Migraine: A History by Katherine Foxhall

Abstract

Reviewed by: Migraine: A History by Katherine Foxhall Clark Lawlor Katherine Foxhall. Migraine: A History. Baltimore: Johns Hopkins University Press, 2019. xvi + 276 pp. Ill. $39.95 (978-1-4214-2948-9). Katherine Foxhall has written an excellent multilayered history of migraine in the Western context, and that must now be the first port of call for medical historians seeking more than a contemporary or specific period analysis of the topic. She takes a long historical view, beginning with classical and medieval approaches to what was then considered migraine, and moves through to the present day. The word "migraine" derives from Galen's "hemicrania" (pain afflicting half the head, although the stomach was also affected in this formulation), but this apparent linguistic continuity masks a large variety of differences in the ways in which migraine was defined and could manifest itself. There are many theoretical problems associated with tracing an unstable disease concept over the very longue durée, and Foxhall by no means solves them, but she does approach the history of migraine in a productive manner. The book moves through different periods while examining migraine through the methodological prism of different kinds of sources, each chapter beginning with a single one, many of which place us directly in the patient experience. Chapter 2 deploys Bald's Leechbook (ca. 950) to give us humoral perspectives and remedies for "healfes heafdes ece" (p. 23) as they evolved through to the fifteenth century. Humoral imagery in patient descriptions and other writings relating to this version of migraine predictably described the errant humors via "fumes, burning, boiling, and hammering" (p. 18). Mrs. Corlyon's recipe book (1606) takes us into the practicalities of early modern migraine treatment for "ordinary people" (p. 78) in Chapter 3, while Chapter 4 shifts gently forward in period into the eighteenth century with a focus on the burgeoning medical marketplace. Different geographies of health (the Derbyshire hills, London, Bath) and a variety of sources, from patient-physician correspondence to astrological casebooks, reveal the shift in migraine's status by the end of the eighteenth century from a serious affliction to object of satire, aided by the rise of nerve theory. One might argue this shift, and concomitant association of women with (inauthentic) migraine as a fashionable French disease ("migraine" being the French version of "Megrim") occurred earlier in the eighteenth century in a British context, as suggested by the poet Alexander Pope's 1714 mock-heroic portrayal in The Rape of the Lock (not cited in the book) of the languishing Goddess Spleen with "Pain at her side, and Megrim at her head." The overall point about the gendering of migraine is well made, however, and the following chapters (5 and 6) trace the complicated evolution of migraine through the nineteenth century and onward into a disease that signified both genius in middle and upper-class white men and—at best—a fashionable female disease signifying pleasing finer-nerved weakness. At worst, migraine signified (and still does to some extent) hysteria, fakery and malingering primarily associated with women. The visual aura that characterizes what came to be called "classical" migraine attracted the admiring attention of the male physicians who both experienced and then drew it, while the invisible but painful and debilitating [End Page 140] forms of migraine suffered by women were often denigrated and ignored, with consequences that have persisted in present treatments (or lack thereof) for different social groups. The advantage of a long historical view is especially apparent in Chapter 7, where Foxhall traces the impact of three historical stories about migraine that have been deployed, consciously or not, in the twentieth-century construction of migraine. Foxhall convincingly argues that neurologists seized the opportunity to authenticate their own ideas about migraine's etiology by retrospectively diagnosing, to take one example, Hildegard of Bingen's alleged migraines. Chapter 8, however, discusses the scramble for ownership of migraine's causation and treatment between different fields, most notably allergy, endocrinology, surgery, and psychology. Is migraine a vascular disorder or a facet (fashionable or stigmatized depending on one's perspective) of personality? Is migraine "one disorder, or many" (p. 20)? As the final chapter (10) states, in its...