Academics

Eukaryon is published by students at Lake Forest College, who are solely responsible for its content. The views expressed in Eukaryon do not necessarily reflect those of the College. Articles published within Eukaryon should not be cited in bibliographies. Material contained herein should be treated as personal communication and should be cited as such only with the consent of the author.

*This paper was written for BIOL 346: Molecular Neuroscience, taught by Dr. Shubhik K. DebBurman.

Oliver Sacks

Knopf Publishing Group (January, 1992)

Migraines have been known to affect human beings since the beginning of history. These incapacitating and debilitating headaches affect a surprisingly large number of people, who often suffer quietly and patiently. Dr. Oliver Sacks analyzes this disorder thoroughly in the revised edition of his brilliant book, Migrane. He copiously cites contemporary and past resources to provide the reader with an unbiased and succinct understanding of the workings of this disease.

Dr. Sacks begins by giving a history of migraines and the past and current theories about their etiology. Quotations and annotations of past works on migraines provide the reader with descriptive first hand medical accounts. He then goes on to characterize the different types of migraines. While discussing the various symptoms of the illness, Dr. Sacks quotes case histories of patients who were affected by a particular manifestation of this disorder. The case histories help readers to understand particular symptoms, like “fluid balance,” and to feel the helplessness of the individuals affected by them. Migraine is a must read for anyone interested in the complexities of the human body and health.

One of the many simple and enlightening descriptions about the disorder characterizes it as a “chaos” of the nervous system. Having suffered from a migraine myself, I can testify that it does indeed feel like “a general feeling of disorder.” As Dr. Sacks explains, it “starts as instability, disturbance, a far-from-equilibrium, unstable state." However, this feeling of illness can either disappear or persist with a perplexing vengeance. Some patients achieve relie by sleeping, having a bowel movement, vomiting or even sneezing!

Colored pictures of hallucinations and scotomas drawn by patients experiencing a migraine attack serve to bring words like “mosaic vision” and “auras” to life. These paintings and drawings are worth a thousand words in explaining the classic symptoms a migraine to someone who has never heard of or experienced one.

While describing the various types of migraines, Dr. Sacks outlines the importance of tests in correctly diagnosing migraine headaches. Auras can also serve as an indication of an angioma in the brain. Questioning the patient and conducting tests like X-rays and EEGs can rule out migraines if an angioma is found. Another indication of a pseudo-migraine is when the patient has auras invariably in the same region.

No stone is left unturned when characterizing circumstantial migraines. Light, noise, smells, inclement weather, hot weather, fever, and visual field distortions are just a few among a host of circumstances that lead to a migraine arousal. My migraines were usually aroused by being in sunshine for too long, or by reading in a moving vehicle.

Why do migraines occur? One of the explanations given by Dr. Sacks is that the nervous system is in a continuous state of equilibrium. Any stimulus that threatens to disrupt this equilibrium, like excessive excitation or prolonged sleep, evokes a migraine, which acts as a warning to “avoid particular circumstances which cannot be tolerated.” This rationale, along with the fact that a migraine is benign and reversible, fits well into an evolutionary explanation for migraines.

After discussing the physiological and biological basis and organization of migraines, Dr. Sacks investigates the psychological approaches to the illness. He views the body and the soul as sharing a very intimate relationship with each other. The role of repressed emotions in causing migraine is acknowledged. This exciting section of Migraine also discusses Darwin, Freud and Deutsch’s explanations of the special relationship between body and soul.

I would recommend this book to anyone with the slightest interest in the human condition. Even though many terms in Migraine will be unfamiliar to the lay person, the glossary comes in handy. Further, the appendices at the back of the book give a brief review of the history of migraine in religion, Cardan’s visions and remedies prescribed in some medieval and modern texts.

Finally, Migraine documents all the past and current knowledge of therapeutic measures taken for the treatment of migraines. In addition to the drugs and general measures to be taken in order to avoid migraines, Dr. Sacks reminds health professionals of the importance of the development of trust between physicians and patients. Speaking about migraines, for which there isn’t a specific cure, Dr. Sacks, says that often the patient can be cured if she/he trusts the doctor and if the physician is hopeful of being able to treat the patient. He reminds the reader that “medicine cannot be reduced to coherent and logically consistent terms- it is dependent on innumerable variables and intangibles,” the most important of which is trust.

Another important point made by Dr. Sacks is that health professionals must always obey the cardinal rule of medicine: “one must always listen to the patient.” In the case of a migraine, it is especially important to do this: migraine patients usually have more than one symptom, and their symptoms are often related to each other. He points out that, frequently patients are “looked at, investigated, drugged, [and] charged: but not listened to.” Coming from a doctor, this advice can only help to remind health professionals of their responsibilities and increase awareness among patients about their right to be listened to.

In conclusion, Migraine is an authoritative and precise book examining all the known aspects of this disorder. It is a must-read for people who are even minutely interested in the human condition. For the layman, Migraine is not only a source of valuable information but a reminder of their rights. Beyond that, it reminds health professionals of the importance of trust in the doctor-patient relationship.

“This was always the central motto and message of Hippocrates, the Father of Medicine: that one must not treat the disease, but the afflicted individual; that though the doctor must be knowledgeable and expert about diseases, drugs, physiology, and pharmacology, his ultimate concern must be for the individual himself [/herself].”