Pain and Profits: The History of the Headache and Its Remedies in America
by Jan R. McTavish, 239 pages, Rutgers University Press, $23.95
The present-day specter of Americans streaming to Canada to buy low-cost medications is nothing new. In the 1890s, a popular nonprescription painkiller and headache remedy called phenacetin was regularly smuggled into the United States from Canada in large quantities. In Europe and Canada, phenacetin cost pennies per ounce, but in the U.S. it sold for $1.25 to $1.30 an ounce, even though its German maker had opened a plant here to produce it. Smuggled phenacetin sometimes turned out not to be phenacetin at all, but a more dangerous drug called acetanilid or, even worse, talcum powder.
The phenacetin frenzy disappeared after the Bayer Company came out with a new drug in 1899 that also was destined to be smuggled into the U.S. for a time. This salicylate derivative called aspirin became the world's most widely used drug and still is.
The rise of aspirin is only one event-filled chapter in the fascinating saga of headache treatment that Jan R. McTavish brings to light in Pain & Profits: The History of the Headache and Its Remedies in America.
McTavish's interest in headaches revolves around the "small but lively role" the headache played in shaping what is now the modern-day relationship between doctors, pharmaceutical companies, and the American public. Whether headaches affected the course of American history is unclear, but some of our most famous historical figures suffered from them. In 1790, Thomas Jefferson hoped an anticipated expedition aboard George Washington's yacht would finally end his weeks-long migraine headache by causing him to expel it in a bout of seasickness.
General Ulysses Grant applied mustard packs to his feet, hoping to draw his frequent sick headaches from his head. But he noted in his diary that a severe headache he suffered in the days before Appomattox vanished instantly on the news that General Lee had agreed to surrender.
In the 19th century, most doctors considered a headache a sign of some underlying medical problem. The most common treatment was an emetic rather than an analgesic.
McTavish records an 1822 practitioner's recommendation for treating sick headache. First, a laxative of rhubarb or calomel or an emetic, ipecac, to be followed up with a mixture of rust of iron, powdered columbo root, and orange peel twice a day for four weeks.
Preventing pain was not the primary goal of physicians, which probably is why headache sufferers preferred self-treatment.
The idea of avoiding pain, including headache pain, came into vogue in the 1840s with the invention of the first surgical anesthetics. In 1845 a New Englander named Perry Davis, who was fed up with doctors, concocted his own recipe for pain relief that worked. He invented the word "painkiller," and his product, Perry Davis' Painkiller, became an instant success, sparking many copycat nostrums. Most of the painkilling nostrums did not market themselves for headaches, however. Most contained alcohol or sedatives such as camphor, which would not have had much effect on headache pain.
Surprisingly, most patent medicines did not contain opiate drugs, which were available to anyone without prescription. By 1899, a study of 2,500 patent medicine recipes showed only five percent contained any opium, morphine, codeine, cocaine, or cannabis. Instead they contained camphor, chloroform, ammonia, red pepper, guaiac, myrrh, turpentine, or oil of sassafras as active ingredients. Most did contain alcohol, including the elixirs of Lydia Pinkham, famous for being a teetotaler, whose medicine was 18 percent spirits.
The first drugs that actually could reduce a headache without clouding the mind arose from chemists working for the German dye industry, which made dyes from coal tar, a byproduct of gas heating. The chemists were trying to find two things: a medicine that could reduce high fevers and one that would act as an internal antiseptic.
In 1874 Hermann Kolbe derived from phenol a synthetic form of salicylic acid, a compound found naturally in willow trees. It turned out not to be an internal antiseptic, but it was effective for treating rheumatic fever, reducing temperature and inflammation. Unfortunately, it was so hard on the stomach, no one wanted to use it. In 1882 Otto Fischer derived a drug from quinoline to treat fevers. Later versions of his drug, the synthetic antipyretics, included antipyrine, antifebrin, and phenacetin. These drugs had the ability to stop headaches and became the basis for a boom in headache powders marketed in the 1890s. Unfortunately, continued use of these drugs could lead to medical problems such as addiction and, worse, circulatory collapse.
Aspirin, a more tolerable form of salicylic acid, was not originally marketed for headache. Until the late 1970s, drugs such as phenacetin were still used in combination with aspirin and caffeine for headache pain before the FDA proscribed the use of the aniline-based drugs. Today, other headache pain relievers such as acetaminophen and ibuprofen are used against headache pain, although none of them actually cure headache.
Thomas Jefferson would have to have waited until the 1980s for the development of sumatriptan (Imitrex), a product of research into the neurotransmitter serotonin, to have perhaps received real relief from his migraines. And General Grant might have waited just as long for the tricyclic antidepressants such as amitriptyline that are used to treat tension-type headaches today. But the interesting saga of headache treatment is far from over, as McTavish points out. The actual cause of most headaches still remains a medical mystery to be solved.
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