Forty-five years of migraine--observations and reflections "from the inside" by a physician-patient.

A case is presented of severe migraine observed by a physician-patient for 45 years from the age of 27 to 72. A system was developed of grading headache frequency and severity which has permitted, over the last 33 years, a semi-quantitative analysis in terms of quarter years of: the course of the disease, the results of various treatments, and the associated psychological tensions. The patient's mother and other family members of four generations had migraine. The frequency and severity of the patient's headaches increased over 22 years to a peak that coincided with his maximal professional work-load; they then receded and disappeared during the last 11 years of retirement. In the first 13 years of no prophylactic treatment a periodicity was present with a median span of 2.4 weeks. In these first 13 years, there was a left-sided preponderance of attacks. It is concluded that migraine is a complex disturbance comprising a genetic defect with an inbuilt biorhythm and a threshold for manifestation of headache sensitive to many physical, physiologic, and psychologic factors of stress in the life of the patient.