Harry Potter - Migraines or Not?
In 2007, Dr. Fred Sheftell and Dr. Timothy Steiner diagnosed Harry Potter with probable Migraine based on evidence in the first five books of the Harry Potter series. (see Does Harry Potter Have Migraines?)
In a recent letter to the editor of the journal Headache, Dr. Sylvia Mohen and Dr. Matthew Robbins offer a different diagnosis based on a review of Harry's symptoms in light of the completion of the series. They opine that Harry's headaches, as described throughout the series, appear to fit the proposed criteria that appear in the appendix of the current version of the International Classification of Headache Disorders, 2nd edition (ICHD-II), for nummular headache (NH).*
The reasons Mohen and Robbins cite for classifying Harry's headaches as NH include:
- the location of his lightning bolt scar (somewhat visible in the photo above)
- the description of his pain as searing and burning
- his pain being felt exclusively in a well defined round or elliptical shape
- his pain being interrupted by spontaneous remissions
- there have been some cases of nummular headache starting with trauma, such as the trauma that resulted in Harry's scar
Mohen and Robbins state:
"The major essence of Harry Potter’s headache disorder is that it is post-traumatic, severe, and well circumscribed, most consistent with NH.As a relatively recently described headache phenomenon, NH has mostly been described in an older patient population with a female predominance. However, larger series indicate that adolescents may experience NH.9,10,12 As its true prevalence and incidence are uncertain, its relative lack of reporting among this age group may be attributable to underrecognition rather than a true absence of NH in this demographic, underscoring the underrecognition of headache in the pediatric population in general, a major emphasis of Sheftell et al that we agree with wholeheartedly."1
Summary and comments:
Regardless of whether Harry Potter has Migraines or nummular headaches, the speculation among Migraine and headache specialists, the publication of their work in medical journals, and the publicity around those publications result in positive attention being paid to headache disorders. This was part of Dr. Sheftell's original intent. When I interviewed him back in 2007, he told me:
"I've always been a big fan of JK Rowling's series on Harry Potter and find her imaginative and creative and able to teach a lot of life lessons to children and adolescents via metaphor and fantasy. I, of course, recognized Harry had headaches and decided why not try to classify them according to our current criteria. I wanted to bring attention to the issues involved with pediatric/adolescent headache, review the current epidemiology, prevalence and impact in a fresh way and discuss the diagnostic issues as well... I'm delighted by the response and interest this article has generated and hope that it will bring about renewed interest in the topic."4
Expressing similar thoughts during an MSNBC interview, Robbins commented:
"If you can get the word out to people who are suffering, it’s a positive thing, and we had some fun along the way."3
* For your reference, here are the proposed IHS criteria for NH:2
A13.7.1 Nummular headache
Previously used terms: Coin-shaped cephalgia
Description: Pain in a small circumscribed area of the head in the absence of any lesion of the underlying structures.
- Mild to moderate head pain fulfilling criteria B and C:
- Pain is felt exclusively in a rounded or elliptical area typically 2-6 cm in diameter
- Pain is chronic and either continuous or interrupted by spontaneous remissions lasting weeks to months
- Not attributed to another disorder
There is a slight female preponderance.
Nummular headache is probably a localised terminal branch neuralgia of the trigeminal nerve. The painful area may be localised in any part of the head but is usually in the parietal region. The pain remains confined to the same symptomatic area which does not change in shape or size over time. Lancinating exacerbations lasting for several seconds or gradually increasing over 10 minutes to 2 hours may be superimposed on the base-line pain. During and between symptomatic periods, the affected area may show variable combinations of hypaesthesia, dysaesthesia, paraesthesia, tenderness and/or discomfort.
Spontaneous periods of remission have been observed in 38% of patients, with return to continuous pain after weeks or months.
1 Mohen, Sylvia A., MD; Robbins, Matthew S., MD. "Harry Potter and Nummular Headache." Headache 2012;4?:323-324
2 Headache Classification Subcommittee of the International Headache Society. "The International Classification of Headache Disorders 2nd Edition, 1st Revision." Cephalalgia 2005;25:460-465.
3 Carroll, Linda. "Harry Potter's headache finally diagnosed." MSNBC.com. February 6, 2012.
4 Sheftell, Fred, MD; Steiner, Timothy J., MB, PhD; Hallie Thomas. “Harry Potter and the Curse of Headache.” Headache 2007;47:911-916.
5 Interview. Teri Robert with Dr. Fred Sheftell. July 1, 2007.
Medical review by John Claude Krusz, PhD, MD