Tuesday, 25 November 2014

What A Pain: Early Modern Migraine Treatments

It’s dark out and bit stormy, the barometer is fluctuating, the fluorescent lighting in your office is flickering, and your officemates’ voices are just grating on your nerves.  The smell of someone’s lunch is making nausea set in.  You’re irritable and your head is exploding in pain.

You have a migraine.

Migraines, according to the thoroughly trustworthy Wikipedia, affect roughly 15% of the population worldwide and costs billions of dollars in lost productivity and medical fees each year.

Migraine sufferers differ.  For some, the onset of a migraine can mean a week of uninterrupted pain, nausea, light and sound sensitivity.  For others, it’s a really big, annoying headache.  Modern treatments and pain management regimes range from surgery to popping a few pills to nasal sprays. 

For Lady Anne Conway (1631-1679), things were a bit more difficult.  Conway’s headaches were likely migraines.  She described them as a “violent fitt of the headache” that lasted for several days.[1]  Throughout her life, Conway sought the advice of different medical men including the mountebank faith healer Valentine Greatrakes, to respected physicians Thomas Willis, William Harvey, Theodore Turquet de Mayerne, and the son of Jan Baptist van Helmont.[2] 

An educated woman, Conway actively sought and researched new pain management methods, rejecting those outright she thought ineffectual and trying those she thought worthy.  Indeed, Conway even rejected a “elixer” her husband recommended and requested instead some of Robert Boyle’s “Ens Veneris,” having read of it in Boyle’s book on experimental philosophy.[3] 

Unfortunately, none of Conway’s efforts, nor those of her doctors, proved successful and she suffered from migraines till her death in 1679. 

The early moderns did not have ibuprofen or triptans.  So what did they use to combat migraines?

Most remedies seem to involve the physical placement of an ointment or plaister on the head.  The Widdows Treasure (1595) for example recommended this remedy for the migraine:

Take a handfull of Camomill, a handfull of Betony, a handfull of Veruaine leaues cleane picked, stamp them and seeth them in Ale woort, and when it hath sod, put thereunto a little Commin seed finely beaten, with a little pouder of Harts horne, three spoonfuls of vineger, the yolkes of two Egs and a little Saffron, stir them about, and lay a playster hot ouer all his forehead. It is an approued medicine for the Megrim.[4]

One would assume that the warmth of the plaister, at least, would certainly have provided some soothing relief.

Even tobacco was thought to cure migraines.
Other herbal remedies included decoctions of sassafras to the semi-magical wearing of St. John’s Wort that had been “gathered when the Sun is in Aries, and then presently dryed, and made into fine Powder, and worn about the Neck in a Silk Bag.”[5]

The so-called Aqua Hungarica or Queen of  Hungary’s Water was also thought efficacious.  Here, two pounds of fresh rosemary flowers were distilled in spirits.  The resulting rosemary flower water could be taken inwardly, applied to the affected part like an ointment, or in the case of migraines, “drawn up the nostrils.”[6]

Two pounds of fresh rosemary flowers is a lot of flowers.  It seems likely that this latter water would have been somewhat pricy to both make and purchase.

For those with even more money, the 1602 Diacatholicon Aureum recommended a powder of gold consumed in a posset.  The patient was to consume anywhere from two to five grains of the gold powder.  The gold, the author argued, was “good for al diseases” and would affect a cure through purgation.[7]

Not all early modern migraine treatments were so benign – if you would call strong purges benign! 

William Bullein, for example, recommended purging followed by bloodletting, very specifically, from the “middle veine of the forehead.”[8]

A veritable "How to Trepan" guide from Scultetus (1674)
It seems natural that as the site of the pain, surgeons would focus their craft specifically on the head.  Ambroise Paré, the eminent French surgeon, related that ancient authority suggested the surgeon:

"marke the Arteries which are behind the eares, then divide them in cutting to the very bone, and make a great incision the breadth of two fingers…the incision be made transverse, cutting or incising the length of two fingers."[9]

Paré, however, thought the incision to be too troublesome and  liable to cause further injury.  Instead, he recommended a more simple course – a single incision to open both “the Arteries behind the eares, and those of the Temples.”[10]
Last, in a case of jumping from the frying pan into the fire, some surgeons recommended trepanning to cure the migraine. 

Perhaps the most invasive of the early modern surgeries, trepanation involved boring a hole into the skull, without any anaesthetic, in order to release the pressure thought to cause migraines.

In 1656, Conway was so desperate to be rid of her constant head pain that she traveled to France to have the operation performed.[11]  
Conway was never trepanned and we’re not entirely sure why.  Various ideas include: she was talked out of the procedure by Henry More, her surgeon was unavailable, or her surgeons thought trepanation too dangerous given her health.

Either way, Conway’s surgeons went ahead with the less dangerous surgical option – they let blood from her jugular vein instead.[12]

Which migraine treatment would you have chosen?
Let me know what you think here or on Twitter – I’m @medhistorian.

[1] Conway, Viscountess Anne, 1631-1679, Letter from Anne Conway to Henry More, January 26, 1652?, in The Conway Letters: The Correspondence of Anne, Viscountess Conway, Henry More, and Their Friends, 1642-1684. Hutton, Sarah. Oxford, England: Clarendon Press, 1992, 592.
[2] Sarah Hutton, Anne Conway: A Woman Philosopher, Cambridge, CUP (2004), 120-123.
[3] Conway, 592. 
[4] The Widdowes Treasure. London: printed by I Roberts for Edward White (1595), f.A8r.
[5] John Durant, Art and Nature John Hand in Hand, London: printed for Sam Clark (1697), 7 and 9.
[6] William Salmon, Pharmacopoeia Bateana, London: printed for S. Smith and B. Ealford (1700).
[7] Diacatholicon Aureum. London: printed for John Flasker (1602), f.C1r.
[8] William Bullein, The Government of Health, London: printed by Valentine Sims (1595)/
[9] Ambroise Paré, The Workes of that Famous Chirurgion, London: printed by Thomas Coates and R. Young (1634), 37-38.
[10] Ibid., 39.
[11] Joe Moshenska, Feeling Pleasures: The Sense of Touch in Renaissance England, Oxford: OUP (2014), 226.
[12] Marilyn Ogilvie and Joy Harvey, The Biographical Dictionary of Women in Science, New York: Routledge (2000), 583.


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