“Neurological literature”: Headache (Part 9)
Correspondence to: AJ Larner, Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Lower Lane, Liverpool L9 7LJ. E-mail: firstname.lastname@example.org
Provenance and peer review: Submitted and internally reviewed.
To cite: Larner, AJ. ACNR 2016:16 (2): online first
It is some years since the previous article in this series presenting accounts of headache encountered in literary or biographical material,1 and, astonishingly, almost a decade since the first.2 I hope readers will indulge me by accepting this further offering.
As neurologists, we now draw a clear clinical distinction between “headache” and “neuralgia”, as enshrined in diagnostic criteria.3 However, our clinical experience indicates that this distinction may not be evident to patients (or even sometimes primary care physicians) who may use the terms interchangeably.
The author W Somerset Maugham (1874-1965) was a medical student at St Thomas’ Hospital, London, in the 1890s,4 during which time he attended, according to his own account, 63 confinements in 3 weeks in houses in Lambeth. This experience of the labouring poor provided the source material for his first novel, Liza of Lambeth (1897). First hand observation may underlie Maugham’s accounts of the headaches suffered by the heroine’s mother, Mrs Kemp, who says to her daughter:
‘Oo, my ‘ead!’ she was saying, as she pressed her hands on each side of her forehead. ‘I’ve got the neuralgy again; wot shall I do? I dunno ‘ow it is, but it always comes on Sunday mornings’.
Later in the novel, apparently neglected by her daughter one day, she complains on her return:
‘I’ve ‘ad the neuralgy all the mornin’, and my ‘ead’s been simply splittin’, so thet [sic] I thought the bones ‘ud come apart and all my brains go streamin’ on the floor.’
The good lady’s drinking habits may give us an all too transparent a clue to the timing of her headaches.5
The use of the term “neuralgia” as a description of head pains, sometimes apparently interchangeably with headache and even migraine, may be encountered elsewhere, for example in the writings of Elizabeth Gaskell (1810-1865),6 Louisa May Alcott (1832-1888),7 and Francis Kilvert (1840-1879),8 all of whom suffered from headaches. I suppose it may be possible that this reflects the usage of these terms in the nineteenth century.
In none of these individuals, Mrs Kemp excepted, did headache appear to stifle creativity, although it might interrupt for a time social and occupational function. Hence it is unsurprising to note that the possessors of very disparate talents may also be afflicted by headache, ranging from the levity of the comedian Peter Kay, who reports:
Nowadays I get a blinding migraine if I stay up until the end of News at Ten and I have to have a siesta the following day.9
to the gravitas of Thomas Henry Huxley (1825-1895), Darwin’s “bulldog”. In Adrian Desmond’s biography, Huxley is reported to be “crushed by headaches after lecturing”. Developing his interests in fossils, he “started another course for his students but it took the inevitable toll. Headaches plagued him”. Both these references relate to the mid-1850s, when Huxley was in his late 20s or early 30s, and still trying to establish himself, this being in the midst of what Desmond chooses to call the “Lost in Wilderness Years (1850-1858)”.10 One might wonder whether Huxley’s “dyspepsia”, accounted one of his “Town afflictions”, might also be ultimately migrainous in origin.
Although a “plague”, might headaches ever enhance, facilitate or stimulate creativity, perhaps by affording new insights, or granting different mind states, which may then be translated to the non-headache state? On the extremely rare occasions that I have had a migraine-type headache I have been subjectively aware that I am seeing things or thinking about things differently from my usual non-headache state.
There is of course a considerable literature addressing these possibilities, One relates to the suggestion that Pablo Picasso may have been a migraineur, the cubist style being in part a response to the fragmentation and distortion of visual images experienced in migraine aura. It is a fascinating idea, but one currently still without any definite evidence to prove or refute.11
- Larner AJ. “Neurological literature”: headache (part 8). Advances in Clinical Neuroscience & Rehabilitation 2011;11(2):21.
- Larner AJ. “Neurological literature”: Headache. Advances in Clinical Neuroscience & Rehabilitation 2006;5(6):23-24.
- Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 2013;33:629-808.
- O’Mahony S. W Somerset Maugham (1874-1965) and St Thomas’s Hospital: Medical School and the making of a writer. J Med Biogr 2014;22:56-60.
- Maugham WS. Liza of Lambeth. London: Vintage Books, 2000 : 19,80.
- Larner AJ. “A habit of headaches”: the neurological case of Elizabeth Gaskell. Gaskell Journal 2011;25:97-103.
- Larner AJ. Louisa May Alcott and headache. Advances in Clinical Neuroscience & Rehabilitation 2014;14(2):20.
- Larner AJ. Francis Kilvert (1840-1879): an early self-report of cluster headache? Cephalalgia 2008;28:763-766.
- Kay P. The sound of laughter. London: Century, 2006:151.
- Desmond A. Huxley. The devil’s disciple. London: Michael Joseph, 1994:217,232.
- Haan J, Ferrari MD. Picasso’s migraine: illusory cubist splitting or illusion? Cephalalgia 2011;31:1057-1060.