by Oliver Sacks
University of California, 298 pp., $8.50
There screen’d in shades from day’s detested glare,
Spleen sighs for ever on her pensive bed,
Pain at her side, and megrim at her head.
Dr. Sacks’s primary purpose in writing this book was, no doubt, to enlighten his fellow practitioners about a complaint of which most of them know all too little. As Dr. Gooddy says in his Foreword:
The common attitude is that migraine is merely a form of mainly non-disabling headache which occupies far more of a busy doctor’s time than its importance warrants…. Some tablets and the current inelegant cliché of “learning to live with it” are advised by the physician, who hopes he will not be on duty the next time the patient comes for advice…. Many doctors are only too pleased when a patient, in desperation, takes himself off to the practitioners of “fringe medicine,” almost hoping that the results will be both disastrous and very costly.
I am sure, however, that any layman who is at all interested in the relation between body and mind, even if he does not understand all of it, will find the book as fascinating as I have.
It has been estimated that migraine afflicts at least 10 percent of the human race and the true percentage may well be higher, since probably only those who suffer severe attacks consult a doctor. Even if, like myself, one has had the good fortune never to have experienced an attack, we all have known some relative or friend who has had them, so that we can compare their character traits and symptoms with Dr. Sacks’s detailed descriptions.
Unlike contagious diseases and genetic disabilities such as hemophilia on the one hand, and hysterias on the other, migraine is a classic example of a psychosomatic illness in which physiological and psychological factors play an equal role. As physical organisms we are pretty much the same, that is to say, our bodies have a limited repertoire of symptoms. This makes it possible to diagnose a case of migraine, to distinguish it from, say, epilepsy or asthma. But as conscious persons who can say I, each of us is unique. This means that no two cases of migraine are identical; treatment that succeeds with one patient can fail with another.
A migraine is a physical event which may also be from the start, or later become, an emotional or symbolic event. A migraine expresses both physiological and emotional needs: it is the prototype of a psychophysiological reaction. Thus the convergence of thinking which its understanding demands must be based simultaneously, both on neurology and on psychiatry…. Finally, migraine cannot be conceived as an exclusively human reaction, but must be considered as a form of biological reaction specifically tailored to human needs and human nervous systems.
The first part of Dr. Sacks’s book consists of a series of detailed clinical observations. He distinguishes between three types of migraine, common migraine, popularly called “a sick headache,” classical migraine, in …