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History in Neurology: Seminal Citation
November 1999

Cluster Headache

Author Affiliations

From the Headache Center, Department of Neurology, University of South Alabama College of Medicine, Mobile.



Arch Neurol. 1999;56(11):1413-1416. doi:10.1001/archneur.56.11.1413

Although not fully recognized until recently, accounts of cluster headache have appeared in medical textbooks since the 17th century. Robert Bing and Bayard Horton will likely have their names affixed to the term for posterity, but the original description of this dramatic disorder probably dates back to Nicolaas Tulp in 1641. This article reviews some of the original citations and historical roots of cluster headache in the medical literature.

Ancient Greek and Roman medical textbooks make various references to headache disorders but offer no evidence of the existence of cluster headache (CH).1 Reports of the rather unique clinical features of CH do not appear in the medical literature until the 17th century.2 Latin-proficient medical historians with expertise in headaches such as Koehler3 and Isler4,5 have meticulously extracted the earliest descriptions of CH in European textbooks. Tulp published Observationes Medicaein Amsterdam, the Netherlands, in 1641.3 Born Nicolaas Pieterzoon in 1593, Tulp (who adopted this name after a tulip that adorned his house in Kiezersgracht, the Netherlands) was 1 of approximately 8 physicians in Amsterdam at that time.3 In addition to being a brilliant clinician, he was also a respected anatomist and scholar (Figure 1). Controversy still exists as to whether he actually contributed the earliest description of Chiari malformations.3 Six editions of Observationes Medicaewere published for nearly a century (the last one in 1739).3 The first volume illustrated and discussed cases of head trauma, epilepsy, movement disorders, hydrocephalus, and headache.3 The dramatic character of some of the autonomic phenomena accompanying CH was exemplified, such as in this case of a headache "cured by nature" in an obese man who had suffered severe headache for a considerable period of time:

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