66 Headache Medicine, v.2, n.2, p.66-69, Apr./May/Jun. 2011

Treatment of migraine attacks before the

twentieth century

Tratamento da crise migranosa antes do século XX

ABSTRACTABSTRACT

ABSTRACT

Migraine accompanies humans throughout their existence

and, for the relieve of their pain, various forms of treatment

were used. From the Neolithic to the Modern Age,

Mesopotamian, Egyptian, Chinese, Greek, among other

people, have suffered intense attacks of chronic headache.

Many different treatments have been used from skull drilling

and bloodletting to the use of herbs and plants. People who

lived before the twentieth century had no knowledge of any

drug treatment.

eywords: eywords:

eywords: Migraine; Treatment; Ancient times

RESUMORESUMO

RESUMO

A migrânea acompanha o ser humano ao longo de sua

existência e, para o alívio de suas dores, diversas formas de

tratamento foram utilizadas. Do período neolítico à idade

moderna, mesopotâmicos, egípcios, chineses, gregos, entre

outros, padeceram de crises intensas de cefaleia. Inúmeros

tratamentos diferentes foram utilizados, desde perfurações

cranianas, sangrias e o uso de ervas e plantas. Os povos

que viveram antes do século XX desconheceram qualquer

tratamento farmacológico.

alavrasalavras

alavras

chave:chave:

chave: Migrânea; Tratamento; Antiguidade

REVIEW ARTICLEREVIEW ARTICLE

REVIEW ARTICLE

Raimundo Pereira Silva-Néto

, Kelson James Almeida

Neurologist and Member of the Brazilian Society of Headache

Neurology Resident at the Hospital das Clinicas/Universidade de São Paulo

Neurology and Headache Center of Piauí - Teresina PI, Brazil

Silva-Neto RP, Almeida KJ

Treatment of migraine attacks before the twentieth century. Headache Medicine. 2011;2(2):66-69

INTRODUCTION

Pain, especially headache, is one of the great

scourges of humanity. In several regions of the world,

there has always been engagement in the search for

its cure. Its dimensions varies according to each

society and the historical moment in which it finds

itself in.

Migraine is manifested clinically by recurrent

episodes of headache and other associated

manifestations such as nausea, vomiting, photophobia

and phonophobia. However, this type of headache is

the most frequent complaint and, when very intense, it

may prevent the patient from doing his/her routine

activities.

Unfortunately, up to the early years of the nineteenth

century, there is no record indicating any pharmacological

treatment for headache, as the first chemical substance

with analgesics to be isolated in the laboratory was salicin,

from willow bark (Salix Alba) by the Italian chemists

Brugnatelli and Fontana, in 1826.

As time went on, this

drug would lead to acetylsalicylic acid, commercialized

only in the twentieth century, starting on October 10th,

1903.

Throughout ancient times to the years preceding the

twentieth century, man has used different treatments to the

relieve of headache.

Headache Medicine, v.2, n.2, p.66-69, Apr./May/Jun. 2011 67

BEFORE THE CHRISTIAN ERA

Approximately 7000 years BC, according to

archaeological finds, Neolithic civilizations had already

been suffering from intense attacks of headache. This pain

was associated with a supernatural explanation, such as

a divine punishment or due to possession by evil spirits

inside the skull, which is why the patient would be isolated

for purification or there would be holes opened "in vivo"

in the head to extract the evil spirit.

6-9

Around 1700 BC, in Mesopotamia, the treatments

for headache were described in the Code of Hammurabi,

and it was also common using skull perforations.

2,7

It was also believed among the ancient Greeks that

the headache was the result of a possession. The Greek

god Zeus, according to the mythology of this people,

suffered from a violent headache that forced Hephaestus

to open his skull with a golden ax so that Athena, his

daughter, were born.

6,9

In ancient Egypt, through mythological stories and

especially the Ebers Papyrus (1536-1534 BC) and the

Chester Beatty V (1300 BC), descriptions of intense and

incapacitating headache affecting a half of the head and

that would alleviate with rest are noticed.

It is perceived

that these characteristics are consistent with the diagnosis

of migrane.

Treatment of migraine attacks used at that time was

limited to the Pharaohs and was associated with the rituals

of magic, needing enchantment and prayers from the

gods.

In the paragraphs of the Egyptian papyri more than

800 prescriptions are described with various forms of

palliative treatment for migraine, such as infusion of leaves

of myrtle (Myrtus communis), anointing the head with oil

in which catfish was fried, cooling the painful head, use

of relaxation, massage and hot or cold pads or even

drinking a mixture of crocodile fat with semen and feces

dissolved in urine three times a day.

Another form of

treatment consisted of placing the patient sitting up and

tying securely on his/her head a clay crocodile with wheat

in its mouth, through a strip of white linen with the names

of several gods (Figure 1).

8,10,11

With this technique, the

reports suggested the improvement of patients, probably

due to the compression of enlarged arteries of the scalp.

In 1000 BC, the Chinese came up with the

acupuncture, from the Latin acus (needle) and punctum

(sting), which consisted, as nowadays, of stimulating specific

body areas with needles or magnet, to relieve the

headaches. It is attributed to Chinese surgeon Hua T'o,

as the first to use acupuncture needles for the treatment of

migraine.

In Greece, Hippocrates (460-377 BC) always

involved himself with the treatment of pain, as evidenced

by the famous sentence attributed to him, "Sedare dolorem

opus divinum est" (easing the pain is a divine work). He

treated the migraine with powder made from the bark

and leaves of willow (Salix alba), a plant rich in salicin (a

precursor substance of salicylic acid).

2,12

Hippocrates was

also the first to use bloodletting as treatment of crises of

migraine.

AFTER THE CHRISTIAN ERA

Around the year 80 AD, Arateus, born in Cappadocia

(modern Asiatic Turkey) described migraine for the first

time.

7, 8,13,14

At that time, the treatments, even though very

ineffective, were very popular, such as the habit of tying a

whip around the neck.

In the Roman Empire, during the first years of the

Christian era, opium was the analgesic used for

headaches, a thick juice that was extracted from the opium

poppy (plant of the Papaver genus). Later on, its major

alkaloids would become known: morphine, codeine and

papaverine.

Fig. 1 - Headache treatment

A B

TREATMENT OF MIGRAINE ATTACKS BEFORE THE TWENTIETH CENTURY

68 Headache Medicine, v.2, n.2, p.66-69, Apr./May/Jun. 2011

In the sixth century, the eminent Greek physician

Alexander of Tralles (525-605 BC) attributed the cause

of headaches to an overflowing of bilious moods which

he treated with emetics (substances for inducing vomiting),

purgatives, laxatives, besides prohibiting greasy foods.

Other methods of pain relief were used in the ninth

and tenth centuries, e.g., Al-Zahrawi or Abu'l Oasim, born

in Spain in 936 AD who treated pain by pressing a hot

iron on the sore spot, or putting garlic on temples after

skin incision.

13,15

The British wore pieces of swallow's nest

on the forehead or drank elderberry juice (plant genus

Sambucus) or ate goat manure.

In the Middle Ages, from the eleventh to the fifteenth

century, some Europeans, to relieve their pain, applied

opium on the head with a vinegar solution that would

open the pores for absorption of the drug. This treatment

was used by the German nun Hildegard von Bingen

(1098-1179), who suffered from migraine with aura.

In South America, from the thirteenth to sixteenth

century, there were the Incan (now Peru) and Aztec (now

Mexico) civilizations, people of a pre-Columbian Andean

culture that used religion, magic and plants, mainly coca

leaves (Erythroxylon coca) and mandrake (Mandragora

officinarum) to control the pain.

In the sixteenth century, during the year 1560, the

French diplomat Jean Nicot (1530-1600) was

ambassador to Portugal and from there he brought to

France the first seedlings of tobacco (Nicotiana tabacum).

He enjoyed snuffing ground tobacco, called snuff, to

relieve his headaches. In 1560, he indicated its use to the

French Queen Catherine de Medici (1519-1589), who

suffered from terrible headaches.

During the eighteenth century and well into the Modern

Age, patients with migraine, epilepsy or other neurological

disorders were often subjected to interventions to remove

the "stone of madness".

17-18

In that same century, the remarkable neurologist Samuel

Auguste Tissot (1728-1797) who lived in Switzerland and

used the knowledge from Hippocrates, also recommended

bloodletting for the treatment of migraine attacks. This

procedure often caused the death of the paciente.

CONCLUSIONS

In the past, migraine was treated only during the

attacks with the knowledge and culture of each civilization.

However, the use of medicinal herbs has contributed to

the emergence of the first analgesic drugs such as

acetylsalicylic acid and dipyrone.

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Headaches in antiquity and during the early scientific era. J

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8. Rapoport A, Edmeads J. Migraine: The evolution of our

knowledge. Arch Neurol. 2000;57(8):1221-3.

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<http://www.migracalm.net/pt/historia.html> Acesso em: 02

dez. 2010.

10. Baptista CMM, Bordini CA, Speciali JG. Cefaleia no Egito antigo.

Migrâneas Cefaleias. 2003;6(2):53-5.

11. Karenberg A, Leitz C. Headache in magical and medical papyri

of ancient Egypt. Cephalalgia. 2001;21(9):911-6.

12. Cristianini MC. Linha do tempo. Disponível em: <http://

historia.abril.com.br/ciencia/dor-cabeca-eterna-435737. shtml>

Acesso em: 29 nov. 2010.

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para entender as dores de cabeça e seus tratamentos. 5ª ed.,

Rio de Janeiro: Prestígio Editorial, 2005, 118 p.

14. Koehler PJ, van de Wiel TW. Arateus on migraine and headache.

J Hist Neurosci. 2001;10(3):253-61.

15. Cauás M, Lima MC, Lago CAP, Ponzi EAC, Oliveira DA, Valença

MM. Migrânea e Cefaleia do tipo tensional: alguns aspectos

históricos. Headache Medicine. 2010;1(1):29-33.

16. Haas LF. Jean Nicot 1530-1600. J Neurol Neurosurg Psychiatry.

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17. Hartman JJ, White SM, Ravin JG, Hodge GP. The stone of

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Correspondence

DrDr

. R. R

. R

aimundo Paimundo P

aimundo P

ereira da Silva Netoereira da Silva Neto

ereira da Silva Neto

Neurology and Headache Center of Piauí

Rua São Pedro, 2071 – Centro

Ed. Raimundo Martins – Salas 303/304

64001-260 – Teresina, PI, Brazil

Phone/fax number: + 55 86 3221-9000

neurocefaleia@terra.com.br

SILVA-NETO RP, ALMEIDA KJ

Headache Medicine, v.2, n.2, p.66-69, Apr./May/Jun. 2011 69

O artigo de Silva-Neto e Almeida – Treatment of migraine

attacks before the twentieth century – nos mostra de forma

lúcida que, embora a cefaliatria tenha iniciado no século XX,

o tratamento da migrânea e de outras cefaleias foi registrado

por médicos de diversas civilizações que precederam aquelas

do século XX.

Graças a estes registros, podemos hoje avaliar tanto a

evolução do conhecimento médico quanto a compreensão

dos mecanismos da migrânea e que motivaram algumas das

técnicas de seu tratamento. Não apenas isto, mas conforme

apontado por Silva-Neto e Almeida, alguns tratamentos atu-

ais (ácido acetil-salicílico e dipirona) foram identificados a

partir de observações empíricas daquela época. Mais infor-

mações acerca da história da migrânea e outras cefaléias

pode ser lida nas revisões de Isler, Isler & Clifford Rose e de

Isler & Koehler.

Além de nos ilustrar na história do tratamento da

migrânea, a leitura do artigo de Silva-Neto e de Almeida tem

o dom de nos remeter a outra reflexão: o quanto negli-

genciamos o nosso passado. Talvez seja hora de resgatarmos

a história da compreensão e do tratamento da migrânea e de

outras cefaleias no tempo do Brasil-Império, o que talvez nos

permita entender o que significa uma dor de cabeça e o seu

tratamento no imaginário de nossos pacientes.

REFERÊNCIAS

Isler H. Historical Background. In: Olesen J, Tfelt-Hansen P, Welch

KMA. The Headaches. Raven Press, New York, 1993; p. 1-8.

Isler H, Clifford Rose F. Historical Background. In: Olesen J, Tfelt-

Hansen P, Welch KMA. The Headaches. Lippincott Williams &

Wilkins, Philadelphia, 2000; p. 1-7.

Isler H, Koehler PJ. History of the Headache In: Olesen J, Goadsby

PJ, Ramadan NM, Tfelt-Hansen P, Welch KMA. The Headaches.

Lippincott Williams & Wilkins, Philadelphia, 2006; p. 1-7.

COMENTÁRIO

DrDr

. P. P

. P

edro Kedro K

edro K

owacsowacs

owacs

Coordenador, Setor de Cefaleias do

Serviço de Neurologia do Hospital de Clínicas do

HC-UFPR e Chefe do Serviço de Neurologia do

Instituto de Neurologia de Curitiba, PR

TREATMENT OF MIGRAINE ATTACKS BEFORE THE TWENTIETH CENTURY