Latham and the Vasomotor Theory of Migraine

Among the lengthy annals of descriptive accounts of migraine and its mechanisms, the 19th century writings[1] are pre-eminent. This paper gives a précis of the vasomotor theory propounded by Latham, in On Nervous or Sick-Headache, written at the time of Edward Liveing's (1873) scholarly book[2] that supported the contrary neural hypothesis. Liveing was Registrar to the Royal College of Physicians of London and Assistant Physician to King's College Hospital. He favored “nerve storms” as the principal mechanism, the forerunner of modern neural theories.[3] In explaining his “nerve storm” theory,[4] he considered migraine along with other “neuroses” to be:

… a primary and often hereditary disposition of the nervous system itself; this consists in a tendency to the irregular accumulation and discharge of the nerve force.”

Hughlings Jackson also favored a neural initiation of migraine:

Some of the symptoms of migraine, the headache among others, are, I think, after-effects of the discharge producing the paroxysm.5

By “middle centres” Jackson referred to the basal nuclei, which in his concept were subservient to the cortex and associational areas that were the higher centres in terms of cerebral organization. Gowers[6] also adhered to the neurogenic hypothesis.[3]

Latham's idea was of a primary vascular mechanism with dilated arteries causing the pulsating headache and the preceding or accompanying vasoconstrictor phase that was thought to account for the diverse symptoms of the migraine aura. This theory was to be examined,[7] and much later was amplified particularly by the groundbreaking investigations of Harold Wolff[8] and his collaborators between 1930 and 1963. Before Latham, Du Bois-Reymond (1818-1896) in 1860 attributed migraine to:

… a Tetanus takes place in the muscular coats of the vessels of the affected half of the head; in other words a Tetanus of the cervical portion of the sympathetic.9

In his “hemikrania sympathicotonica,” Du Bois-Reymond postulated an increased sympathicotonic effect on the blood vessels of one side of the head. Migraine was not a disease of the brain or cranial blood vessels, but of the cilio-spinal center in the cord. Brown-Séquard, in respect of Du Bois-Reymond's paper, said that irritation of the cervical sympathetic did not cause pain.

REFERENCES

• 1 Pearce J MS. Historical aspects of migraine.  J Neurol Neurosurg Psychiatry. 1986;  49 1097-1103
• 2 Liveing E. On Megrim, Sick Headache, and Some Allied Disorders: A Contribution to the Pathology of Nerve Storms. London; Churchill 1873
• 3 Pearce J MS. Is migraine explained by Leão's spreading depression?.  Lancet. 1985;  2 763-766
• 4 Pearce J MS. Edward Liveing's theory of nerve storms in migraine. In: Rose FC A Short History of Neurology. Oxford; Butterworth 1999: 192-203
• 5 Jackson J H. Diagnosis and treatment of brain diseases. In: Taylor J Selected Writings of JH Jackson. Vol. 2. London; Staples Press 1958: 371-372
• 6 Gowers W R. Diseases of the Nervous System. Vol. 2. London; Churchill 1886: 776-792
• 7 Lance J W, Goadsby P J. Mechanism and Management of Headache. 6th ed. Oxford; Butterworth-Heinemann 1998
• 8 Wolff H G. Headache and Other Head Pain. Oxford; Oxford University Press 1963
• 9 Du Bois-Reymond E. [no title given]. Archiv für Anatom Physiol u wissensch Medecin, Leipzig. 1860: 461-468 Brit Med J 1872; April 6:365
• 10 Latham P W. On Nervous or Sick-Headache: Its Varieties and Treatment. Cambridge; Deighton, Bell, and Co; London: Bell and Daldy 1873
• 11 Pearce J MS. Current Topics In Migraine. London; Heinemann 1975
• 12 Airy H. On a Distinct Form of Transient Hemiopsia. Philosophical; Transactions 1870: 247
• 13 Möllendorff E. [no title given]. Virchow's Archiv, B xli. S. 385. 1867
• 14 Wilks S.. [no title given]. Medical Times and Gazette. Jan 2, 1869
• 15 Latham P W. The pathology of sick-headache.  BMJ. 1893;  1 113-114
• 16 Whytt R. Observations on the Nature, Causes and Cure of Those Disorders Commonly Called Nervous, Hypochondriac, or Hysteric. Edinburgh; Becket, Pond, and Balfour 1764
• 17 Rao N S, Pearce J MS. Hypothalamic-pituitary-adrenal axis studies in migraine with special reference to Insulin sensitivity.  Brain. 1971;  94 289-298
• 18 Pearce J MS. Neural aspects of migraine. In: Blau JN Migraine. London; Chapman Hall 1987
• 19 Goadsby P J. Advances in the understanding of headache.  Br Med Bull. 2005;  73-74 83-92
• 20 Goadsby P J. Can we develop neurally acting drugs for the treatment of migraine?.  Nat Rev Drug Discov. 2005;  4 741-750
• 21 Afridi S K, Giffin N J, Kaube H et al.. A positron emission tomographic study in spontaneous migraine.  Arch Neurol. 2005;  62 1270-1275
• 22 Munk's Roll .Lives of the Fellows of the Royal College of Physicians of London. Vol. IV (1826-1925). Compiled by GH Brown. London; Royal College of Physicians of London 1955: 153-154