A History of Migraine

Migraine is one of the three most prevalent conditions in the world along with anemia and hearing loss. But in spite of that prevalence, migraine is widely misunderstood, really at every level.

Learn more about your ad-choices at https://www.iheartpodcastnetwork.com

See omnystudio.com/listener for privacy information.

Episode Transcript

Speaker 1 (00:01):
Welcome to Stuff You Missed in History Class, a production
of I Heart Radio. Hello, and welcome to the podcast.
I'm Tracy V. Wilson and I'm Holly Fry. I have
a family history of migraine. Um. I remember my grandmother
talking about what she called her sick headaches. Uh. And

(00:25):
I know a lot of people outside of my family
who have migraine as well, and some of them started
dealing with migraine attacks really quite recently. So I've been
thinking about doing an episode on the history of migraine
for a while because of all these different personal connections.
And then after our recent episode on the Nelson Pill hearings,
we got a lot of email from listeners who mentioned

(00:47):
their experiences with migraine, so that moved this topic up
to the top. As one note, this isn't and can't
possibly be comprehensive. Have there is just a wealth of
historical writing about migraine. But I also didn't expand this

(01:08):
into a two part episode because, at least in terms
of what's available in English, a lot of that writing
is really similar. I had a whole lot more quotes
from historical sources, and I felt like I was reading
the same thing over and over again, so I paired
it down a bit. And migraine is really prevalent. According
to the World Health Organization, it is one of the

(01:30):
three most prevalent conditions in the world, along with anemia
and hearing loss. But in spite of that prevalence, migraine
is widely misunderstood really at every level. One reason is
that the vast majority of people in the world have
headaches at some point, so it's easy for people who
have headaches but not migraine to think of a migraine

(01:50):
attack as just a headache. I know in my family too,
it was also like, if it's a bad headache, they
would just call it a migraine, and that's not accurate. Yes, yes,
a lot of the historical writing about migraine really does
focus on the head pain, though the word migraine even
comes from this. In English, it was originally megram, which

(02:14):
could also mean vertigo or dizziness, especially if that was
accompanying a headache. Megram was first used in writing in
fourteen forty, and it's been spelled so many different ways,
Like when I looked at the Oxford English Dictionary and
it had the other versions, and it's like clicked to
open for more, and it was like eight lines of

(02:34):
different spellings of this. The first use in writing was
M y g r E y m E, and there's
just a whole assortment of spellings that generally combine a
couple of m's energy with every vowel that exists in English,
megrim was derived from the Old French word min, and

(02:57):
that French term and the word for migraine most of
the Romance languages was derived from the Greek word hemicrania,
meaning half of the head do's because often, but not always,
the pain associated with a migraine attack occurs on one
side of the head. But head pain, which to be clear,
can be severe and disabling, is really just one piece

(03:20):
of how migraine is understood today, so to level set
on that today, a migraine attack is often described as
a four phase process. The first is the pro dome,
which can start twenty four hours or more before the
pain begins, and this can involve changes in a person's mood,
energy level, perception, or appetite. Some people describe it as

(03:42):
an early warning sign that an attack is incoming. The
next phase is the aura, although this doesn't happen in
every case. About one in five people with migraine have
migraine with aura, but not necessarily with every attack. The
aura usually involves visual dis urbances like flashing lights or
blind spots in a person's vision, often in an arcing,

(04:05):
zigzagging pattern. In medical terms, these are often called scintillating scatoma,
visual representations of what people see what their aura can
look a bit like the patterns used in dazzle camouflage,
which we've talked about on the show before. Migraine aura
can also involve strange sensations in the body, like pins
and needles, or a sense of heaviness, vertigo, or a

(04:28):
ringing in the ears. If you've ever heard the term
classic migraine, that came around in the nineteenth century to
describe migraine with aura, but it's less common in medical
literature today, and those same nineteenth century terms migraine without
aura was common migraine. We will get more to the

(04:48):
reasons behind that later. For people who experience aura, that
typically starts somewhere between a few minutes and an hour
before the migraine pain begins the third phase, the headache itself.
In most people, the headache lasts at least six hours,
and in some cases it can last for three days
or even more. This headache is typically severe and throbbing,

(05:11):
often so acutely painful that it's impossible to sleep or
it wakes a person up from sleep, and in some cases,
people can also experience silent migraine, which involves the other
physiological and visual disturbances associated with migraine, but not pain.
Sometimes this is mistaken for transient ischamic attacks, also known

(05:33):
as mini strokes, particularly in older people. Noise and bright
light can both worsen a migraine attack, and attacks can
also be accompanied by nausea or vomiting, and some odors
can make this worse and some people specific smells can
trigger a migraine attack, and smells are just one possible trigger.

(05:53):
Others include specific foods, alcohol, drugs, and hormone levels in
the body, and looting hormone levels connected to the use
of hormonal contraceptives. This is why some people have a
migraine attack that coincides with the same phase of their
menstrual cycle every month. Stress, interrupted sleep, and hunger can

(06:14):
all trigger migraine attacks as well, and so can caffeine
or caffeine withdrawal. But in some people caffeine helps relieve
the symptoms, so this is complicated and it can vary
a lot from person to person. Beyond what we just
said here, the fourth phase of a migraine attack is
known as the post drome, which begins after the headache

(06:35):
has ended. Although in some people this can bring on
a sense of euphoria. Often it's marked with muscle aches, fatigue,
and inability to concentrate, or a sense of just feeling drained.
Some people call this phase a migraine hangover. So, as
we said earlier, migraine is extremely prevalent. At least a
billion people around the world have it, but that number

(06:59):
might actually be pretty low by some estimates. Migraine goes
undiagnosed as much as half the time. Symptoms can vary tremendously,
and in some cases people might not think they're severe
enough or frequent enough to seek medical treatment. People may
also avoid seeing a doctor for all kinds of reasons,
including money, time, fear, and the stigma involved with migraines

(07:23):
specifically or with seeking medical treatment for pain more generally.
Research in the US suggests that people experience severe headaches
at about the same rate regardless of race or ethnicity,
but white people in the United States are far more
likely to be diagnosed with migraine than people of any
other race. There is some data to suggest that this

(07:45):
isn't about the actual prevalence of migraine, though, but it
is more connected to a whole set of social and
economic factors involving medical bias, racism, and access to care.
Migraine is prevalent in children, and there's not a huge
difference in its prevalence based on children's sex, but that
starts to really shift as people reach puberty. In adults,

(08:08):
migraine is significantly more common among women, including transgender women
if they're taking estrogen. As many as one in seven
people have migraine, but as many as one in five women.
For many years, this disparity in the prevalence of migraine
has been largely explained by hormonal differences, but there's also

(08:28):
research that suggests that migraine is not only more prevalent
but also worse among women, involving more severe pain and
longer lasting attacks. So it's possible that women are diagnosed
more often because they're generally more severe attacks make them
more likely to seek treatment, although this again folds into
all kinds of expectations and bias related to gender. Like

(08:50):
there's a lot of research at this point backing up
the idea that women have a harder time getting accurate diagnoses,
especially for chronic diseases, and that women's report of pain
are just not taken seriously. But at the same time,
at least here in the US, men are generally expected
to shake it off or tough it out when it
comes to pain. So exactly what all of these social

(09:13):
and cultural effects have on the rate of migraine diagnosis
is again super complicated. Yeah, it also varies across the world.
If you look at a map of where migraine is
most prevalent, that's surely complicated. Social and economic factors are
playing into that in addition to just whether it's more

(09:33):
prevalent among different groups. So, as we said, this is
just the basics of migraine. There are other ways that
migraine can present and other symptoms that people can experience.
There are also other types of headache and other neurological
disorders that can have some overlap with migraine. But the
idea that there are gender disparities related to migraine is

(09:56):
not new nor is this baggage that's related specifically to
women's experiences with migraine. A lot of that baggage came
about during the eighteenth and nineteen centuries, and we're going
to get into that, but after the break will start
with migraine in the ancient world and medieval Europe. Some

(10:20):
sources claim that the oldest evidence were migraine and migraine
treatments dates back at least nine thousand years, thanks to
the existence of Trapan's skulls, and that's skulls that have
holes carved or chiseled or drilled through them. Archaeologists have
found Trapan's skulls in the America's Europe, Africa, Asia, and

(10:43):
the Polynesian Islands, basically a lot of the inhabited world,
and in many cases these holes show evidence of healing,
meaning that this was a surgical procedure performed on a
living person who survived it. The basic assumption here is
people were performing trepid nation in the ancient world in
order to treat or provide relief from migraine. But this

(11:06):
is actually pretty speculative and it's a pretty recent idea.
In nineteen o two, Sir Thomas Louder Brunton gave a
lecture in which he theorized that trepidation had been used
to treat migraine. Even though he did not have written
evidence to back this up. People really gloamed onto it,
and within about a decade people were taking for granted
not only that he was right, but also that this

(11:28):
link had been definitively established. Somehow, it really hadn't. Though.
The earliest surviving written accounts of trepidation are by Hippocrates
and Galen, and they lived during the fourth century BC
and the second century CE, respectively. Both wrote about using
trepan nation to treat head injuries, and Galen also wrote

(11:51):
about using it to treat hydrous of ballast. They didn't
write about it as a migraine treatment. And that doesn't
mean that Mesolithic and Neolithic people's weren't using trap nation
to treat migraine. There's just no clear evidence that they were.
Like other diseases and conditions we've talked about on the
show before, the first written record we have of migraine

(12:13):
is from the Ebers Papyrus. This is a collection of
Egyptian medical texts that dates back to about fifteen fifty
b C. And it is named for German egyptologist George Ebers.
He purchased it in the late nineteenth century and then
published it as a two volume text. The Ebers Papyrus
is one of several ancient Egyptian papyri that mentioned headaches,

(12:35):
and it describes one particular type of headache as a
quote disease of one half of the head. Previous podcast
subject Sa Shrewda, who lived around eight hundred BC, described
eleven different types of headache diseases in his work, and
one of them was a headache involving one half of
the head, sometimes with vertigo, nausea, and sensitivity to light.

(12:59):
So Shruda was working in the ira Vedic medical tradition,
which involves the balancing of three docias known as Vata, Pitta,
and Kafa. Sa Shruda described migraine as involving vidiation in
all three of the docias. Three predominant figures in ira
Vedic medical history are Sashruda, Sharaka and Vagbada, and like Shahruda,

(13:22):
Sharraka and Vagbada both wrote about migraine. In Sharaka's view,
migraine came from vidiated vada and kafa, while Vagbata described
it as stemming from vidiated vada. Only around the fourth
century BC, Greek physician Hippocrates described illnesses as coming from
imbalances in four humors, which were black, bile, yellow bile, blood,

(13:45):
and phlim This basic idea stuck around for centuries, with
a big part of medical practice involving balancing the humors
and drawing out corrupted humors. For the most part, people
working in this tradition described migraine as being a cold,
wet condition to be treated with substances and procedures that
were warming and drying. A few described migraine as hot

(14:09):
rather than cold, but the wet part was pretty consistent
In terms of migraines specifically. Hippocrates described one patient's experience
this way quote, he seemed to see something shining before
him like a light, usually in part of the right eye,
at the end of a moment of violent pains supervened
in the right temple, then in all the head and

(14:31):
neck vomiting when it became possible, was able to divert
the pain and render it more moderate. His recommended treatment
for this included plants from the hell bore family, which
were believed to purge harmful humors from the brain, and
he also recommended that old chestnut blood letting. Yeah, that
went on. We're gonna be talking about blood letting again

(14:54):
like years later in this episode. Around the year thirty CE,
Roman physicians, Celsus described a patient's experience in his book
dere Medicina quote a long weakness of the head, but
neither severe nor dangerous through the whole life. Sometimes the
pain is more violent, but short yet not fatal, which

(15:17):
is contracted either by drinking wine or crudity, or cold
or heat of a fire or the sun. And all
these pains are sometimes accompanied with a fever, and sometimes not.
Sometimes they affect the whole head, at other times a
part of it. Roughly fifty years later, Oraetus of Cappadocia

(15:37):
described an assortment of recurring headaches. He used the term
hetero crania for ones that occurred only on one side
of the head. He described this as quote an illness
by no means mild, even though it intermits, and although
it appears to be slight, for if at any time
it's said in acutely, it occasions unseemly and dreadful symptoms

(15:59):
spas um and distortion of the countenance take place. The
eyes either fixed intently like horns, or they are rolled
inwardly to this side or to that vertigo, deep seated
pain of the eyes, as far as the meningingy's irrestrainable sweat,
sudden pain of the tendons as of one striking with
a club, nausea, vomiting of bilious matters, collapse of the patient.

(16:24):
But if the affection be protracted, the patient will die,
or if more slight and not deadly, it becomes chronic.
There is much torpor, heaviness of the head, anxiety, and
on wei for they flee the light. The darkness soothes
their disease. Nor can they bear readily to look upon
or hear anything agreeable. Their sense of smell is vitiated.

(16:47):
Neither does anything agreeable to smell delight them, and they
have also an aversion to fetted things. The patients, moreover,
are weary of life and wish to die. Okay, So
two things here. One is that there's been some speculation
that when he talks about this being fatal, those might
not have been migraine cases. That might have been something
else going on, because migraine does not typically cause people

(17:11):
to die because of a migraine attack. The other is,
of all the things that are included in this episode,
this is really the one that I feel like says
the most about how anxiety producing having migraine can be
because it is a recurring condition and a lot of
times people just don't know, like is today the day

(17:31):
of the migraine is going to happen. Like there's a
sense of like anxious waiting and a lot of people
not really knowing whether their life is going to be
suddenly disrupted by a migraine attack. Uh And about the
second century, Roman physician Galen coined the term him a crania,
and he called this quote a painful disorder affecting approximately

(17:53):
one half of the head, either the right or left side,
and which extends along the length of the lawn stitudinal suture.
It is caused by the ascent of vapors either excessive
in amount or too hot or too cold. It's likely
that at around the same time as Galen coined the
term hemicrania, people in China were using acupuncture to treat migraine.

(18:16):
Han Dynasty physician Hua Tuo is credited with successfully resolving
the emperor's migraine attacks by treating an acupuncture point on
the soul of his foot. Jumping ahead to the twelfth
century past podcast subject, Hildegard of Bingen is often credited
with writing the medical text cause at cure a. This

(18:37):
text describes migraine as stemming from bad humors, especially melancholy
or black bile, and it also explains that the pain
occurs only in half the head, because if it was
experienced across the whole head at once, it would be
simply unbearable. There's been some speculation that Hildegard herself had
migraine attacks, and even that these offers some explanation and

(19:00):
for her religious visions. Her illustrated works give you us
details these visions. In nineteen thirteen, scientists and historian Charles
Singer wrote a paper about Hildegard in which he interpreted
some of the illustrations as depicting scintillating skatoma. Oliver Sacks
revived this idea in his book Migraine, which was first

(19:21):
published in nineteen seventy and while it's possible to see
some similarities between these illustrations and descriptions or depictions of
migraine aura. We don't actually know whether Hildegard was involved
with making those illustrations, and if she was, what her
intent was with those illustrations. Yeah, they I mean, they
also have similarities to lots of other medieval artwork that

(19:44):
you know has repetition in the same way in the pictures,
So we just we just don't really know. At about
the same time as Hildegard was living, Persian physicians were
also writing about migraine. This included past podcast subject Ben
Sina as well as Ibn al Jazar. Persian medicine at
this point had parallels to the Greek humoral medicine system,

(20:07):
but even Sina also described migraine as originating from membranes
under the skull and from various parts of the brain,
which then caused pain in the muscles. Even Sina described
two types of migraine, hot and cold, with treatments meant
to cool or warm depending. Blood letting and enemas were
part of the regiment as well. Even Sina recommended that

(20:31):
patients take a bath when they felt a migraine coming on,
induced sneezing with pistachio oil and massage the vein on
the side of the head that hurt with opium. Eben
al Jassar's work on migraine was translated by Constantine the African,
and from there it influenced the thirteenth century medical Compendium
on the Properties of Things. This was compiled by Franciscan

(20:54):
monk Bartholomaus Anglicus, and the treatments that it recommended for
migraine included scarifying the shins to try to draw bad
humors out of the head. Also around the twelfth and
thirteen centuries, Chinese physician Winsulu also wrote a book of
medical formulas, and one of them described the treatment of

(21:14):
migraine using two specific Chinese herbs. We have mentioned the
use of bleeding to treat migraine, and in the fifteenth
century the Guild Book of the Barber Surgeons of the
City of York included a diagram of bleeding sites for
treating various illnesses. A point for megram was marked between
the thumb and index finger on the right hand. This

(21:36):
is actually close to the acupuncture point large intestine four,
which is one of the points commonly used for headaches
along with other pain and stress. Other sources recommended blood
letting using the vein in the middle of the forehead
or on the temporal vein, on whichever side the pain
was happening on. There are a lot of recipe books

(21:57):
and medical texts from the medieval and early modern period
that include different treatments for migraine. They include herbs to
be ingested inhaled, held in the mouth, or worn as
a poultice or a plaster. One ingredient that makes multiple
appearances that's not a plant is earthworms, the idea being

(22:17):
that if earthworms feed on rotten matter out in the world,
then if you pound them into a poultice and wear
that on your head, it might drop putrid elements out
of your head. One person who documented such a recipe
was a Mrs Coraland, who's sixteen o six recipe book
belonged to Althea Talbot, Countess of Rondel and Surrey. Mrs

(22:40):
Coraland included multiple recipes for migraine treatments, as did Jane Jackson,
whose recipe book dates to sixteen forty two. These are
on a whole spectrum from like really simple here's a
couple of herbs to try to really involved setups that
would require like a long period of time to create
a medicine just you know, get some earthworms. Uh. We

(23:02):
are going to move on to the early modern world,
particularly in Europe after we pause for a sponsor break
to quickly recap. In ancient Greece, Persia, China, and India,
the practice of medicine usually involved the idea of balancing,

(23:23):
whether what was being balanced was referred to you as
a humor, adosia or qi, and those concepts continue to
be part of traditional Iranian medicine, traditional Chinese medicine, and aurveda. Obviously,
these were not the only places in the ancient world
where people developed systems of medicine or where people were

(23:43):
experiencing migraine attacks. They're just the places where we have
the most concrete information available in English at this point,
and for the last part of this episode, we're going
to be focusing mainly on Europe and how the treatment
of migraine has evolved in Western medicine. In the early
modern and modern world. Physician Thomas Willis was the person

(24:05):
who coined the term neurology. He did a lot of
influential work related to brain anatomy. The circle of Willis,
which is the area at the bottom of the brain
where several arteries come together roughly as a circle, is
named for him. In sixteen seventy two he published two
chapters on headaches that included a classification of different headache types.

(24:27):
He thought migraine was caused by increased arterial blood flow
in the membranes surrounding the brain. By the early seventeen hundreds,
more and more migraine drugs and other preparations were being
sold pre made, rather than people mostly making their own
from herbs and other ingredients that they had bought are grown,
and this is also when English speakers started to shift

(24:49):
more from the word megraham to migraine, although there were
some doctors who argued that megraham has described in Britain,
was a difference but similar condition to migraine as described
in France. In seventeen fifty eight, John Fordyce published to
him a Crania, which was based on his own migraine attacks,

(25:10):
and in seventeen seventy eight John Fathergill wrote about food
as a cause of migraine. He wasn't quite onto the
idea that specific foods could trigger an attack, though it
was more that butter, fatty meat and black pepper were
all part of a poor diet, which meant that popular
foods like meat pies were particularly bad. Father Gil recommended

(25:32):
a healthier diet combined with drinking lots of mineral water.
Swiss physicians Samuel Auguste Andre David Tisso researched migraine in
the late eighteenth century, and his Treatise on the Nerves
and Nervous Disorders included a clinical overview of migraine. This
was based on previous writing and on his own research,

(25:52):
and it included a lot of elements that still really
hold up today. He described migraine as recurring with aine,
often accompanied by vomiting, and vomiting sometimes signaling that the
headache is coming to an end. He also described migraine
aura and other visual disturbances, and that specific factors could
trigger an attack. One thing from this that didn't really

(26:16):
hold up was his idea that migraine had gastric causes.
That was a commonly held view around this time. Like
going all the way back to the first definition of
him a crania, was this idea of like vapors arising
from the gut. So that was a long held idea.
Tisso's work on migraine was really influential for at least

(26:38):
the next century. But even as medical science was making
some more concrete progress on consistently describing the condition, migraine
was starting to pick up a lot of negative connotations.
In Britain, migraine became increasingly connected to stereotypes of French
delicacy and excess. Caricatures and satirical publications depicted foppish, seemingly

(27:01):
high maintenance doctors who minced around with snuff and elaborate outfits.
One character at the King's Theater Masquerade in London in
seventeen eighty two was dcor de Medica, so naming a
probably very ineffectual doctor after it. Yeah, and that trend

(27:22):
continued into the nineteenth century. In eighteen fifty four, Patrick J.
Murphy published Headache and Its Varieties in The Lancet. Although
many ordinary people were using megraham, hem acrania, and sick
headache interchangeably, he described these as three different things. Megram
was an anemic headache common among quote mothers in the

(27:45):
lower classes of life. Hem Acrania was a neuralgic headache
which he described as hysterical in origin, and a sick
headache was congestive, again common mostly in women. This was
the continuation of earlier work that connected migraine to things
like a lack of blood due to menstruation and mothers

(28:08):
who breastfed their children for too long. In eighteen fifty eight,
as migraine was becoming more strongly associated with supposedly worn out,
anxious women, Sir John Herschel gave a lecture titled Sensorial Vision.
He talked about his own experience with what sounds like
migraine aura quote a singular shadowy appearance at the outside

(28:29):
corner of the field of vision of the left eye.
It gradually advanced into the field of view and then
appeared to be a pattern in straight lined angular forms,
very much in general aspect, like the drawing of a fortification,
with salient and re entering angles, bastions and ravelins, with
some suspicion of fate lines of color between the dark lines.

(28:52):
He said he'd told various people about this experience, and
that one woman he knew said this happened to her
as well, and every time it did, a terrible headache followed. Meanwhile,
doctors were still discussing different potential explanations and classifications for migraine.
In eighteen fifty eight, John Addington Simmons argued that sick

(29:13):
headache and him a crania were two different things, and
then in eighteen seventy three Edward Living published the five
hundred page on megrim which again argued that people experienced
migraine for different reasons. He concluded that in working class
men it was from too much work being done in

(29:33):
poor ventilation, but that in men of a quote somewhat
higher social grade it was essentially from too much thinking.
But for women, regardless of class, he wrote that it
was coming from their anxious nervousness and the various pressures
associated with housekeeping and child rearing. That same year P. W.

(29:54):
Latham published on Nervous or Sick Headache, It's Varieties and Treatment,
two lectures delivered at Addenbrook's Hospital, Cambridge. This included a
visual depiction that Dr Hubert Airy had drawn of scintillating
skatoma in eighteen seventy side note, Airy and Sir John
herschel knew each other and they had discussed their visual

(30:16):
disturbances during Ari's visits. Then in neurologist Sir William Gowers,
author of diseases of the nervous system, gave a lecture
at which he displayed a visual representation of a patient's
migraine aura. Gower's patient, a Mr. Beck, had created a
whole collection of aura pictures that he had collected into

(30:37):
a book. Things like Herschel's description and aries and Beck's
visual recreations of their own experiences launched just a ton
of interest in this quote transiently defective vision. Soon, migraine
with r O is being described as classic migraine, with
migraine without aura described as comment. Migraine with aura became

(31:02):
viewed as the most authentic presentation of migraine, even though
migraine without aura was more common, and hubert Aries representation
of his aura became the standard of what aura looked like.
And even though women experienced migraine with aura for the
most part, they were not the ones going to these
medical lectures, or seeing artistic interpretations of migraine aura in

(31:25):
medical journals, or discussing all of that at medical society meetings.
So there was a growing sense that men in particular
had these visual disturbances, whether they happened with or without headache,
because of their over stimulated brains, while women's migraine attacks
were more likely to be ascribed to things like neurasthenia,

(31:45):
nervous exhaustion, or having too many babies. Increasingly, migraine and
men was viewed as a mark of genius, especially in
intellectual men, whether it was connected to pain or not,
but migraine and women was a mark of neurosis and martyrdom.
This is obviously continued to influence people getting treated for

(32:06):
migraine in the years that has followed all this. By
the early twentieth century, multiple medical fields had become more
firmly established as fields, including neurology, interchnology, allergy and immunology, psychology,
and ophthalmology, and many of them were starting to find
potential connections between what they were studying in those fields

(32:29):
and migraine. For example, George Bray reported that many of
his migraine patients had positive skin tests for various food allergies.
In one but the idea of a migraine personality was
evolving as well. Physician John Graham describes this as quote
a personality that seeks and creates stress and a physiology

(32:52):
that handles it poorly. Another person to suggest a personality
connection was Dr Harold G. Wolfe of Cornell Medical Center,
who had migraine himself. He referenced his own perfectionism and
ambition and that of his upper class friends and colleagues
who also had migraine. Broadly speaking, apart from all of

(33:13):
this sort of social baggage that had evolved, two general
theories had emerged to explain migraine. It either had a
vascular cause or a nervous system cause. The vascular theory
gained a lot of support in the nineteen thirties after
physician Alfred Goldman described the case of a nurse who
had experienced recurring severe headaches with vomiting. At one point,

(33:38):
a neurosurgeon had done exploratory surgery through a burr hole.
That hole had healed over as a depression in her
skull that was full of blood vessels. Goldman noticed that
when she had a migraine attack, those vessels seemed to
fill in this depression and swell almost like a tumor.
Dr Harold G. Wolfe worked on the vascular theory of

(34:00):
migraine as well. His experiments suggested that migraine aura was
connected to vasa constriction, and when those vessels dilated again.
Migraine pain followed. This type of work led to the
use of vaso constrictors to treat migraine, which did help
some people. Vaso Constrictors were one of several drugs used
in the twentieth century to treat migraine, and before this point,

(34:23):
drugs to treat migraine included non steroidal anti inflammatoryes like
aspirin and pyrazole, morphine, digitalist quinine, and cannabis extracts, among
other things. Ergotamine is derived from urgut fungus and was
first introduced as a drug to treat migraine in Along

(34:46):
with other effects, this acts as of as a constrictor,
and for the next few decades it really became the
primary drug to treat migraine pain. In nineteen forty four,
Brazilian researcher Aristides Leao described a theory of cortical spreading depression,
basically a complex phenomenon involving a wave of excited and
then suppressed brain activity. A couple of years before, psychologist

(35:10):
Carl Spencer Lashly had proposed a similar wave of activity
across the visual cortex when describing his own aura. It's
possible that this is connected to migraine with aura, although
this is not well understood. In the nineteen fifties, researchers
discovered a link between serotonin and migraine, and they started
working on drugs to target specific serotonin receptors, and the

(35:34):
result was a whole new class of drugs, tripped in's,
with multiple different tripped iNTS on the market. By the
late nineteen nineties, for the most part, tripped in started
replacing Urga derivatives as the primary treatment from migraine. The
term migraine er made its first appearance in writing in
nineteen seventy. That was in Oliver Sax's book on Migraine

(35:56):
that we referenced a little bit ago. Today, some people
disc dribe themselves as migraine urves, but for others it's
a term to avoid for a number of reasons, including
its negative connotations and the idea that it makes migraine
into a person's entire identity. In the nineteen eighties, researchers
measured blood flow through the brain and found that in

(36:18):
migraine without aura, there's no significant difference in the blood
flow during a migraine attack, but in migraine with aura,
blood flow is reduced at a rate of about two
millimeters a minute, and this roughly lines up with the
rate of cortical spreading depression that had been described, although
again this connection is not well understood. By the nineteen nineties,

(36:42):
functional mri I studies were suggesting that migraine was not
a purely vascular phenomenon, and it's been increasingly framed as
a biochemical process, and a wide range of drugs have
been used to treat it, often because people who were
taking a drug for some other reason reported that it
also helped with their migraine attacks. Among other things, this

(37:02):
has included people taking beta blockers for heart issues, various antidepressants,
and medicines to treat epilepsy. The f d A approved
botox as a migraine treatment in The FDA also approved
a transcranial magnetic stimulator for migraine treatment in tween, the
first device to be approved for that purpose. Until very

(37:26):
very recently, the drugs used to treat migraine were generally
used to reduce and shorten migraine attacks after the attacks
had started, and in the US, the FDA started approving
the first drugs developed specifically to prevent migraine attacks in
ten so just three years ago. These are known as

(37:49):
calcitonin gene related peptide or cd RP monoclonal antibodies. CDRP
is related to various pain processes in the body, and
it also acts as of as a dial later and
these drugs block that action. To wrap it up, there
are just so, so so many historical figures who are

(38:09):
known to have had recurring headaches, many of which are
described as migraine today. Just as examples and Countess of Conway,
Charles Darwin, Thomas Jefferson, Virginia Wolf, and Pablo Picasso. Some
people interpret the entirety of Lewis Carroll's Alice's Adventures in
Wonderland as a literary exploration of migraine, as well as

(38:31):
Emily Dickinson's I felt the funeral in my brain. Sometimes
this can seem a little bit speculative, As we've talked
about on the show before, diagnosing people from the past
can be tricky when they are not here to be examined.
But we will end on a quote from Rudyard Kipling
which was written in a letter to Miss Margaret Burne Jones,

(38:55):
and this is pretty specific and detailed. He wrote, quote,
do you know what him A cranium means a half headache.
I've been having it for a few days, and it's
a lovely thing. One half of my head, in a
mathematical line from the top of my skull to the
cleft of my jaw, throbs and hammers and sizzles and
bangs and swears, while the other half, calm and collected

(39:18):
takes notes of the agonies next door. My disgusting doctor
says it's overwork again, and I'm equally certain that it
arose from my suddenly and violently discarding tobacco for three days. Anyhow,
it hurts awfully, feels like petrofaction in sections, and makes

(39:39):
one right abject drivel. Hi. This is devilitating and horrible. Yeah,
it's um. One of the World Health Organization statistics that
I didn't cite was that, in terms of years lived
with a disability, uh, migrain is is like the sixth
most disabling condition. Everybody I know who has experienced migraines,

(40:02):
which is like some people. I got a spectrum between
folks that have had like a cluster of several migraines
that then sort of went away to folks that have
been dealing with recurring migraine attacks throughout their whole entire
life has generally been something that has just profoundly affected
their lives through all of that time. Uh So, if

(40:24):
you want to know more about the medical history of migraine,
particularly in the West, Migraine a History by Katherine Foxhle
from Johns Hopkins University Press was one of the sources
for this episode. It's from an academic press, but it's
pretty widely available. UM. There are open access copies of
it that you can get without um having to purchase

(40:46):
one or get it from a library if that's not
an option for you. So I read that as one
of the sources for this and it is I found
pretty accessible in terms of more academic writing, UM, with
lots and lots of details and specific that we didn't
really get into as much. Here. Do you have some
listener mail to get into Okay, I do have listener mail.

(41:07):
It is from Kelsey who writes Pest Control in New
Zealand and Kelsey writes Kura Kurua. Hey, Holly and Tracy.
I've been an avid listener of your podcast for years
and I really enjoy it, so thank you very much
for that. I just listened to the kudzoovine episode and
it brought to mind all the predator and pest control
that has gone on in New Zealand. Because New Zealand

(41:30):
was isolated from larger land masses for such a long
time after the breakup of Gondwana, our flora and fauna
are really unique. Our only native land mammals or bats,
and most of our birds prefer to wander about on
the ground because we used to have the host eagle,
which was a major predator before it went extinct. When

(41:50):
Maori arrived in about twelve hundred a d. We brought
rats and dogs that devastated the bird population, and we
also burned lots of forest. But what really set our
native populations back was when the Pocaha Europeans showed up
with worse rats, pigs, cats, and other animals. Some plants

(42:11):
were introduced by farmers that had worked really well in Britain,
such as gorse and broom, but quickly became pests in
New Zealand's more temperate climate. Acclimatization societies introduced brown trout
to our rivers, which wiped out some of our fish species.
They also called Kao which are the only alpine parrot

(42:32):
in the world. Because ko would attack sheep by eating
the liver while the sheep was still alive and running around.
Other animals, such as Australian possums were introduced for fur
trade but have become omnivorous. In New Zealand and our
real pests, rabbits were introduced for sport and then became pests,
so ferrets and stoats were introduced to control the rabbits,

(42:54):
but they found the flightless birds a bit easier to
catch and eat, such as our kiwi species. So many
mistakes by humans have led to New Zealand having one
of the highest rates of endangered bird species in the world.
Successive governments have attempted to control pests in different ways,
but there is a national strategy of predator free New

(43:14):
Zealand by twenty This can involve extensive trapping and monitoring,
but also the widespread use and aerial dropping of ten
eight poison, which is controversial albeit necessary. We are in
a unique situation where conservation efforts require systematic massacres of animals,
which can be hard for foreigners to understand. Listening to

(43:35):
your podcast is an absolute treat and I love the
diversity of subjects you cover things heaps For everything you do, Kelsey,
thanks so much for sending this in, Kelsey. Um, I
hope I did okay with the Maori pronunciations. I tried
to practice them ahead of time. Um. But the discussion,
especially at the end, about the attempts to control these

(43:55):
pests reminded me of I think it was our podcast
on Endlings where we're talking about the last of various species.
I don't remember how much detail we got into it
in the episode, but I had gone down a huge
rabbit hole of reading about goat control projects in the
Galapagos Islands that similarly required just like couling of all

(44:17):
the goats that had been left on the islands and
had just taken over and become really damaging to the ecosystem.
So thank you again, Kelsey for sending that in. If
you would like to write to us about this or
any other podcast, where at History podcasts at i heeart
radio dot com, and we are also all over social
media at miss in History. That's where you'll find our Facebook, Twitter, Pinterest,

(44:39):
and Instagram. And you can subscribe to our show on
the I Heart radio app and anywhere else you like
to get your podcasts. Stuff you Missed in History Class
is a production of I heart Radio. For more podcasts
from I heart Radio, visit the iHeart Radio app, Apple podcast,

(45:00):
or wherever you listen to your favorite shows. M