Historical Feature The "periodical head-achs" of Thomas Jefferson1 John D. Battle, Jr., M.D.1 The "Sage of Monticello" was plagued with the treatment of his headaches. Several physi- periodic attacks of severe and prolonged head- cians were close friends: Dr. George Gilmer and aches that occurred from 1776 to 1808. In letters Dr. James Currie of Virginia and the famous Dr. to members of his family and intimate friends, Benjamin Rush. Jefferson valued their friend- he referred to these as "periodical head-achs." In ship, but rarely sought their professional advice. the biographies of Jefferson published since He was reluctant to request medical opinions 1930, these have usually been called migraine because he deplored the prevalent unscientific headaches. After a study encompassing 40 years, theories and practices of doctors. Dumas Malone completed the definitive biog- Many physicians concur that classifying the raphy of Jefferson. He called the headaches type of headache may be difficult in spite of ideal "probably migraine."1 Evidence will be presented conditions, such as a face-to-face consultation. to suggest a better diagnosis: nervous tension or The single most important diagnostic aid is a muscular contraction headaches. The most reli- comprehensive history obtained from the patient. able information is recorded in the letters Jeffer- In addition to all the pertinent details about the son wrote to the members of his immediate fam- headache, such factors as personality, health hab- ily. It is unfortunate that specific descriptions of its, and heredity are essential. Many experienced the headache, such as the location of the pain, physicians find it more important to know what prodromal symptoms, and vomiting were not kind of patient suffers with a headache rather included in his letters. Jefferson wrote that the than what type of headache the patient has. minimum duration of the headache was about one week and the maximum about eight weeks. Personality Concomitant symptoms such as chills, fever, and Jefferson was tense and intense. Of a quiet nausea were rarely mentioned in the letters. Pre- temperament, he was shy and often ill at ease monitory scotomata or blurring of vision were with strangers. He was a poor orator, but a su- not recorded. He noted, however, that on several perb writer. He had a brilliant intellect and an occasions the headache was so severe that he was abiding capacity for hard work. He deplored scarcely able to read or write. No records have indolence and "idle chatter" and welcomed pe- been found to indicate that Jefferson consulted riods of solitude. He guarded his private life as any physicians for advice about the diagnosis or much as possible. Violent outbursts of temper were rare, and his daughter could recall only 1 Resident Emeritus Consultant, Department of Hematology and two. Medical Oncology, The Cleveland Clinic Foundation. Submitted for publication July 1983; revision accepted Aug 1983. lp Health habits 0009-8787/84/03/531/09/$3.25/0 Jefferson's health habits were good to excel- lent. For exercise, he preferred walking, but in Copyright © 1984, The Cleveland Clinic Foundation his later years, enjoyed riding a trotting horse, 531 Downloaded from www.ccjm.org on September 30, 2021. For personal use only. All other uses require permission. 532 Cleveland Clinic Quarterly Vol. 51, No. 3 which he called "half exercise." His diet consisted the hour of night and violent headach with which chiefly of fruits, vegetables, and dairy products. I have been afflicted these two days . my head Beef, pork, and other meats were eaten in small achs, my candle is just going out and must bid amounts. A love of French cuisine and French you, adieu."5<pl6> In the body of this letter, young wine was acquired during his five-year tour of Thomas reconciles his feelings for the loss of duty in France. He refrained from strong spirits, Rebecca Burwell to another suitor. Jefferson was but enjoyed cider and malt liquor (beer). He infatuated with this attractive girl whom he met raised tobacco for a cash crop, but did not use when he was 19 and she was 16. A few months tobacco in any form. Jefferson retired early and before his headache, he had proposed to Rebecca started each day with the sunrise, usually obtain- and wrote that he was tongue-tied, inept, and ing six to seven hours of sleep. For over 50 years, stammering. In this two-year period of romance he bathed his feet in cold water each morning, and melancholia, Jefferson mentioned just one which he thought reduced the frequency of his headache of two days' duration. At that time, he head colds. was immersed in studying law and helping his widowed mother run the plantation. Heredity The records and letters of Jefferson during the The family records and letters reveal no men- period 1764 to 1776 do not refer to or describe tion of headaches occurring in Jefferson's par- headaches. He was a prolific writer, but no letters ents, six siblings who lived to maturity, nor in his between him and his mother, or his wife, have 12 grandchildren. His older daughter, Martha been found. He probably destroyed them. In this (Patsy), had several attacks of headache. At the II -year period, he was never indolent. Between age of 15, when a student in Paris, she wrote to 1767 to 1771, he was busy with his general law her father, "I have not been able to do more, practice and building his library. In February having been confined some time to my bed with 1770, a devastating fire destroyed his mother's a violent head-ach, and a pain in my side, which home and Jefferson lost about 1,200 books, in- afterward blistered up and made me suffer a cluding many priceless legal volumes. Such a great deal."2 Another record of a headache is tragedy to a bibliophile might be expected to found in the unpublished manuscript, "Memoirs cause a headache, but his letters fail to mention of Martha J. Randolph," which was probably one. written by one of Martha's daughters. The ex- His bachelor years ended happily in January cerpt is quoted in full. "At another time she 1772 when he married the young and beautiful missed an opportunity of seeing Marie Antoinette Martha Wayles Skelton. From 1772 to 1776, he and being in company with her, which she said was a member of the House of Burgesses, a was a great disappointment. She received an in- delegate to the Continental Congress, and an vitation to pass an evening at the Duke of Dor- architect (he built Monticello). One of his most set's. The queen was to be there incognito. This severe attacks of headache occurred after the invitation she was prevented from accepting by sudden death of his mother of apoplexy on 31 3 an ill-timed attack of sick headache." March 1776. Jefferson made a brief and une- In 1877, Sarah H. Randolph wrote recollec- motional note of this event in his Memorandum tions about her grandmother, Martha.3 She de- Book. He was "ill and incapacitated" for five to scribed the terminal events. "The fatigue caused six weeks. Later, information leaked out that a by the preparation for her departure gave Mrs. severe and prolonged headache was the major Randolph a severe headache; but being subject symptom of this illness. In early May, he rode to to such attacks, the apprehensions of the family Philadelphia and from there on 16 May 1776 he were not excited about her. At sunrise the next wrote to his friend, Thomas Nelson, "I arrived morning, the alarm was given that she had sud- here last Tuesday after being detained hence six denly grown worse."4 Martha died shortly there- weeks longer than I intended by a malady of after of "apoplexy." She was 64 years old. which Dr. Gilmer can inform you." Dr. George Gilmer left no records about this malady, and his Jefferson writes about his headaches letters of this period are missing. Gilmer's Com- monplace Book contains no reference to Jeffer- Jefferson first wrote about a headache at age 6 21 in a letter to his close college friend, William son's health. On 24 May 1776, Edmund Pendle- Flemming. "Your letter I will endeavor to answer ton wrote to Jefferson from Virginia, "I am sorry Downloaded from www.ccjm.org on September 30, 2021. For personal use only. All other uses require permission. Fall 1984 The "periodical head-achs" of Thomas Jefferson 533 to hear your pleasure at home was interrupted January 1784, he wrote to his intimate friend, by an inveterate headach. I don't remember the James Madison (later to become President), "I hard name for it which I hope you have travelled have had very ill health since I have been here off."5(p29B) What was the hard name his friend and am getting rather lower than otherwise."2(p23) could not remember? Dr. Gilmer may have called On 15 January, he wrote to his daughter, Martha, it hemicrania, megrim (Old English), migraine the same news, but added, "I have been just able (French), or even cephalgia. The faulty memory to attend my duty in the state house, but not to of Pendleton has deprived us of a potential clue. go out on any other occasion." The nature of his While convalescing from a fall from his horse illness is obscure, but on 18 February, he wrote in the summer of 1781, Jefferson wrote his Notes to Francis Hopkinson, "I have been in a state of on the State of Virginia.