Therapeutic implications of central and peripheral neurologic mechanisms in migraine.

Abstract

The oldest known medical manuscript, the Ebers Papyrus, discovered at Thebes, Egypt (about 1550 BC) mentions several cures for headache, including anointing the head with ashes from the burnt skull of a catfish and fried in oil (“a remedy for suffering in half-the-head”).1,2⇓ In the fifth century BC, Hippocrates made careful observations of headache (e.g., describing the visual aura and the onset of headache after the aura) and first recognized that headache is an actual disease.3 He believed that headache resulted from imbalances of “humors” (fluids or vapors circulating in the body) rising from the liver to the head. As treatment, Hippocrates recommended bleeding to drain the excess humors and application of herbs to the head to draw out the humors. It is to the Roman Galen (AD 131–201) that we owe the term “hemicrania,” (later transformed to the Old English “megrim” and French “migraine”) and the concept of four humors that govern health and disease (blood, phlegm, black bile, and yellow bile, an excess of which caused vomiting in migraine). “We ought not to omit or postpone the use of millipedes or woodlice, for that the juice of them, wrung forth, with the distilled water, also a powder of them prepared, often bring notable help, for the curing of old and pertinacious headaches.” Quite surprisingly, this bizarre prescription was written by Dr. Thomas Willis (1621–1675), the man who so accurately observed that “the subject of the head-ache must be in the parts of the head that are most nervous, that is, the nerves themselves, also the fibres and membranes, […]; and those parts which are affected with pain are chiefly the two meninges and their various processes, […]. As to the brain and cerebellum, and their medullary appendixes, we conclude that these bodies […] continue free …