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Baylor University Medical Center at Dallas

 
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General Review of Headache 

The clinical entity of HEADACHE dates back to ancient times.  As early as the dawn of civilization, primitive headache remedies included procedures aimed at ridding the body of the “demons and evil spirits” that were believed to cause headaches.  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.  The writings of the early Greeks referred to headache as a serious medical condition. 

Hippocrates (400 BC) may have been the first to describe the clinical symptoms of migraine.  In the historical Hippocratic books Hippocrates discussed what appears to have been the visual aura that can precede migraine.  The term “migraine’ itself is derived from the Greek word hemicrania. Throughout history, there have been famous individuals such as Plato, Thomas Willis, Erasmus Darwin (Charles Darwin’s grandfather), and others who have contributed to our understanding of headache. More recent scholars, such as Dr Harold Wolff, played an important role in our classification of different types of headache and their treatment. Following his classic 1948 publication of the first edition of Wolff’s Headache, it was Dr Wolff who introduced important scientific concepts which have served to modernize the study of headache.  Since that publication there has been an explosion in headache research which has resulted in our better understanding of this clinical condition.  There are now scientific mechanisms which more clearly define the pathophysiology of some headaches such as migraine.  This has also led to the development of new migraine specific medications and ultimately more effective treatment opportunities.  Epidemiological studies show that Migraine itself currently affects 30 million Americans. 

Migraine has played an influential role throughout world history.  There have been many famous and accomplished individuals who 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 Woolf, Cervantes (best known for Don Quixote) and Lewis Carroll (Alice’ Adventures in Wonderland) had migraine. There is even evidence to suggest that at least some of Alice’s Adventures were based on Carroll’s personal migraine visual 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 which indicates 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 sufferers constitute one of the largest groups of patients within a 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 under diagnosed, misdiagnosed and/or mistreated.  Whereas in some individuals, headache may be an occasional episodic, sometimes nuisance, for others the symptoms of headache may be a manifestation of a disabling chronic disease.  In the latter group, headache disrupts daily routines and impairs quality of life.  The frequency, severity, and even life consequences of headache sufferers vary widely.  The causes of headache are different in different individuals.  The treatment needs of patients who have occasional mild headaches are significantly different from those patients whose attacks are frequent and completely disabling.  Headache remains one of the most common health issues which challenge physicians and other health professionals.  The symptoms of head pain are 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 BAYLOR NEUROSCIENCE CENTER HEADACHE CENTER. 

Stuart B Black M.D.; FAAN

Chief of Neurology at Baylor University Medical Center at Dallas

Co Director of the Baylor Neuroscience Center