A (Very Brief) History of Migraine

history migraine blog flow
If you're reading this and you get migraines you should thank your lucky stars you're not alive in the 15th century. Whilst we're not yet perfect, the way we manage migraine has come a long way from drilling holes in the skull!

You would think that for a condition that affects one in five people and that’s been around for at least 6000 years (1), we would have a firm understanding of what it is. As you’re about to find out, that has unfortunately not been the case until very recently.

For many centuries people have debated what causes migraine. Thankfully, gone are the days of theories of demonic possession or an imbalance in the four humors (blood, yellow bile, black bile, phlegm) to explain this debilitating condition.

We have to go back to the 17th century to see the first descriptions of what we now recognise as chronic migraine (2). Since this time the debate around what causes migraine has generally swung between it being an issue with the blood vessels in the brain and the nerves in the brain.

 

19th Century: Two Clear Front Runners

Around 150 years ago, both the vascular and neural theories were equally dominant in medicine. Two seminal books were published that established these seemingly contradictory theories into popular opinion.

In the book “On Megrim, Sick Headache, and Some Allied Disorders: A Contribution to the Pathology of Nerve-Storms” (3), Edward Liveing makes a case for migraine being an issue with the nerves in our brain*.* He describes migraine to be the result of a “nerve-storm, an inherited tendency for the discharge of nerve force”.

Around the same time, Peter Latham described migraine as being caused by vasodilation of blood vessels in his book “On Nervous or Sick-Headache” (4).

 

20th Century: Migraine is All About the Blood Vessels

In the 1940s the case for migraine being a blood vessel disorder began to gain popularity. Wolff and his colleagues began doing studies after he noted that pressure and stretching on the blood vessels during an operation would often result in the patient waking with headache (5, 6, 7).

These studies would make the vascular theory the dominant theory for nearly 50 years.

In the 1960s a triptan drug called ‘sumatriptan’ started being used as a treatment for migraine. Today you’re most likely to know this kind of drug as Maxalt or Imigran among others. At the time it was believed sumatriptan only acted to constrict blood vessels (8). As you could imagine this served to strengthen the argument for a vascular cause.

However, there was more to the drug than was first suspected.

 

Where Are We Now?

Studies began emerging in the late 1990s that showed sumatriptan has an effect on the nerves in our brain (9). As time went by and more studies emerged it became clear that the therapeutic effect had nothing to do with blood vessels at all. The drug was in fact acting on areas of the brainstem related to migraine pain (10, 11).

In recent years as assessment tools have become more sophisticated we have seen more and more evidence emerge that migraine is a disorder of the brain, and not the blood vessels. Specifically, migraine effects areas in the brainstem and hypothalamus. Whilst we still don’t have a clear understanding of what initiates a migraine attack, this new understanding of migraine is beginning to lead to more effective and sustainable forms of treatment.

At Flow Osteopathy, we are passionate about supporting our local community of Whitehorse, Mitcham, Heathmont, Forest Hill, Donvale, Box Hill and the surrounding suburbs.

If you’re suffering from headaches and migraine, click here for more information on how we can help.

 

  1. Eadie MJ. A history of migriane. In: The Migraine Brain, edited by Borsook D, May A, Goadsby PJ, and Hargeaves R. New York: Oxford Univ. Press, 2012, p. 3– 16.
  2. Willis T, Pordage S. Two Discourses Concerning the Soul of Brutes, which Is that of the Vital and Sensitive of Man: The First Is Physiological, Shewing the Nature, Parts, Powers, And Affections Of The Same; And The Other Is Pathological, Which Unfolds the Diseases Which Affect It and Its Primary Seat, to Wit, the Brain and Nervous Stock, and Treats of Their Cures: With Copper Cuts. London: Dring, Harper and Leigh, 1683.
  3. Liveing E. On Megrim, Sick-Headache, and Some Allied Disorders. A Contribution to the Pathology of Nerve-Storms. London: Arts & Boeve Nijmegen, 1873.
  4. Latham PW. On Nervous or Sick-Headache. Cambridge, UK: Deighton, Bell and Co, 1873.
  5. Graham JR, Wolff HG. Mechanism of migraine headache and action of ergotamine tartrate. Arch Neurol Psychiatry 39: 737–763, 1938.
  6. Ray BS, Wolff HG. Experimental studies on headache. Pain sensitive structures of the head and their significance in headache. Arch Surg 41: 813–856, 1940.
  7. Wolff HG. Headache and Other Head Pain. New York: Oxford Univ. Press, 1963.
  8. Feniuk W, Humphrey PPA, Perren MJ, Connor HE, Whalley ET. Rationale for the use of 5-HT1-like agonists in the treatment of migraine. J Neurol 238: S57–S61, 1991.
  9. Humphrey PPA, Goadsby PJ. Controversies in headache. The mode of action of sumatriptan is vascular? A debate. Cephalalgia 14: 401–410, 1994.
  10. Hoskin KL, Kaube H, Goadsby PJ. Sumatriptan can inhibit trigeminal afferents by an exclusively neural mechanism. Brain 119: 1419–1428, 1996.
  11. Kaube H, Hoskin KL, Goadsby PJ. Sumatriptan inhibits central trigeminal neurons only after blood-brain barrier disruption. Cephalalgia 13: 41, 1993.
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