Johns Hopkins, 292 pages, $39.95
It’s estimated that over 1 billion people today suffer from migraines, two-thirds of them women. I am one of them.
In Migraine, Katherine Foxhall delivers a thorough and illuminating history of migraine that traces our endeavors to understand, treat, and eliminate this painful condition we still know little about. Is migraine a disease? What causes migraine? What are its social costs? These are not the questions I ask when a migraine hits, but I’m glad Foxhall does. Her intention to write “a history of migraine from below” by examining the experiences of people in pain, many of whom lived centuries ago, puts my own pain in perspective. I and my wincing, throbbing right eye do not suffer alone: Migraine is as old as humanity.
Foxhall’s early chapters are a cornucopia of historical detail and examples of human ingenuity in the service of finding, if not a cure, then a way to live with migraine. Early remedies included bloodletting, an evolving and increasingly sophisticated practice that relied on specific charts and instructions. Applying to the forehead a plaster of ground-up boiled earthworms encased in linen was another. Then there was trepanning, a process of drilling holes in the skull to dispel bad vapors in the brain. By the 1700s, pills promising relief were advertised in British newspapers and sent through the mail. Lower’s Restorative Powder, a snuff product, was sold on London street corners by gangs of dealers, like crack. By 1781, the French word migraine entered the English language as the accepted medical term, replacing older words such as megrim.
The history of migraine also involves gender and class. Foxhall, a cultural and social historian, relates how migraine came to be seen as a female disorder in the 19th century, and how the belief in a migraine personality — “sensitive, effeminate, and nervous” — infected the medical establishment with gender bias. By the 1960s, an image of a suffering housewife with her face in her hands appeared in advertisements for migraine medications. Men who suffered migraines were seen differently. An 1888 article in The Lancet, the prestigious medical journal founded in 1823, declared that “the [male] migrainous patient frequently belongs to the most cultivated and intellectual class of society.”
Smart men got migraines — Freud dosed his with cocaine — from thinking too hard, but men working in factories and on farms were evidently pain free. Women were simply nervous and hysterical. With growing knowledge about the brain and nervous system, the occurrence of such medical cum moralistic declarations declined, though their sexist residue still exists: In 2017, the National Institutes of Health budgeted $22 million for migraine research compared with $57 million for smallpox, a disease that was declared “globally eradicated” in 1980. One way to explain the disparity is that migraine, an ongoing global problem, is still considered a women’s problem and therefore gets less funding.
Foxhall’s erudite and vivid accounts of migraine spoiled me for other books on the subject, but I wanted to see how self-help books approach migraine. The ones I read are focused on recovery; all their case histories are success stories. Their titles vibrate with attitude and resolve. There’s a migraine relief plan; a migraine miracle; a you-can-take-back-your-life promise. These books do provide basic medical information but are overstuffed with bulleted factoids, endless pages of recipes, and daily tracking goals. They are carelessly written, historically shallow, and contain no elegance, no awe, only plans of action and can-do peppiness. Worst of all, they bully the reader. Did I learn anything from them? Yes — to stay away from bananas. Bananas!
Oliver Sacks’ 1985 book, Migraine, does contain elegance and awe. Sacks — the late neurologist best known for his book The Man Who Mistook His Wife for a Hat — eschews self-help but embraces mystery and acceptance of a condition that remains shrouded. To him, migraine is both “physical and symbolic.” His medical analogies are often literary. In a section about visual disturbances with migraine, Sacks describes the “Lilliputian vision,” wherein an “apparent diminution” of whatever object you’re looking at occurs. Thanks to Sacks, I now have a word for what I once experienced as I felt a migraine coming on. I looked down and perceived that my left leg was the size of a rolling pin. Fortunately, this distortion soon passed. Since my late 40s, I’ve had migraines but, luckily, only one Lilliputian vision. Nevertheless, I’ve not told my doctors about this experience for fear they’ll think I’m “sensitive, effeminate, and nervous.” Having a name for this neurological mix-up is helpful. It means others have experienced what I have, and I take comfort in knowing this.
MRIs, CT scans, spinal taps, along with discoveries about the brain’s chemistry have changed our view of migraine. With these new advancements in medical knowledge, what Foxhall calls “the neurological turn,” the social complexity of the body can too easily be reduced to neurological or hormonal functions. The migraine medicine Imitrex debuted in 1991 and has given relief to millions, including me, but there’s no complexity in taking Imitrex, no snuff-sniffing gangster standing on the corner.
Foxhall’s history of migraine, unlike the self-help books, accommodates human complexity without scanting medicine’s contributions to a condition that affects roughly 1 in 7 people on our planet. A lively, scholarly book about migraine, Foxhall’s history is also a treatise on the human condition. Although relief from pain is wonderful, pain remains the great equalizer. Whether we take Imitrex or dress our foreheads with worms, we shouldn’t forget this.