20 years ago:

A history of migraine

Dr Dorothy J Cooper produced this 9-page article from notes for a paper read at the Bristol Symposium in 1983. As early as 1398, John de Trevisa spoke of ‘My̆grāme and other evil passions of the head’. A Chronicle of 1420, in Middle English stated ‘A fervent my̆grēyn was in the right side of her head’. By the 16th century the form was mēgrym. The earliest traceable medical description was in a translation of the works of the famous 16th century surgeon Ambroise Paré in 1634 ‘The mēgrim is properly a disease affecting the one side of the head right or left’. The use of the adverb ‘properly’ suggests a scientific response to the developing lay use of the word: ‘vertigo’ (1595); ‘whim, fancy, fad’ (1593); ‘blue devils, low spirits, vapours’ (1633).

The first recorded use of the word ‘migraine’ was by Horace Walpole in 1777, referring to a Madam de Jernac. In 1837 the word is used about a Baroness Burson … there is an implication of high social status. In the 18th and 19th centuries it was seen as ‘the vapours’, ie depression, spleen, hypochondria, hysterics. By the late 19th century there was much discussion about migraine, and considerable interest; on the one hand attempts to delineate it more accurately, and on the other to support the theory of its neurotic origins. For example, one of Dr Douglas Morgan's treatments was ‘a cup of strong tea taken at the onset’ (might the active ingredient here have been the sugar in it?). In 1899, Volume VIII of Allbutt's System of Medicine refers to ‘ophthalmic migraine, ie paroxysmal pain in the eye or temple’, and states ‘attacks of megrim are often accompanied by contraction of the temporal artery’, using both forms of the word!

In 1941, Price's Textbook of Medicine devoted 3 pages to the subject, while a later edition in 1978 added a further 1 pages to migraine variants. However, Dr Cooper found little basic development in advice for treatment from 1935 to 1983. The Medical Annual of 1972, referring to the sickness absence statistics for large industries, noted that migraine was seldom mentioned as a cause. They commented that migraine had often been regarded as an excuse for malingering, and stated ‘However, attitudes to this disabling infirmity are changing and migraine has become recognised as a serious problem. At last, active efforts are being made, particularly in this country, by the medical profession to define, diagnose, and cure it.’ The 1976 Annual confirmed this decision when a fresh problem arose: ‘There seems now no doubt that taking oral contraceptives does have an effect on the pattern of migraine.’

There seems to be a similar lack in homeopathic literature. Richard Hughes, in his Manual of Therapeutics (1877), defined migraine as ‘that form of sick headache which is primarily cerebral and where vomiting is only secondary and sympathetic’, and ‘it recurs periodically’. He recommended seven remedies. Then in 1923, G L Royal, in his Homoeopathic Practice of Medicine, devoted 5 pages to the subject. He listed 14 remedies in order of importance. Only Belladonna was common to both lists. Dr Cooper searched the BHJ from 1953 to 1982 and found only two references; S J Mount's (1973) ‘On the genesis, nature and control of migraine—with particular reference to bowel nosodes’, and a 1957 article by Frank Bodman. Dr Cooper found the latter most interesting in contrasting the typical English patient with the typical American one. She also noted that in five physicians lists (dating from 1877 to 1981) of most effective remedies for migraine or acute headaches, there was no remedy common to all, and only two (Belladonna and Sanguinaria) common to four. This confirms that migraine is one of the best examples of the need to find the similimum.