History of Migraines Part II – the middle period

November 13, 2015

shutterstock_242825554Electric torpedo fish…holes drilled into the head in a process called “trepanation,” leeches, divin intervention…the history of attempts to treat migraines is colorful, ghastly, and, alas, fairly ineffectual. Back in June, this blog featured a post called “Migraines are Ancient History”at covers humanity’s war against migraines from the Stone Age to second century A.D. It won’t cure your migraine, but it may give you a little comfort to know that you’re not the only one to have been willing to try anything to get your peace of mind back. It’s well worth a read and can be found here: https://migrainecenters.com/blog/migraines-are-ancient-history/

Consider this post Part II of the history of migraine treatments.

Migraines and the Islamic Golden Age

In the midst of Europe’s middle ages—around 1000 A.D.—the Islamic world was at the height of its Golden Age. Art, literature, and especially science flourished. Some of the great scientific ideas—like careful observation and methodological experimentation—were either discovered or greatly refined. At one point, Mohamed Ibn Zakariya Râzi, also known as Rhazes, turned his attention to the age-old problem of the migraine. Noting the trigger effect of migraines in women’s biological cycles—particularly childbirth, menopause, and dysmenorrhea—Rhazes is is credited as the first to notice a link between migraines and hormones.

Next came Avicenna, usually considered the greatest of all the thinkers in the Golden Age. His most lasting achievement–The Canon of Medicine—is a medical textbook and encyclopedia that found a ready audience in Europe and was used into the 18th Century. Imagine a textbook having a lifespan of 700 years! While the book had many huge discoveries, modern migraine researchers have keyed in on one particularly fascinating first: Avicenna hypothesized that the cause of migraines was neurovascular in nature, meaning that it something to do with the interaction of the blood, the nerves, and the brain itself.shutterstock_242818486

Rhazes and Avicenna also saw a link between migraines and the gastric system and posited an idea called “gastric headache,” a type of migraine that results from digestion problems, especially owing to poor interactions between various types of bile.1 This early idea of gastric headache was developed over the centuries and is now referred to as “gastric stasis,” a condition similar to constipation. Researchers now believe these early researchers had the relationship backwards: it is not digestion problems that cause the headache, it is headaches that cause the digestion problems. Almost unbelievably, after centuries of wondering about the relationship of migraines and the stomach, the issue is far from settled. It does seem fairly clear that migraineurs suffer from gastric stasis more than others, but exactly why—and exactly what mechanisms are in play—is still unknown!2

“Scarcely Anything to be Done”

Time moved on. The Crusades and extreme religiosity prevented the Islamic scientists from pursuing their early discoveries, and it took the West many centuries to pick up where they had left off. Only they didn’t exactly pick up where they should have. Arguably, most of Western science throughout the Renaissance went back to bloodletting and other attempts at trepanation.

Perhaps the best work done on migraines in this period was observational. Very good and specific accounts of headache—including migraine—remain. Telling, however, are the writings of the famous 18th Century Swiss physician Samuel-Auguste-Tissot, who wrote of his migraine patients, “scarcely anything to be done … . Baths to the legs, enemas, applications to the forehead, do no good and only worry the patient.”3

Fire, Water, and Pressure

Newer areas of migraine research exploded in the 18th Century, too late for probable migraineur Thomas Jefferson, but not too late for Charles Darwin, a man plagued by all kinds of awful physical maladies, all of which may have related to his frequent migraines. Among the cures Darwin pursued was water therapy, which tended to use water in any possible way: moving it from one temperature extreme to another, circulating it, et cetera.

Early attempts at migraine control via water therapy were enthusiastically greeted, but in a few years Darwin and others decided that it just wasn’t doing the trick. One wonders if the early enthusiasm for water therapy was due to the participants’ drinking of the water, since we know that hydration helps most sufferers.

In addition to water, researchers tried all sorts of more electrical cures, some involving electric eels and others involving harnessed currents, but these tended to shock and not to cure. Massage therapy was introduced and that helped some.

Remember Avicenna’s contribution of the idea that migraines were related to the blood and the nerves? This type of thinking was taken back up in the 19th Century and certain kinds of venous or arterial constriction came into vogue. The idea was that when a migraine was beginning, the best thing to do was to press down on the carotid artery—or any other artery that may lead toward the brain—until the pulse disappears and with it the pain of the migraine. But alas, by 1914 noted researcher Eduard Flatau had reported the demise of compression therapy in migraine treatments.

Ergotamine

Ergotamine is a naturally occurring substance that has been known for several hundred years to induce childbirth, but at the beginning of the 20th century, the researchers Graham and Wolff realized that ergotamine could be used to relieve migraines. As is often the case in medical history, the reason why it worked was not known until after it worked. The reason turned out to be that something in the crystalline, white substance of ergotamine cause vasoconstriction of the blood vessels in the brain.

Now this is the kind of discovery that almost looks like it could be a complete cure! But, alas, it didn’t work for everyone, which means the process that produces a migraine was still not completely nailed down. But note what is important about ergotamine: it represented a hope to treat migraines chemically. It was out with the water and the blood, in with the crushed powder…

How did it turn out?

Decidedly mixed. The crushed powder worked for some, but left others feeling more frustrated than ever.

And that concludes Part II in this tiny history of the migraine. The third and final part witnesses the evolution of drugs and the introduction of neurostimulation.

Please check back soon.

References

  1. Fazljou SMJ. In commemorating one thousandth anniversary of the Avicenna’s Canon of Medicine: gastric headache, a forgotten clinical entity from the medieval Persia. Acta Medica Iranica. Vol. 51, No. 5 (2013)
  2. Aurora SK et al. Gastric stasis in migraine: more than just a paroxysmal abnormality during a migraine attack. 2006 Jan;46(1):57-63
  3. Koehler PJ and Boes CJ. A history of non-drug treatment in headache, particularly migraine. 2010;133:2489-2500

 

 

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