29 Jul 2019

Dr Katherine Foxhall and the history of migraines

From Afternoons with Jesse Mulligan, 3:08 pm on 29 July 2019

Blood-letting, tying a dead mole to the head; these are just a few of the ways migraines have been treated over the centuries. The pain can be so debilitating, patients have agreed to have holes drilled in their heads to stop it.

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Photo: cheschhh/123RF

Descriptions of migraines appear in literature going back as far as the 13th century, medical historian, Dr  Kathrine Foxhall says.

A Franciscan monk described it as a “hammering and pounding” in the head.

“Bartholomaeus Anglicus was a Franciscan monk from the 13th century and he wrote an encyclopedia called On The Properties of Things and one of the things he did was look at all kinds of different diseases, but he had this incredible description of migraine and it just feels like a modern description.

“It's so recognisable to anybody who's experienced the pain of migraines,” she told Jesse Mulligan.

Dr Foxhall has written a book Migraine: A History which looks at the social and medical contexts of a disease that still affects one in seven of the world’s population.

“More and more I'm beginning to think there's something inherent to the human condition about migraine, that it has been around forever, but it is shaped by the culture and the society we live in,” she says.

Through the ages people have associated the pain in their head with changing environmental conditions, Dr Foxhall says.  

“In the 19th century you get people trying to explain the noises that they hear in their head and they talk about the whistle of a steam train. And I think now when you look at artistic depictions of what life is like with migraine you often see people talking about televisions and hammer drills and strip lights and working in front of computers, living in polluted cities.

“So there are so many aspects of life that can make migraine worse if you have it, or just affect how we interpret it and explain it to others.”

Science now accepts that migraine is a neurological disorder, she says, although much remains unknown about it.

“In terms of what it is, medically it is a spectrum disease, it's a neurological disorder and it's really currently understood as a problem of brain function.

“So, we know that, well we're pretty sure, it involves nerve pathways and chemicals in the brain. There's a lot of genetic factors that predispose an individual to having migraines.”

But despite that fact it’s been around for so long, and our knowledge of it is growing, the treatment of migraines remains rudimentary she says.

“On a global scale it is underfunded, it's under treated, it's under-recognised, it's under diagnosed. So really one of the points I want to make with this book is that this is a disease it's been around for so long and at times in the past it seems to have been taken more seriously than it is now.”

While we may no longer use trepanning or a paste of earthworms to treat the condition, that doesn’t mean people are getting the treatment they need, she says.

“You know, you hear of so many people who just don't get access to adequate medical treatment at the moment even though those treatments are the drugs that are available are relatively cheap.

“They're relatively easy to get hold of and yet still millions and millions of people don't have access to basic adequate medication.”

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