Dr. Airy's "morbid affection of the eyesight" (the migraine aura)
July 12, 2019 8:54 PM   Subscribe

Hubert Airy illustrated his experience of progressive migraine auras (National Geographic) in 1870. There was no concept of migraine at the time—he referred to it as transient half-blindness. A modern opthalmologist calls it "an iconic illustration ... It's so precise, like a series of time-lapse photographs."

Dr. Airy's illustration is reused in a 1915 textbook of nervous system diseases (alongside a contemporaneous description of "classical migraine").

On Wikimedia Commons, some other illustrations of migraine aura.
posted by sylvanshine (54 comments total) 44 users marked this as a favorite
Oh yeah, that's exactly what they look like. I used to get an aura like that at least 4 times a week. Ugh, just thinking about it almost gives me a headache.
posted by shapes that haunt the dusk at 8:59 PM on July 12, 2019 [13 favorites]

This is incredible. Unfortunately, I was not able to read most of the article because just seeing the perfectly rendered auras made me pretty queasy. Can anyone give me a tl;dr of the article?
posted by NoMich at 9:03 PM on July 12, 2019 [4 favorites]

I get a couple of migraines a year, so I'm damn lucky.

Light and sound are unbearable, but never had the visual hallucinations/auras.
posted by Windopaene at 9:07 PM on July 12, 2019

I got intense vertigo instead of auras, and consider myself damn lucky.
posted by The Underpants Monster at 10:06 PM on July 12, 2019 [2 favorites]

Can anyone give me a tl;dr of the article?

He drew the thing. It's been used as a reference ever since. His dad also drew the thing in a less developed/artistic/realistic way. It's been compared to many other depictions and experiences and it's deemed as the best drawing of it.
posted by hippybear at 10:14 PM on July 12, 2019 [8 favorites]

I get these auras but. fortunately for me, I don't get the headaches. I would not have thought it possible to actually draw these things but this guy does an amazing job of capturing them. They have always reminded me of the decorative art on the pottery of some Navajo pottery and made me wonder if the were the inspiration for said art.
posted by charlesminus at 10:18 PM on July 12, 2019 [11 favorites]

Yup, that's them alright.
posted by Artw at 10:42 PM on July 12, 2019 [6 favorites]

Yep that looks like exactly it. I’m also in the boat where I get these but usually not the terrible headaches. Brains are weird.
posted by sleeping bear at 10:46 PM on July 12, 2019 [10 favorites]

Dust and noise seem to be the triggers for me. 30 minutes of the aura, 2 hours of moderate headache and light nausea, 2 hours of post-workout relaxation and euphoria.

Right before the aura I’m unable to read. I see the words on the page or screen and know what’s supposed to occur, but it does not. Terrifying.

It’s been a few years and I hope this hasn’t jinxed it.
posted by notyou at 11:40 PM on July 12, 2019 [7 favorites]

I get these auras but. fortunately for me, I don't get the headaches.

Yeah, that happened to me at work last week, first time ever, scared the shit out of me. Pointy little headache that turned into a dull throb, suspect the headache was more a result of stress and anxiety. Amazing illustration.
posted by Alvy Ampersand at 11:57 PM on July 12, 2019 [1 favorite]

Yeah, I'm another one that gets a very occasional aura -- which usually seems to be stress or overwork related -- but not the debilitating migraine headaches that my dad does. Brains are weird.

I found the Wikipedia page on scintillating scotoma quite comforting in a "yes, that one's exactly what I'm seeing" kind of way but wasn't aware of Airy's illustrations.
posted by We had a deal, Kyle at 12:14 AM on July 13, 2019 [7 favorites]

I have visual migraines. His father’s illustrations are closer to what I experience, although they lack the glowing and movement that characterize mine.
posted by GenjiandProust at 12:18 AM on July 13, 2019 [1 favorite]

I used to be unable to make sense of faces just before the pulsating fortification illusions arrived, but these days I'll typically be reading and parts of words and sentences will disappear.

It took years before I was willing to admit to myself how badly they were degrading my judgement — I've written some strange comments here when I was having a migraine, and I know I've weirded out a few cashiers by turning 90 degrees to the side so I could see the credit slip well enough out of the corner of my eye to sign it, because 80% of my visual field was obliterated.
posted by jamjam at 12:22 AM on July 13, 2019 [4 favorites]

Oh yeah I sort of skimmed it despite getting a headache just looking at the picture. I guess there’s also something in there about the visual cortex. I checked out before I could go any deeper.

Right before the aura I’m unable to read. I see the words on the page or screen and know what’s supposed to occur, but it does not. Terrifying.

Yeah, that’s what often happens to me. I was at work the first time it happened, when I was 19. I was working the cash register and I suddenly couldn’t read at all. They let me sit down for half an hour, but the blind spot at the center of my vision kept getting worse. I told a coworker who was a nurse, and he told me to go to the ER. The ER doctor suggested it was either an extremely rare condition with my optic nerve, or it was a migraine. It wasn’t until after I left the hospital that I started getting the headache. First of many!
posted by shapes that haunt the dusk at 12:27 AM on July 13, 2019 [4 favorites]

Also, multiple people have suggested there’s no medical connection, but when I went off Xanax cold turkey, the frequency of my migraines shot up. I had previously gotten a migraine 3-4 times a year; immediately after I stopped taking Xanax, I got a severe migraine every day for a month. Then 4-5 times a week for the next 5 years. That has to mean something, right?

(Incidentally, I went off Xanax cold turkey because I stopped being able to afford psychiatrist appointments, and I didn’t have enough to taper my doses. Terrible.)
posted by shapes that haunt the dusk at 12:35 AM on July 13, 2019 [4 favorites]

I can't recall seeing these before: they're excellent illustrations of the kind of scintillating scotoma I sometimes get. I've had these both with & without accompanying headache; and sometimes the headache without these, though never without some sense of prefatory unease. Nor had I been aware of the term migraineur: I'll be filing that one away for future use - makes it sound all elegant & Parisian!
posted by misteraitch at 12:38 AM on July 13, 2019 [1 favorite]

Ha! I knew they had to be related. Hubert Airy is the son of (Astronomer Royal) George Biddell Airy, who among many other discoveries, characterized the Airy Disk, another optical phenomenon arising from diffraction in circular lenses. Also TIL he used a water-filled telescope (?!) to disprove the existence of the aether.
posted by sexyrobot at 1:03 AM on July 13, 2019 [6 favorites]

I get the auras, but not the pain, thankfully. Strangely, it’s usually early in the morning. More than half of them have been occurring as I am awakening after sleeping late on the weekends.

I remember the first time I had an aura. I was in my 30s and it totally freaked me out. I was reading at the time and suddenly I couldn’t see or understand the words. I just couldn’t make them out. I looked away, blinked, rubbed my eyes, and the words just weren’t making sense.

I got REALLY scared because I thought I was maybe having a stroke or a seizure or an aneurysm or something. Within a few minutes, the aura became visible as the classic, jagged zig-zag. I ran downstairs to tell the family that was rooming in my house with me at the time. The wife said “that sounds like a migraine.”

“No, it’s not a migraine...I don’t have a headache.”

“Not all migraines are accompanied with pain,” she said. “Some are just visual. I get those too. They’re called auras.” She described how the effect would grow in size over 5-10 minutes and then go away.

I was skeptical, and her calling my brain problem an “aura” did not give me confidence that she knew what she was talking about. But I sat at the breakfast table for a while and sure enough, the visual effect got larger, and as it did, I could read words through/around the affected part of the field, just as she predicted. So I didn’t feel I needed to dash off to the emergency room.

Still in awe at what had just happened to my brain — something I’d never heard about before — I went upstairs and did an internet search and found out all about them. Honestly, had that woman not been in the house that day to talk me through it, I would have gone to the emergency room, afraid my brain was about to switch off, or stroke out, or spring a leak or something.

I’ve had auras now about 20-30 times since then. They’re an inconvenience, yet never hurt. But they always make me feel like my brain is reminding me that I’m not completely in control. Spooky brains.
posted by darkstar at 1:11 AM on July 13, 2019 [7 favorites]

Just had two of these today--woke up with one, in fact, which was disconcerting. They're quite distinct from actual painful-headache auras for me (which I also get, but less frequently), but they often leave me semi-stupefied for some time after.
posted by praemunire at 1:28 AM on July 13, 2019 [1 favorite]

I was surprised to read in the article that such a small percent of migraineurs get an aura—mine always come with one and I assumed most people got them with their migraines.

That drawing is very accurate; for me there is a sparkling effect as well (scintillating scotoma). I’m impressed he was able to capture it so accurately that it’s instantly recognizable to anyone who’s had one, and for him to realize that it had to do with the brain and not the eye. I liked the part in the article where the ophthalmological neurologist said he still shows the picture to his patients today and they’re astonished and want to know where he got it from because it’s so accurate. I have to say the freakiest part for me is the tiny one at the centre of the drawing, representing how the aura starts out—when I see that it’s my “oh shit” moment because I know I’m getting a migraine and there’s nothing I can do to stop it. Mitigate, yes; stop it, no.

The first time I got a migraine it was just an aura for the first hour or so. I was in the middle of teaching and was writing on the board when I realized there was a ragged-edged sparkling circle in the middle of my vision and I couldn’t see what I was writing anymore. It got bigger and my head got fuzzier so I dismissed my class. I found a colleague who drove me home, then I made an appointment with the eye doctor who talked to me, checked my eyes, told me it was a migraine and sent me to my GP.

At this point the migraines became frequent but unpredictable, and the accompanying headaches became progressively more severe. Eventually I had to carry a prophylactic drug with me at all times and take it the second the aura started. If I did that, the migraine would still happen but it would usually be shorter and less painful; if I did not take it within 5 minutes, it was too late and it would definitely become so painful I could not function.

Stress was a definite trigger overall (the first time I had one I was teaching full time, revising and preparing to defend my master’s thesis, and in a shitty relationship). Other triggers: cleaning with bleach, lack of sleep, being hungry, being too hot, my shoulder and neck muscles seizing up from a repetitive strain injury doing home renos. But sometimes there was no discernible trigger.

The worst one I had (after the home renos) was debilitating pain for three days. Thankfully that was nearly 15 years ago and I haven’t had one that painful since. Lately they’ve been very infrequent; I will go years without having one. They also have very little head pain anymore (knock on wood) but always, always the aura.
posted by hurdy gurdy girl at 2:17 AM on July 13, 2019 [3 favorites]

wrt the actual pain being separate from the aura: you can definitely get one without ever having the other, have one for days without the other, have them weirdly interchageably flipping back and forth like a horrible light switch, never have them at the same time ever, have both simultaneously for 3 FUCKING YEARS until the sole desire you have left on this earth is to perish instantly. the human body is disgusting and frankly i'm embarrassed to have one.
posted by poffin boffin at 3:31 AM on July 13, 2019 [6 favorites]

I am fond of mine because, like several others here, they aren't accompanied by pain (that comes completely separately, and unfortunately more often). So they're more of a pleasant interlude that I take as a reminder to pause whatever I'm doing, insofar as that is possible, and meditate upon the weirdness of being human and embodied. Mine are beautifully colored, muted rainbow throughout with tiny divisions like angular fishscales, and have a slow kaleidoscopic sort of rotating progression that I have come to enjoy watching.

Likewise, I get vertigo but never with headache, so when it comes on and I'm someplace I can just sit and drift it out, the sensation is pretty pleasant even if I didn't choose it. Of all the things I can't control in my life, the slow rocking of the walls and the gentle sinking of my entire body through the floor, upon occasion, is definitely among the less unpleasant possibilities.

I am less chill about the headaches (please excuse me while I go die in a hole for a while, thank you) but they have taught me a lot as well.
posted by notquitemaryann at 3:58 AM on July 13, 2019 [7 favorites]

Right before the aura I’m unable to read. I see the words on the page or screen and know what’s supposed to occur, but it does not. Terrifying.

I just finished reading Oliver Sacks' Migraine which discusses this and many other migraine-related symptoms. It's not as readable as his popular science books but it's certainly not as difficult as a medical text. The dyslexia or aphasia you describe are among the more common agnosias (inability to know) that may be caused by a migraine, although it seems to me (as a lay-person) that pretty much every neurological symptom that can occur, can also occur to a migraineur.

Anyway, a common theme in medical accounts is the additional distress that can be caused by a patient's unfamiliarity with their symptoms and their inability to contextualise them within the experience of people generally. I think there must be some comfort in knowing that one has company; consequently I commend his book to anyone troubled by unusual migraine-related symptoms.
posted by Joe in Australia at 4:18 AM on July 13, 2019 [8 favorites]

Yeah, the scariest is not knowing what is or isn't serious. The first tine I had facial numbness, I was convinced it was a stroke. I looked it up online, and sure enough, it's a migraine symptom. Terrifying.
posted by shapes that haunt the dusk at 4:29 AM on July 13, 2019 [4 favorites]

Neurology is the best. (Yes, I'm biased.) Anecdotally, many (most?) neurologists have migraine, and I wonder if it's that shared fascination that drew us into this field. Personally, I experienced my first migraine in college -- the semester I was taking organic chemistry -- sleep-deprivation and eating junk are huge triggers for me. For many women, including myself, the hormonal shifts of the menstrual cycle are triggers as well. (For any women migraneurs reading this, keep track of your migraines/auras and menstruation -- this is one of those things that seems so obvious to doctors that we sometimes forget to actually ask the patient because we assume they know too.) One of the best descriptions of what it's like to have a migraine is Joan Didion's "In Bed," from the White Album. I assign it as required reading for my medical students.

The current migraine hypothesis is that they happen because of cortical spreading depression, basically a Mexican wave of depolarization across the brain. Depending on where it starts and where it goes, you can have a variety of auras -- scintillating scotomas (scotomata?) and fortification spectra are definitely the most common, but you can have all kinds of strange transient neurological symptoms. My migraine auras are a fun little thing called Alice in Wonderland syndrome, where things seem either too big or too small. I vividly remember getting an aura on the way home from work once, stopping at a CVS to get ibuprofen (totally blocks the headache if I take it soon enough; I now stash Motrin in all my bags), and being so unable to judge the distance between my hand and the shelf that I knocked over several bottles. CVS workers must have thought I was drunk at 6pm.

The cool thing about CSD is that there are new medications that actually block that depolarization, as opposed to generic painkillers. My colleagues who see headache patients say it's totally revolutionized the management of chronic migraine.

There's also an older, vascular hypothesis, where blood vessels clamp down and cause localized reduced blood flow to that part of the brain. That's where most of our older (cheaper) migraine meds work. In reality, it's probably a little bit of both -- like most things about the brain, there's no one-size-fits-all explanation or experience.
posted by basalganglia at 5:14 AM on July 13, 2019 [23 favorites]

That’s fascinating! I’ve had migraines most of my life, but never the kind with auras. I just get photosensitivity with my pain and have to go sit in a very dark quiet room. I suppose an aura might liven the dark-room waiting-it-out time, but must be weird and scary as shit the first few times when you don’t know what’s it is.
posted by Stacey at 5:16 AM on July 13, 2019 [1 favorite]

The thing that terrified me the first time I had them, in my early teens, was not the auras themselves but the accompanying visual drop outs: sections of my sight just gone - and somehow it wasn’t that the aura replaced them because they weren’t replaced by anything, just gone.

They came back as the migraine ended and I haven’t had a migraine since my late twenties. Boy do I not miss them.
posted by Artw at 5:34 AM on July 13, 2019 [3 favorites]

I don't get auras. Cold sweat, increased sense of smell, inability to concentrate, headache, more body aches than usual, and more sensitive than usual to bright light.
posted by Foosnark at 7:25 AM on July 13, 2019 [2 favorites]

Finding images such as this one on the internet when I first had a visual migraine was very helpful. It was late at night and I had no idea what was happening. I used to get typical migraines with pain. Now I get just the visual migraines without pain. In my experience the visual reminds me of a Memphis house of design sort of cartoon with oscillating gears and spikes, yellow and black checkerboard and other clashing, vibrating colors (it's very 80s!). The visual starts small and grows slowly wider and wider as a circle until the shape overcomes my field of vision for about twenty minutes - and then it's 'over'. (Or, is it still going on just beyond my range of awareness? Is it always going on?).
posted by marimeko at 7:36 AM on July 13, 2019 [1 favorite]

I get auras about half an hour before a headache develops, and if I immediately dose with the typically recommended treatment (water + caffeine + OTC painkiller like ibuprofen) then I won’t get more than a mild headache. The auras serve as a good early-warning system. Mine start out as a little sparkle in the center of my vision, tend to grow to blot out a noticeable portion of my visual field, and then fade over about 45 minutes. It’s annoying because the aura always shows up exactly where I’m looking, so even trying to write an email to say, “Hey, I’m going to be late because migraine aura” is difficult because I can’t see the damn words.

But yeah, you hear migraine suffers constantly going on about how “migraines are special and if your head doesn’t feel like it’s about to come off, it’s not a migraine and you don’t know what pain is” as if a migraine is strictly defined as a painful headache. I’ve had migraines that came with the full suite of features (pain, nausea, light sensitivity, etc) and migraines that didn’t hurt at all.
posted by Autumnheart at 8:17 AM on July 13, 2019 [2 favorites]


hello we are friends now
posted by biogeo at 8:56 AM on July 13, 2019 [7 favorites]

This thread is bringing me so much peace.

I have had many "visual migraines" in my life, for years they were just the kind where you lose peripheral vision or get tunnel vision. I was a bit frightened by them, and I saw the scintillating scotoma images (though not this perfectly rendered one -- amazing) on the internet and thought, good lord I hope I never get one of those. I never got the headache part of the migraine.

Until about 3 years ago. I was sitting at work in a cafe in our building, by a fireplace, with my laptop. It was quite dark around except for the fire, and suddenly I had exactly what the artist described - at first it was though I'd looked into the fire too long and was just a little blinded by the after image, but then, a shimmery dot appeared and it grew into a rainbow zig zag and I thought - oh! this is just the migraine thing I saw on the internet!

I managed to call my husband (boyfriend at the time) through blindness by looking at my phone with one eye closed, to ask him to come and pick me up. I then went and found my boss to tell him I had to leave work. I can't say you're really blind. In fact it's more like being extra-sighted - as in you can see the world but also the zig zaggy rainbows, and everything looks scrambled and confusing. I had my hand over my eyes to try to make it less unpleasant, but I was a bit frightened, even though I KNEW what it was. What is the least pleasant about it is that you can close your eyes, but there's no escape. It definitely is a humbling message from your brain about who is really in charge.

I found my boss and told him, holding my hand over my eyes, that I had to leave.

Boss: "Um, are you ok? Why are you covering your eyes?"
Me: "Well, I think it's a migraine, but I can't see."
Boss: "You can't see?!?!"
Me: "Well, I can see... but I see rainbows."

He insisted on driving me to the ER. They confirmed migraine and gave me some ativan. I was told that there wasn't really any other medicine for the visual symptoms, and I didn't have the pain.

I've had 4 since -- all of them in the last year, which has caused me quite a bit of anxiety. I have read all about them but they are just SO CRAZY that I find it very hard to believe it's no big deal. The last one was after an intense workout, and I've read that a common trigger can actually be the moment where you actually relax after a long period of stress.

I've kept an incredibly detailed journal and I can definitely see that stress, lack of sleep, dehydration, messing with my circadian rhythms (I've done a lot of international travel in the last year with crazy jet lag) and lady hormones seem to all conflate to put me in the danger zone. I started taking beta blockers a few months ago and I haven't had one (touch wood) since.

But it is very comforting to read how many of you have these and don't have a total existential meltdown every time. I look forward to being more like you!
posted by pazazygeek at 9:16 AM on July 13, 2019 [4 favorites]

I had migraine auras exactly twice in my life, both at work during my early twenties, minus the migraine. At that point I was aware of the phenomenon, so I understood what was happening, but I still have no idea what could have triggered them at that particular time and never again.
posted by confluency at 9:42 AM on July 13, 2019 [1 favorite]

Yep, that's exactly what I see too.
posted by djeo at 10:06 AM on July 13, 2019

I was having them every few months a few years back, exactly like this, and finding any information online about it was next to impossible. It never occurred to me that it might be a migraine, since it wasn’t accompanied by a headache. I just assumed a horrible parasite was burrowing through my eyes.
posted by Sys Rq at 10:18 AM on July 13, 2019

Wow. I have tried to draw my auras before in an effort to explain what an aura is, but now I can just point to this. I don't get the colors, though, just the sparkling/pulsing and the shape and zigzag. Sometimes when I can't tell if I'm getting an aura or it's just a little afterimage of some bright light/flash, I try to read something. If the words don't get blocked out, I know I don't need to rush off and take preemptive headache meds.
posted by kittensyay at 10:31 AM on July 13, 2019

This site has a big gallery of migraine art. It covers a huge range of migraine experience, but you can filter for aura. Mine are often like this one, but usually neon green or lavender and moving in a kaleidoscopic fashion.
posted by congen at 12:21 PM on July 13, 2019 [1 favorite]

I get the visual part of these, without the headaches, though not often. They last fifteen or twenty minutes then go away. For many years I had no idea what they were. I wasn't very concerned about them, because they didn't hurt, didn't happen often and went away quickly.

For me, though, they've either changed over the years or my perceptions of them have changed. The first time I got one, probably 30 years ago, it was like watching an old Commodore 64 computer displaying random memory in realtime -- flashing, rotating characters, etc (those who poked around with their C=64s enough will know what I mean). Now I just see the auras.
posted by lhauser at 12:37 PM on July 13, 2019

pazazygeek: it is very comforting to read how many of you have these and don't have a total existential meltdown every time.

I did find them quite freaky the first few times I had them! It’s frightening when you don’t know what the aura is but also scary when you know (you’re not actually going blind or having a stroke)), but then you realize you can’t stop it from happening.
posted by hurdy gurdy girl at 1:48 PM on July 13, 2019 [1 favorite]

Interesting to hear that Joan Didion is a migraineur, basalganglia .

She also has MS, I've read, and it would be interesting to know which came first, because I've wondered for a long time whether migraines cause the immune system to attack the brain, and thereby precipitate MS in some cases.

There seems to be pretty good evidence for an arrow of causation going in the other direction:
Migraine is not typically included in the clinical features of multiple sclerosis (MS), although it occurs 2 to 3 times more frequently in patients with MS than the general population.1,2 Clinical overlap between migraine and MS has been recognized since 1952, when a study by McAlpine and Compston3 observed that 2% of patients with MS developed migraine within 3 months of an initial relapse. A higher overall prevalence of migraine in MS has since been supported by multiple controlled and uncontrolled studies reporting rates between 21% and 69%.1 Still, the effects of this possible association are unclear, with hypotheses suggesting that migraine may be a precursor of MS, that migraine and MS share a common pathophysiology, and that migraine experienced in MS is a distinct subtype.
posted by jamjam at 2:22 PM on July 13, 2019 [3 favorites]

On the scintillating, iridescent bright side, however, apparently there is an inverse relationship between migraines and schizophrenia.
posted by jamjam at 3:28 PM on July 13, 2019 [7 favorites]

I’ve had three or four of these in my life, unaccompanied by headaches. The first time I had one, I recognized what was going on because I’d seen illustrations online. Possibly Dr. Airy’s illustrations!
posted by Metroid Baby at 4:21 PM on July 13, 2019 [2 favorites]

I had a disturbing moment a few months ago while talking with a co-worker. He was relaying some information to me and as I was looking at him in the left eye, he appeared to not have a right eye. Which is absurd, I immediately thought, and looked directly at his right eye, which was, indeed, still there. I looked back to his left eye, and his right eye disappeared again, as if the whole right side of his face was just wiped smooth. I looked at a checksheet on my clipboard, and words to the left of my immediate point of focus just vanished. I looked across the room to a distant wall with one eye closed, then the other, trying to figure out the extent of the issue. About that time, the off-center blind-spot resolved into a scintillating crescent. That was a relief to me, because had seen videos and read articles about visual auras, and I knew it would resolve itself in a matter of 20 minutes. I've had retinal detachments and retinal tears, so when things go wonky with my vision, I tend to get maybe a little more anxious than some.
posted by coppertop at 6:15 PM on July 13, 2019 [1 favorite]

I had a spate of these every few months that lasted a couple of years. But as mysteriously as they showed up, at age 40 or so, they went away and I haven't experienced these "halos" for a while (still get migraines every now and then though). I had never heard of them, and the first time I saw the halos it scared the shit out if me; I thought I was having a stroke.
posted by zardoz at 7:14 PM on July 13, 2019 [2 favorites]

You know, it just occurred to me: this artwork depicting migraine auras is all fairly recent. As in, within the past hundred years or so. Which leads me to wonder:

1. Are migraine auras a relatively modern development in humankind, or

2. Have humans been experiencing these occasional zig-zag rainbow visions since before recorded history?

I suspect the latter. And if so, where are the records or evidence if it?

Medieval lords, Bronze Age farmers, Stone Age hunters and gatherers. They must all have experienced this transient phenomenon. How did they explain it? Will-o-the-wisps? Demon possession? Witchcraft? Divine visions? Spirit manifestations? Incipient lunacy?

Did they tend to not talk about it out of fear of the implications of madness?

What ancient artwork, literature, or medicine might have been inspired by seeing migraine auras?

posted by darkstar at 7:36 PM on July 13, 2019 [4 favorites]

You know, it just occurred to me: this artwork depicting migraine auras is all fairly recent. As in, within the past hundred years or so.

Not so! About nine hundred years ago St Hildegard of Bingen described visions which, according to Oliver Sacks, were very clearly caused by migraine. She felt that they were extraordinarily significant (something Sacks says may also be found among the symptoms of migraines) and interpreted them through the lens of theology. For instance, she understood the classic "fortifications" to be the walls of the heavenly Jerusalem. And she (or possibly someone under her authority) drew them in great detail, and you can see some reproductions of them here.

I think it's very probable that there's a lot of other artwork and accounts that actually depict migraines too. But , how are we to distinguish stylised art from literal depictions of internal experiences? E.g., I can look at some Australian Aboriginal art and imagine I see migraine-like fortifications or distortions there. Surely the artists can't all be migraneurs, but maybe migraine experiences informed the works of an Aboriginal artist way back when, and we're seeing a depiction of a depiction of a depiction? And if you accept literary depictions, I've heard it plausibly suggested that Ezekiel's visions resemble migraines.
posted by Joe in Australia at 8:03 PM on July 13, 2019 [10 favorites]

It's interesting to think about, but I think things can get pretty problematic when we start ascribing modern understandings of medical phenomena to ancient people. We end up looking for patterns and matching our woldview to theirs, which often means overlooking significant aspects in favor of the ones that seem to fit the theory. There's also a tendency to assume that pre-modern people didn't really have any solid means of interpreting things like this, so they just sort of made things up as they went along.

All of this ends up doing a disservice to those people, because it's treating a different understanding of the physical world as more or less equal to plain ignorance and guesswork. We know, for example, that there were solid theories behind various health afflictions -- imbalance of humours, etc -- and much of the work that went into understanding health afflictions drew on a fairly rigorous theoretical background. With that in mind, I'd wonder if people understood that headaches were a medical concern, and made efforts to understand their root causes in human physiology. After all, we can all get loopy or delirious from something as simple as... not eating enough -- without having to make wild speculations.

Obviously, having not lived in the distant past myself, I can't rule out the possibility that religious visions might have been migraines. I'm not a historian of medicine, although I've taken classes on the subject. Nothing I'm saying is intended to be authoritative, only to point out that there may have been a much greater understanding of headaches, including migraines, in even the distant past. After all, I've never seen visions of chariots and winged serpents when I've gotten auras -- the important thing is the cultural and religious context in which visions occurred and were interpreted. I'm not so convinced it's anything as pat as a migraine (or schizophrenia, and so on).
posted by shapes that haunt the dusk at 8:36 PM on July 13, 2019 [4 favorites]

In general I agree with the point that we should be careful in assuming historical people were unsophisticated in their understanding of medical phenomena, but in this case I think it's potentially quite valuable to look for historical references to things that we may now be able to understand as migraine (or other neurological and psychiatric phenomena). We know, for example, that ancient physicians in the late Republican / early Imperial era of Rome understood epilepsy to be a physiological disease, even while some in their culture interpreted it in supernatural terms. I will say that I think describing humoral theory as "fairly rigorous" may be overly charitable, but certainly it was not a simplistic theory.

In the case of Hildegarde of Bingen, she had a sophisticated theological explanation rooted in her culture's beliefs about the duality between temporal existence and the divinity of God and Heaven. For medieval Europeans, human conscious experience derived entirely from their immortal souls, and the idea of repeatedly seeing complex patterns ripe for symbolic interpretation due solely to natural causes in the brain would have been very alien to them, even crazy-seeming. Today we have found that mental phenomena and experiences can be reliably explained in terms of physiological processes in the brain, and furthermore that some of these are so repeatable (like the migraine aura) that those who have experienced them instantly recognize them when drawn.

In times when literacy was much more rare, and written material was hard to produce and distribute, sophisticated thinkers like Hildegarde of Bingen didn't have the luxury of exposure to the experiences of many other migraneurs (if indeed that is the origin of her experiences), and had to make sense of her unusual experiences entirely on her own. Of course she would apply her understanding of both the natural world and the origin of human experiences and consciousness to the problem, which would have been theological in general, and tending towards eschatology in particular. But we can look at her descriptions of her experiences and notice striking parallels with phenomena that we understand in very different terms today, and infer that they are probably the same phenomena.

There's real value in this, not just from historical interest but also for better understanding that certain diseases have indeed been present at various times and places in history, and that their presentation may have not been identical to modern descriptions. Different cultural backgrounds can often influence how neurological and psychiatric disorders present, and a historical perspective on this can be beneficial in helping train doctors to be better at applying this knowledge to modern patients with different cultural backgrounds from their own.

(Incidentally, most of the little I know about Hildegarde of Bingen comes from the outstanding History of Philosophy Podcast, which also has great episodes on ancient medical theories and practices.)
posted by biogeo at 10:10 PM on July 13, 2019 [6 favorites]

These are all good points! It's true that there wasn't an even distribution of knowledge. Calling humoral theory rigorous might be charitable, but in the context, I just mean that it was very different from how it's usually treated as ignorant folk medicine -- the point being that the actions taken by a barber-surgeon would have had a basis in something, and their understandings of disease informed by an internal logic.

Honestly, I think the catch for me is that I don't necessarily see migraines in what I've read of Hildegarde, or in the patterns I've seen in related illustrations. Repeating patterns aren't an otherwise-unknown thing, especially not in the context of religious imagery. Not to mention the social and religious significance of being someone who sees visions. So if I don't agree with the initial premise that those must have been migraines, then everything that follows will be less persuasive. Which is why it's hard for me to buy that a migraine would have been this inexplicable thing to ancient people, as opposed to any number of other possibilities. It's not impossible for me to believe that she saw a pronounced aura and interpreted the patterns as significant, but I'm not totally confident that there couldn't have been something more significant going on, especially given the complex history of religious visions. I think it's a lot harder to draw conclusions about how neurological and psychological conditions present themselves differently, if we can't be confident that the condition described was really what we think it is.

Don't get me wrong, I think it's a really interesting avenue to explore. I've spoken with people from the group of doctors and academics (whose name escapes me, unfortunately) that regularly meets to discuss possible diagnoses of ancient and historic peoples' causes of death. Especially neuro/psych stuff, where we're relying on someone's own description of things. I'm not trying to say it's not worth thinking about. It's just that on balance, it's going to be very, very hard for modern people to place themselves in that ancient mindset, which is why I think there's a high risk that we'll be the ones seeing patterns that aren't there, if you know what I mean.
posted by shapes that haunt the dusk at 11:55 AM on July 15, 2019 [2 favorites]

Well put! I don't think I reach the same conclusions as you, but I appreciate your points.

Personally I wouldn't take as an initial premise that Hildegarde's experiences were migraine auras, just that that is one possible explanation. My initial premise, stemming from my own worldview that is radically different from hers in various important ways, is that whatever she experienced, it wasn't divine in origin, because I don't believe there's any such thing.

(As an aside I'd like to also preemptively dismiss the idea that my atheistic worldview necessarily presumes that Hildegarde and other Medieval European thinkers were unsophisticated because of their tendency to explain natural phenomena in terms of divine action. There are unfortunately plenty of atheists who do hold such a view, but I'm not one of them. Hildegarde and her contemporaries were intelligent, sophisticated thinkers who drew reasonable inferences from the premises they were working from. I just happen not to share those premises, so for me to make sense of their beliefs and experiences necessarily involves both perspective-taking within their worldview and reinterpretation within my own.)

For me personally, the chain of thinking goes something like:

1. All phenomena have natural explanations.
2. Hildegarde of Bingen describes visions that she attributed to a supernatural origin.
2a. Considering the meaning and effect that her visions had for her and her contemporaries requires taking that explanation seriously even if ultimately I don't accept it. That's a distinct set of questions from thinking about natural explanations for her visions.
3. Her descriptions bear some similarity to phenomena that we can explain today in neurological or psychiatric terms.
4. Perhaps the natural explanation for her visions is migraine aura.
4a. Conditioned upon that, we can draw some further inferences.
5. Perhaps the natural explanation for her visions is something else.

The reality of course is that we can't ever know for sure whether her visions were due to migraine aura or something else, we can only consider the consequences of the various possibilities. If we were to commit ourselves to the idea that her visions were definitely migraine aura, then I agree with you completely that we'd be at strong risk of projecting patterns onto historical evidence that may not be there. The exercise is valuable only if we acknowledge that it is speculative.
posted by biogeo at 6:33 PM on July 15, 2019 [2 favorites]

Here is a page of Hildegarde of Bingen's visionary art.

Do they look to be inspired by migraine auras? I would say very possibly yes. And a self portrait showing her receiving one of her visions seems to show divine inspiration directly entering her eyes.

One of the many very intriguing things about her, which I learned from a tiny pamphlet included in a beloved old cd of her work recorded by Anonymous 4, and which had cover art I thought looked even more migraine inspired than the pieces I linked, was that she had a reputation for being able to predict the colors of calves from the colors of cow and bull.
posted by jamjam at 10:36 PM on July 15, 2019

This CD; too powerful for me to listen to right now, though.

According to something else I looked at, the things entering her eyes in the self portrait are flames from her first vision at age 43.
posted by jamjam at 11:11 PM on July 15, 2019 [1 favorite]

Wait, she wrote music about the visions? Off to check Apple Music!
posted by Johnny Wallflower at 1:23 PM on July 16, 2019

I'm getting a migraine aura RIGHT NOW (I often don't get pain, hoping that's true this time too), and for the first time ever I think the aura is passing over the taste part of my sensory cortex because there's a line of sour slowly traveling up my tongue!
posted by moonmilk at 9:30 AM on July 17, 2019 [4 favorites]

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