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Allodynia and Osmophobia Proposed in a “Case Approach Textbook” for Graduate Examination of the Seventeenth Century We report the description of a migraine case drawn from the 1636 edition of the textbook Scholae medicae written by Abram de la Frombosier (1560-1636). This case, unusually for the period, contains a remarkably precise summary of the characteristics of a migraine without aura attack with specific reference to allodynia and osmophobia. Interestingly, these features characterizing the migraine attack have, to the best of our knowledge, not been found together in the classic migraine descriptions within early medical literature. We also draw attention to the remarkable “modern” written description of the case and the still unresolved issues regarding osmophobia in the Classification of Headache Disorders (ICHD)-III beta-version. The case reported here was described in the 1636 edition of Scholae medicae.1 Scholae medicae was a textbook, written in Latin, for students preparing for medical examinations of the day. De la Frombosier was a son of a medical doctor, a king’s physician, and adviser, as well as a professor and dean of the Faculty of Medicine at Reims. He had earlier taken courses at the Faculty of Medicine of Paris.2 His works, containing voluminous amounts of contemporary medical knowledge, also represented a testimony of the struggle at the turn of the sixteenth and seventeenth centuries between the defenders of “orthodox” medicine and supports of the new “medicine paracelsiste.”3 In reading the text, we were intrigued by the following “theme” proposed as a teaching case for a candidate examination (and we report it here in our English translation).
Doctor II Praesulis Hemicrania Laborantis Historiam Bacchalaureo Proponit. Ecclesiasticus vir pietate et doctrina insignis, temperamento calidus et siccus, trigesimo aetatis anno; per intervalla, capitis dolore tentato, dextram potissimum parte occupante, et a cerebro ad oculi destri radicem pertinente, integrum diem durante; ita interdum saeviente, ut nec lucem, nec clamorem, nec odorem, nec vini potionem laborans ferre queat: quin et tactu sic exacerbatur, ut nec capillos inverti sinat; adeoque contumax malum, Conflict of Interest: None.
April 2015 ut aliquot abhinc annis perseveret, licet aegrotans multus expertus sit rimedia; ut cui vena saepius secta, pluraque pharmaca exhibita. Simul ac morbi diagnosim atque prognosim patefeceris, si quae curationis spes reliqua tibi videatur, quo pacto molienda sit, aperi.
Second Medical Doctor The History of a Migrainous Priest Is Proposed to the Baccalaureate. A 30-year-old priest was distinguished for virtue and wisdom and hot-dry temperament. Periodically, he presented headaches, mainly located at the right side, extending from the occipital to the retro-orbital area, and lasting the whole day. Sometimes, these were so intense that he was not able to tolerate light, noise, odors, or small quantities of wine, and he was so exacerbated by the fact that he could not bear even to touch his hair. Pain was so persistent that it began years before, despite the patient having been subjected to numerous therapies like often bloodletting and the use of many drugs. Once you’ve identified the diagnosis and prognosis of the disease, and if you think there has been some hope of finding a cure, indicate how you intend to proceed. Further into the text, we find the questions and the corresponding answers regarding the possible migraine pathogenesis, prognosis, and treatment needed to pass the examination. These prove to be consistent with the level of understanding of the time. Of greatest significance is the clinical history of the case. It summarizes, concisely and precisely, the characteristics of migraine without aura. Such is the accuracy and richness of the description, the case as described could readily be proposed as the theme for a modern-day undergraduate examination. In particular, two anamnestic data items were described, atypically so, with notable clarity: osmophobia and cutaneous allodynia. These features characterizing the migraine attack were not usually found together in classical descriptions within the older literature. Although osmophobia was reported by the renowned medical research of antiquity, Galen,4 we did not find cutaneous allodynia in other previously reported migrainous descriptions. However, it is difficult to
Headache determine whether the description of this symptom in this “case report” is original or derived from a previous unknown report. Furthermore, cutaneous allodynia and osmophobia have recently been highlighted and studied, but some aspects of these symptoms are still debated both regarding their importance for the timing of treatment of the attack5 and as a diagnostic migraine criteria, respectively.6 Indicative of the latter point, osmophobia was introduced in the ICHD guidelines in 1988 (AppendixICHD-II),7 but then no longer considered in the 2013 beta-version (ICHD-III)8 for reasons unexplained at the time of writing. Finally, we see that then, as today, the appropriate migraine therapy remains a major and unsolved problem. Ferdinando Maggioni, MD; Umberto Maggioni, MS From the Headache Centre, Department of Neurology, School of Medicine, University of Padua, Padua, Italy (F. Maggioni); School of Medicine, University of Padua, Padua, Italy (U. Maggioni).
577
REFERENCES 1. Frambesarii NA. Scholae Medicae. Parisiis: Apud Ioannem Iost; 1636. 2. Wikipedia. http://fr.wikipedia.org/wiki/Nicolas_Abraham _de_La_Framboisi%C3%A8re. 3. Bamforth S. Médecine et philosophie dans l’œuvre de La Framboisière. In: Dupèbe J, ed. Esculape et Dionysos. Mélanges en l’honneur de Jean Céard. Genève: Droz; 2008:177-202. 4. Diamond S, Franklin MA. Headache Through the Ages. New York: Professional Communication; 2005. 5. Burstein R, Collins B, Jakubowski M. Defeating migraine pain with triptans: A race against the development of cutaneous allodynia. Ann Neurol. 2004;55:19-26. 6. Zanchin G, Dainese F, Trucco M, Mainardi F, Mampreso E, Maggioni F. Osmophobia in migraine and tension-type headache and its clinical features in patients with migraine. Cephalalgia. 2007;27:1061-1068. 7. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 2nd edition. Cephalalgia. 2004;24(Suppl. 1):9-160. 8. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013;33:629-808.
Allodynia and Osmophobia Proposed in a “Case Approach Textbook” for Graduate Examination of the Seventeenth Century We report the description of a migraine case drawn from the 1636 edition of the textbook Scholae medicae written by Abram de la Frombosier (1560-1636). This case, unusually for the period, contains a remarkably precise summary of the characteristics of a migraine without aura attack with specific reference to allodynia and osmophobia. Interestingly, these features characterizing the migraine attack have, to the best of our knowledge, not been found together in the classic migraine descriptions within early medical literature. We also draw attention to the remarkable “modern” written description of the case and the still unresolved issues regarding osmophobia in the Classification of Headache Disorders (ICHD)-III beta-version. The case reported here was described in the 1636 edition of Scholae medicae.1 Scholae medicae was a textbook, written in Latin, for students preparing for medical examinations of the day. De la Frombosier was a son of a medical doctor, a king’s physician, and adviser, as well as a professor and dean of the Faculty of Medicine at Reims. He had earlier taken courses at the Faculty of Medicine of Paris.2 His works, containing voluminous amounts of contemporary medical knowledge, also represented a testimony of the struggle at the turn of the sixteenth and seventeenth centuries between the defenders of “orthodox” medicine and supports of the new “medicine paracelsiste.”3 In reading the text, we were intrigued by the following “theme” proposed as a teaching case for a candidate examination (and we report it here in our English translation).
Doctor II Praesulis Hemicrania Laborantis Historiam Bacchalaureo Proponit. Ecclesiasticus vir pietate et doctrina insignis, temperamento calidus et siccus, trigesimo aetatis anno; per intervalla, capitis dolore tentato, dextram potissimum parte occupante, et a cerebro ad oculi destri radicem pertinente, integrum diem durante; ita interdum saeviente, ut nec lucem, nec clamorem, nec odorem, nec vini potionem laborans ferre queat: quin et tactu sic exacerbatur, ut nec capillos inverti sinat; adeoque contumax malum, Conflict of Interest: None.
April 2015 ut aliquot abhinc annis perseveret, licet aegrotans multus expertus sit rimedia; ut cui vena saepius secta, pluraque pharmaca exhibita. Simul ac morbi diagnosim atque prognosim patefeceris, si quae curationis spes reliqua tibi videatur, quo pacto molienda sit, aperi.
Second Medical Doctor The History of a Migrainous Priest Is Proposed to the Baccalaureate. A 30-year-old priest was distinguished for virtue and wisdom and hot-dry temperament. Periodically, he presented headaches, mainly located at the right side, extending from the occipital to the retro-orbital area, and lasting the whole day. Sometimes, these were so intense that he was not able to tolerate light, noise, odors, or small quantities of wine, and he was so exacerbated by the fact that he could not bear even to touch his hair. Pain was so persistent that it began years before, despite the patient having been subjected to numerous therapies like often bloodletting and the use of many drugs. Once you’ve identified the diagnosis and prognosis of the disease, and if you think there has been some hope of finding a cure, indicate how you intend to proceed. Further into the text, we find the questions and the corresponding answers regarding the possible migraine pathogenesis, prognosis, and treatment needed to pass the examination. These prove to be consistent with the level of understanding of the time. Of greatest significance is the clinical history of the case. It summarizes, concisely and precisely, the characteristics of migraine without aura. Such is the accuracy and richness of the description, the case as described could readily be proposed as the theme for a modern-day undergraduate examination. In particular, two anamnestic data items were described, atypically so, with notable clarity: osmophobia and cutaneous allodynia. These features characterizing the migraine attack were not usually found together in classical descriptions within the older literature. Although osmophobia was reported by the renowned medical research of antiquity, Galen,4 we did not find cutaneous allodynia in other previously reported migrainous descriptions. However, it is difficult to
Headache determine whether the description of this symptom in this “case report” is original or derived from a previous unknown report. Furthermore, cutaneous allodynia and osmophobia have recently been highlighted and studied, but some aspects of these symptoms are still debated both regarding their importance for the timing of treatment of the attack5 and as a diagnostic migraine criteria, respectively.6 Indicative of the latter point, osmophobia was introduced in the ICHD guidelines in 1988 (AppendixICHD-II),7 but then no longer considered in the 2013 beta-version (ICHD-III)8 for reasons unexplained at the time of writing. Finally, we see that then, as today, the appropriate migraine therapy remains a major and unsolved problem. Ferdinando Maggioni, MD; Umberto Maggioni, MS From the Headache Centre, Department of Neurology, School of Medicine, University of Padua, Padua, Italy (F. Maggioni); School of Medicine, University of Padua, Padua, Italy (U. Maggioni).
577
REFERENCES 1. Frambesarii NA. Scholae Medicae. Parisiis: Apud Ioannem Iost; 1636. 2. Wikipedia. http://fr.wikipedia.org/wiki/Nicolas_Abraham _de_La_Framboisi%C3%A8re. 3. Bamforth S. Médecine et philosophie dans l’œuvre de La Framboisière. In: Dupèbe J, ed. Esculape et Dionysos. Mélanges en l’honneur de Jean Céard. Genève: Droz; 2008:177-202. 4. Diamond S, Franklin MA. Headache Through the Ages. New York: Professional Communication; 2005. 5. Burstein R, Collins B, Jakubowski M. Defeating migraine pain with triptans: A race against the development of cutaneous allodynia. Ann Neurol. 2004;55:19-26. 6. Zanchin G, Dainese F, Trucco M, Mainardi F, Mampreso E, Maggioni F. Osmophobia in migraine and tension-type headache and its clinical features in patients with migraine. Cephalalgia. 2007;27:1061-1068. 7. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 2nd edition. Cephalalgia. 2004;24(Suppl. 1):9-160. 8. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013;33:629-808.
