Speaker 1: Welcome to Stuff You Missed in History Class, a production
Speaker 1: of I Heart Radio. Hello, and welcome to the podcast.
Speaker 1: I'm Tracy V. Wilson and I'm Holly Fry. I have
Speaker 1: a family history of migraine. Um. I remember my grandmother
Speaker 1: talking about what she called her sick headaches. Uh. And
Speaker 1: I know a lot of people outside of my family
Speaker 1: who have migraine as well, and some of them started
Speaker 1: dealing with migraine attacks really quite recently. So I've been
Speaker 1: thinking about doing an episode on the history of migraine
Speaker 1: for a while because of all these different personal connections.
Speaker 1: And then after our recent episode on the Nelson Pill hearings,
Speaker 1: we got a lot of email from listeners who mentioned
Speaker 1: their experiences with migraine, so that moved this topic up
Speaker 1: to the top. As one note, this isn't and can't
Speaker 1: possibly be comprehensive. Have there is just a wealth of
Speaker 1: historical writing about migraine. But I also didn't expand this
Speaker 1: into a two part episode because, at least in terms
Speaker 1: of what's available in English, a lot of that writing
Speaker 1: is really similar. I had a whole lot more quotes
Speaker 1: from historical sources, and I felt like I was reading
Speaker 1: the same thing over and over again, so I paired
Speaker 1: it down a bit. And migraine is really prevalent. According
Speaker 1: to the World Health Organization, it is one of the
Speaker 1: three most prevalent conditions in the world, along with anemia
Speaker 1: and hearing loss. But in spite of that prevalence, migraine
Speaker 1: is widely misunderstood really at every level. One reason is
Speaker 1: that the vast majority of people in the world have
Speaker 1: headaches at some point, so it's easy for people who
Speaker 1: have headaches but not migraine to think of a migraine
Speaker 1: attack as just a headache. I know in my family too,
Speaker 1: it was also like, if it's a bad headache, they
Speaker 1: would just call it a migraine, and that's not accurate. Yes, yes,
Speaker 1: a lot of the historical writing about migraine really does
Speaker 1: focus on the head pain, though the word migraine even
Speaker 1: comes from this. In English, it was originally megram, which
Speaker 1: could also mean vertigo or dizziness, especially if that was
Speaker 1: accompanying a headache. Megram was first used in writing in
Speaker 1: fourteen forty, and it's been spelled so many different ways,
Speaker 1: Like when I looked at the Oxford English Dictionary and
Speaker 1: it had the other versions, and it's like clicked to
Speaker 1: open for more, and it was like eight lines of
Speaker 1: different spellings of this. The first use in writing was
Speaker 1: M y g r E y m E, and there's
Speaker 1: just a whole assortment of spellings that generally combine a
Speaker 1: couple of m's energy with every vowel that exists in English,
Speaker 1: megrim was derived from the Old French word min, and
Speaker 1: that French term and the word for migraine most of
Speaker 1: the Romance languages was derived from the Greek word hemicrania,
Speaker 1: meaning half of the head do's because often, but not always,
Speaker 1: the pain associated with a migraine attack occurs on one
Speaker 1: side of the head. But head pain, which to be clear,
Speaker 1: can be severe and disabling, is really just one piece
Speaker 1: of how migraine is understood today, so to level set
Speaker 1: on that today, a migraine attack is often described as
Speaker 1: a four phase process. The first is the pro dome,
Speaker 1: which can start twenty four hours or more before the
Speaker 1: pain begins, and this can involve changes in a person's mood,
Speaker 1: energy level, perception, or appetite. Some people describe it as
Speaker 1: an early warning sign that an attack is incoming. The
Speaker 1: next phase is the aura, although this doesn't happen in
Speaker 1: every case. About one in five people with migraine have
Speaker 1: migraine with aura, but not necessarily with every attack. The
Speaker 1: aura usually involves visual dis urbances like flashing lights or
Speaker 1: blind spots in a person's vision, often in an arcing,
Speaker 1: zigzagging pattern. In medical terms, these are often called scintillating scatoma,
Speaker 1: visual representations of what people see what their aura can
Speaker 1: look a bit like the patterns used in dazzle camouflage,
Speaker 1: which we've talked about on the show before. Migraine aura
Speaker 1: can also involve strange sensations in the body, like pins
Speaker 1: and needles, or a sense of heaviness, vertigo, or a
Speaker 1: ringing in the ears. If you've ever heard the term
Speaker 1: classic migraine, that came around in the nineteenth century to
Speaker 1: describe migraine with aura, but it's less common in medical
Speaker 1: literature today, and those same nineteenth century terms migraine without
Speaker 1: aura was common migraine. We will get more to the
Speaker 1: reasons behind that later. For people who experience aura, that
Speaker 1: typically starts somewhere between a few minutes and an hour
Speaker 1: before the migraine pain begins the third phase, the headache itself.
Speaker 1: In most people, the headache lasts at least six hours,
Speaker 1: and in some cases it can last for three days
Speaker 1: or even more. This headache is typically severe and throbbing,
Speaker 1: often so acutely painful that it's impossible to sleep or
Speaker 1: it wakes a person up from sleep, and in some cases,
Speaker 1: people can also experience silent migraine, which involves the other
Speaker 1: physiological and visual disturbances associated with migraine, but not pain.
Speaker 1: Sometimes this is mistaken for transient ischamic attacks, also known
Speaker 1: as mini strokes, particularly in older people. Noise and bright
Speaker 1: light can both worsen a migraine attack, and attacks can
Speaker 1: also be accompanied by nausea or vomiting, and some odors
Speaker 1: can make this worse and some people specific smells can
Speaker 1: trigger a migraine attack, and smells are just one possible trigger.
Speaker 1: Others include specific foods, alcohol, drugs, and hormone levels in
Speaker 1: the body, and looting hormone levels connected to the use
Speaker 1: of hormonal contraceptives. This is why some people have a
Speaker 1: migraine attack that coincides with the same phase of their
Speaker 1: menstrual cycle every month. Stress, interrupted sleep, and hunger can
Speaker 1: all trigger migraine attacks as well, and so can caffeine
Speaker 1: or caffeine withdrawal. But in some people caffeine helps relieve
Speaker 1: the symptoms, so this is complicated and it can vary
Speaker 1: a lot from person to person. Beyond what we just
Speaker 1: said here, the fourth phase of a migraine attack is
Speaker 1: known as the post drome, which begins after the headache
Speaker 1: has ended. Although in some people this can bring on
Speaker 1: a sense of euphoria. Often it's marked with muscle aches, fatigue,
Speaker 1: and inability to concentrate, or a sense of just feeling drained.
Speaker 1: Some people call this phase a migraine hangover. So, as
Speaker 1: we said earlier, migraine is extremely prevalent. At least a
Speaker 1: billion people around the world have it, but that number
Speaker 1: might actually be pretty low by some estimates. Migraine goes
Speaker 1: undiagnosed as much as half the time. Symptoms can vary tremendously,
Speaker 1: and in some cases people might not think they're severe
Speaker 1: enough or frequent enough to seek medical treatment. People may
Speaker 1: also avoid seeing a doctor for all kinds of reasons,
Speaker 1: including money, time, fear, and the stigma involved with migraines
Speaker 1: specifically or with seeking medical treatment for pain more generally.
Speaker 1: Research in the US suggests that people experience severe headaches
Speaker 1: at about the same rate regardless of race or ethnicity,
Speaker 1: but white people in the United States are far more
Speaker 1: likely to be diagnosed with migraine than people of any
Speaker 1: other race. There is some data to suggest that this
Speaker 1: isn't about the actual prevalence of migraine, though, but it
Speaker 1: is more connected to a whole set of social and
Speaker 1: economic factors involving medical bias, racism, and access to care.
Speaker 1: Migraine is prevalent in children, and there's not a huge
Speaker 1: difference in its prevalence based on children's sex, but that
Speaker 1: starts to really shift as people reach puberty. In adults,
Speaker 1: migraine is significantly more common among women, including transgender women
Speaker 1: if they're taking estrogen. As many as one in seven
Speaker 1: people have migraine, but as many as one in five women.
Speaker 1: For many years, this disparity in the prevalence of migraine
Speaker 1: has been largely explained by hormonal differences, but there's also
Speaker 1: research that suggests that migraine is not only more prevalent
Speaker 1: but also worse among women, involving more severe pain and
Speaker 1: longer lasting attacks. So it's possible that women are diagnosed
Speaker 1: more often because they're generally more severe attacks make them
Speaker 1: more likely to seek treatment, although this again folds into
Speaker 1: all kinds of expectations and bias related to gender. Like
Speaker 1: there's a lot of research at this point backing up
Speaker 1: the idea that women have a harder time getting accurate diagnoses,
Speaker 1: especially for chronic diseases, and that women's report of pain
Speaker 1: are just not taken seriously. But at the same time,
Speaker 1: at least here in the US, men are generally expected
Speaker 1: to shake it off or tough it out when it
Speaker 1: comes to pain. So exactly what all of these social
Speaker 1: and cultural effects have on the rate of migraine diagnosis
Speaker 1: is again super complicated. Yeah, it also varies across the world.
Speaker 1: If you look at a map of where migraine is
Speaker 1: most prevalent, that's surely complicated. Social and economic factors are
Speaker 1: playing into that in addition to just whether it's more
Speaker 1: prevalent among different groups. So, as we said, this is
Speaker 1: just the basics of migraine. There are other ways that
Speaker 1: migraine can present and other symptoms that people can experience.
Speaker 1: There are also other types of headache and other neurological
Speaker 1: disorders that can have some overlap with migraine. But the
Speaker 1: idea that there are gender disparities related to migraine is
Speaker 1: not new nor is this baggage that's related specifically to
Speaker 1: women's experiences with migraine. A lot of that baggage came
Speaker 1: about during the eighteenth and nineteen centuries, and we're going
Speaker 1: to get into that, but after the break will start
Speaker 1: with migraine in the ancient world and medieval Europe. Some
Speaker 1: sources claim that the oldest evidence were migraine and migraine
Speaker 1: treatments dates back at least nine thousand years, thanks to
Speaker 1: the existence of Trapan's skulls, and that's skulls that have
Speaker 1: holes carved or chiseled or drilled through them. Archaeologists have
Speaker 1: found Trapan's skulls in the America's Europe, Africa, Asia, and
Speaker 1: the Polynesian Islands, basically a lot of the inhabited world,
Speaker 1: and in many cases these holes show evidence of healing,
Speaker 1: meaning that this was a surgical procedure performed on a
Speaker 1: living person who survived it. The basic assumption here is
Speaker 1: people were performing trepid nation in the ancient world in
Speaker 1: order to treat or provide relief from migraine. But this
Speaker 1: is actually pretty speculative and it's a pretty recent idea.
Speaker 1: In nineteen o two, Sir Thomas Louder Brunton gave a
Speaker 1: lecture in which he theorized that trepidation had been used
Speaker 1: to treat migraine. Even though he did not have written
Speaker 1: evidence to back this up. People really gloamed onto it,
Speaker 1: and within about a decade people were taking for granted
Speaker 1: not only that he was right, but also that this
Speaker 1: link had been definitively established. Somehow, it really hadn't. Though.
Speaker 1: The earliest surviving written accounts of trepidation are by Hippocrates
Speaker 1: and Galen, and they lived during the fourth century BC
Speaker 1: and the second century CE, respectively. Both wrote about using
Speaker 1: trepan nation to treat head injuries, and Galen also wrote
Speaker 1: about using it to treat hydrous of ballast. They didn't
Speaker 1: write about it as a migraine treatment. And that doesn't
Speaker 1: mean that Mesolithic and Neolithic people's weren't using trap nation
Speaker 1: to treat migraine. There's just no clear evidence that they were.
Speaker 1: Like other diseases and conditions we've talked about on the
Speaker 1: show before, the first written record we have of migraine
Speaker 1: is from the Ebers Papyrus. This is a collection of
Speaker 1: Egyptian medical texts that dates back to about fifteen fifty
Speaker 1: b C. And it is named for German egyptologist George Ebers.
Speaker 1: He purchased it in the late nineteenth century and then
Speaker 1: published it as a two volume text. The Ebers Papyrus
Speaker 1: is one of several ancient Egyptian papyri that mentioned headaches,
Speaker 1: and it describes one particular type of headache as a
Speaker 1: quote disease of one half of the head. Previous podcast
Speaker 1: subject Sa Shrewda, who lived around eight hundred BC, described
Speaker 1: eleven different types of headache diseases in his work, and
Speaker 1: one of them was a headache involving one half of
Speaker 1: the head, sometimes with vertigo, nausea, and sensitivity to light.
Speaker 1: So Shruda was working in the ira Vedic medical tradition,
Speaker 1: which involves the balancing of three docias known as Vata, Pitta,
Speaker 1: and Kafa. Sa Shruda described migraine as involving vidiation in
Speaker 1: all three of the docias. Three predominant figures in ira
Speaker 1: Vedic medical history are Sashruda, Sharaka and Vagbada, and like Shahruda,
Speaker 1: Sharraka and Vagbada both wrote about migraine. In Sharaka's view,
Speaker 1: migraine came from vidiated vada and kafa, while Vagbata described
Speaker 1: it as stemming from vidiated vada. Only around the fourth
Speaker 1: century BC, Greek physician Hippocrates described illnesses as coming from
Speaker 1: imbalances in four humors, which were black, bile, yellow bile, blood,
Speaker 1: and phlim This basic idea stuck around for centuries, with
Speaker 1: a big part of medical practice involving balancing the humors
Speaker 1: and drawing out corrupted humors. For the most part, people
Speaker 1: working in this tradition described migraine as being a cold,
Speaker 1: wet condition to be treated with substances and procedures that
Speaker 1: were warming and drying. A few described migraine as hot
Speaker 1: rather than cold, but the wet part was pretty consistent
Speaker 1: In terms of migraines specifically. Hippocrates described one patient's experience
Speaker 1: this way quote, he seemed to see something shining before
Speaker 1: him like a light, usually in part of the right eye,
Speaker 1: at the end of a moment of violent pains supervened
Speaker 1: in the right temple, then in all the head and
Speaker 1: neck vomiting when it became possible, was able to divert
Speaker 1: the pain and render it more moderate. His recommended treatment
Speaker 1: for this included plants from the hell bore family, which
Speaker 1: were believed to purge harmful humors from the brain, and
Speaker 1: he also recommended that old chestnut blood letting. Yeah, that
Speaker 1: went on. We're gonna be talking about blood letting again
Speaker 1: like years later in this episode. Around the year thirty CE,
Speaker 1: Roman physicians, Celsus described a patient's experience in his book
Speaker 1: dere Medicina quote a long weakness of the head, but
Speaker 1: neither severe nor dangerous through the whole life. Sometimes the
Speaker 1: pain is more violent, but short yet not fatal, which
Speaker 1: is contracted either by drinking wine or crudity, or cold
Speaker 1: or heat of a fire or the sun. And all
Speaker 1: these pains are sometimes accompanied with a fever, and sometimes not.
Speaker 1: Sometimes they affect the whole head, at other times a
Speaker 1: part of it. Roughly fifty years later, Oraetus of Cappadocia
Speaker 1: described an assortment of recurring headaches. He used the term
Speaker 1: hetero crania for ones that occurred only on one side
Speaker 1: of the head. He described this as quote an illness
Speaker 1: by no means mild, even though it intermits, and although
Speaker 1: it appears to be slight, for if at any time
Speaker 1: it's said in acutely, it occasions unseemly and dreadful symptoms
Speaker 1: spas um and distortion of the countenance take place. The
Speaker 1: eyes either fixed intently like horns, or they are rolled
Speaker 1: inwardly to this side or to that vertigo, deep seated
Speaker 1: pain of the eyes, as far as the meningingy's irrestrainable sweat,
Speaker 1: sudden pain of the tendons as of one striking with
Speaker 1: a club, nausea, vomiting of bilious matters, collapse of the patient.
Speaker 1: But if the affection be protracted, the patient will die,
Speaker 1: or if more slight and not deadly, it becomes chronic.
Speaker 1: There is much torpor, heaviness of the head, anxiety, and
Speaker 1: on wei for they flee the light. The darkness soothes
Speaker 1: their disease. Nor can they bear readily to look upon
Speaker 1: or hear anything agreeable. Their sense of smell is vitiated.
Speaker 1: Neither does anything agreeable to smell delight them, and they
Speaker 1: have also an aversion to fetted things. The patients, moreover,
Speaker 1: are weary of life and wish to die. Okay, So
Speaker 1: two things here. One is that there's been some speculation
Speaker 1: that when he talks about this being fatal, those might
Speaker 1: not have been migraine cases. That might have been something
Speaker 1: else going on, because migraine does not typically cause people
Speaker 1: to die because of a migraine attack. The other is,
Speaker 1: of all the things that are included in this episode,
Speaker 1: this is really the one that I feel like says
Speaker 1: the most about how anxiety producing having migraine can be
Speaker 1: because it is a recurring condition and a lot of
Speaker 1: times people just don't know, like is today the day
Speaker 1: of the migraine is going to happen. Like there's a
Speaker 1: sense of like anxious waiting and a lot of people
Speaker 1: not really knowing whether their life is going to be
Speaker 1: suddenly disrupted by a migraine attack. Uh And about the
Speaker 1: second century, Roman physician Galen coined the term him a crania,
Speaker 1: and he called this quote a painful disorder affecting approximately
Speaker 1: one half of the head, either the right or left side,
Speaker 1: and which extends along the length of the lawn stitudinal suture.
Speaker 1: It is caused by the ascent of vapors either excessive
Speaker 1: in amount or too hot or too cold. It's likely
Speaker 1: that at around the same time as Galen coined the
Speaker 1: term hemicrania, people in China were using acupuncture to treat migraine.
Speaker 1: Han Dynasty physician Hua Tuo is credited with successfully resolving
Speaker 1: the emperor's migraine attacks by treating an acupuncture point on
Speaker 1: the soul of his foot. Jumping ahead to the twelfth
Speaker 1: century past podcast subject, Hildegard of Bingen is often credited
Speaker 1: with writing the medical text cause at cure a. This
Speaker 1: text describes migraine as stemming from bad humors, especially melancholy
Speaker 1: or black bile, and it also explains that the pain
Speaker 1: occurs only in half the head, because if it was
Speaker 1: experienced across the whole head at once, it would be
Speaker 1: simply unbearable. There's been some speculation that Hildegard herself had
Speaker 1: migraine attacks, and even that these offers some explanation and
Speaker 1: for her religious visions. Her illustrated works give you us
Speaker 1: details these visions. In nineteen thirteen, scientists and historian Charles
Speaker 1: Singer wrote a paper about Hildegard in which he interpreted
Speaker 1: some of the illustrations as depicting scintillating skatoma. Oliver Sacks
Speaker 1: revived this idea in his book Migraine, which was first
Speaker 1: published in nineteen seventy and while it's possible to see
Speaker 1: some similarities between these illustrations and descriptions or depictions of
Speaker 1: migraine aura. We don't actually know whether Hildegard was involved
Speaker 1: with making those illustrations, and if she was, what her
Speaker 1: intent was with those illustrations. Yeah, they I mean, they
Speaker 1: also have similarities to lots of other medieval artwork that
Speaker 1: you know has repetition in the same way in the pictures,
Speaker 1: So we just we just don't really know. At about
Speaker 1: the same time as Hildegard was living, Persian physicians were
Speaker 1: also writing about migraine. This included past podcast subject Ben
Speaker 1: Sina as well as Ibn al Jazar. Persian medicine at
Speaker 1: this point had parallels to the Greek humoral medicine system,
Speaker 1: but even Sina also described migraine as originating from membranes
Speaker 1: under the skull and from various parts of the brain,
Speaker 1: which then caused pain in the muscles. Even Sina described
Speaker 1: two types of migraine, hot and cold, with treatments meant
Speaker 1: to cool or warm depending. Blood letting and enemas were
Speaker 1: part of the regiment as well. Even Sina recommended that
Speaker 1: patients take a bath when they felt a migraine coming on,
Speaker 1: induced sneezing with pistachio oil and massage the vein on
Speaker 1: the side of the head that hurt with opium. Eben
Speaker 1: al Jassar's work on migraine was translated by Constantine the African,
Speaker 1: and from there it influenced the thirteenth century medical Compendium
Speaker 1: on the Properties of Things. This was compiled by Franciscan
Speaker 1: monk Bartholomaus Anglicus, and the treatments that it recommended for
Speaker 1: migraine included scarifying the shins to try to draw bad
Speaker 1: humors out of the head. Also around the twelfth and
Speaker 1: thirteen centuries, Chinese physician Winsulu also wrote a book of
Speaker 1: medical formulas, and one of them described the treatment of
Speaker 1: migraine using two specific Chinese herbs. We have mentioned the
Speaker 1: use of bleeding to treat migraine, and in the fifteenth
Speaker 1: century the Guild Book of the Barber Surgeons of the
Speaker 1: City of York included a diagram of bleeding sites for
Speaker 1: treating various illnesses. A point for megram was marked between
Speaker 1: the thumb and index finger on the right hand. This
Speaker 1: is actually close to the acupuncture point large intestine four,
Speaker 1: which is one of the points commonly used for headaches
Speaker 1: along with other pain and stress. Other sources recommended blood
Speaker 1: letting using the vein in the middle of the forehead
Speaker 1: or on the temporal vein, on whichever side the pain
Speaker 1: was happening on. There are a lot of recipe books
Speaker 1: and medical texts from the medieval and early modern period
Speaker 1: that include different treatments for migraine. They include herbs to
Speaker 1: be ingested inhaled, held in the mouth, or worn as
Speaker 1: a poultice or a plaster. One ingredient that makes multiple
Speaker 1: appearances that's not a plant is earthworms, the idea being
Speaker 1: that if earthworms feed on rotten matter out in the world,
Speaker 1: then if you pound them into a poultice and wear
Speaker 1: that on your head, it might drop putrid elements out
Speaker 1: of your head. One person who documented such a recipe
Speaker 1: was a Mrs Coraland, who's sixteen o six recipe book
Speaker 1: belonged to Althea Talbot, Countess of Rondel and Surrey. Mrs
Speaker 1: Coraland included multiple recipes for migraine treatments, as did Jane Jackson,
Speaker 1: whose recipe book dates to sixteen forty two. These are
Speaker 1: on a whole spectrum from like really simple here's a
Speaker 1: couple of herbs to try to really involved setups that
Speaker 1: would require like a long period of time to create
Speaker 1: a medicine just you know, get some earthworms. Uh. We
Speaker 1: are going to move on to the early modern world,
Speaker 1: particularly in Europe after we pause for a sponsor break
Speaker 1: to quickly recap. In ancient Greece, Persia, China, and India,
Speaker 1: the practice of medicine usually involved the idea of balancing,
Speaker 1: whether what was being balanced was referred to you as
Speaker 1: a humor, adosia or qi, and those concepts continue to
Speaker 1: be part of traditional Iranian medicine, traditional Chinese medicine, and aurveda. Obviously,
Speaker 1: these were not the only places in the ancient world
Speaker 1: where people developed systems of medicine or where people were
Speaker 1: experiencing migraine attacks. They're just the places where we have
Speaker 1: the most concrete information available in English at this point,
Speaker 1: and for the last part of this episode, we're going
Speaker 1: to be focusing mainly on Europe and how the treatment
Speaker 1: of migraine has evolved in Western medicine. In the early
Speaker 1: modern and modern world. Physician Thomas Willis was the person
Speaker 1: who coined the term neurology. He did a lot of
Speaker 1: influential work related to brain anatomy. The circle of Willis,
Speaker 1: which is the area at the bottom of the brain
Speaker 1: where several arteries come together roughly as a circle, is
Speaker 1: named for him. In sixteen seventy two he published two
Speaker 1: chapters on headaches that included a classification of different headache types.
Speaker 1: He thought migraine was caused by increased arterial blood flow
Speaker 1: in the membranes surrounding the brain. By the early seventeen hundreds,
Speaker 1: more and more migraine drugs and other preparations were being
Speaker 1: sold pre made, rather than people mostly making their own
Speaker 1: from herbs and other ingredients that they had bought are grown,
Speaker 1: and this is also when English speakers started to shift
Speaker 1: more from the word megraham to migraine, although there were
Speaker 1: some doctors who argued that megraham has described in Britain,
Speaker 1: was a difference but similar condition to migraine as described
Speaker 1: in France. In seventeen fifty eight, John Fordyce published to
Speaker 1: him a Crania, which was based on his own migraine attacks,
Speaker 1: and in seventeen seventy eight John Fathergill wrote about food
Speaker 1: as a cause of migraine. He wasn't quite onto the
Speaker 1: idea that specific foods could trigger an attack, though it
Speaker 1: was more that butter, fatty meat and black pepper were
Speaker 1: all part of a poor diet, which meant that popular
Speaker 1: foods like meat pies were particularly bad. Father Gil recommended
Speaker 1: a healthier diet combined with drinking lots of mineral water.
Speaker 1: Swiss physicians Samuel Auguste Andre David Tisso researched migraine in
Speaker 1: the late eighteenth century, and his Treatise on the Nerves
Speaker 1: and Nervous Disorders included a clinical overview of migraine. This
Speaker 1: was based on previous writing and on his own research,
Speaker 1: and it included a lot of elements that still really
Speaker 1: hold up today. He described migraine as recurring with aine,
Speaker 1: often accompanied by vomiting, and vomiting sometimes signaling that the
Speaker 1: headache is coming to an end. He also described migraine
Speaker 1: aura and other visual disturbances, and that specific factors could
Speaker 1: trigger an attack. One thing from this that didn't really
Speaker 1: hold up was his idea that migraine had gastric causes.
Speaker 1: That was a commonly held view around this time. Like
Speaker 1: going all the way back to the first definition of
Speaker 1: him a crania, was this idea of like vapors arising
Speaker 1: from the gut. So that was a long held idea.
Speaker 1: Tisso's work on migraine was really influential for at least
Speaker 1: the next century. But even as medical science was making
Speaker 1: some more concrete progress on consistently describing the condition, migraine
Speaker 1: was starting to pick up a lot of negative connotations.
Speaker 1: In Britain, migraine became increasingly connected to stereotypes of French
Speaker 1: delicacy and excess. Caricatures and satirical publications depicted foppish, seemingly
Speaker 1: high maintenance doctors who minced around with snuff and elaborate outfits.
Speaker 1: One character at the King's Theater Masquerade in London in
Speaker 1: seventeen eighty two was dcor de Medica, so naming a
Speaker 1: probably very ineffectual doctor after it. Yeah, and that trend
Speaker 1: continued into the nineteenth century. In eighteen fifty four, Patrick J.
Speaker 1: Murphy published Headache and Its Varieties in The Lancet. Although
Speaker 1: many ordinary people were using megraham, hem acrania, and sick
Speaker 1: headache interchangeably, he described these as three different things. Megram
Speaker 1: was an anemic headache common among quote mothers in the
Speaker 1: lower classes of life. Hem Acrania was a neuralgic headache
Speaker 1: which he described as hysterical in origin, and a sick
Speaker 1: headache was congestive, again common mostly in women. This was
Speaker 1: the continuation of earlier work that connected migraine to things
Speaker 1: like a lack of blood due to menstruation and mothers
Speaker 1: who breastfed their children for too long. In eighteen fifty eight,
Speaker 1: as migraine was becoming more strongly associated with supposedly worn out,
Speaker 1: anxious women, Sir John Herschel gave a lecture titled Sensorial Vision.
Speaker 1: He talked about his own experience with what sounds like
Speaker 1: migraine aura quote a singular shadowy appearance at the outside
Speaker 1: corner of the field of vision of the left eye.
Speaker 1: It gradually advanced into the field of view and then
Speaker 1: appeared to be a pattern in straight lined angular forms,
Speaker 1: very much in general aspect, like the drawing of a fortification,
Speaker 1: with salient and re entering angles, bastions and ravelins, with
Speaker 1: some suspicion of fate lines of color between the dark lines.
Speaker 1: He said he'd told various people about this experience, and
Speaker 1: that one woman he knew said this happened to her
Speaker 1: as well, and every time it did, a terrible headache followed. Meanwhile,
Speaker 1: doctors were still discussing different potential explanations and classifications for migraine.
Speaker 1: In eighteen fifty eight, John Addington Simmons argued that sick
Speaker 1: headache and him a crania were two different things, and
Speaker 1: then in eighteen seventy three Edward Living published the five
Speaker 1: hundred page on megrim which again argued that people experienced
Speaker 1: migraine for different reasons. He concluded that in working class
Speaker 1: men it was from too much work being done in
Speaker 1: poor ventilation, but that in men of a quote somewhat
Speaker 1: higher social grade it was essentially from too much thinking.
Speaker 1: But for women, regardless of class, he wrote that it
Speaker 1: was coming from their anxious nervousness and the various pressures
Speaker 1: associated with housekeeping and child rearing. That same year P. W.
Speaker 1: Latham published on Nervous or Sick Headache, It's Varieties and Treatment,
Speaker 1: two lectures delivered at Addenbrook's Hospital, Cambridge. This included a
Speaker 1: visual depiction that Dr Hubert Airy had drawn of scintillating
Speaker 1: skatoma in eighteen seventy side note, Airy and Sir John
Speaker 1: herschel knew each other and they had discussed their visual
Speaker 1: disturbances during Ari's visits. Then in neurologist Sir William Gowers,
Speaker 1: author of diseases of the nervous system, gave a lecture
Speaker 1: at which he displayed a visual representation of a patient's
Speaker 1: migraine aura. Gower's patient, a Mr. Beck, had created a
Speaker 1: whole collection of aura pictures that he had collected into
Speaker 1: a book. Things like Herschel's description and aries and Beck's
Speaker 1: visual recreations of their own experiences launched just a ton
Speaker 1: of interest in this quote transiently defective vision. Soon, migraine
Speaker 1: with r O is being described as classic migraine, with
Speaker 1: migraine without aura described as comment. Migraine with aura became
Speaker 1: viewed as the most authentic presentation of migraine, even though
Speaker 1: migraine without aura was more common, and hubert Aries representation
Speaker 1: of his aura became the standard of what aura looked like.
Speaker 1: And even though women experienced migraine with aura for the
Speaker 1: most part, they were not the ones going to these
Speaker 1: medical lectures, or seeing artistic interpretations of migraine aura in
Speaker 1: medical journals, or discussing all of that at medical society meetings.
Speaker 1: So there was a growing sense that men in particular
Speaker 1: had these visual disturbances, whether they happened with or without headache,
Speaker 1: because of their over stimulated brains, while women's migraine attacks
Speaker 1: were more likely to be ascribed to things like neurasthenia,
Speaker 1: nervous exhaustion, or having too many babies. Increasingly, migraine and
Speaker 1: men was viewed as a mark of genius, especially in
Speaker 1: intellectual men, whether it was connected to pain or not,
Speaker 1: but migraine and women was a mark of neurosis and martyrdom.
Speaker 1: This is obviously continued to influence people getting treated for
Speaker 1: migraine in the years that has followed all this. By
Speaker 1: the early twentieth century, multiple medical fields had become more
Speaker 1: firmly established as fields, including neurology, interchnology, allergy and immunology, psychology,
Speaker 1: and ophthalmology, and many of them were starting to find
Speaker 1: potential connections between what they were studying in those fields
Speaker 1: and migraine. For example, George Bray reported that many of
Speaker 1: his migraine patients had positive skin tests for various food allergies.
Speaker 1: In one but the idea of a migraine personality was
Speaker 1: evolving as well. Physician John Graham describes this as quote
Speaker 1: a personality that seeks and creates stress and a physiology
Speaker 1: that handles it poorly. Another person to suggest a personality
Speaker 1: connection was Dr Harold G. Wolfe of Cornell Medical Center,
Speaker 1: who had migraine himself. He referenced his own perfectionism and
Speaker 1: ambition and that of his upper class friends and colleagues
Speaker 1: who also had migraine. Broadly speaking, apart from all of
Speaker 1: this sort of social baggage that had evolved, two general
Speaker 1: theories had emerged to explain migraine. It either had a
Speaker 1: vascular cause or a nervous system cause. The vascular theory
Speaker 1: gained a lot of support in the nineteen thirties after
Speaker 1: physician Alfred Goldman described the case of a nurse who
Speaker 1: had experienced recurring severe headaches with vomiting. At one point,
Speaker 1: a neurosurgeon had done exploratory surgery through a burr hole.
Speaker 1: That hole had healed over as a depression in her
Speaker 1: skull that was full of blood vessels. Goldman noticed that
Speaker 1: when she had a migraine attack, those vessels seemed to
Speaker 1: fill in this depression and swell almost like a tumor.
Speaker 1: Dr Harold G. Wolfe worked on the vascular theory of
Speaker 1: migraine as well. His experiments suggested that migraine aura was
Speaker 1: connected to vasa constriction, and when those vessels dilated again.
Speaker 1: Migraine pain followed. This type of work led to the
Speaker 1: use of vaso constrictors to treat migraine, which did help
Speaker 1: some people. Vaso Constrictors were one of several drugs used
Speaker 1: in the twentieth century to treat migraine, and before this point,
Speaker 1: drugs to treat migraine included non steroidal anti inflammatoryes like
Speaker 1: aspirin and pyrazole, morphine, digitalist quinine, and cannabis extracts, among
Speaker 1: other things. Ergotamine is derived from urgut fungus and was
Speaker 1: first introduced as a drug to treat migraine in Along
Speaker 1: with other effects, this acts as of as a constrictor,
Speaker 1: and for the next few decades it really became the
Speaker 1: primary drug to treat migraine pain. In nineteen forty four,
Speaker 1: Brazilian researcher Aristides Leao described a theory of cortical spreading depression,
Speaker 1: basically a complex phenomenon involving a wave of excited and
Speaker 1: then suppressed brain activity. A couple of years before, psychologist
Speaker 1: Carl Spencer Lashly had proposed a similar wave of activity
Speaker 1: across the visual cortex when describing his own aura. It's
Speaker 1: possible that this is connected to migraine with aura, although
Speaker 1: this is not well understood. In the nineteen fifties, researchers
Speaker 1: discovered a link between serotonin and migraine, and they started
Speaker 1: working on drugs to target specific serotonin receptors, and the
Speaker 1: result was a whole new class of drugs, tripped in's,
Speaker 1: with multiple different tripped iNTS on the market. By the
Speaker 1: late nineteen nineties, for the most part, tripped in started
Speaker 1: replacing Urga derivatives as the primary treatment from migraine. The
Speaker 1: term migraine er made its first appearance in writing in
Speaker 1: nineteen seventy. That was in Oliver Sax's book on Migraine
Speaker 1: that we referenced a little bit ago. Today, some people
Speaker 1: disc dribe themselves as migraine urves, but for others it's
Speaker 1: a term to avoid for a number of reasons, including
Speaker 1: its negative connotations and the idea that it makes migraine
Speaker 1: into a person's entire identity. In the nineteen eighties, researchers
Speaker 1: measured blood flow through the brain and found that in
Speaker 1: migraine without aura, there's no significant difference in the blood
Speaker 1: flow during a migraine attack, but in migraine with aura,
Speaker 1: blood flow is reduced at a rate of about two
Speaker 1: millimeters a minute, and this roughly lines up with the
Speaker 1: rate of cortical spreading depression that had been described, although
Speaker 1: again this connection is not well understood. By the nineteen nineties,
Speaker 1: functional mri I studies were suggesting that migraine was not
Speaker 1: a purely vascular phenomenon, and it's been increasingly framed as
Speaker 1: a biochemical process, and a wide range of drugs have
Speaker 1: been used to treat it, often because people who were
Speaker 1: taking a drug for some other reason reported that it
Speaker 1: also helped with their migraine attacks. Among other things, this
Speaker 1: has included people taking beta blockers for heart issues, various antidepressants,
Speaker 1: and medicines to treat epilepsy. The f d A approved
Speaker 1: botox as a migraine treatment in The FDA also approved
Speaker 1: a transcranial magnetic stimulator for migraine treatment in tween, the
Speaker 1: first device to be approved for that purpose. Until very
Speaker 1: very recently, the drugs used to treat migraine were generally
Speaker 1: used to reduce and shorten migraine attacks after the attacks
Speaker 1: had started, and in the US, the FDA started approving
Speaker 1: the first drugs developed specifically to prevent migraine attacks in
Speaker 1: ten so just three years ago. These are known as
Speaker 1: calcitonin gene related peptide or cd RP monoclonal antibodies. CDRP
Speaker 1: is related to various pain processes in the body, and
Speaker 1: it also acts as of as a dial later and
Speaker 1: these drugs block that action. To wrap it up, there
Speaker 1: are just so, so so many historical figures who are
Speaker 1: known to have had recurring headaches, many of which are
Speaker 1: described as migraine today. Just as examples and Countess of Conway,
Speaker 1: Charles Darwin, Thomas Jefferson, Virginia Wolf, and Pablo Picasso. Some
Speaker 1: people interpret the entirety of Lewis Carroll's Alice's Adventures in
Speaker 1: Wonderland as a literary exploration of migraine, as well as
Speaker 1: Emily Dickinson's I felt the funeral in my brain. Sometimes
Speaker 1: this can seem a little bit speculative, As we've talked
Speaker 1: about on the show before, diagnosing people from the past
Speaker 1: can be tricky when they are not here to be examined.
Speaker 1: But we will end on a quote from Rudyard Kipling
Speaker 1: which was written in a letter to Miss Margaret Burne Jones,
Speaker 1: and this is pretty specific and detailed. He wrote, quote,
Speaker 1: do you know what him A cranium means a half headache.
Speaker 1: I've been having it for a few days, and it's
Speaker 1: a lovely thing. One half of my head, in a
Speaker 1: mathematical line from the top of my skull to the
Speaker 1: cleft of my jaw, throbs and hammers and sizzles and
Speaker 1: bangs and swears, while the other half, calm and collected
Speaker 1: takes notes of the agonies next door. My disgusting doctor
Speaker 1: says it's overwork again, and I'm equally certain that it
Speaker 1: arose from my suddenly and violently discarding tobacco for three days. Anyhow,
Speaker 1: it hurts awfully, feels like petrofaction in sections, and makes
Speaker 1: one right abject drivel. Hi. This is devilitating and horrible. Yeah,
Speaker 1: it's um. One of the World Health Organization statistics that
Speaker 1: I didn't cite was that, in terms of years lived
Speaker 1: with a disability, uh, migrain is is like the sixth
Speaker 1: most disabling condition. Everybody I know who has experienced migraines,
Speaker 1: which is like some people. I got a spectrum between
Speaker 1: folks that have had like a cluster of several migraines
Speaker 1: that then sort of went away to folks that have
Speaker 1: been dealing with recurring migraine attacks throughout their whole entire
Speaker 1: life has generally been something that has just profoundly affected
Speaker 1: their lives through all of that time. Uh So, if
Speaker 1: you want to know more about the medical history of migraine,
Speaker 1: particularly in the West, Migraine a History by Katherine Foxhle
Speaker 1: from Johns Hopkins University Press was one of the sources
Speaker 1: for this episode. It's from an academic press, but it's
Speaker 1: pretty widely available. UM. There are open access copies of
Speaker 1: it that you can get without um having to purchase
Speaker 1: one or get it from a library if that's not
Speaker 1: an option for you. So I read that as one
Speaker 1: of the sources for this and it is I found
Speaker 1: pretty accessible in terms of more academic writing, UM, with
Speaker 1: lots and lots of details and specific that we didn't
Speaker 1: really get into as much. Here. Do you have some
Speaker 1: listener mail to get into Okay, I do have listener mail.
Speaker 1: It is from Kelsey who writes Pest Control in New
Speaker 1: Zealand and Kelsey writes Kura Kurua. Hey, Holly and Tracy.
Speaker 1: I've been an avid listener of your podcast for years
Speaker 1: and I really enjoy it, so thank you very much
Speaker 1: for that. I just listened to the kudzoovine episode and
Speaker 1: it brought to mind all the predator and pest control
Speaker 1: that has gone on in New Zealand. Because New Zealand
Speaker 1: was isolated from larger land masses for such a long
Speaker 1: time after the breakup of Gondwana, our flora and fauna
Speaker 1: are really unique. Our only native land mammals or bats,
Speaker 1: and most of our birds prefer to wander about on
Speaker 1: the ground because we used to have the host eagle,
Speaker 1: which was a major predator before it went extinct. When
Speaker 1: Maori arrived in about twelve hundred a d. We brought
Speaker 1: rats and dogs that devastated the bird population, and we
Speaker 1: also burned lots of forest. But what really set our
Speaker 1: native populations back was when the Pocaha Europeans showed up
Speaker 1: with worse rats, pigs, cats, and other animals. Some plants
Speaker 1: were introduced by farmers that had worked really well in Britain,
Speaker 1: such as gorse and broom, but quickly became pests in
Speaker 1: New Zealand's more temperate climate. Acclimatization societies introduced brown trout
Speaker 1: to our rivers, which wiped out some of our fish species.
Speaker 1: They also called Kao which are the only alpine parrot
Speaker 1: in the world. Because ko would attack sheep by eating
Speaker 1: the liver while the sheep was still alive and running around.
Speaker 1: Other animals, such as Australian possums were introduced for fur
Speaker 1: trade but have become omnivorous. In New Zealand and our
Speaker 1: real pests, rabbits were introduced for sport and then became pests,
Speaker 1: so ferrets and stoats were introduced to control the rabbits,
Speaker 1: but they found the flightless birds a bit easier to
Speaker 1: catch and eat, such as our kiwi species. So many
Speaker 1: mistakes by humans have led to New Zealand having one
Speaker 1: of the highest rates of endangered bird species in the world.
Speaker 1: Successive governments have attempted to control pests in different ways,
Speaker 1: but there is a national strategy of predator free New
Speaker 1: Zealand by twenty This can involve extensive trapping and monitoring,
Speaker 1: but also the widespread use and aerial dropping of ten
Speaker 1: eight poison, which is controversial albeit necessary. We are in
Speaker 1: a unique situation where conservation efforts require systematic massacres of animals,
Speaker 1: which can be hard for foreigners to understand. Listening to
Speaker 1: your podcast is an absolute treat and I love the
Speaker 1: diversity of subjects you cover things heaps For everything you do, Kelsey,
Speaker 1: thanks so much for sending this in, Kelsey. Um, I
Speaker 1: hope I did okay with the Maori pronunciations. I tried
Speaker 1: to practice them ahead of time. Um. But the discussion,
Speaker 1: especially at the end, about the attempts to control these
Speaker 1: pests reminded me of I think it was our podcast
Speaker 1: on Endlings where we're talking about the last of various species.
Speaker 1: I don't remember how much detail we got into it
Speaker 1: in the episode, but I had gone down a huge
Speaker 1: rabbit hole of reading about goat control projects in the
Speaker 1: Galapagos Islands that similarly required just like couling of all
Speaker 1: the goats that had been left on the islands and
Speaker 1: had just taken over and become really damaging to the ecosystem.
Speaker 1: So thank you again, Kelsey for sending that in. If
Speaker 1: you would like to write to us about this or
Speaker 1: any other podcast, where at History podcasts at i heeart
Speaker 1: radio dot com, and we are also all over social
Speaker 1: media at miss in History. That's where you'll find our Facebook, Twitter, Pinterest,
Speaker 1: and Instagram. And you can subscribe to our show on
Speaker 1: the I Heart radio app and anywhere else you like
Speaker 1: to get your podcasts. Stuff you Missed in History Class
Speaker 1: is a production of I heart Radio. For more podcasts
Speaker 1: from I heart Radio, visit the iHeart Radio app, Apple podcast,
Speaker 1: or wherever you listen to your favorite shows. M