Migraines: A Historical Perspective and Modern Understanding
Efforts to treat migraines have been ongoing for centuries. The Ebers Papyrus, an ancient document from around 1550 BC, references a “disease of one half of the head” and suggests treating it with fried catfish applications. Fast forward to the second century, Galen, a Roman physician, recommended blood-letting as a remedy, which, honestly, was his go-to solution for many ailments. By the 20th century, there was speculation that repressed emotions might be the cause, leading some to mistakenly label women—who suffer more from migraines—as overly fragile or neurotic. Even a few decades ago, the notion that migraines were primarily caused by blood vessel changes in the brain was a commonly taught theory in medical schools.
However, recent advancements over the last decade have greatly enhanced our understanding of these neurological disorders, which are technically classified as a type of headache. Fortunately, the perception of migraines has shifted as well. Now, we have a clearer picture of what’s going on in the brain.
Generally, headaches can be categorized into two main types: primary headaches, which don’t stem from an underlying issue, and secondary headaches, which may arise from conditions like stroke, meningitis, or even a brain tumor. For instance, a hangover can be considered a secondary headache due to dehydration and other factors, while primary headaches, like cluster headaches, can be triggered by alcohol almost immediately. Migraines, although primary, often get confused for secondary headaches, which is part of why those who suffer from them often face challenges in receiving proper care.
“As healthcare providers, we are trained to ask the right questions to identify the type of headache,” explains Alexandra Sinclair, from the University of Birmingham. “Using classifications from the International Headache Society helps, but many patients experience headaches that feel quite similar, making precise categorization tricky.” Typically, if someone has a headache that is moderate to severe and prefers to lie down while avoiding light and noise, it’s likely a migraine.
“Migraines typically occur over four phases, including a warning period that might include excess yawning, urination, or fatigue,” notes Sinclair.
Studies now show that migraines originate from the trigeminovascular system, a complex network of nerves and blood vessels responsible for detecting pain in the brain. The trigeminal nerve is the most intricate sensory nerve in the head and, when disturbed, releases a neurotransmitter called CGRP (calcitonin gene-related peptide) that activates the brain’s pain pathways, leading to headaches that can range from moderate to debilitating.
Migraines generally unfold over four distinct phases. The early stage, known as the “prodrome,” may include unusual cravings for food, along with physical symptoms like yawning and fatigue. It’s a tricky situation because this occasionally leads to blame on the sufferer: “In the past, people would think, ‘You must have caused this headache by eating cheese or chocolate,’” Sinclair clarifies. “But recent research suggests the opposite; it’s the migraine that drives those cravings, not the other way around.” Following the prodrome, about a third of those affected may experience an “aura,” which can involve visual disturbances or even speech difficulties before the headache itself begins, lasting anywhere from four hours to three days. Afterward, during the “postdrome” phase, a person might feel drained for up to two days before returning to normalcy.
This sensory network likely evolved for good reasons. Sinclair mentions that some theories suggest heightened sensitivity to headaches might alert individuals to serious health issues like meningitis or brain injuries. In prehistoric times, those prone to migraines could have been more vigilant, offering a survival advantage—though in modern times, this sensitivity can hinder one’s ability to function effectively in daily life. The World Health Organization even ranks migraines among the most disabling diseases globally.
“It’s a significant problem affecting people during their most productive years,” says Sinclair. “For many, their capacity to function can be severely impacted for large parts of the month. And there’s still a stigma surrounding migraines; they’re often dismissed as not being a ‘real’ health issue, leading to delays in treatment.” Interestingly, women are affected by migraines about twice as often as men, likely due to hormonal variations and differences in how pain is processed in the brain, which adds another layer to the ongoing issue of proper treatment.
There are various measures individuals can take to reduce migraine frequency. Factors like sleep deprivation, excessive sleep, dehydration, and high stress are all contributors. Interestingly, while many migraine sufferers are sensitive to light, the relationship between screen time and migraine onset remains unclear.
On the brighter side, identifying CGRP has led to significant advancements in migraine treatments. New medications, including Gepants—oral drugs that block CGRP receptors—and monoclonal antibodies (Mabs), which are usually administered via injection, have transformed how migraines are managed. However, accessing these treatments can be challenging due to costs. Sinclair emphasizes the importance of improving healthcare access for migraine management and educating patients on the importance of seeking help. For many, effective treatment can be the difference between losing a job and maintaining employment. There’s hope; if you struggle with migraines, know that there have been meaningful changes in care and understanding.
While headaches may remain unchanged over the last couple of millennia, society’s view on migraines has thankfully evolved, moving away from perceiving them as mere character flaws.
