Prehistoric Headaches

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Medicine turns out to be a rather fluid and changeable discipline. This really shouldn’t be much of a surprise, as medicine involves the treatment of illness – which is generally caused by organisms that are constantly changing.

As an example, have you noticed that flu no longer kills the millions and millions that it killed in 1917? That’s not because of superior sanitation, or superior medical treatments, though both are certainly true. The simple fact is that the flu virus mutated into a form that doesn’t kill its host (usually). In evolutionary terms, a virus or bacterium that kills its host is poorly adapted. A much more successful virus would leave its host alive, and relatively healthy – like the chicken pox virus. Ever have chicken pox? Well, you still do, then:  the virus that causes chicken pox doesn’t go away! The illness it causes is basically the body’s attempt to eliminate the virus, coupled with the virus’ attempt to defeat the immune reaction. Eventually, an equilibrium is reached:  the virus enters the nervous system, when it lives happily and causes no trouble. Our immune system keeps antibodies on hand, just in case, but generally, the battle has ended in a stalemate. The virus lives on, though, and can be reactivated by severe stress, or heavy steroids:  when this happens it shows up as shingles or herpes zoster.

The chicken pox virus (Varicella Zoster) is an evolutionary success story – and it’s the model for any number of other mutated germs and viruses.  You’ve heard of the Black Death, the Bubonic Plague of the Middle Ages, that killed maybe 2/3 of Europe’s population?  Would it surprise you to know that it’s still around? It is, but it has mutated:  it’s endemic in Southwest Asia, and in the Southwestern United States – where it’s usually called Tularemia.  Instead of plague rats, it’s carried by Prairie dogs, and transmitted to one another – and potentially to us – by the fleas that prey on them. Modern Medicine can quash the illness pretty quickly and effectively, but that isn’t why we no longer have epidemics of plague:  the pathogen has mutated to a milder form, we’ve learned better sanitary procedures, so it doesn’t spread as easily, and we have evolved better immune responses, so we can fight the infection more effectively.

Bye-bye plague!

To be sure, there are still plenty of horrifying ailments caused by viruses and bacteria, but over time they all tend to get milder. Measles, Mumps, Diphtheria, Tetanus, all still exist, but have been clobbered by vaccination, so they aren’t nearly as widespread as they once were – and both Polio and Small Pox have been nearly eradicated: Small Pox exists only in heavily secured labs belonging to CDC, the US Army, and any other army that ever had an active bio-weapons program. As for Polio, CDC projects that it will be exterminated by 2018.

There are some ailments, nevertheless, that have come down to us from antiquity virtually unaltered. It’s hard to tell when all you have to work with are fossilized bones – except in the case of conditions that leave distinct marks on those bones. in 1908, in La Chapelle Aux Saints, a Neanderthal skeleton was found horribly deformed by what must have been Juvenile Rheumatoid Arthritis. The skeleton was dated at 60,000 years of age.

And then there are the trephinations.

Trephination, or trephining, is a surgical procedure involving the opening of the skull. Nowadays, surgeons open the skull for only a very few reasons: the treatment of depressed skull injuries, the removal of brain tumors, and the relief of high cerebro-spinal fluid pressure. In ancient times, however, the operation had different purposes. Indeed, there is strong evidence for two types of trephination. The first was trephination by surgeons:  there is clear evidence of great skill, and often, the bone has begun to regrow, indicating that the patient lived on for some years after the surgery. These operations were likely performed primarily to address depressed skull fractures. The second type of trephination involves individuals of greatly lesser skill – likely shamans, using the operation for a supernatural purpose, such as permitting the evil spirits to escape. What evil spirits? Well, there are two very strong candidates.

The first of these would be severe mental illness, such as schizophrenia. Even today, it’s easy to mistake a psychotic attack for a demonic one – particularly as schizophrenia so often has a strong religious component, in the sufferer’s point of view:  they can see themselves as special, touched by God, messianic. Ancient shamans may well have hypothesized evil spirits as the cause, and, unable to drive the spirits out by any other method, they may well have decided to open the skull to give the spirits a clearer exit. Sadly, in most cases, judging by the lack of bone regrowth, the only spirit that escaped was likely the patient’s.

Another likely reason, for either the shaman, or even perhaps the surgeon, to open a man’s skull would be migraine.

I suffer from migraines, and I can tell you from personal experience, it’s the only disorder where the patient might actively consider letting someone use a sharpened rock to open his skull! The thing is, the pain of a migraine is incredibly severe, and often extremely localized. Each person experiences it differently:  my dad used to say his were like an axe buried in the left side of his skull; a friend described hers as being like an icepick in the exact center of the top of her head; the child of a colleague described hers as a feeling that something was penetrating her upper-left cheek.

So you have two essential components: extreme pain – pain so severe you might actually think it a good idea to open your skull with a rock – and the fact that you could point a surgeon to the exact spot of your head that needed to be cut open!

I’ve mentioned this theory to doctors: some laugh and say “maybe” – which means they’ve never had anything close to the pain of a migraine. Another, a surgeon, frowned sternly at me for suggesting one of his forebears might have been foolish enough to open someone’s head with a rock, to let out the evil spirits that were causing a migraine – which means, he’s an arrogant jerk, and has never experienced anything close to the pain of a migraine. A third doctor suggested that I was nuts, which, while technically true, has no bearing on the question at hand. Also, he’s never experienced anything even close to the pain of a migraine.

A fourth doctor immediately agreed that my scenario was likely. On a hunch, I asked if he’d ever suffered from migraine. He gave me a wry smile and said “about once a month.”

There are some things that have to be experienced to be believed. And believers tend to huddle together against the infidels. Jerks.

Ok, maybe “Jerks” is going too far – but I can’t tell you the number of times I’ve been told “Oh, come on, it’s just a headache!” or “Oh, please! It can’t possibly be that bad!” or, “Scott was out yesterday … seems he had a ‘migraine’ … [assorted snickers from the room].”

Let me address those impressions in order:

A) It’s not just a headache. You can tell by the fact that medical science has designated a special term for this particular type of headache! Jerk.

B) It actually can, in fact, be that bad. Migraine pain can rival bone pain – one of the worst pains known to medical science. It is mentally debilitating, as it literally prevents your from thinking of anything  other than “Oh, God, it hurts!” and sometimes “Please won’t someone shoot me!?!”. Migraine pain, coupled with the extreme photophobia associated with it, can, and does, cause grown men to huddle under their desk, or close themselves in a closet – anyplace dark, and quiet. In antiquity, Hercules is said to have slaughtered his children during an attack of migraine – which is one reason we know for a fact that the Greeks were describing the same disorder that exists today!

C) Given the mental and physical disabilities associated with migraine, and the fact that severe pain can impair judgement, and make it difficult to hold on to your temper (witness the children of Hercules), people at work should consider it a blessing that migraine sufferers often know when they’re coming on, and certainly know when they can’t function in the workplace!  Would anyone consider it funny if someone said “Johnny wasn’t at work yesterday … seems he had a ‘heart attack’ … [assorted snickers from the room]”

Part of the prejudice, believe it or not, centers around the fact that migraine sufferers experience ‘aura’ and often know a migraine is coming before it gets there! Look, there are loads of disorders that have precursors the patient can recognize beforehand! I used heart attacks as an example above, and that turns out to be a good model:  while many heart attacks occur without warning, just as some migraines do, in many cases, they are preceded by angina, shortness of breath, and lowering of blood-pressure which causes dizziness and faintness.  Usually when these symptoms are mentioned, people understand that the situation is potentially a serious one, and they’d recommend the person get to an emergency room!

If a migraine sufferer complains of weird stabs of light, distortion of vision, auditory hallucinations (mine take the form of a sharp metallic BANG, close to one of my ears), and severe nausea, in many cases these are disregarded by those who’ve never had a migraine – and they may even believe the sufferer is a hypochondriac!

In fact, the symptoms I mentioned are forms of classic aura which very often precede a migraine. Why? No one knows. Migraine, in general, is an extremely poorly understood condition.  There are generally two forms, we know that much:  some, like mine, are triggered by excessive amounts, or lack of, certain foods … cheddar cheese, LOTS of caffeine, or too little, and MSG, are items in a fairly long list of things that can trigger my migraines.  Avoiding those things, means avoiding nearly all of my attacks. My type of migraine has been called Cluster Migraines.

And then there’s the other form of migraine: Classic Migraine … cause: unknown, triggers: unknown.  They strike, sometimes without even a preceding aura, resulting in instant and complete disablement of the sufferer. This type is a complete mystery – and, while I can avoid the worst of my migraines by simply avoiding certain foods, the classic migraine sufferer is completely out of luck!

One thing that is known with certainty:  cutting holes in the skull doesn’t help.

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~ by dourscot on January 12, 2016.

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