General Review of Headache

By Stuart B Black , M.D.; FAAN 

The clinical entity of HEADACHE dates back to ancient times.  As early as the dawn of civilization, headache remedies included a procedures aimed at ridding the body of the demons and evil spirits that were believed to cause headaches and other central nervous system diseases such as epilepsy.  As early as the Neolithic period dating back to 7000 BC, skulls have been found bearing man made holes (called trephination) presumably done for medical reasons which may have included the treatment of headache.  Skulls demonstrating trepanation have also been found in Peru dating back to the thirteenth century.    As late as 1660, the famous Dr William Harvey recommended trepanation to a patient with appears to have been intractable migraine.  The Greeks also regarded headache as a serious complaint.  Hippocrates (400 BC) may have been the first to describe the clinical symptoms of migraine.  In the Hippocratic books he discusses the visual aura that can precede the headache and its relief by vomiting.  The term “migraine’ itself is derived from the Greek word hemicrania.   Throughout history, other famous individuals such as Plato, Thomas Willis, Erasmus Darwin (Charles Darwin’s grandfather), and other more recent physicians including Dr Harold Wolff, who in 1948 published the first edition of Wolff’s Headache, have played an important role in our better understanding the causes and treatment of headache. Some believe that Dr Wolff first introduced modern science to the study of headache.  Since the publication of Wolff’s Headache, there has been an explosion of new knowledge about headache.  There are now scientific mechanisms which better define the pathophysiology of headache and new treatments based on a better understanding of the Central Nervous System.  Headache has always been an important clinical entity, but only within the last decade has a body of solid, research – based evidence grown enough to allow development of our current treatment strategies.      

Throughout history, many famous and accomplished people have suffered from migraine.  Examples of just a few include Julius Caesar, Napoleon, Thomas Jefferson, Ulysses S. Grant, and Robert E. Lee.  Great painters such as Vincent Van Gogh, George Seurat, and Claude Monet had migraine.  The famous authors Virginia Woolfe, Cervantes (best known for Don Quixote) and Lewis Carroll (Alice’ Adventures in Wonderland) had migraine. There is evidence to suggest that at least some of Alice’s Adventures were based on Carroll’s personal migraine aura perceptions. As Cheshire Cat observed, “One pill makes you smaller; one pill makes you larger, the pills mother gives you do nothing at all”.  There has been literature to suggest that Thomas Jefferson’s headaches were so severe and debilitating that they often interfered with his ability to function.  As he wrote to Martha Jefferson in February 18, 1784, “Having to my habitual ill health….lately added an attack of my periodical headache, I am obliged to avoid reading, writing, and almost thinking”.  In March 1807, while still President, Jefferson wrote “…Indeed, I have but little moment in the morning in which I can either read, write, or think, being obliged to be shut up in a dark room from early in the forenoon till night, with a periodical headache”. 

Headache patients constitute the largest group of patients in neurological practice.  More patients who visit doctors complain of headache than any other single ailment. Headache and migraine in particular, may be considered as a universal human condition which continues to be underdiagnosed, misdiagnosed and mistreated.  Whereas in some individuals, headache may be an occasional episodic, sometimes nuisance, symptom, for others it may be a manifestation of a disabling chronic disease.  In the latter group, headache disrupts daily routines and impairs quality of life.  The cause, frequency, severity, and even life consequences of headache sufferers vary widely.  The treatment needs of patients who have occasional mild headaches are significantly different from those patients whose attacks are frequent and completely disabling.  Thus, headache is one of the most common health issues which challenge physicians and other health professionals.  The symptoms of head pain is a frequent cause of human suffering and disability.  For many patients with headache, an organized, multidisciplinary headache center environment is necessary to provide the entire spectrum of headache management.  Specialized headache centers are for patients in whom comprehensive services are essential to address the multifunctional components of their headaches.  This entire spectrum of headache management is available at the DALLAS HEADACHE ASSOCIATION.