Both patient and public awareness and education have become a focus of many doctors as well as various organizations and other individuals. Educated patients are more compliant with their treatment regimens and have better outcomes. Educating the public will, hopefully, help non-sufferers become more aware of head pain disorders as genuine health problems and offer them a better understanding of the problems of sufferers. I recently spoke with Dr. Fred Sheftell, one of the authors of an article in Headache, "Harry Potter and the Curse of Headache:"
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 enlisted the help of my colleague Tim Steiner who currently chairs the Global Burden of Headache Campaign and helped me start the World Headache Alliance, which became the patient arm of the World Health Organization in regard to Headache Disorders. Halley Thomas our "senior" author helped me locate all descriptions related to his headaches, and then we attempted to go through a variety of possible diagnoses and came up with probable migraine as the most likely. I'm delighted by the response and interest this article has generated and hope that it will bring about renewed interest in the topic.
Fred Sheftell, MD
Director, New England Center for Headache
President, American Headache Society
In studying the passages describing Harry's "headaches," Dr. Sheftell and Dr. Steiner, noted:
• Harry did not have headaches prior to the age of 11, a common age of onset for primary headache disorders, especially Migraine.
• The onset in Harry's case seems to be some time prior to puberty since the first evidence of headaches in the series was apparent when he was 14.
• Although Harry's headaches haven't been frequent, they have periodically left him temporarily dysfunctional, thus significantly impacting his life and activities.
• All of Harry's attacks strike without warning.
• Harry's primary (and perhaps only) trigger is proximity to "He Who Must Not Be Named" (Lord Voldemort).
Sheftell and Steiner quote this conversation between headmaster Dumbledore and Cornelius Fudge, the Minister of Magic:
"I assume that you are referring to the pains Harry has been experiencing in his scar?" said Dumbledore coolly.
"You admit that he has been having these pains, then?' said Fudge quickly. 'Headaches? Nightmares? Possibly - hallucinations?"
"Listen to me, Cornelius,' said Dumbledore . . . 'Harry is as sane as you or I. That scar upon his forehead has not addled his brains. I believe it hurts him when Lord Voldemort is close by, or feeling particularly murderous.'"
This exchange is nothing new to headache and Migraine sufferers. Others often blame headaches and Migraines on psychological issues rather than recognizing the biological origin. Regarding the passage above, Sheftell and Steiner commented,
"Indeed, lack of understanding of the nature and impact of headache disorders amongst people generally is a part of the burden of headache. We are not surprised to see it expressed so openly in the Wizard community."
Descriptions of Harry's headaches:
Here are some passages describing Harry's headaches and the diagnoses considered from each passage:
- "Then a pain pierced his head like he'd never felt before, it was as though his scar was on fire - half blinded, he staggered backwards . . . The pain in Harry's head was so bad he fell to his knees. It took a minute or two to pass."1 This passage led Sheftell and Steiner to consider primary stabbing headache, aka ice pick headaches, and trigeminal neuralgia.
"At once, a needle-sharp pain seared across Harry's scar; his head felt as though it was about to split in two; he yelled, struggling with all his might, and to his surprise, Quirrell let go of him. The pain in his head lessened." 1 This passage, once again, led the researchers to consider primary stabbing headache, plus secondary headache due to a structural lesion.
"And then, without warning, Harry's scar exploded with pain. It was agony such as he had never felt in all his life; his wand slipped from his fingers as he put his hands over his face; his knees buckled; he was on the ground and he could see nothing at all; his head was about to split open. . . . The pain in his scar reached such a pitch that he retched, and then it diminished . . ." 2 From this description, the ICHD-II diagnosis 6.2.2 Headache attributed to subarachnoid haemorrhage was considered but rules out because there had been like episodes previously with no lasting consequences, and Harry's recovery was quick and complete.
- "The scar on Harry's forehead seared with a sharp pain again . . . and [he] thought his head would burst with the pain." 2 See #6.
- "It was pain beyond anything Harry had ever experienced . . . his head was surely splitting along his scar; . . . he wanted it to end . . . to black out . . . to die . . . And then it was gone." 2 See #6.
- "His head was surely going to burst with pain, he was screaming more loudly than he'd ever screamed in his life. And then it stopped. Harry . . . was shaking uncontrollably." 2 These three descriptions caused cluster headaches to be considered.
- "His scar seared and burned . . . the pain of it was making his eyes stream..."3 The watering eyes bring to mind cluster headaches, paroxysmal hemicrania, and Migraine.
- Harry laughed again because he knew it would incense her, the pain building in his head so badly he thought his skull might burst." 3 See #9.
- "His forehead hurt terribly . . . it was aching fit to burst. He opened his eyes . . . he felt as though a whitehot poker were being applied to his forehead . . .He clutched his head in his hands; the pain was blinding him . . . he rolled right over and vomited over the edge of the mattress." And soon after: "The pain in his forehead was subsiding slightly . . .He retched again . . . feeling the pain recede very slowly from his scar." 3 In both examples 8 and nine, for the first time, the pain is described by Rowling as "building." This indicates the possibility of Migraine. Other indicators of Migraine are that Harry awoke in pain, and the pain caused him to vomit, which brought relief.
Harry's attacks meet all but one of the criteria for Migraine without aura, the one that says the attacks last from 4-72 hours, untreated or unsuccessfully treated. It's not unusual for children's Migraines to have a somewhat different pattern than in adults. It may be that, as Harry gets older, the pattern will become better established and facilitate diagnosis.
Thus, Sheftell and Steiner classify Harry's attacks as probable Migraine, which they describe as "a diagnostic refuge for headache that appears to be migraine but obstinately fails to meet one (and only one) of the criteria for that diagnosis."
They do reserve the possibility that Harry's attacks are a secondary headache disorder, meaning that it has an underlying cause or is attributable to another disorder. They state, "the proximity of Voldemort still suggests this is in fact a secondary headache disorder manifesting with migrainous features. This possibility needs to be tested by final removal of the presumed cause: resolution following removal of the cause is an important diagnostic criterion for almost all secondary headaches.
I borrow this paragraph from the authors of the journal article as it so eloquently summarizes the need for education and awareness as well as the motivation for the article:
That even a young male Wizard has recurrent disabling headache is a reflection of the wider problem of headache in children and adolescents. In the Muggle world, the burden of child and adolescent headache is of under-recognized importance; as in adults, it is very often under-treated. We applaud the efforts of the paediatric subcommittees of both the International Headache Society and the American Headache Society to raise awareness of these issues, and appeal for assistance to the world of Magic. Headache need not be a curse for Muggles or Wizards: it can be lifted with research, better to understand it, and education, better to manage it.
1 Harry Potter and the Philosopher's Stone
2 Harry Potter and the Goblet of Fire
3 Harry Potter and the Order of the Phoenix
Sheftell, Fred, MD; Steiner, Timothy J., MB, PhD; Hallie Thomas. "Harry Potter and the Curse of Headache." Headache 2007;47:911-916.
Interview with Dr. Fred Sheftell. July 1, 2007.
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