Founding Fathers and Migraines
Recently, like so many others, I have discovered and become obsessed with the musical Hamilton. Since there's no way I'm seeing it on stage any time soon (or ever), I purchased the book Alexander Hamilton by Ron Chernow, which inspired Lin-Manuel Miranda with its fascinating story of the “ten dollar founding father.”
Something in common with Thomas Jefferson
About halfway through, I was reading about the dinner meeting upon which the song “The Room Where It Happened” is based. Hamilton, James Madison, and Thomas Jefferson sat around that table and compromised, trading the location of the U.S. capital for votes in favor of Hamilton's financial debt assumption plan. Then my mouth dropped open as I read “For more than a month, Jefferson had been bedeviled by a migraine headache, yet he presided with commendable civility.”
I had forgotten that Thomas Jefferson suffered from migraines. I tried to picture hosting what Chernow referred to as “the most celebrated meal in American history” in the midst of status migrainosus, having to debate and compromise with someone I firmly disliked and felt threatened by. I wondered what Jefferson used to treat his pain and how effective it was. I decided to do some research.
First I found Tammy Rome's article on Health Central under Famous Migraineurs. But there was no mention of how he treated them. I just wondered... trepanning? Blood letting? Laudanum?
Then I found an article called “Bark's Bite: did 18th century pharmacopeia complicate Thomas Jefferson's headaches?” Bingo! Originally presented at the American Academy of Neurology annual meeting by M. Luedke and E.W. Massey, it was published in Neurosciences and History in 2015. It states that Jefferson treated his headaches with something called Peruvian Bark. “His pharmaceutical of choice, Jesuit (also called Peruvian) bark, was a popular 18th and 19th century fever drug from Cinchona trees, and the first popular vector of quinine in Western medicine.”
While there is a lot of information available from Jefferson's correspondence about his “fits,” or severe bouts of debilitating headache, modern researchers have had a difficult time diagnosing them. “While he often wrote extensively of his headaches, his symptoms do not fit the standard definitions of primary headache syndromes.” They have been described as migraine, cluster headache, or tension headache, and seemed to last for hours to weeks, often corresponding to stressful time periods. He would remove himself to dark rooms; have difficulty reading and traveling. He even almost missed his opportunity to author the Declaration of Independence.
Jesuit bark, probably first used for malaria, started to become a cure-all in Europe and the Colonies, and was mentioned later on in Chernow's book as having treated the Hamilton family's Yellow Fever. In fact, the first physician to identify cluster headaches, Gerard van Swieten, recommended its use. Other popular remedies for pain during that time included liquor and laudanum (an opium preparation), but Jefferson's ledgers show many purchases of Jesuit bark from 1790 to 1807, leading historians to believe that he used it frequently and that it was his remedy of choice for head pain.
Medication overuse headache
While we have no means of calculating Jefferson’s quinine intake, both acute and chronic toxicity can cause headache. Since the quinine concentration in different species of Cinchona was so variable, toxicity could have occurred unpredictably and inadvertently... Prolonged quinine use as an analgesic could potentially have caused a medication-overuse headache, which could account for the amorphous symptoms and prolonged duration of Jefferson’s cephalalgia.”
See, even the Founding Fathers dealt with Medication Overuse Headache, one of the most frustrating, between-a-rock-and-a-hard-place aspects of migraine disease. Apparently the quinine in the Jesuit bark also had the side effect of diarrhea for Jefferson, which was another difficult chronic issue he dealt with. He treated that with laudanum, which could have complicated his headache situation even further. Sounds familiar, right? What is worse, the migraine or the side effect? Treat the side effect, and get even more headaches as a result. One can't help but feel empathy with Jefferson. Even me, with my love for Hamilton and the fact that Jefferson seems more the villain in Act 2 of that story than even Aaron Burr.
Can you tell when a migraine attack is coming?