Submitted by Cara Marcus, Past President, MAHSLIN
I woke up with a headache. Not a debilitating headache, mind you, but certainly an annoying one. While my head pounded, I decided to take a few moments to read through some of the texts in the library archives in search of the wisdom of how our forefathers handled their headaches.
I decided to start at about fifty years or so ago and work my way backwards, one text at a time. The first book I picked up was a slim 86 page volume from the American Lecture Series entitled The Common Headache Syndrome: Biochemistry, Pathophysiology, Therapy . Despite that daunting title, the front cover (which actually looked typewritten) reassures readers, “This is an intensely personal book – an outgrowth of the author’s own experience in dealing with the common headache syndromes. It will leave the reader with a deeper appreciation of the true nature of the problem.”
Dr. Ostfeld begins with some vignettes of typical headache patients. His patient “may sit with a furrowed brow . . . her hands may grip the chair; she is intent and she scarcely moves.” He theorized that “prolonged use of the eyes, coupled with intense concentration as in reading or auto driving, may . . . induce tension headache.” Remember that this was long before the days of librarians “reading” computer screens all day. I looked away from my computer screen to ponder this thought and felt better already. While his book contained a chapter on “new” medicines for headache, including chlorpromazine and methysergide, the overarching message of his book was that a psychotherapist could help patients with headache by changing their attitudes or life experiences or both. Ostfeld concludes, “The most important medical ingredient in the treatment situation is not in the physician’s technical knowledge or his scholarship. It is his humanness . . .”
Shifting back a decade to the 1950s, the next book I selected was by none other than the esteemed Honorary Physician and Clinical Assistant to King Edward VII, Dr. Nevil Leyton. While I felt that Dr. Ostfeld’s book from the 1960s certainly was true to its “talk it all out” period, I was curious to see what I would glean from a more serious time in our history from Migraine and Periodic Headache: A Modern Approach to Successful Treatment . Focusing mainly on migraine headaches, this book espoused medical treatment to “turn a sour, dispirited and unhappy patient into a happy and useful member of society,” although the author believed that, “The average prognosis given in cases of migraine is gloomy.” And the “commonest method of treatment of severe migraine in use to-day” was said to be the exhibition of ergotamine tartrate, and anti-histamine preparations were up-and-coming treatments. The author then went on to provide a series of case reports, mostly of females with “house duties” who were cured of their headaches by various medication and hormone therapies. While I didn’t feel particularly better after reading this book, I did feel somewhat less “sour” and “gloomy.”
Back now to the 1940s to Dr. Wolff’s book, Headache and Other Head Pain.  It is a scholarly book with over 150 figures and data charts that are quite amazing considering that they were drawn by hand; this was considered among the best contributions to the field of headache medicine of its time. Chapter references spanned back to the 1800s (and remember that researchers did not have online databases or DOCLINE back then) and the first hundred pages or so were an in-depth and fascinating illustrated look at all the brain, nerves and organs responsible for causing headache. Dr. Wolff, like Dr. Ostfeld, felt that life situations had an impact on headache, especially migraine, and also that some personality features were common among migraine sufferers, such as orderliness and inflexibility. It is interesting to note that in future editions of this book, personality traits were discussed more in a historical setting or as reactions to headache. 
Ergotamine tartrate, which was also recommended by Dr. Leyton, was considered to relieve headache by Dr. Wolff within an hour in 90% of cases.  Dr. Wolff also recommended many other approaches to treatment, including dietary methods, glandular therapy, surgery and preventive therapy that included “the management of work and rest periods.” Relaxation included watching “suitable moving pictures” (as movies were known by in the 1940s), although Dr. Wolff advised that watching those that “depict ‘gangster warfare’ were apt to precipitate headaches through inducing fear, tension or horror.”
All this research spurred my interest in going even further back in time. In the 1899 edition of Practice of Medicine by Sir William Osler  (the first professor of medicine at Johns Hopkins University and known as one of the most influential physicians in history), migraine was considered a synonym of “sick headache” and women and members of “neurotic families” were most frequently attacked. Recommended treatments were quite different than those from the next century; headache sufferers from the late 1800s may have been treated with bromides, iron, arsenic, nitroglycerin, a saline cathartic, caffeine, chloroform, citrate, nux vomica, and ergot (which appears to be the predecessor of ergotamine tartrate used half a century later). Dr. Osler’s recommendation for the most “satisfactory remedy” was Cannabis indica, but he stated that, “Electricity does not appear to be of much service.” Some of the medicinal treatments suggested – arsenic, nox vomica, chloroform – are considered poisons today; the only treatments from this list that are still cautiously recommended nowadays are caffeine – many headache specialists state that having some coffee may improve symptoms, although caffeine may also contribute to headache, and ergots. [6, 7]
Still curious, and having just read the oldest textbook in my library’s print collection, I perused an online textbook from two-hundred years ago. Headaches were considered a malady of “women in the higher ranks of life, and those of a delicate constitution” during monthly cycles by Dr. Alexander Hamilton (not the United States President, but a fellow of the Royal College of Physicians) in his 1813 book A Treatise on the Management of Female Complaints.  Interestingly, this book provides no therapy for headache sufferers, other than implying the affected women partake in some good exercise and manual labor.
My archival exploration of headache gave me an appreciation of the advances medicine has made in the understanding of and treatments for this common condition, and yes, my headache symptoms did seem to improve while writing it! In addition, reading older textbooks this way resulted in an observation that physicians seemed influenced by the cultural mores and prevailing thoughts of their times and that this was reflected in their writings. Care providers could benefit from reading books and journals from distant times to learn from what therapies have been tried in the past and are no longer in use. Libraries that retain specialized archival collections are doing more than just shelving older books – they are providing a unique window to the past that may very well provide a key to new treatments in the future.
1. Ostfeld AM. The common headache syndromes: biochemistry, pathophysiology, therapy. Springfield, IL: Thomas, 1962.
2. Leyton N. Migraine and periodic headache: a modern approach to successful treatment. Springfield, IL: Thomas, 1954.
3. Wolff HG. Wolff’s headache and other head pain. New York: Oxford University Press, 1948.
4. Wolff HG, Dalessio DJ, Silberstein SD, Wolff HG. Wolff’s headache and other head pain. 6th ed. New York: Oxford University Press, 1993.
5. Osler W. The Principles and Practice of Medicine, Designed for the use of practitioners and students of medicine. 3d ed. New York: D. Appleton and Company, 1898.
6. Rizzoli P, Loder E, Neporent L. The migraine solution: a complete guide to diagnosis, treatment, and pain management. New York: St. Martin’s Griffin, 2012.
7. Green MW, Green LM, Rothrock JF. Managing your headaches. 2nd ed. New York, NY, USA: Springer, 2005.
8. Hamilton A and Hamilton J. A treatise on the management of female complaints. Edinburgh: Hill, 1813.