Book excerpt: "Migraine: A History"

In the book "Migraine: A History" (Johns Hopkins University Press), medical historian Katherine Foxhall writes of a disabling disease that has been documented going back thousands of years, though the causes of this neurological disorder are still unclear. Symptoms vary, as have treatments through the ages (such as wrapping the patient's head with ground-up earthworms).

Migraine affects three times as many women as men, leading it to be considered by some a "women's disease," though it affects one out of seven people on Earth. As Foxhall writes in her book, advances in the diagnosis and treatment of migraine came from the examination of desperate women whose symptoms were disabling – and, in the 1800s, financially devastating.

Read the excerpt from Foxhall's book below, and don't miss Susan Spencer's report on migraines and an interview with Foxhall on "CBS Sunday Morning" February 16!

Elizabeth, the Girl Who Dropped Trays, 1895

In April 1895, Elizabeth, a sixteen-year-old servant from the small village of Burbage in rural Wiltshire, southern England, traveled eighty miles to central London. She sought the help of physicians at the National Hospital for the Paralysed and Epileptic in Queen Square. Her casenotes, which can be found in the thick bound volume of casenotes and treatment cards for prominent neurologist John Hughlings Jackson's female patients during 1895, reveal something of her first meeting with the doctors and the story she recounted about her illness. Elizabeth described how she had been experiencing St. Vitus Dance (rapid involuntary movements) on her left side, headaches and pains in her eyes, sickness, and nervousness. The headaches occurred two or three times every day and lasted for five minutes at a time. They particularly affected her left side, at the back part of the top of her head. Noise, or sometimes reading in the morning, was most liable to bring on an attack. Elizabeth had experienced spells of giddiness and twice felt weakness in her hands in the mornings. She described episodes in which she could only see the left side of her visual field, or the left half of objects. This hemiopia (or half vision) could come on suddenly or gradually, from the periphery, though she had never seen zigzags or vomited. While she said that she had never experienced any illness other than "nettle rash" (hives), she had known sickness and pains in her head ever since she could remember. These worsened when she went to school, and particularly as she learned to read. By all visible measures, Elizabeth appeared healthy. Her admission report describes "a bright intelligent healthy looking girl of 16." She was not anemic, and she showed no outward appearance of disease. Both her facial expression and her behavior appeared "natural," and her muscles were strong and normal in size. The only thing a careful observer might note was the "constant flexion and extension of the left fingers with a rough rhythm & having an amplitude of almost half an inch." For the past month, she explained, she had been unable to keep her left hand still.

Elizabeth also recounted a particular event, which the physician recorded in the margin of her hospital casenotes. One day, while carrying a tray full of things at her employer's house, the spoons on the right-hand side of the tray had suddenly disappeared from her vision. Making a dash to catch them, she "dropped the lot." We might imagine her employer's reaction to such an apparent episode of clumsiness. It is likely, for a start, that the cost of replacing the breakages would have come directly out of Elizabeth's pay. Any repeat of such an incident would certainly endanger her employment, not to mention her chance of receiving a good reference to take onward. Her predicament helps explain the young woman's decision to travel to London for help. Elizabeth described her home life to the physician, underscoring further the significance of her trip in hope of a cure. She was one of eleven children. At first, she said they were all healthy, but when pressed further, she admitted that one sister had neuralgia in her face. It turned out that another sister did, too. A brother, age fifteen, had water on the brain. Her mother was alive and healthy, and Elizabeth had always been well fed and clothed, but the family was poor. "The house was unhealthy," the notes record, "very draughty and damp – moss grew up the walls. Drains are carried straight into a stream." From such a description, there is little doubt that the family would have relied heavily on Elizabeth's ability to work to bring money into the household.

This chapter explores how, in the nineteenth century, physicians developed new theories about head disorders, including sick headache, bilious headache, megrim, and hemicrania. Rather than focusing on the character and location of pain (as had been common in humoral explanations), they based their ideas on the presumed cause and physiology of pain within the body, and, in so doing, increasingly made assertions about the gender and class of people subject to such conditions. Women, especially exhausted mothers and working women, came to be seen as migraine's "martyrs." By the 1860s, researchers – keen to develop theories about migraine and its causes and test potential treatments – could take advantage of the availability of inpatients in specialist settings, such as the National Hospital for the Paralysed and Epileptic.

Like Elizabeth, people often traveled great distances to access care at the National Hospital in the hope they might be treated and return to the working lives that chronic illness was making impossible. The casenotes and re-ports produced in institutional settings as varied as lunatic asylums and court trials reveal how ordinary people explained the onset of illness within the context of their lives, the profound effect of migraine on work and relationships, and the sometimes disturbing experiences of institutional patienthood. There is no doubt that neurological laboratories and hospital wards in places like London's National Hospital were the crucible for some of the most advanced neurological breakthroughs in modern medicine, but it is also true that these developments came at a human cost, as people in pain willingly submitted to exploratory ideas, therapeutic fashions, and experimental pharmacological mixtures.

From "Migraine: A History" by Katherine Foxhall, published by Johns Hopkins University Press. Copyright © 2019 by Johns Hopkins University Press. Reprinted by permission.

      
For more info:

• "Migraine: A History" by Katherine Foxhall (Johns Hopkins University Press), in Trade Paperback and eBook formats, available via Amazon