As evidenced by the ancient writings from the Fertile Crescent, migraine has existed within humankind for millennia. Given migraine’s high prevalence, with approximately 10% of the general population afflicted by the disorder, and the profound effect migraine may have on one’s mood and behavior, it should come as no surprise that migraine has influenced our culture and history. One striking example involves Ulysses S. Grant, military hero and America’s 18th president.

Like his commander-in-chief, Abraham Lincoln, Grant suffered from attacks of clinically severe migraine throughout the years of the American Civil War. In April 1865, at Appomattox Courthouse (Virginia), Grant finally had managed to corner the sparse remnants of Robert E. Lee’s once-mighty Army of Northern Virginia. Even with final victory seemingly so close at hand, Grant feared that Lee would slip from his grasp, unite his troops with a Confederate army in North Carolina and potentially prolong the war by a year or more.

But Lee realized his army was at last defeated, and he sent across the lines a note requesting terms of surrender. He did so with some trepidation, as Grant was a known for his harsh treatment of defeated foes. It seemed to Lee quite possible that he and his lieutenants would endure the humiliation of imprisonment, trial on charges of treason and, ultimately, the gallows.

Racked by anxiety and impatient to bring his pursuit of Lee to a close, Grant had developed a migraine. In his memoirs he wrote, “I was suffering very severely with a sick headache... I spent the night in bathing my feet in hot water and mustard, and putting mustard plasters on my wrists and the back part of my neck.” Despite these efforts, his “sick headache” still persisted the following morning. Then Lee’s message arrived, and even writing decades later Grant recalled that “the instant I saw the contents of the note, I was cured.”

Grant’s mood was oddly muted when later on that Palm Sunday he sat opposite Lee in Wilmer McLean’s parlor, drawing up the formal terms of surrender. He wrote that “... my feelings which had been quite jubilant on the receipt of his letter were sad and depressed. I felt like anything but rejoicing at the downfall of a foe who had fought so long and valiantly, and had suffered so much for a cause, though that cause was, I believe, one of the worst for which a people ever fought and for which there was the least excuse.” Such emotional depletion and “flatness” is typical of the postdrome that immediately follows the headache phase of a migraine attack (see the Comment that follows).

His terms of surrender reflected his subdued mood. Lee’s officers would keep their side arms and all cavalry their horses so as “to work their little farms”. There would be no arrests, imprisonment or public spectacle. When the Union batteries began to roar in celebration after the surrender ceremony, Grant sent word to have the guns silenced. “The war is over,” he told his staff. “The rebels are our countrymen again.”

The war indeed was over. The Union was preserved. What Lincoln described as the “great experiment” in social democracy would not fail, and the South would retain its place in the national community.

How much of Grant’s behavior on April 9, 1865 was rooted in migrainous biology? Did his generous terms of surrender result from the dysphoria of a migraine postdrome? If not for his acute migraine, how much compassion would he have shown his enemy? In contemplating history, be it that of a nation or an individual, it’s no simple task to separate the “psycho” from the “somatic”.

Comment In its most fully developed clinical form, a migraine attack consists of 4 distinct phases: prodrome, aura, headache and postdrome. The prodromal symptoms signal the migraineur that an attack is imminent. These symptoms differ from person to person and can be difficult to describe. They may include a feeling of euphoria, uncharacteristic clumsiness, a craving for sweets or agitation.

The aura involves a much more specific neurologic symptom, most likely commonly visual but also extending to include sensory disturbance (“numbness and tingling”), difficulty expressing words, face or limb weakness and a variety of other focal neurologic misfires. The aura typically lasts 15-30 minutes and is immediately followed by the headache phase; occasionally aura may persist for an hour or more, and in roughly a third of migraineurs the aura occurs during the headache phase. Only 20-25% of migraineurs ever experience aura, and very few have aura with every migraine attack.

While the pain experienced during the headache phase may vary widely in its intensity and character, for many it is throbbing, sickening, localized to one side of the head or centered on the eye and accompanied by light and sound sensitivity, nausea and vomiting.

The postdrome follows on the heels of the headache phase. Although some head discomfort may persist, it is typically of low intensity. Many migraineurs liken the postdrome to the hangover one experiences after over-indulging in alcohol. Despite the welcome relief from migrainous headache, postdromal symptoms may include a pervasive sense of melancholy or a feeling of being “let him down”.

This postdrome is precisely what Grant describes having experienced immediately following the abrupt cessation of the migraine headache he suffered at Appomattox. That his postdrome contributed to the generous terms of surrender and treatment he extended to the defeated Confederates seems quite plausible. If so, then Grant’s migraine-influenced behavior served to ease the nation’s difficult transition from war to peace.

Thumbnail image: Brady-Handy Photograph Collection (Library of Congress) (1870-1880). The 18th President of the United States Ulysses S. Grant. [Photograph].  Library of Congress Prints and Photographs division. Retrieved from https://en.wikipedia.org/wiki/Ulysses_S._Grant#/media/File:Ulysses_S._Grant_1870-1880.jpg.

Banner image: "365-340" by Canned Muffins. Used under CC BY 2.0.