Headache and Migraine Biology and Management (eBook)

Roger K. Cady, Merle L. Diamond, Seymour Diamond, Mark W. Green, Vincent T. Martin (Herausgeber)

eBook Download: PDF | EPUB

2015 | 1. Auflage
334 Seiten
Elsevier Science (Verlag)
978-0-12-801162-1 (ISBN)

Infos

There are two crucial issues in the treatment and management of headache patients: More than 50% of individuals experiencing headache have only been treated symptomatically, with no appropriate diagnosis established; and history and neurologic examination are essential to establishing a diagnosis, and thus selecting appropriate therapy.

Headache and Migraine Biology and Management is a practical text that addresses these issues, featuring contributions from expert clinical authors. The book covers in detail topics including chronic and episodic migraine, post-traumatic headache, sinus headache, cluster headache, tension headache, and others. Chapters are also dedicated to treatment subjects, including psychiatric and psychological approaches, medication overuse, inpatient treatment, and pediatric issues.

This book is an ideal resource for researchers and clinicians, uniting practical discussion of headache biology, current ideas on etiology, future research, and genetic significance and breakthroughs. This resource is useful to those who want to understand headache biology, treat and manage symptoms, and for those performing research in the headache field.

• A practical discussion of headache biology, current ideas on etiology, future research, and genetic significance and breakthroughs
• Features chapters from leading physicians and researchers in headache medicine
• Full-color text that includes both an overview of multiple disciplines and discusses the measures that can be used to treat headaches

Inhalt

Front Cover 1
Headache and Migraine Biology and Management 4
Copyright Page 5
Dedication 6
Contents 8
Preface 12
About the Editor 14
List of Contributors 16
Acknowledgments 18
1 Introduction – The History of Headache 20
Introduction 20
The Ancients 20
The Middle Ages 21
The 16th To 19th Centuries 23
The 20th Century Onwards 25
United States of America 25
United Kingdom 27
Australia 28
Italy 28
Scandinavia 29
Recent Advances 29
Conclusion 30
References 30
2 Classification, Mechanism, Biochemistry, and Genetics of Headache 32
Classification 32
Mechanisms of Migraine-Associated Symptoms 33
Mechanisms of Migraine Triggers and Risk Factors 35
Genetics and Hypothalamic Regulation of Sleep 37
References 37
3 Evaluation of the Headache Patient in the Computer Age 40
Evaluation of the Headache Patient 40
The Headache History 40
Structured Interview Versus Open Questioning 40
The Special Challenge of Talking to the Headache Patient … What Patients Tell Us 42
“Sinus” Headaches 42
“I Have a Pinched Nerve in My Neck” 42
“I can’t Stay Asleep” 42
Migraine Aura Versus Other Conditions 42
“Blurred Vision” 42
“Numbness” or “Heaviness” 42
“Trouble Talking” 43
“Dizziness” 43
Screening for Secondary Headaches 43
Clinical History – What We Need to Ask the Patient with Primary Headaches 43
Headache Diary 43
What Type of Headache is it? 44
How Often are Your Headaches Occurring? 45
When Did These Headaches Begin? 45
What Do You Do When You Get a Headache? 45
How are you Treating your Headaches? 45
What Precedes your Headaches? 45
What Triggers the Headaches? 45
What are the Accompaniments? 45
Inquire About Migraine Comorbidities 46
Asking About the Common Migraine Comorbidities 46
Depression and Anxiety 46
Sleep Disorders 46
Fibromyalgia 47
Restless Legs Syndrome 47
Other Somatic Complaints 47
Other Systemic Complaints 47
Substance Abuse 47
Cardiovascular Comorbidity 47
Quality of Life 47
Previous Treatment Attempts 47
Examination of a Headache Patient 48
Testing 48
Computer-Assisted History Taking 48
Telemedicine 49
Summary 50
References 50
4 Screening and Testing of the Headache Patient 52
Introduction 52
Neuroimaging 52
Subarachnoid Hemorrhage 53
Cerebral Venous Thrombosis 53
White Matter Abnormalities 53
Lumbar Puncture 54
Subarachnoid Hemorrhage 54
Bacterial and Aseptic Meningitis 54
Encephalitis 55
Idiopathic Intracranial Hypertension (Pseudotumor Cerebri) 55
Electroencephalography 55
Laboratory Studies 56
Thyroid Function Studies 56
Other Laboratory Studies 56
Medication Compliance Monitoring 56
Genetic Testing 57
Conclusion 57
References 57
5 Overview of Migraine: Recognition, Diagnosis, and Pathophysiology 60
Recognition of Migraine 60
History of Migraine 60
Epidemiology of Migraine 61
Acephalgic Attacks 63
The Spectrum of Migraine Attacks 63
The Diagnosis of Migraine 64
Precipitating Factors 64
Secondary Headaches 65
Pathophysiology 65
Comorbidities of Migraine 67
The Inheritance of Migraine 67
Progression of Migraine 67
Complications of Migraine 67
References 67
6 Complicated Migraine 70
Introduction 70
Types of Migraine Auras and “Complicated Migraine” 70
Hemiplegic Migraine 71
Familial Hemiplegic Migraine 71
FHM1 71
FHM2 & FHM3 and Other Familial Variants
Treatment 73
Basilar Migraine 73
Retinal Migraine 74
Migraine with Prolonged Aura 75
Ophthalmoplegic Migraine 75
Visual Disturbances in Migraine 75
Transient Global Amnesia 76
CADASIL 76
HaNDL Syndrome 76
Migralepsy and Occipital Seizures 77
Unusual Sensory Complications of Migraine 77
Is Angiography Safe in Migraine? 77
Treatment of Complicated Migraine 77
References 78
7 Cerebrovascular Disease and Migraine 80
Introduction 80
The Biology Behind the Relationship 80
Neuroimaging 81
The Relationship Between Migraines and Secondary Causes of Stroke 81
The Diagnostic Challenge 83
Summary 84
References 85
8 Acute and Preventative Treatment of Episodic Migraine 88
Part 1 88
Introduction 88
Acute Medications for Migraine 89
Clinical Factors 89
Pattern 89
Phenotype 89
Patient 90
Pharmacology 90
Precipitants 90
Attack-Based Acute Treatment of Migraine 91
Phase-Based Acute Treatment of Migraine Attacks 91
The Therapeutic Phases of Migraine 92
1. Vulnerability Phase 92
2. Premonitory Phase 92
3. Aura 93
4. Headache 93
Treatment of Migraine when the Headache is Mild 93
Treatment of Migraine during Moderate to Severe Headache 94
5. Resolution, Recovery, and the Postdrome Phase of Migraine 94
6. Rescue Phase 95
Acute Medications for Episodic Migraine 95
Goals 95
Medications Indicated for Treatment of Acute Migraine (Table 8.2) 96
Triptans 96
Formulations: the Key to Long-Term Successful Acute Intervention 98
Subcutaneous Sumatriptan 98
Nasal Formulations 98
Nasal Sprays 98
Dry Nasal Powder of Sumatriptan 98
Iontophoretic Transdermal Delivery of Sumatriptan 99
Oral Formulations 99
Sumatriptan 85mg/Naproxen 500mg Combination (Treximet®) 99
Non-steroidal Anti-inflammatory Drugs 99
Dihydroergotamine 100
Ergotamine 101
Neuroleptics and Anti-emetics 101
Opioids and Butalbital 101
Special Populations 102
Pregnancy and Nursing 102
Children and Adolescents 102
Elderly 102
Part 2 102
Preventative Pharmacological and Non-Pharmacological Treatment of Migraine 102
Staging: Preventive Treatment Needs Based on the Evolution of Migraine 103
Migraine Stages to Chronification 104
Stage 1 – Infrequent Episodic Migraine 104
Stage 2 – Frequent Episodic Migraine 104
Stage 3 – Transforming Migraine 104
Stage 4 – Chronic Migraine 105
Preventive Medications for Migraine (Table 8.5) 105
Neuronal Stabilizers (Anti-epileptic Drugs) for Stages 2, 3, & 4
Topiramate (Evidence Level A) 106
Sodium Valproate (Evidence Level A) 107
Other AEDs 107
Beta-blockers 108
Antidepressants 108
Tricyclic Antidepressants 108
Selective Serotonin/Norepinephrine Reuptake Inhibitors 109
Selective Serotonin Reuptake Inhibitors 109
Angiotensin Receptor Blockers and Angiotensin Converting-Enzyme Inhibitors 109
Calcium Channel Blockers (Evidence Level U) 109
Triptans (Table 8.8) 109
NSAIDs 109
Part 3 110
Attack-Based Care: Clinical Approach and Medications Many Patients Find Most Useful and Effective 110
Summary 111
Preventative Medications 111
Conclusion 112
References 112
9 Chronic Migraine: Diagnosis and Management 118
Introduction 118
Recognition of Chronic Migraine 118
Challenges and Implication of Defining a Diagnosis for Chronic Migraine 118
Epidemiology and Natural History of Chronic Migraine 119
Epigenetic Considerations in the Pathophysiology of Chronic Migraine 120
Diagnosis of Chronic Migraine 123
The Successful Management of Chronic Migraine 124
Steps to the Management of Chronic Migraine 124
Step 1: Confidently Provide a Diagnosis of CM to the Patient 124
Step 2: Define Management Roles for the Patient and the Provider 124
Step 3: Establish Agreed-upon Objective Goals and Boundaries 124
Step 4: Avoid Being Judgmental 125
Step 5: Establish Agreement on Management Decisions, Especially Medications 125
Non-Pharmacological Management of Chronic Migraine 125
Lifestyle Factors 125
Exercise 125
Diet 126
Sleep Hygiene 126
Smoking Cessation 126
Behavioral Therapies for Chronic Migraine 126
Biofeedback Training 126
Relaxation Training 126
Behavioral Retraining 126
Physiological Recalibration 127
Mindfulness 127
Cognitive Behavioral Therapy 127
Acupuncture 127
Complementary and Alternative Medicine 128
Osteopathic and Chiropractic Manipulative Therapy 128
Pharmacological Management of Chronic Migraine 128
Prophylaxis of Chronic Migraine 128
OnabotulinumtoxinA (Evidence Level A) 128
Topiramate 130
Repetitive Dihydroergotamine 130
Methysergide/Methergine 130
Phenelzine 130
Naproxen vs Sumatriptan/Naproxen 131
Neurostimulation 131
Repetitive Sphenopalatine Ganglia Blockade 131
Chronic Opioids 131
Co-Pharmacy 132
Acute Medication for Management of Chronic Migraine 132
Dihydroergotamine 132
Triptans 133
Adverse Events and Contraindications 133
Non-steroidal Anti-inflammatory Drugs 133
Intravenous Sodium Valproate 134
Phenothiazine/Metoclopramide 134
Addressing the 800-Pound Gorilla: Acute Medication Overuse and Misuse in Patients with Chronic Migraine 134
Medication Overuse and Medication Overuse Headache 134
Intravenous Magnesium 135
Continuity of Care 137
Consultation and Referral 137
Putting IT Together 137
Summary 137
Appendix 138
References 139
10 Gender-Based Issues in Headache 142
Introduction 142
Menstrual Migraine 142
Treatment 144
Contraception and Migraine 146
Pregnancy and Migraine 147
Lactation 149
Menopause 149
Conclusion 150
References 150
11 Cluster Headache 154
Introduction 154
Epidemiology 154
Diagnostic Classification and Clinical Description 154
Demographics 157
Circadian and Circannual Features 157
Other Trigeminal Autonomic Cephalalgias 158
Pathophysiology 159
Treatment 161
Acute Treatment 161
Preventative Treatment 162
Short-term Treatments or Bridges in Therapy 162
Lithium 163
Verapamil 163
Anti-epileptic Drugs 163
Miscellaneous Therapies 163
Intractable Cluster Headache Treatment 163
Occipital Nerve Blocks 163
Surgery 164
Hypothalamic Stimulation 164
Jannetta Procedure 164
Occipital Nerve Stimulation 164
Other Procedures 164
Gamma Knife Irradiation of the Trigeminal Root Outlet 164
Histamine Desensitization 164
Treatment of the Other Trigeminal Autonomic Cephalalgia 164
Conclusion 165
References 165
12 Tension-Type Headache 168
Classification 168
Clinical Presentation 168
Diagnostic Testing 170
Epidemiology and Impact 171
Comorbid Conditions 172
Pathophysiology of Tension-Type Headache 172
Management of Tension-Type Headache 174
Non-Pharmacological Treatments 174
Acute Pharmacological Therapies 174
Preventive Pharmacological Therapies 175
Prognosis of Tension-Type Headache 176
Conclusions 177
References 177
13 Post-Traumatic Headache 180
Introduction 180
Traumatic Brain Injury, Concussion, and Post-Concussive Syndrome 181
Epidemiology of Post-Traumatic Headache 182
Potential Risk Factors for Post-Traumatic Headache 184
The Phenotype of Post-Traumatic Headache 184
Post-Traumatic Headache in Military Settings 185
Physiology of Post-Traumatic Headache 186
Management of Post-Traumatic Headache 187
The Post-Traumatic Headache Ichd-III Criteria 188
Conclusions 190
References 190
14 Headache and the Eye 194
Introduction 194
Basics of the Bedside Eye Examination 194
Visual Acuity 194
The Pupil 194
Visual Fields 194
Eye Movements 194
Funduscopic Examination 195
General Examination 195
Migraine-Related Visual and Eye Symptoms 195
Migraine-Related Visual Aura 195
Retinal Migraine 197
Photophobia and Eye Pain 197
Trochlear Headache 197
Photophobia 197
Headache and the Red Eye 198
Glaucoma 198
Cavernous Sinus Fistula 198
Inflammation 199
Idiopathic Orbital Inflammatory Syndrome 199
Headache and Visual Loss 199
Vascular 200
Arterial Dissection 201
Cerebral Venous Sinus Thrombosis 201
Optic Neuritis 201
Giant Cell Arteritis 201
The Orbital Apex Syndrome 202
Headache and the Abnormal Pupil 202
Headache and the Small Pupil 202
Painful Horner’s Syndrome 203
Headache and the Large Pupil 203
Third Nerve Palsy 203
Benign Pupillary Mydriasis 204
Acute Glaucoma 204
Adie’s Pupil 204
Pharmacologic Pupil 204
Headache and Double Vision 204
Increased Intracranial Pressure 205
Intracranial Hypotension 206
Thyroid Eye Disease 206
Microvascular Cranial Neuropathy 206
Pituitary Apoplexy 206
Ophthalmoplegic Migraine 207
Conclusion 207
References 207
15 Cranial Neuralgias, Sinus Headache, and Vestibular Migraine 210
Introduction 210
Anatomy of Facial Pain 210
Rhinogenic Headache 210
Cranial Neuralgias 211
Types of Cranial Neuralgias 212
Occipital Neuralgia 212
Glossopharyngeal Neuralgia 213
Trigeminal Neuralgia 213
Treatment of Cranial Neuralgias 213
Persistent Idiopathic Facial Pain (Previously Atypical Facial Pain) 214
Sinus Headache 214
Motion Sickness 216
Childhood Equivalents in Migraine 216
Role of Hormonal Factors 216
Migraine and Vertigo 216
Vestibular Migraine 218
Long-Term Follow-up of Clinical Symptoms 218
Examination 219
Treatment 219
References 219
16 Cervicogenic Headache 222
The Relationship of Headache and Neck Pain as a Manifestation of Neck Disorders 222
Cervicogenic Headache Diagnosis 222
Anatomical Concepts 223
Clinical Characteristics 224
Evaluation of Cervicogenic Headache 225
Treatment of Cervicogenic Headache 226
Physical Modalities 226
Pharmacological Therapies 226
Anti-Epileptic Drugs 227
Antidepressant Medications 227
Greater Occipital Nerve Blockade 227
Cervical Medial Branch Neurotomy 228
Surgical Intervention 229
Other Modalities 229
Conclusion 229
References 230
17 Headache in Children and Adolescents 232
Introduction 232
Historical Perspective 232
Epidemiology and Pathophysiology 233
Clinical Approach 233
Treatment 235
What Happens to our Patients as They Grow Up? 237
What the Future Holds for Pediatric Headache 237
References 238
18 The Psychiatric Approach to Headache 242
Introduction 242
Migraine and Psychiatric Comorbidities, Beyond Coexistence 242
Beyond Coexistence: Complex Neurobiological Underpinnings of Mood Disorders and Pain 244
Prevalence of Psychiatric Comorbidities in Migraine Patients 245
Mood Disorders 245
Anxiety Disorders 245
Post-Traumatic Stress Disorder 245
Psychiatric Illness: Making the Correct Diagnosis 246
Choosing the Right Medication 247
The Antidepressants 247
The Anti-Epileptic Mood Stabilizers 247
The Antipsychotics 248
Migraine, Pain, and Suicide 248
Personality and Coping Styles in Migraine Headache 250
Cluster A Personality Disorders 251
Paranoid Personality Disorder 251
Schizoid Personality Disorder 251
Schizotypal Personality Disorder 251
Cluster B Personality Disorders 251
Antisocial Personality Disorder 251
Borderline Personality Disorder 252
Histrionic Personality Disorder 252
Narcissistic Personality Disorder 252
Cluster C Personality Disorders 252
Avoidant Personality Disorder 252
Dependent Personality Disorder 253
Obsessive-Compulsive Personality Disorder 253
Influence of Axis II Personality Disorders in Headache 253
Understanding and Managing Personality Disorders in Headache Patients 254
Psychotherapy in Headache and Pain Disorders 255
Summary: What is the Psychiatric Approach to Headache? 256
References 256
19 Psychological Approaches to Headache 258
Introduction 258
Trigger Factors 259
Stress 259
Sleep 260
Diet and Obesity 260
Personality Traits and Migraine 261
Psychiatric Comorbidity 261
Psychological Factors in Medical Treatment of Headache Disorders 263
Medication Adherence 263
Patient–Physician Communication 264
Psychological Approaches to Treating Headache Disorders 264
Biofeedback and Relaxation-Based Therapies 265
Cognitive Behavioral Approaches 265
Conclusion 266
References 266
20 Too Much of a Good Thing: Medication Overuse Headache 272
Introduction 272
History/Background 273
Pathophysiology 274
Central Sensitization Pathway 274
Neuroimaging 275
Genetic Basis for Medication Overuse Headache 275
Psychological/Behavioral Aspects of Medication Overuse Headache 275
Clinical Presentation of Medication Overuse Headache 276
Detoxification from Medication Overuse Headache 277
Patient Education for Medication Overuse Headache 277
Treatment of Medication Overuse Headache 279
Infusion Center Withdrawal 280
Inpatient Treatment of Medication Overuse Headache 280
Appropriate Opiate Use in Chronic Migraine 281
Medication Overuse Pearls 283
References 283
21 Presentation of Headache in the Emergency Department and its Triage 286
Introduction 286
The Role of the Emergency Department 286
Epidemiology of Headache in the Emergency Department 287
Diagnosis 287
Diagnostic Testing 291
Approach to Treatment 292
Difficult Emergency Department Populations 292
Discharge Care 293
Conclusion 293
References 294
22 Headache Clinics 296
Introduction 296
Establishment of the Headache Clinic 297
Staffing of the Headache Clinic 298
Physical Plant of the Headache Clinic 300
Reimbursement Issues 300
Marketing the Headache Clinic 301
The Patient Attending the Headache Clinic 302
Conclusion 303
References 303
23 Inpatient Treatment of Headaches 304
Introduction 304
Indications for Inpatient Headache Treatment 304
Admission Criteria 305
Advantages of Inpatient Treatment 305
Treatment 305
Detoxification 305
Pharmacological Treatment 306
Interventional Treatment Modalities 308
Non-Pharmacological Treatment 308
References 310
24 Newer Research and its Significance 312
Introduction 312
Epidemiology 312
Neuroimaging 313
Genetics 314
Pharmacological Models 316
Nitric Oxide 316
CGRP 317
PACAP-38 318
Treatment 319
Supraorbital Transcutaneous Electrical Stimulation 319
Occipital Nerve Stimulation 319
Transcranial Magnetic Stimulation 320
Vagal Nerve Stimulation 320
Conclusions 320
References 321
Index 326

Textauszug

Chapter 1

Introduction – The History of Headache

Seymour Diamond1,2 and Mary A. Franklin2,    1Diamond Fellowship and Educational Foundation, and Diamond Headache Clinic, Chicago, Illinois,    2National Headache Foundation, Chicago, Illinois, USA

The history of headache, starting with the earliest records from Mesopotamia, and continuing through Hippocrates, Aerateus, and Galen, provides a glimpse into a malady that has endured through several millenia. In this chapter, we also explore the history of headache treatment from the ancients, through the Middle Ages, and to the end of the 19th century. Finally, we explore the development of the remarkable innovations in pharmaceutical therapies during the late 20th and early 21st centuries.

Keywords

discarded therapies; major discoveries; headache pioneers; ancient remedies

Introduction

In a previous monograph with my editorial collaborator, Mary Franklin, we reviewed the history of headache through the ages – in the arts and literature.1 In this comprehensive work on headache, I would be remiss to not update the history of the advances in headache medicine during the 20th and early 21st centuries.

The history of headache treatment did not start with the discovery of the triptans. The approval of propranolol for the indication of migraine prophylaxis was not the nascent event for migraine prevention; neither was the introduction of dihydroergotamine into the migraine armamentarium. When Bayer started manufacturing acetylsalycilic acid for pain prevention, that was just one step in the long struggle for effective migraine and headache treatment, which has blossomed in recent years.

The Ancients

The earliest mention of headache can be found in Mesopotamia (modern-day Iraq), dating from 4000 BC. When the Ancients experienced headache, they blamed their affliction on Tiu, the evil spirit of headache. Our knowledge of the ancient Egyptians’ headache management is found in the Ebers Papyrus, a collection of medical texts, named for the German Egyptologist George Ebers (1837–1898) who had acquired it. This papyrus contains the earliest written reference to the central nervous system and brain. For headache, the recommended treatment includes a combination of frankincense, cumin, ulan berry, and goose grease, to be boiled together and applied externally to the head.

The Egyptians also attributed the cause of headache as the work of an evil spirit. For those experiencing a “warmth in the head,” the application of moistened mortar to the head was suggested. Another therapy was derived from Egyptian mythology – a combination of coriander, wormwood, juniper, honey, and opium. For joint pain, the Egyptians recommended a mixture of myrtle and willow leaves. The use of willow leaves is cited in treatment for an inflammatory condition: “… you must make cooling substances for him to draw the heat out … leaves of the willow.” Salicylic acid is derived from willow bark, and its use led to the discovery of aspirin. Later, the Assyrians, using stone tablets, recommended the use of willow leaves for treating inflammatory rheumatoid disorders, such as arthritis.2

The Greeks were the next to espouse willow bark as a treatment for pain. Hippocrates (4th or 5th century BC) recommended the extract of willow bark for headache pain. As we know, the teachings of Hippocrates formed the basis of medicine for centuries in the Greek and then the Roman Empires.

At Alexandria, Egypt, the Greeks established a center for medical education and practice. Once the Romans conquered this area, they maintained the center. Aretaeus of Cappodocia (AD 81–138) was probably educated at Alexandria and practiced medicine in Rome. He was the first to distinguish migraine from general headache, noting migraine’s unilaterality, periodicity, and the associated symptom of nausea.3 Aretaeus divided all diseases into acute and chronic. For headache, he described headaches of short duration, lasting a few days, as cephalalgia. The term “cephalea” referred to headaches which lasted longer. Because of migraine’s one-sided occurrence, Aretaeus named it Heterocrania, meaning “half-a-head.” The recommended treatment for headache by this ancient physician was counter-irritation in the form of application of blisters to the affected area, which had been shaved. In Aretaeus’ repertoire of blister agents were pitch, peilitory, euphorbium, lemnestis, or the juice of the thapsia.

During the 2nd century AD, Galen (131–201) gained prominence in Rome. Like Aretaeus, he was trained in Hippocratic medicine and became the court physician to Commodus, the heir of Marcus Aurelius. He is credited with describing migraine as Hemicrania.4 Galen further advanced counter-irritation as a treatment for headache when he proposed the use of the electric torpedo fish applied to the forehead. This form of therapy foreshadowed the use of electrotherapy by Duchenne (1806–1875) and the transcutaneous electric stimulator (TENS) introduced in the late 20th century for all types of chronic pain.

The Middle Ages

The use of trephination for headache treatment was described by Paul of Aegina (625–690), who practiced in ancient Alexandria. The procedure, removing a circular portion of the skull, was believed to disturb the evil spirits which were causing the headache pain and allow them to escape through the wound (Figures 1.1, 1.2).

Figure 1.1 Electrotherapy.
Guillaume-Benjamin Duchenne demonstrates electric stimulation therapy on a patient by holding an electric apparatus to the patient’s head. ©CORBIS.

Figure 1.2 Trephination, 1593.
Use of an elevator to remove a piece of bone from the skull. Reproduced from the Veldt Boeck van den Chirugia Scheel-Hans, by Hans von Gersdorf (Amsterdam, 1593). Oxford Science Archive.

The fall of the Roman Empire did not mean the end of ancient Greek and Roman medicine. Those early texts on medicine influenced Arab physicians throughout the Islamic world from the 7th century and beyond. One of the most prominent of these physicians was Avicenna (980–1037). A native of Persia (modern day Iran), his textbook, The Book of Healing, was used by his contemporary Islamic physicians but was also available as a Latin translation for the scientists in Europe. Avicenna noted that headache location could vary between frontal, occipital, or generalized, and that one-sided headaches could be provoked by smells. He used cashews as a remedy for headache as well as other neurological and psychiatric disorders. Other Arab physicians wrote of treating headache, epilepsy, and syncope with anomum nelegueta, an African ginger.

In Cordoba, Spain, Abulcasis (935–1013) was physician to the Spanish caliph and was considered the greatest of Islamic medieval surgeons. His book, Kitab al-Tasrif, remained the leading textbook on surgery for the next five centuries in Europe and the Middle East. Abulcasis recognized the importance of the physician–patient relationship. Also, he advised his students to observe individuals closely in order to establish the appropriate diagnosis and select the most effective therapy. His recommended therapy for headache was extreme – applying a hot iron to the head of the individual with headaches. Another headache intervention that he suggested was an incision made to the temple, and application of garlic to the wound.

In addition to its prominence in the Islamic world, Cordoba was also known as the birthplace of the medieval Jewish scholar and physician Maimonides (1135–1204). He studied medicine at Fez, Morocco, and later settled in Egypt, serving as court physician to the Sultan, Saladin, during the first crusade.5 Maimonides’ works on medicine continue to be studied, and it is apparent that he was influenced by Hippocrates and Galen. In his work on headache, Maimonides recognized various triggers of headache, including extremes of cold and heat, caused by changes in barometric pressure.

For headache treatment, Maimonides recommended that those suffering from a “strong midline headache, secondary to thick blood or internal coldness” could benefit from consumption of undiluted wine either during or after a meal. The warming effect of the wine would help, and also would thin the blood. Maimonides also instructed individuals with headache to refrain from physical exertion and other activities until their headache resolved. He cautioned that certain foods which were “rich in moisture” should be avoided, including melons, peaches, apricots, mulberries, fresh dates, etc.6 For milder headache, Maimonides did not believe medication was appropriate, believing nature could relieve this pain without assistance.

During the same period, in what is now modern Germany, a remarkably intelligent and creative nun, the Abbess Hildegard of Bingen (1098–1179), became prominent in the Church because of her preaching. She is also remembered for her religious music and several texts that she wrote on a variety of subjects. In the world of headache medicine, she is known for the illuminated manuscripts that she created from her “visions,” but which have been described as excellent depictions of migraine auras.7 Hildegard lived in a area of Germany near the Rhine...

Produkt-Details

• Erscheint lt. Verlag: 13.3.2015
• Sprache: englisch
• Themenwelt: Sachbuch/Ratgeber ► Gesundheit / Leben / Psychologie
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Neurologie
• ISBN-10: 0-12-801162-9 / 0128011629
• ISBN-13: 978-0-12-801162-1 / 9780128011621