Then vs. Now: The Evolution of Migraine Treatment

Fact: Migraines were once considered a symptom of demonic possession.

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Migraines continue to be a condition that plagues 12 percent of the United States population, and it’s the third most common health condition in the world, according to the Migraine Research Foundation. These migraines can happen monthly, weekly, or even daily in some cases.

Today, migraines are still not well understood, and many people who suffer from migraines go undiagnosed and untreated. Yet, if you look back at the early civilizations, you’ll see just how far migraine treatment and research has come.

The Early Days of Migraines

Migraines are considered one of the oldest known health problems. A number of ancient civilizations have left behind evidence of their migraines. For example, humans have found Mesopotamian poems describing migraine symptoms dating all the way back to 3000 B.C.

The “father of medicine” himself, Hippocrates, described symptoms of migraines in his patients during the Classical Greece era. He wrote of one patient that “he seemed to see something shining before him like a light” (what’s now known as “aura”)  and “a violent pain supervened in the right temple, then in all the head and the neck.”

Sometime in the first century, a Roman by the name of A. Cornelius Celsus wrote in his book De Re Medicina that migraines can sometimes be “more violent, but short, yet not fatal; which is contracted either by drinking wine, or crudity, or cold, or heat of a fire, or the sun.” (Here are actual migraine triggers you should know about.)

Aretaeus of Alexandria (and later Rome) also described migraines around the same time, wrote of his patients: “For they flee the light; the darkness soothes their disease: nor can they bear readily to look upon or hear anything disagreeable: their sense of smell is vitiated.”

Back in Greece during the second century, Galen, a Greek physician, surgeon, and philosopher, blamed migraines on “the ascent of vapours,” which was early medicalese for “hysteria,” or a disease thought to be caused by psychological stress.

Most of these accounts describe symptoms, but treatments were either unattempted or unwritten. One exception: during the Han Dynasty in China (around the second century), the surgeon Hua T’o may have used acupuncture to treat the migraines of Emperor Gaozu.

The Middle Ages: A Cruel Time for Migraines

Perhaps the worst time to be someone who suffers from migraines would be during the Middle Ages (the fifth to 15th centuries). While some treatments for migraines finally popped up, they weren’t exactly fruitful—let alone safe.

Common methods for treating migraines sometime around the 11th century included:

  • Sticking garlic cloves into incisions in the scalp

  • Applying a hot iron to the head

  • Bloodletting, or withdrawing blood, which was believed to be cure a number of illnesses at the time

  • And possibly trephining, or drilling a hole in the skull.

These rather violent techniques stem from the supernaturalism at the time. The common belief was that many illnesses were caused by demonic possessions. Because many migraine patients were (and still are) women, many people in the Middle Ages suspected witchcraft was at play.

The Discovery of Modern Migraine Treatments

The 19th and 20th centuries hosted a number of medical discoveries and advancements. (For example, find out how anesthesia was discovered during the 19th century here.) During the 19th century, medicine became more scientific and less supernatural, setting the stage for modern medicine as we know it.

The first true medication for migraines didn’t appear until 1938, which exemplifies just how long migraines have baffled doctors. This medication was ergotamine tartrate, proposed by the physicians John Graham and Harold Wolff.

In the 1938 paper, Graham and Wolff noted that migraines involved dilated blood vessels, which ergotamine helped to constrict. While the ergotamine definitely helped relieve the migraine pain, it often came with unpleasant side effects, like nausea, vomiting, and even dependency.

The 1950s introduced a variation known as dihydroergotamine. Again, it worked by constricting the blood vessels—this time by targeting all serotonin receptor subtypes. Once again, the medication helped relieve migraines but caused nausea and vomiting.

Finally, in the 1990s, the triptans were born. Instead of targeting all serotonin receptors, triptans specifically target the serotonin 5-Ht1 receptor, which helped constrict the blood vessels without causing so many side effects.

Today’s migraine treatment options still include ergotamine and triptans, especially for people with recurring migraines that are not relieved by OTC pain relievers. More recently, there are even new medications that can help prevent a migraine before it starts, or make them less severe. These include beta-blockers, some anti-depressants, and calcium channel blockers, according to the American Migraine Foundation.

To learn more about current migraine research, here are outdated migraine myths you can safely ignore.