Migraine

by Oliver Sacks

Overview

"Balanced, authoritative . . . brilliant." —The London Times

"Written by one of the great clinical writers of the twentieth century, Migraine . . . should be read as much for its brilliant insights into the nature of our mental functioning as for its discussion of the migraine." —The New York Times Book Review


The many manifestations of migraine can vary dramatically from one patient to another, even within the same patient at different times. Among the most compelling and perplexing of these symptoms are the strange visual hallucinations and distortions of space, time, and body image which migraineurs sometimes experience. Portrayals of these uncanny states have found their way into many works of art, from the heavenly visions of Hildegard von Bingen to Alice in Wonderland. Dr. Oliver Sacks argues that migraine cannot be understood simply as an illness, but must be viewed as a complex condition with a unique role to play in each individual's life.

"I am sure . . . that any layman who is interested in the relation between the body and mind . . . will find the book as fascinating as I have." —W. H. Auden, The New York Review of Books

Product Details

ISBN-13:	9780307834102
Publisher:	Knopf Doubleday Publishing Group
Publication date:	05/29/2013
Sold by:	Random House
Format:	eBook
Pages:	368
File size:	8 MB

About the Author

OLIVER SACKS was a neurologist, writer, and professor of medicine. Born in London in 1933, he moved to New York City in 1965, where he launched his medical career and began writing case studies of his patients. Called the “poet laureate of medicine” by The New York Times, Sacks is the author of thirteen books, including The Man Who Mistook His Wife for a Hat, Musicophilia, and Awakenings, which inspired an Oscar-nominated film and a play by Harold Pinter. He was the recipient of many awards and honorary degrees, and was made a Commander of the British Empire in 2008 for services to medicine. He died in 2015.

Hometown:

New York, New York

Date of Birth:

1933

Place of Birth:

London, England

Education:

B.M., B.Ch., Queen's College, Oxford, 1958

Table of Contents

	List of Illustrations	xiii
	Preface to the Revised (1992) Edition	xv
	Preface to the Original (1970) Edition	xvii
	Acknowledgments	xix
	Foreword	xxi
	Historical Introduction	1
Part I	The Experience of Migraine
	Introduction	11
Chapter 1	Common Migraine	13
	Introductory Comments
	Headache
	Nausea and Associated Symptoms
	Facial Appearance
	Ocular Symptoms
	Nasal Symptoms
	Abdominal Symptoms and Abnormal Bowel-Action
	Lethargy and Drowsiness
	Dizziness, Vertigo, Faintness and Syncope
	Alterations of Fluid Balance
	Fever
	Minor Symptoms and Signs: Pupillary Abnormalities, Horner's Syndrome, Bradycardia, Multiple Ecchymoses, Whitening of Hair, etc.
	Organic Irritability and Photophobia
	Mood-Changes
	Symptom-Constellations in Common Migraine
	The Sequence of a Common Migraine: Prodromal Symptoms, Modes of Resolution, Post-Migrainous Rebound
	Concluding Comments
	Postscript (1992)
Chapter 2	Migraine Equivalents	34
	Introductory Comments
	Cyclic Vomiting and Bilious Attacks
	Abdominal Migraine
	Periodic Diarrhoea
	Periodic Fever
	Precordial Migraine
	Periodic Sleep and Trance-States
	Periodic Mood-Changes
	Menstrual Syndromes
	Alternations and Transformations of Migraine
	Borderlands of Migraine: Vagal Attacks, Faints, Reactions to Heat, Exhaustion, Passive Motion, Alcohol, etc.
	Alternations and Concomitances with other Disorders: Asthma, Angina, Laryngospasm, Sleep-Disorders, Peptic Ulcer, Ulcerative Colitis, Crohn's Disease, Psoriasis, etc.
	Differential Diagnosis of Migraine Equivalents
	Concluding Comments
Chapter 3	Migraine Aura and Classical Migraine	51
	Introductory Comments: Historical Descriptions of Migraine Aura
	Specific Visual Hallucinations: Phosphenes and Elementary Hallucinations, Varieties of Migraine Spectra, Characteristics of Scintillating and Negative Scotomata
	Specific Tactile Hallucinations: Paraesthesiae, Anaesthesia
	Other Sensory Hallucinations: Auditory, Olfactory, Taste, Epigastric, Motor, Vertiginous, etc.
	Pseudo-objectivity of Migraine Hallucinations
	General Alterations of Sensory Threshold
	Alterations of Consciousness and Postural Tone
	Specific Motor Disorders: Weakness, Paralyses, Spasms, Seizures
	Alterations of Affect and Mood
	Disorders of Higher Integrative Functions: Complex Visual Distortions (Micropsia and Macropsia, Mosaic and Cinematographic Vision, Metamorphopsias, Visual Agnosias, etc.)
	Complex Apraxias, Agnosias, and Distortions of Body-Image
	Aphasias
	Time-Distortions, Deja Vu, and Forced Reminiscence
	Dreamy States
	Migrainous Deliria and Psychoses
	Illustrative Case-Histories
	Comments on the General Structure of Migraine Aura: Its Differential Diagnosis and Distinction from Epilepsies
	Classical Migraine
	Postscript (1992): The Angst of Scotoma
Chapter 4	Migrainous Neuralgia ("Cluster Headache")--Hemiplegic Migraine--Ophthalmoplegic Migraine--Pseudo-Migraine	99
	Migrainous Neuralgia: Synonyms, Typical Features, Illustrative Case-Histories
	Hemiplegic and Facioplegic Migraine: Typical Features, Possible Mechanisms of Attack, Case-Histories
	Ophthalmoplegic Migraine
	Pseudo-Migraine: Organic Lesions Simulating Migraine
	Permanent Neurological or Vascular Damage from Migraine
Chapter 5	The Structure of Migraine	109
	Introductory Comments, Components and Functional Levels of Migraine, Psychophysiological Stages of Migraine, General Characteristics of Migraine: Relation to Sleep, Epilepsy, etc.
Part II	The Occurrence of Migraine
	Introduction	117
Chapter 6	The Predisposition to Migraine	119
	Introductory Comments
	Overall Incidence of Migraine
	Familial Occurrence and Inheritance of Migraine
	Signs of Migrainous Constitution
	Migraine Diathesis in Relation to Other Disorders
	Migraine in Relation to Age
	General Discussion and Conclusions
Chapter 7	Periodic and Paroxysmal Migraines	133
	Migraine and Other Biological Cycles
	Time Between Attacks: Relation Between Frequency and Severity of Attacks
	Immunity Between Attacks
	Signs of Approaching Attacks
	Intrinsic and Extrinsic Determinants of Periodicity
	Conclusions: The Notion of Idiopathy
	Postscript (1992)
Chapter 8	Circumstantial Migraine	140
	Classification of Provocative Circumstances
	Arousal Migraines: In Response to Light, Noise, Odours, Weather, Exercise, Excitement, Violent Emotions, Pain, Drugs, etc.
	Slump Migraines: In Relation to Eating, Fasting, Heat, Fever, Passive Motion, Exhaustion, Drugs (Alcohol, Reserpine, etc.)
	Nocturnal Migraines, and Relation of Attacks to Dreams and Nightmares
	Migraine Aura in Response to Flickering Light, Patterned Stimuli, and Visualisation of Scotomata
	Miscellaneous Determinants: Food, Constipation, Menstrual Cycles, Hormones, Allergies, etc.
	Self-Perpetuation of Migraines
	Provocation of Attacks in Relation to "Tuning" and Homeostatic Limits Within Nervous System
Chapter 9	Situational Migraine	164
	Migraine in Relation to Intolerable Emotional Stress
	Preliminary Comments on "Migraine Personality" and Relation of Attacks to Repressed Hostility
	Case-Histories Illustrating Wide Range of Situations and Character-Types in which Repeated Migraines May Occur
Part III	The Basis of Migraine
	Introduction	175
	Clarification of the Term "Cause" in Relation to Migraine
	Necessity to View Migraine in Three Ways: as a Process in the Nervous System, as a Reaction to Certain Stimuli, and as a Particular Form of Experience
Chapter 10	Physiological Mechanisms of Migraine	178
	Historical Introduction: Classical Theories (Humoral and Sympathetic), Vascular and Vasomotor Theories of the Nineteenth Century
	Critiques of These
	Liveing's Theory of "Nerve Storms"
	Current theories of Migraine Mechanisms and their Supporting Data
	Vasomotor Theories (Latham-Wolff) Considered and Disputed
	Chemical Theories of Migraine, with Particular Reference to Acetylcholine, Histamine, and Serotonin: Critique of These
	Electroencephalographic Findings in Migraine: Notion of "Dysrhythmic Migraine," and of "Spreading Depression" in Relation to Migraine
	Limitations of Current Theory and Data
Chapter 11	The Physiological Organisation of Migraines	193
	Introductory Comments
	Migraines as Polymorphous Parasympathetic or Trophotropic Events
	Migraine as a Slow Form of Centrencephalic Seizure
	Consideration of Visual Hallucinations in Migraine and Their Cortical Basis
	Hierarchical Organisation of Migraines, and Their Relationship to other Paroxysmal Events
	Migraine Considered as a "Neural Task," with Fixed Ends and Variable Means
Chapter 12	Biological Approaches to Migraine	205
	Migraine Considered as a Special Form of Protective Behaviour
	Its Affinities to other Passive Reactions to Threat (Passive Fear, "Freezing," Sham Death, Pathological Sleep, Fainting, etc.)
	Contrast of These Reactions to Fight-Flight Responses
	Concept of the Migraine Archetype, and its Differentiation in Response to Human Needs and Human Nervous Systems
Chapter 13	Psychological Approaches to Migraine	211
	Necessity of Considering Migraines as Experiences to which Emotional Values are Attached. Common Uses of Migraines: Recuperative, Regressive, Encapsulative, Dissociative, Aggressive, and Self-Punitive Attacks
	Mechanisms of Psychosomatic Illness in Reference to Migraine
	Migraine Considered as a "Vegetative Neurosis" and as a Special Form of Conversion Reaction
	Attachment of Symbolic Value to Particular Symptoms of Migraine
	Migraine Considered as an Archaic Form of Bodily Language
	Conclusions
Part IV	Therapeutic Approaches to Migraine
	Introduction	229
Chapter 14	General Measures in the Management of Migraine	230
	Introductory Comments: Approach to the Patient and Role of the Physician
	General Health Measures and Avoidance of Provocative Circumstances
	Forms and Uses of Psychotherapy
	Definition of Therapeutic Goals
	Reasons for Success and Failure in the Treatment of Migraine
Chapter 15	Specific Measures During and Between Attacks	238
	Introductory and Historical Comments
	Drugs of Specific Use During Acute Attacks: Ergotamine, its Uses and Contraindications, Caffeine, Parasympathetic Blockers (Belladonna, etc.), Sympathomimetic Drugs (Amphetamines, etc.)
	Symptomatic Drugs: Analgesics, Anti-Emetics, etc.
	Miscellaneous Drugs: Legitimate and Otherwise General Measures in the Acute Attack
	Management of "Status Migrainosus"
	Drugs Employed in the Prevention of Migraine Attacks: Methysergide (Sansert, Deseril), its Uses and Dangers
	Use of Ergotamine Prophylactically
	The Role of Sedatives, Tranquillisers, Anti-Depressants, etc.
	Other Forms of Medication
	The Uses of Placebos
	Histamine "Desensitisation"
	Allergic "Desensitisation"
	Hormone Preparations, Their Abuses and Dangers
	The Place of Surgical Procedures
	Conclusions
Chapter 16	Recent Advances in the Treatment of Migraine	256
Part V	Migraine as a Universal
Chapter 17	Migraine Aura and Hallucinatory Constants (with Ralph M. Siegel, PH.D.)	273
	Introduction
	Types or Levels of Hallucination
	Hallucinatory Constants
	Mechanisms of Hallucination
	Self-Organising Systems
	A New Model of Migraine Aura
Appendix I	The Visions of Hildegard	299
Appendix II	Cardan's Visions (1570)	302
Appendix III	Remedies Advised by Willis (1672), Heberden (1801) and Gowers (1892)	304
	Glossary of Case-Histories	307
	Glossary of Terms	311
	Bibliography	319
	Index	329

Editorial Reviews

"Balanced, authoritative ... brilliant." —The London Times

"Written by one of the great clinical writers of the twentieth century, Migraine ... should be read as much for its brilliant insights into the nature of our mental functioning as for its discussion of the migraine." —The New York Times Book Review

"I am sure ... that any layman who is interested in the relation between the body and mind . . . will find the book as fascinating as I have." —W. H. Auden, The New York Review of Books

From the Publisher