Those familiar with neurological consultations will know from experience that patients referred with headache may sometimes (but not always!) struggle to describe their symptoms, requiring some semi-structured promptings from the clinician to draw out the salient features (it makes no sense, conceptually, to speak, as some do, of “featureless” headaches).
Many years ago, the Neurologist JN (“Nat”) Blau (1928-2010) reported that in his clinics most patients (70%) spoke for two minutes or less when invited to describe their symptoms, indeed 42% spoke for less than 1 minute [1]. Although not all were headache patients (although that was Blau’s area of specialist interest, and some of the patients were seen in a dedicated migraine clinic), the findings may nevertheless support the idea that, without interruptions or promptings, patient accounts are generally brief. It would be interesting to know, more than 30 years after Blau’s report, if this is still the case.
Blau noted that those with experience of speaking in public spoke the longest. How might professional writers, whose metier is dependent on words, describe headache?
Previous instalments in this series of occasional pieces published in ACNR (and now conveniently collected elsewhere [2]) documenting accounts of headache encountered in literary or biographical material have provided some examples, but whether or not these are based on personal experience, or simply products of the writerly imagination, is seldom disclosed.
AS Byatt (b. 1936) won the 1990 Booker Prize for her novel Possession [3]. In a correspondence purportedly dating to the mid-nineteenth century, one of the characters, Christabel LaMotte, reports to the poet, Randolph Henry Ash,
I write to you from an unhappy House … for I have an invalid dependent upon me – my poor Blanche – quite racked with hideous headaches – and nausea – quite prostrated – and unable to pursue the work which is her life. … she is too ill and cannot go on. I am not in much better case myself – but I make tisanes, which I find efficacious. (172-3)
Christabel’s correspondent responds:
I do have the clearest olfactory ghost of yr [sic] tisanes – though they hesitate between verveine and lime and raspberry-leaves, which my own dear mother found most efficacious in case of headache and lassitude. (177)
Tisanes are herbal teas, made from the infusion or decoction of herbs, spices, or other plant material. Verveine, or vervain, also known as lemon verbena, is a type of herbal tea. Other literary examples of tea used as a headache treatment may be noted, for example in Jane Austen’s Mansfield Park (1814), and in Thomas Mann’s Doctor Faustus (1947) where “real strong tea made real sour with lots of lemon” is suggested.
Christabel later reports to Ash that:
I see whole bevies of shooting stars – like gold arrows before my darkening eyes – they presage Headache … The headache proceeds apace. Half my head – is merely a gourd full of pain – . (194-5)
In the novel, these old letters only come to light in the late twentieth century when two academics, respectively researching LaMotte and Ash, collaborate. They also view the journal of Ash’s wife, Ellen, who, it turns out, also had headaches:
June [1859]
I felt a headache coming on … I retired to my room and slept for two hours, waking somewhat refreshed, though with a vestigial headache. (227)
A worse day. The headache seized me and I lay all day in a darkened bedroom, betwixt asleep and wake. There are many bodily sensations that are indescribable yet immediately recognisable … which could never be conveyed to one who had no previous experience of them. Such is the way in which the preliminary dizziness or vanishing incapacitates the body and intimates the headache to come. It is curiously impossible – once entered into this state – to imagine ever issuing out of it – so that the Patience [sic] required to endure it seems to be a total eternal patience. Towards evening it lifted a little.
Worse still. Dr Pimlott came and prescribed laudanum, which I found some relief in. (230)
Much of the typical migraine symptomatology is to be found in these letters and journal entries: their severity, accompanying nausea and visual symptoms, hemicranial involvement, interruption of occupational function, recourse to treatment. All contribute to the authenticity of the account. The report that these “sensations … could never be conveyed to one who had no previous experience of them” might be pertinent to the brevity of patients’ accounts of their headache symptoms (and also of other neurological symptoms).
Interestingly, Ellen Ash’s sister, Patience, also complains of “incessant … headaches” (225).
A family history of migraine is, of course, not uncommon, and may be associated with a lower age of onset [4]. As is well-known, AS Byatt’s younger sister, Margaret Drabble (b. 1939), is also a writer. If we accept the premise that AS Byatt is writing from personal experience of migraine with aura in Possession, it might be interesting to know if her sister may be similarly afflicted, perhaps assessed by any reference to headaches in her literary works.
Although I claim no familiarity with Drabble’s extensive oeuvre, I think there is some subtle evidence to answer this question. For example, in what may be her first written short story, A Pyrrhic victory (although not the first published, appearing in 1968) [5], the central character, Anne, is described at the outset as “exhausted: her head ached with the sun, she felt both sick and hungry” (49). In A day in the life of a smiling woman (1973), the title character, Jenny Jamieson, has a headache when tired on returning late from her work one evening (111). In The merry widow (1989), an offstage character, Harriet, is described as “always ill … what stories of migraines” (151). No detailed account of symptoms is provided in any of these passing references.
Despite featuring scenes set in both primary and secondary medical care settings, no headaches occur in Drabble’s novel The millstone (1965). However, in Jerusalem the golden (1967) [6], the central character, Clara Maugham, a student in London, encounters the Denham family, whose attitudes and behaviour differ greatly from her own restricted upbringing in “Northam”. At the end of a visit to the Denham household in Highgate, Clara “began to feel a sense of overwhelming fatigue. Her head ached … her mind would no longer pay attention. Whole concepts, whole reorganizations of thought swam drunkenly through her head … when she got home she was suddenly and violently sick” (106). Subsequently Clara finds that “she grew accustomed to leaving their house with a headache” (107) and later discloses that this was because the experience was “so marvellous I couldn’t take it” (167).
These brief descriptions of headache in some of Drabble’s works may lack the richness of the material in Byatt’s novel, but nonetheless suggest a familiarity with headache symptomatology. The brevity of Drabble’s portrayals may be typical of patient accounts before the clinician draws out additional details. To paraphrase, it may indeed be the case that even with the word skills of a professional writer “many bodily sensations … are indescribable” and cannot therefore “be conveyed to one who had no previous experience of them”.
References
- Blau JN. Time to let the patient speak. BMJ 1989;298:39. https://doi.org/10.1136/bmj.298.6665.39
- Larner AJ. Neuroliterature: Patients, doctors, diseases. Literary perspectives on disorders of the nervous system. Gloucester: Choir Press, 2019:241-271.
- Byatt AS. Possession. A romance. London: Vintage [1990] 1991.
- Hsu YW, Liang CS, Lee JT et al. Associations between migraine occurrence and the effect of aura, age at onset, family history, and sex: a cross-sectional study. PLoS One 2020;15(2):e0228284. https://doi.org/10.1371/journal.pone.0228284
- Drabble M. A day in the life of a smiling woman. The collected stories. London: Penguin, 2011.
- Drabble M. Jerusalem the golden. Harmondsworth: Penguin [1967] 1969.
