of trepanning for migraine, and how it started.

This is an article I wrote for The Conversation UK in response to a question that I have often been asked when I’ve talked about my book project, and after a hunt through the literature for the origins of this common story (original post here).

Trepanation is the technique of removing bone from the skull by scraping, sawing, drilling or chiselling, and it is often stated to be one of the most ancient treatments for migraine.

The word trepanation comes from the Greek trypanon, meaning a borer. The earliest known trepanned skulls date from around 10,000 BCE, and come from North Africa. There are trepanation accounts in the Hippocratic texts (5th century BCE), when it was used in cases of fracture, epilepsy or paralysis, and in the second century CE Galen wrote of his experiments with trepanation on animals in his clinical studies.

But the reasons for trepanning remain largely unknown. While the famous 17th-century physician William Harvey may have suggested that the procedure was used for migraines, recent authors have acknowledged that there is little evidence to suggest this. So where did this persistent idea come from?

Migraines and fairies

Inca skull showing trepanning. © Wellcome Collection

The real source of the myth seems to have come much later. In 1902, the Journal of Mental Science published a lecture by Sir Thomas Lauder Brunton, a London physician well-known for his work on pharmacology and ideas about migraine pathology. The lecture mixed neurological theory and armchair anthropology, and ranged over subjects including premonitions, telepathy, hypnotism, hallucinations, and epileptic and migrainous aura. In one notable passage, Brunton proposed that visions of fairies and the sound of their jingling bells were “nothing more” than the zigzags of migraine aura, and the aural results of nerve centre stimulation.

Brunton proposed that openings bored into ancient Stone Age skulls during life had been made to cure migraine. His suggestion followed considerable excitement during the 1870s when the French physician and anthropologist Paul Broca claimed that ancient skulls discovered in Peru and France had not only been opened surgically during life in order to release evil spirits, but that the patients had survived. To Brunton, it seemed obvious that the holes would have been made at the request of migraine sufferers in order to “let the headache out”. He wrote:

For when the pain of headache becomes almost unbearably severe, an instinctive desire sometimes arises either to strike the place violently in the hope of relieving the pain, or to wish that some operation could be done to remove the pain.

The French surgeon Just Lucas-Champonnière had claimed in 1878 that some South Sea islanders still performed a similar procedure but, essentially, Brunton’s ideas about trepanning were as imaginative as his thoughts on fairies.

Nevertheless, the theory gained traction. In 1913, the world-famous American physician William Osler repeated that trepanation operations had been used “for epilepsy, infantile convulsions, headache and various cerebral diseases believed to be caused by confined demons”. By 1931, T Wilson Parry (who was partial to the odd experiment of his own) reasoned in The Lancet that as the large numbers of trepanned skulls found throughout France could not all be accounted for by epilepsy, the procedure must also have been used to cast out “other devils”. He proposed that this included disorders with “exasperating” head symptoms such as migraine, giddiness, “and distracting noises of the head”.

A ‘burr hole’

If Victorian theories about ancient trepanation for migraine were largely speculative, there is evidence of cutting holes in skulls for migraine somewhat closer to home. In 1936, Alfred Goltman, a physician from Tennessee, observed something strange about a woman with migraine that he was treating for allergies.

In the left frontal region of her skull, the woman had a depression, an inch in diameter, with a marked concentration of blood vessels. Four years earlier, she had been admitted to the care of Dr Raphael Eustace Semmes, the first neurosurgeon in Memphis, who had trained under Harvey Cushing, the American “father” of modern neurosurgery. Semmes had drilled a small circular opening known as a “burr hole” during one of the woman’s severe headaches, while she was under local anaesthetic. As he opened the thick membrane surrounding the brain, “a quantity of fluid escaped under increased pressure”. There was no evidence of a tumour.

This now seems a troubling era in experimental interventionist neurosurgery. Between the 1890s and the 1920s, some surgeons believed that brain surgery could “cure” inherited criminal tendencies. Children referred by juvenile courts were operated on in an attempt to release “pressure on the brain”, a procedure with a mortality rate of up to 42%. By the 1930s, frontal lobotomy was emerging as a treatment for mental illness.

Semmes’ patient survived the surgery, but her migraine headaches did not stop. Goltman noticed that during her headaches the depression left by the surgery began to fill up. As the migraine attack ended, the swelling would recede. Goltman’s observations helped influence the widespread acceptance of a theory that would dominate understanding of migraine until the 1970s: that the origin of migraine headache must be vascular, characterised by dilation of the blood vessels during the attack.

While we now see migraine as neurological, much still remains to be discovered about its causes and mechanisms in the brain. In some ways, trepanning does seem a logical response to the intense pain of migraine. As Andrew Levy notes in his memoir: “The migraining head wants to be cut open; it longs to be cut open.” This does not, of course, mean that it should be.

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A Book! And what to do with 1998?

I’m looking at the last date I posted on this blog and wondering what has happened in the last 16 months… In short, I’ve had a (second) baby, taken a year away from work to look after her, moved house (twice), settled my older son in a new school. I’m back at work now, sitting in my makeshift office (it should be the dining room, but we don’t ‘dine’ and it’s got a lovely log fire). So I’ve been writing, and watching the village comings and goings through the window over the top of my laptop screen.

The other thing I’ve done is to agree a contract with Johns Hopkins University Press for my book on a thousand years of migraine’s social, cultural and medical history. All of the things I’ve talked about on this blog will be in it. Thanks to funding from the fabulous Wellcome Trust, it will also be available Open Access – meaning it will be free to download for anyone who’d like to read it. I’m so excited to bring seven years of research together.

And I now have a computer (and several backup drives) full of draft chapters.

But there’s some bits of this history that I still don’t know what to do with. At the moment, it is two pieces of evidence from 1998 that I’m wondering about.

First, ‘Serotonin’. This was an album track from ‘Six’, the second album from English alternative rock band Mansunreleased in the UK in 1998. It opens with the lines:

My migraine makes me ill

My electricity is low.

‘Serotonin’ was hardly Mansun’s best-known tune, but it fit right in with the tone of an album variously greeted as weird, hallucinogenic, baffling, or endearingly flawed. No-one really seemed to know what to make of it, but the fans (including me, then aged 17) thought it was great. I still do.

And I drop and I drop

And my body levels drop

And my nerves clogging up

Sucking all the substance up

Mansun certainly got something about migraine right – the chemistry, the sense of falling, the clogged nerves. But Paul Draper, the lead singer, has never given much away about what inspired the track.

Then we have a Swatch watch. GK275. What was the designer thinking?

Swatch GK275 (1998)

A clear/white plastic watch, with a line of blurry black and grey circular holograms on the plastic strap, a jagged black star shape in two layers that changed shape at different angles, the top layer partially obscuring the movement of the hands. (I’m curious about how the holograms move, so I’ve just bought one of these watches from Ebay. As research, obviously.)

Swatch were producing some pretty surreal objects at this point, incorporating photography and holographic designs of explosions, bubblegum, teddies, pigs, snails. In 1997, the Ticking Brain watch featured a cranial cutaway revealing the movement within, with a vein and artery for hands. But if anything, after looking at some of the entries to the Migraine art competitions it is the watch covered in images of eyes, just staring, that feels more migrainous.

These things feel important – the 1990s was the decade that triptans transformed the lives of millions of people with migraine after all – but do they tell us anything more than that migraine had got into our heads? Or is it enough to realise that migraine – and some of its neuroscience – had entered the cultural subconscious?

 

 

 

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Migraines were taken more seriously in medieval times – where did we go wrong?

This is a piece I wrote for The Conversation (08/09/2016) and which was subsequently republished in the Independent (17/09/2016). It is reproduced here under the terms of the Creative Commons Attribution No Derivatives license.

Katherine Foxhall, University of Leicester

Have you ever experienced a migraine? If so, perhaps you recognise 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.

Such a precise explanation of the pain and disorientation experienced during a migraine might have been written yesterday. In fact, it comes from an encyclopedia, compiled by the Franciscan monk Bartholomaeus Anglicus (Bartholomew the Englishman), in the 13th century.

There aren’t many ailments that have maintained so clear a course over so many centuries. And what’s more, looking at the history of migraines reveals that the ailment was actually taken more seriously in the past, something we can learn a lot from today.

Hemicrania deciphered

We can pinpoint the beginning of the history of migraine as a named disorder to Galen (c. 129 – c. 216/17 CE), the most famous philosopher and physician in the Roman Empire. Galen set migraine, or hemicrania as he termed it, apart from other types of headache: as a painful disorder affecting only half the head, caused by the ascent of vapours from the stomach that were excessive, too hot, or too cold.

The 12th-century text of Causae et Curae, which scholars generally accept as the work of the the celebrated German abbess Hildegard of Bingen (1098-1179), gave a compelling explanation of why migraine seized only half the brain at a time: this was a bodily force so powerful, that if it seized the whole head, the pain would be unendurable.

An 18th-century portrait of Galen.

Although Galen’s writings were lost with the fall of the Roman Empire, Galen’s term, hemicrania, persisted, being adapted and adopted into various languages over the centuries. For example, in Middle English, we find emigranea and in medieval Wales the term migran. William Dunbar, writing in Middle Scots, used the term magryme in his poem describing the physical pain of migraine as being like an arrow piercing his brow, a pain so bad that he couldn’t look at the light. Dunbar also captured the migraine aftermath, the “postdrome” that came with the new morning, when he sat down to write but was unable to find any words. His head “dulled in dullness”, his body was unrefreshed, his spirit asleep.

Throughout the 16th and 17th centuries, a wealth of remedies in manuscript and printed recipe collections suggest a sophisticated general knowledge about this disorder. For example, Jane Jackson’s recipe book, dating from 1642, gives six separate recipes for “Migrim in the Head”, requiring various amounts of effort to produce. The simpler remedies could be made in a few minutes from common garden ingredients (mix houseleek and earthworms with flour, spread it on a cloth and bind to the forehead), but the most complex concoction required equipment, planning and financial outlay to produce a medicine that would last 20 years.

As well as taking migraine seriously, Jackson’s recipe book suggests that people of the 17th century appreciated that migraine could occur on a spectrum, from the occasional acute attack to a chronic illness that could last for several days.

Losing legitimacy

These historical descriptions of migraine reveal that we have lost something. In all of the sources from the medieval and early modern period that I have come across during the five years I have spent tracing the history of migraine, one thing is clear: these people took migraine seriously.

This is important. Migraine is now accepted as a “real” disorder which affects around one in seven people, two-thirds of whom are women, and is recognised by the WHO as the sixth highest cause worldwide of years lost due to disability (YLD). But despite this, it (along with other headache disorders) is nevertheless chronically under-funded, its sufferers often ignored, dismissed or blamed, and their ailments under-diagnosed and under-treated. In her recent book Not Tonight, the sociologist Joanna Kempner has described this situation as migraine’s “legitimacy deficit”.

So what has happened? Historical sources suggest that the question we need to ask is not how we can begin to give migraine the legitimacy it needs, but when and why we stopped taking it seriously in the first place.

‘La migraine’, 1823.

Over the course of the 18th century, something changed, as migraine became the stuff of ridicule. In May 1782, for instance, a flamboyant character graced the King’s Theatre Masquerade in London, and introduced himself to the gathering as “Le Sieur Francois de Migraine, Docteur en Medicine”. And in the summer heat of August 1787, the General Evening Post described how “half Paris had the migraine, and no lady of fashion could be prevailed upon to quit her boudoir”. Migraine was becoming something to joke about, a complaint that affected a particular kind of person, usually female.

By the 19th century, physicians routinely talked
of young female “martyrs”, and of sick headache and megrim as a disorder of “mothers in the lower classes of life” whose minds and bodies had been weakened by daily toil, disturbed sleep, insufficient nourishment and constant lactation.

Ring any bells?
Migraine Action

During the 1980s, many migraine sufferers took the opportunity to share their experiences of migraine by entering four international art competitions. The resulting collection, which includes over 500 pieces, reveals the powerful effect migraine has on people’s lives. Perhaps most striking is the frequency with which motifs such as arrows, hammering, pounding, light, glare and disorientation appear in this art – seemingly as familiar to sufferers today as they were to the medieval poets and physicians who discussed this disorder nearly 1,000 years ago.

For the first time, this collection is the subject of a dedicated website, which has now been launched by the charity Migraine Action as part of Migraine Awareness Week.

These paintings, backing up a thousand years of historical sources, make it clear that migraine is more than just a headache. It needs to be taken as seriously now as it was by Galen.

The Conversation

Katherine Foxhall, Lecturer in History, University of Leicester

This article was originally published on The Conversation. Read the original article.

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Making the Migraine Art Collection Public

Migraine Action is the national advisory and support charity for people affected by migraine, and is based just down the road from me in Leicester, UK. It provides support to individuals, families, businesses, medical professionals and support workers, with the aim to help sufferers to take control of their migraine and reduce its impact in their home life and in the workplace.

Migraine Action also holds a remarkable archive of around 550 original pieces of artwork which were produced by members of the public for four Migraine Art Competitions held between 1980 and 1987. Entrants were invited to illustrate their own impressions of visual disturbance or the effect migraine has on their everyday lives. The collection represents the work of around 450 artists, of whom three-quarters were women, and one in ten were children aged 16 and under.

Child detail

Detail of a Child’s Drawing. Reproduced with permission of Migraine Action.

Since the beginning of my project, I have wanted to include the art collection as a chapter in my book. While neurologists have considered the depictions of aura in these works to be useful in understanding something about the mechanisms of migraine, they have also dismissed the significance of the depictions of pain and lived experience. This seems wrong to me. Individually and collectively the artworks in the collection provide a vivid insight into life with pain and illness. Aesthetically many pieces of work – the hairstyles, the airbrushing, the net curtains, the cultural references – are very much a product of the 1980s, but the concerns represented by these artists often appear to be timeless. Depictions of daggers, hammers, flashing lights, pulsing veins, flames, social isolation, are as relevant now, as they were to the people who talked of migraine in the fifteenth or seventeenth centuries. But it is the images by children that I found most moving, and difficult to look at. I often wonder how a parent must have felt, after urging their child to draw a picture for the competition, but then having to see the results – their child’s view of pain, isolation and unhappiness.

As I have been working in the Migraine Action offices on my research, we have often wondered about how we could make this important collection more accessible to the public. The opportunity came earlier this year, when we successfully bid for funding from the University of Leicester REF Impact Development Fund, which aims to help researchers develop the public impact of their work.

The grant we were awarded has enabled us to employ a Research Assistant to catalogue and scan the collection, and to commission the Leicester-based social-enterprise design and communications agency We Are Epic to create a website which will give free public access to the entire collection.

The project began in earnest in early March, and the first task for Dr Steve Ling, our ReseAura detail 2Aura detail 3arch Associate, was to catalogue the entire collection. One of the most important aspects of this cataloguing has been the ‘tagging’ of images with keywords that will transfer to the website as search terms. Steve is now well into the high-resolution scanning. Seeing these images at such a large scale on the screen is wonderful, revealing the detail of every brushstroke and pen line.

Migraine detailMeanwhile, We Are Epic have been working hard on the website design. I am so excited about the ways that people will be able to search for images by theme and keyword. The website will be completed over the summer, and we hope to launch during Migraine Awareness week in September.

The historian’s research process is a long one, and it can be years before our results appear in print. This project has happened fast. It’s been so exciting to work with such an enthusiastic team on something that has such a clear and simple purpose. I can’t wait to share it with you all. More soon!

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Finding the Patients in the Notes.

It seems a long time since my summer immersed in the strange world of Anglo-Saxon and medieval medicine, and maintaining momentum on my research project is proving tricky halfway through a full semester of teaching mainly colonial history. Nevertheless, I’ve been spending a few days in the lovely Queen Square Library, home to UCL’s Institute of Neurology Library and the archival collections for the National Hospital for Neurology and Neurosurgery, originally the National Hospital for Paralysed and Epileptic when it first opened in 1860.

National Hospitals for the Paralysed and Epilectic.

The National Hospital for the Paralysed and Epilectic (from Building News, 1884) Courtesy of Wellcome Library, London.

The archives are home to the case notes of the physicians who worked at the National Hospital, a collection of approximately 1500 bound volumes dating from 1863-1946.

Although John Hughlings Jackson, William Gowers and their colleagues at the London Hospital must have often encountered patients with migraines, particularly when illness affected a patient’s ability to work, case notes specifically diagnosing migraine are relatively few among the volumes that discuss inpatient cases. It is clear, however, that patients who presented with migraine – particularly those who experienced distortions of vision – were of particular interest to Hughlings Jackson because their experiences offered insight into the relationship between the two sides of the brain. Migraine was one variation of a whole series of disorders that he believed could be caused by lesions in different parts of the brain. In his lectures and writings, Hughlings Jackson often used migraine as a footnote to illustrate a complex argument he was making with regard to epilepsy.

But medical casenotes are about more than the history of biomedicine. At particular moments of strain, they transcribe and immortalise ordinary people’s accounts, and their efforts to deal with, and understand the reasons for their illness. These are accounts of the everyday world which are usually left unrecorded.

A sixteen year old girl recounted her childhood; although she was always well-fed and clothed, her family had lived in a ‘very unhealthy’ house, draughty and damp, where the drains emptied straight into a stream. The girl said that she had sickness and pains in the head ever since she could remember. These had worsened when she started school, and increased again since she learnt to read.

One female patient explained that her pain was worse on the right side than the left. It often commenced with a flushing of her face and head, and she experienced noises in her head and ears that she described “like an engine letting off steam”.

Pulvermacher galvanic belts.

Pulvermacher galvanic belts. Credit: Wellcome Library, London.

Another woman described her attempts at self-treatment: “Has tried all kinds of diets, starving herself & lived once on toast & water for a month, but no good; taken patent medicines and tried Pulvermacher’s [galvanic belt] and other appliances but no good. Taken chlorodyne.”

Dr Gowers’ notes record the case of a 54 year-old deaf cab driver. After experiencing headaches, vomiting and dimness of sight for twenty years, the attacks had got suddenly worse in 1887, forcing him to give up work. He had been treated by Dr Beevor at Queen’s Square for six months, and his health had improved, but in early 1897 “he again commenced to have daily attacks & he has been laid up ever since”.

These cases are fascinating because they give such personal accounts of the experience of migraine and similar disorders in the nineteenth century. But they are also important because they represent rare institutional records of migraine treatment. These are real cases being treated by the men who were at the forefront of neurological knowledge in the nineteenth century. We know a great deal about these physicians, but very little about the medical practice, and the ordinary people that shaped their ideas.

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Why the Long History?

The heating in my office is back on, the students are returning to the flats next door, and the new academic year is rapidly advancing. Over the last few days I have found myself looking back over my summer of writing and thinking about my project as a whole, as I attempt to gather my thoughts and preserve my ideas, in the knowledge that until at least December, I will have precious little time to dedicate to writing chapters about migraine, as I turn my thoughts to teaching modules about Australia, migration and convicts.

Text page

British Library Royal 12 D XVII (Bald’s Leechbook) f. 7

Even since the beginning of the summer, the scope of my project has expanded far beyond my already stretched comfort-zone. Somewhat to my surprise I found myself spending much of July working on a chapter that begins in the tenth century with four remedies for ‘half’s heads ache’ in Bald’s Leechbook, and ends in the fifteenth century, with William Dunbar’s fantastic poem.

In early September I presented some of my work on migraine to the bi-annual European Association for the History of Medicine and Health conference, on the theme of ‘Cash and Care’. It was in many respects an excellent event – particularly the hospitality of our hosts – but I was shocked at how few papers considered any period before a very modern era, not least given the significance of the ‘medical marketplace’ scholarship over recent years. I began my own paper by talking about Linda Ehrsam Voigts’ work on the fifteenth-century banns of an itinerant medical practitioner, and joked that I had accidentally found myself working on the medieval period.

In the questions, a member of the audience commented that they had never heard of anyone trying to write a thousand year history of an illness before.

There is, perhaps, a reason for that.

And so since then, I have been thinking about this chronology: what am I trying to do? And why has this long time span come to matter so much to me, when many of my colleagues would consider it naively ambitious at best, if not simply impossible? Certainly, I cannot imagine a funding committee would have endorsed such a proposal when I began…

Historians have, of course, long advocated for paying attention to the longue duree. Fernand Braudel famously described events as ‘the ephemera of history’, as ‘surface disturbances, crests of foam that the tides of history carry on their strong backs’ . More recently, in their much-debated History Manifesto, the historians Jo Guldi and David Armitage argued that “historians once told arching stories of scale but, nearly forty years ago, many if not most of them stopped doing so. For two generations, between about 1975 and 2005, they conducted most of their studies on biological time-spans of between five and fifty years, approximating the length of a mature human life”. Guldi and Armitage identify a shift in our historical horizons. They have begun to expand once more, this time with the turn to ‘deep’ history. Medical historians have been among those diving in. In 2011 Monica Green urged historians of health to ‘go deep’ as well as ‘go global’ if we are to compete with the historical insights being produced in fields such as genomics & bioarchaeology.

My scale is not quite that expansive. For me, it is the availability of digitised material that has driven this chronology, sending a project that I had initially conceived as modern in scope, creeping ever further back through the centuries. A stream of highly fragmented, but extremely rich sources, has become navigable through online catalogues, digitisation projects and Google searches. Alongside bread-and-butter archival research, images of glittering medieval and early modern manuscripts – now freely available in high resolution – have repeatedly demanded my attention.

I will write more about the digital challenge soon, suffice to say that I have become acutely aware of the inbuilt distortions inherent to digitization that reinscribe hierarchies of class, race, gender & wealth privilege even while purporting to make archives ‘open to all’. My own project is geographically focused on Britain and Ireland, with glances across the English Channel and Atlantic to France and America. In the few cases where I discuss ‘global’ knowledge, I am aware that these are often ideas that have been appropriated by observers and collectors of the exotic in only the most superficial of ways.

13th century trepanation.

Mediaeval surgeon trepanning. 13th century.

Attempting a project of this chronological scale has proved a real challenge – not least in the amount of reading required to come even to the most basic understanding of any new era. As a colleague pointed out to me as I began to make plans, “You are not Owsei Temkin”. He was referring to Temkin’s magisterial Falling Sickness – his classic study of epilepsy, first published in 1945, which took readers on an odyssey through two millenia from ancient Hippocratic texts to John Hughlings Jackson, the nineteenth century ‘father’ of modern neurology. Temkin’s scholarship is staggering, but there are good reasons for looking at topics such as migraine over a long period, even if our attempts are on a far more modest chronological and intellectual scale than Temkin.

For a start it reveals surprising continuities. In many cases, medieval descriptions of the symptoms of ’emigranea’  as a piercing pain associated often with problems of eyesight seem closer to our own modern understanding of migraine with aura, than do eighteenth-century discussions in which migraine is associated with dizziness, unease, and seems to be – for want of a better word – altogether more fuzzy.

When we stretch out to a thousand years we see also that our current gendered pre-occupations, are far from inevitable – more of a blip, than the status quo. This is not to say that these assumptions are not deeply entrenched or that they will be easy to challenge. Far from it.

Taking the long view seriously, and populating the medieval, early modern, and modern period with a whole variety of people who experience, treat and discuss migraine takes us way beyond the old cliche of trepanation. It puts women back into the story as creators of knowledge, puts men back into the story as sufferers. Far from simply serving to reinforce a modern sense of superiority by highlighting the inadequacies of past knowledge, and the barbarity of practices long since abandoned, a long time span humbles our own knowledge, putting it into historical context. It emphasises the contingent nature of medical understanding, and the fragility of consensus.

Most of all, it is really really fascinating. I can’t wait to pick the chapters up again with a fresh set of eyes, when I get the chance.

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Oliver Sacks and Migraine’s ‘Strange and Riddling Landscapes’

We learnt earlier in the week of the death of the neurologist and prolific author Oliver Sacks. In February Sacks had announced that nine years after being diagnosed with an ocular melanoma, the tumour had spread, and that he now faced death.

There have been many heartfelt tributes to Sacks, who had a rare gift of writing about neurology in a way that appealed to millions. In studies on music, hallucinations, deafness, sleeping sickness, and migraine he mingled history, personal memoir and medical science to ponder the mysteries and marvels of the human brain.

I have only come to Sacks’ work relatively recently. No-one can spend much time on migraine without reading his seminal account, first published in 1970, and revised a number of times since. For Sacks, migraine was a disorder which struck particularly close to home. In 2008, in a blog for the New York Times Sacks talked of how he had experienced migraines, and particularly migraine auras, for most of his life. After experiencing his first aura at the age of 3 or 4, the young Oliver was reassured by his mother, a doctor, who shared her own experiences with her son. Years later, he went on to work in a migraine clinic, where he discovered more people who saw the same patterns that he did. Sacks mused that  perhaps “the geometrical hallucinations of migraine allow us to experience in ourselves not only a universal of neural functioning, but a universal of nature itself”. Such a comment reflected his fascination with the cultural importance – in art, folklore and religion – of neurological quirks, and the creative potential of ‘defects, disorders and disease’.

Sacks’ writings were united by his empathy for patient selfhood, his eye for a good story, and his ability to take meaning and wonder from the real-world lives of the people he encountered during his practice, lives so often assumed to be marred by loss, deficit and inadequacy.

In the revised version of Migraine Sacks added an epilogue in which he wrote:

“For every patient with migraine there is A Long Road, and a Short Cut. The Short Cut is a diagnosis, a pill, a pat on the head. It takes all of five minutes. There is nothing wrong with this. The only thing is – it doesn’t usually work. Hence the necessity, for many patients, to take the Long Road. The Long Road is the road of understanding – an understanding of the heart no less than the mind.”

Sacks certainly received criticism – from other neurologists and disabled people – for his ‘popular’ approach, and for the way he transformed medicine into literature. But the centrality of Sacks’ patients to his writing (Migraine, alone, contains over 80 case histories), and his appreciation for their journeys, sticks with me. As I continue to make my own way through the history of what Sacks’ called migraine’s ‘strange and riddling landscapes’ it is patient stories that I, too, hope will be at the centre of my work.

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On Elizabeth Garrett Anderson

In 1870 Elizabeth Garrett Anderson obtained her M.D. with a thesis on the history of migraine.

I’ve noticed Elizabeth Garrett Anderson popping up in my Twitter feed recently. On 29 September the Royal Society of Medicine in London are hosting ‘A celebration of Elizabeth Garrett Anderson and 150 years of medicine’, to commemorate the 150th anniversary of Elizabeth Garrett becoming a Licentiate of the Worshipful Society of Apothecaries. This made her the first woman in Britain to qualify for inclusion in its Medical Register.

In 1872, Elizabeth Garrett Anderson founded the New Hospital for Women, which was also staffed by women. After her death the purpose-built premises in Euston Road were renamed in her honour. Until 1988 it remained facility run by women, for women. The building is still a prominent feature on Euston Road, now part of the UNISON Centre and housing a gallery commemorating her achievements. Continue reading

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How migraine lost its legitimacy

In May 1782, a flamboyant character graced the King’s Theatre Masquerade in London. Gliding his way past the Venetian sailor, the gentleman in a coat of two different colours, and the usual unremarkable costumes of some eight hundred attendees, the High German Doctor cut a dashing figure. He introduced himself to the gathering as ‘Le Sieur Francois de Migraine, Docteur en Medicine’. Continue reading

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Diagnosing Hildegard of Bingen

‘The Heavenly City’, miniature from Scivias (c.1165), reproduced in Charles Singer (ed.) Studies in the History and Method of Science (Oxford, 1917).

In 1913, more than eight centuries after she died, Hildegard of Bingen got a migraine. During her life she had admitted to long periods of illness, but this was something quite new. Continue reading

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