Eliseo y el hijo de la sunamita: una cefalea de proporciones bíblicas / Elisha and the Shunammite child: a headache of biblical proportions

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Oliver Sacks and migraine.

Background Oliver Sacks (1933-2015) published a large number of books on a variety of neurological topics. Of these, numerous copies have been sold and they probably serve as the only or main source of information on neurological diseases for many persons without a medical background. His first book was on migraine and in his subsequent books many descriptions of migraine can be found, mainly those of auras. Methods We explored the descriptions of migraine in Sacks' work in order to evaluate the image of migraine offered to the readers. Conclusion Oliver Sacks gave wonderful descriptions of migraine auras, but hardly any of migraine headache. Furthermore, he described rare auras such as 'amusia' and olfactory auras. Overall, this makes his descriptions of migraine not very useful to serve as medical information for laypersons. Oliver Sacks, however, wrote great literature.

Dr. Airy's "morbid affection of the eyesight": lessons from Teichopsia Circa 1870.

Hubert Airy's iconic drawing of his own migraine visual aura for which he coined the term, "teichopsia," conveys important lessons for the contemporary clinician. His observations of the expansion ("build-up"), minification/magnification, and color/achromatopsia of migrainous teichopsia are consistent with (and possibly anticipatory of) the later discoveries of cortical spreading depression, cortical magnification of primary visual cortex (V1), and specialized cortical centers for color vision.

Phenotype of migraine headache and migraine aura of Richard Wagner.

BACKGROUND: The headache phenotype and neurological symptoms of the German composer Richard Wagner (1813-1883), whose music dramas count towards the most frequently performed operas across the world, are previously undocumented. METHODS: Richard Wagner's own descriptions of his headache symptoms in his original writings and letters are investigated, as well as the complete diary records of his second wife, Cosima Wagner. RESULTS: There are manifold indications that Richard Wagner suffered from a severe headache disorder, which fulfils most likely the diagnostic criteria of migraine without aura and migraine with aura of ICHD-3 beta. CONCLUSIONS: Richard Wagner's life and opus can help to better understand the burden and suffering caused by migraine with its severe effects on the individual, familial and social life, the culture and community.

Friedrich Nietzsche and his illness: a neurophilosophical approach to introspection.

There are some arguments that Friedrich Nietzsche suffered from the autosomal dominant vascular microangiopathy: Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL). Here, a hypothesis is formulated supporting that CADASIL presenting with symptoms of bipolar disorder and Gastaut-Geschwind syndrome would contribute to the increased insight and creativity of a philosopher whose perceptions and intuitions often bear out the results of modern neuroscience. Alterations of the brain default and reward networks would account for such an increased level of introspection and creativity. A new framework on approaching illness is proposed, which, in conformity with Nietzsche's positive view, outlines the enabling aspects of some otherwise highly disabling neuropsychiatric disorders.

Nikola Tesla: relámpagos de inspiración / Nikola Tesla: flashes of inspiration

Nikola Tesla (1856-1943) fue uno de los principales inventores de la historia, hombre clave en la revolución que supuso el empleo de la electricidad a gran escala. Realizó también aportaciones en campos tan diversos como los rayos X, el control remoto, la radio, la teoría de la conciencia o el electromagnetismo. Como homenaje, la unidad internacional de inducción magnética recibió su nombre. Sin embargo, su fama es escasa en comparación con la de otros inventores de la época, como Edison, con quien sostuvo enconadas disputas. Persona peculiar y huraña, vivía para unos inventos que concebía a base de momentos de inspiración, que relaciona en su autobiografía con diversas manifestaciones neuropsiquiátricas, entre las que se pueden reconocer auras migrañosas, sinestesias, obsesiones y compulsiones (AU)

Nikola Tesla (1856-1943) was one of the greatest inventors in history and a key player in the revolution that led to the large-scale use of electricity. He also made important contributions to such diverse fields as x-rays, remote control, radio, the theory of consciousness or electromagnetism. In his honour, the international unit of magnetic induction was named after him. Yet, his fame is scarce in comparison with that of other inventors of the time, such as Edison, with whom he had several heated arguments. He was a rather odd, reserved person who lived for his inventions, the ideas for which came to him in moments of inspiration. In his autobiography he relates these flashes with a number of neuropsychiatric manifestations, which can be seen to include migraine auras, synaesthesiae, obsessions and compulsions (AU)

[An encounter between medicine and astronomy: migraine visions]. / Une rencontre entre médecine et astronomie: les visions migraineuses.

Until the second half of the eighteenth century, the very definition of migraine as hemicrania (pain felt in one side of the head) eclipsed symptoms that were then considered as "marginal", although tingling sensations, speech impairment and visual impairment had already been described by Piso and Wepfer. The possibility of a migraine without a headache nevertheless started to be envisaged, inviting one to re-evaluate the status of these phenomena. But, as paradoxical as it may seem, it is in the field of astronomy that some of these phenomena such as visual aberrations were analyzed systematically and acknowledged to be migrainous. Scintillating scotoma is no exception: it was indeed mentioned as early as in the Hippocratic corpus, but until the end of the nineteenth century it was addressed as a separate condition to migraine. We limit our study to the visual aura. Our purpose is to show that the ophthalmic symptoms affecting migraine sufferers were not, by themselves, a medical object--which somehow calls into question the very functioning of science.

[Blaise Pascal and his visual experiences]. / Pascal, l'emicrania e la luce mistica.

Blaise Pascal (1623-1662) the mathematician, physicist, and theologian, is often considered as an example of classical French prose. Pascal's primary scientific contribution was the principle of hydrostatics, known as Pascal's Law. Furthermore, he is also regarded as one of the most important French philosophers, principally due to his publication: "Pensées". There is documentation affirming that Pascal suffered from visual migraines with recurring headaches, episodes of blindness in half of his visual field, zigzag, fortification spectra, and other visual hallucinations. It has been hypothesised that these migraine aura experiences acted as a source of inspiration for Pascal's philosophical reflections. Pascal's sudden religious conversion, probably the most decisive moment in Pascal's personal life, during the night of the 23rd to 24th of November 1654, was accompanied by a lighted vision which he interpreted as fire convincing him of God's "reality and presence". This experience may have been triggered by the effects of a migraine aura attack. This spiritual epiphany led him to dedicate the rest of his life to religious and philosophical interests.

History of migraine with aura and cortical spreading depression from 1941 and onwards.

Several personal descriptions of migraine with aura from 1870 onwards reported a slow, gradual progression of symptoms. Lashley in 1941 meticulously chartered his own auras and concluded that the symptomatology reflected a cortical process progressing with a speed of 3 mm/min across the primary visual cortex. Leão described cortical spreading depression (CSD) in rabbits in 1944 and noticed its similarity to the migraine aura. Despite these scattered pieces of evidence, the prevailing theory was that the migraine aura was caused by a vasospasm and cortical ischaemia. The advent of a technique for measurements of regional cerebral blood flow (rCBF) in 1974 made it possible to detect spreading oligaemia during migraine aura. Between 1981 and 1990 a series of studies of rCBF during migraine attacks showed reduced brain blood flow posteriorly spreading slowly and contiguously anteriorly and crossing borders of supply of major cerebral arteries. These observations refuted the ischaemic hypothesis. The human studies showed initial hyperaemia followed by prolonged hypoperfusion. The relation between aura and CSD was known to cause short-lasting, and therefore not obvious vasodilation and it was considerably strengthened by the demonstration of a long-lasting oligaemia in rats in the wake of CSD. In the primates CSD is not easily elicited, but it has in recent years been clearly demonstrated in patients with brain trauma and stroke. Finally, mutations for familial hemiplegic migraine have been expressed in mice and lower the threshold for CSD. The seminal papers on rCBF and CSD published in the 1980s caused a dramatic shift in our concepts of migraine aura. They moved attention from ischaemia to CSD and thereby to the brain itself, and paved the way for subsequent discoveries of brainstem mechanisms.

Hubert Airy, contemporary men of science and the migraine aura.

Although there had been occasional references to the visual aura of migraine even in ancient medicine, little attention was given to the phenomenon until the first half of the nineteenth century when French authors began to describe it. In the medicine of English-speaking countries, apart from a few descriptions, it went largely unnoticed until the British Astronomer Royal, Sir George Airy, described his own experience of the visual aura in 1865. Five years later his son, Hubert Airy, also described his experience of it and that of a number of eminent contemporary men of science. The topic of the migraine aura was almost immediately taken up by two of the younger Airy's contemporaries and fellow Cambridge medical graduates, Peter Wallrock Latham and Edward Liveing, in their monographs. Subsequently, migraine with aura quickly became a well-recognised clinical entity in British medicine.

John Ruskin's relapsing encephalopathy.

John Ruskin (1819-1900) is chiefly remembered for his works on painting and architecture, and for his powerful and original prose style. In middle age, he suffered recurring episodes of delirium with visual hallucinations and delusions. At about the same time, his writing developed a disjointed polemical character, with cryptic and intemperate elements that disorientated some readers. The nature of Ruskin's 'madness' is a key to understanding his later writing career but the psychiatric explanations given by many of his literary biographers seem unsatisfactory. Ruskin left numerous clues about the illness in his diaries, correspondence and publications. It is likely that he had a relapsing-progressive neurological disorder with neuropsychiatric manifestations. It could have been a fluctuating metabolic or immunological encephalopathy, but the diagnosis that best fits the time course of his illness and the prior history of mood disorder and of migraine with aura is Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL). Whatever the pathology, its first effects on frontal lobe function may have actually enhanced Ruskin's creative energy for a long time before stepwise cognitive impairment degraded his ability to write.

The difference between epileptic auras and migrainous auras in the 19th century.

In the International Headache Society classification of headaches, the concept of aura is given a key role. It serves as a boundary between 'migraine without aura' and 'migraine with aura'. Historically, the concept of an aura was borrowed from the epilepsy vocabulary; a borrowing that took place in English medicine at the beginning of the 19th century and in French medicine in the mid-19th century. It would therefore be interesting to see which features of the epileptic aura are used to explain the migraine aura. Based on the French and English medical literature of the 19th century, two processes have been reviewed: (i) the emergence of the concept of aura, and (ii) the modifications of this concept throughout the 19th century. It appears that the original medical use of the term 'aura' as a set of rising tactile sensations was in use from the 2nd century until late in the 19th century, but then various other symptoms were recognized and the aura gradually became accepted as an early part of the seizure. By the end of the 19th century the aura that preceded a migraine was seen as a similar process, and thought of as part of the migraine sequence.

Leao's cortical spreading depression: from experimental "artifact" to physiological principle.

Cortical spreading depression was described in 1943 by Aristides Leão, a Brazilian neurophysiologist. Initially considered to be a mysterious event as it was discovered serendipitously, its nature has become progressively better known. Cortical spreading depression is now accepted as the mechanism underlying migraine aura and has became known as either Leão's spreading depression or cortical spreading depression. Recent studies have suggested a role for Leão's cortical spreading depression in the pathogenesis and symptomatology of neurologic disorders such as transient global amnesia, head injury, and cerebrovascular diseases.