06 Jan Eye Migraines: A 19th Century Cure Revisited
Hubert Airy, who first experienced an eye migraine aura in 1854, made significant contributions to our understanding of migraines and their visual symptoms. Initially perceiving a small blind spot, his experience escalated into a full migraine, complete with a vividly colored, zigzag visual hallucination. Airy, later becoming a physician, detailed his experiences in the Philosophical Transactions of the Royal Society in 1870, including a precise drawing of his aura’s progression over 20 minutes.
Yes, your torture may last only 20 minutes (strangely enough as long as most panic attacks).
This illustration has been recognized and related to by many eye migraine sufferers over the years, and it remains an iconic representation in the study of migraines.
Airy’s insights were not only detailed but also prescient, particularly in his understanding that the source of his hallucinations was the brain, not the eyes. His drawing anticipated the discovery of the visual world’s orderly map in the primary visual cortex, a crucial brain region for processing visual information. This discovery, made nearly half a century later by neurologist Gordon Holmes, was based on studying the visual deficits of soldiers with head wounds from World War I. Holmes’s findings about the visual cortex’s organization and the magnification of its central part aligned remarkably with Airy’s observations about his own visual aura.
Despite Airy’s detailed and accurate documentation of his migraine experiences, much remains unknown about the neural mechanisms behind migraines and their auras. Theories suggest an electrical wave sweeping across the visual cortex could cause the corresponding hallucinations, but the exact processes, especially those producing vivid colors, are still not fully understood. Airy’s work, a singular contribution to the field, stands out for its accuracy and foresight at a time when little was known about the brain’s functioning. Airy had exceptional observational skills.
In the book, On Nervous Or Sick-headache Airy states:
“I will now state the conditions under which this disorder shows itself. The great majority of persons who have come under my notice suffering from the headache were at the time more or less anemic; there was a general want of tone — a relaxed condition of the muscular and the arterial systems, especially of the latter; the pulse being rather small and soft, often decidedly slow, but much accelerated on slight exertion or excitement. Even in those who were not anemic and appeared robust, there was still this want of tone about the pulse. The sufferers possess what is called the nervous temperament; their brains are excitable, their senses acute, and their imaginations free. The attacks are induced by prolonged mental work, protracted mental excitement, or any intense strain on the feelings, such as grief, anxiety, passion, etc. Bodily fatigue, late hours, loss of sleep, the depression which follows over-excitement, a debauch, etc., are all predisposing causes; and it is curious that the attack is not generally developed during the paroxysms of mental excitement, but afterwards, when the excitement has passed off, and the mental strain is somewhat lessened. In some persons already predisposed to an attack, any strong impression produced on the retina or on the olfactory or auditory nerves is sufficient to excite the headache. Again, in females, the attacks are more frequent at or after the catamenial period. Now, it is to be observed that all these causes, and causes like to them, are of a depressing nature; exhausting the powers and, therefore, lowering the tone of the system; putting it out of tune, disturbing the harmony in the functions, and, at the same time, exalting the susceptibility of the nervous system. What results from this condition? We possess, besides the cerebrospinal system of nerves, a sympathetic nervous system, the ganglia of which can conduct, transfer, and radiate the effects of impressions; their power being controlled and regulated by the superior force in the cerebro-spinal centres. Let the general tone of the body be lowered, and with it the regulating power of the brain be impaired, then the conduction and radiation of impressions through the sympathetic ganglia are no longer interfered with, and, instead of tranquil, even, harmonious action in the various organs, as in perfect health, we have convulsive, excited, and painful movements.”
“Lastly, while viewing this as a nervous disorder, it is clear that if the theory proposed is accurate or close to the truth, gastric derangement, or any other condition that irritates the sympathetic nervous system, can be an exciting cause. It is well known that irritation in the stomach or intestines has a powerful effect on the sympathetic nervous system. Therefore, the terms ‘sick-headache’ or ‘bilious headache,’ which imply that the disorder has arisen from derangement of the abdominal organs, may not be entirely inapplicable in some cases.”
During the Stage of Disturbed Sensation: In cases of migraines with visual disturbances, the longer this stage lasts, the more severe the headache tends to be. Therefore, it’s crucial to try to shorten this stage. If the condition depends on a deficient blood supply to a part of the brain, measures should be taken to increase blood flow. This can be achieved through posture and stimulants. As soon as the visual disturbance begins, the patient should lie down with their head as low as possible. If the disturbance is on one side of the visual field, lying on the opposite side is recommended. The patient should immediately drink a full-sized glass of sherry, with half a bottle of soda water as a useful addition, or champagne if available. Alternatively, a large tablespoonful of brandy diluted can be used. If alcohol is not advisable, a teaspoonful of sal volatile in water may be prescribed. If the patient feels chilly or has cold feet, they should be placed near a fire with a hot bottle at their feet. These measures help the heart pump blood more forcefully to the brain, reducing the duration of the vibratory movement. After it passes, the patient should remain still to prevent the glimmering from returning. This is especially important if the headache is mild; in cases of severe headache with nausea or vomiting, the patient will likely remain in a recumbent position.
Administration of Cerebrospinal Stimulants: If the migraine is preceded by feelings of depression, irritability, or restlessness, cerebrospinal stimulants like henbane, valerian, assafoetida, spirit of chloroform, or ether can be effective in curtailing the attack. A combination of henbane tincture and spirit of chloroform can soothe nervous irritability in milder forms and may be repeated if necessary. For significant mental depression, valerian or assafoetida should be tried. Valerian is often preferred, prescribed in half a drachm to a drachm of the ammoniated tincture. Assafoetida can be given in similar doses of spiritus ammonise foetidus. Generally, alcoholic stimulants are not recommended in these cases, as they can cause flushing and confusion without relieving the depression.
Effectiveness of Remedies: It’s astonishing how promptly and certainly remedies like valerian or assafoetida can dispel the gloomy visions of the hypochondriac, calm nervous agitation, allay spasms, and bring a soothing calm to someone who was previously overwhelmed by morbid sensations and fears. While severe headaches may be averted, alcoholic stimulants are not as effective as the previously mentioned remedies in these scenarios.