Walsh & Hoyt: Migraine

Migraine is derived from the Greek word hemicrania, introduced by Galen in approximately 200 B.C. Over the years, a variety of popular names for this disorder have evolved, including sick headache, blind headache, and bilious headache. Because of his classic descriptions, Aretaeus of Cappadocia (second century A.D.) is credited as the discoverer of migraine headaches. Migraines have appeared in popular literature for centuries. Shakespeare describes migraine treatment in Othello and King John. Lewis Carroll described migrainous phenomena in Alice in Wonderland and Through the Looking Glass; these included central scotoma, tunnel vision, distortions in body image, and visual hallucinations. It is therefore perplexing that, even today, migraine remains underdiagnosed and undertreated. There are a number of contributing factors. Some health care providers may not devote time and resources to identifying migraine, particularly given the limited time available to evaluate patients in a nonspecialty clinic. Some patients with migraine may fail to seek medical attention. Recent data suggest that the presence of concomitant headache types may interfere with diagnosis as well.