Migraine in the cradle of civilization: Evaluating ancient Mesopotamian texts through the lens of ICHD ‐3

BACKGROUND: Migraine is a neurological disorder with well-established diagnostic criteria. In its current formulation, migraine is a modern-day diagnosis, whereas descriptions consistent with migraine may date back to ancient civilizations. OBJECTIVE: This study aimed to investigate whether symptoms consistent with migraine without aura, as defined by criteria of ICHD-3, are present in cuneiform medical texts from ancient Mesopotamia. METHODS: A total of 37 Akkadian-language cuneiform medical texts dated between the second and first millennia bce were analyzed. Texts containing references to secondary headache or aura symptoms were excluded. Each remaining text was examined for descriptions corresponding to ICHD-3 diagnostic criteria (B: duration; C: pain characteristics; D: associated symptoms). RESULTS: Among the 37 texts, 15 included expressions equivalent to continuous or prolonged pain, satisfying criterion B. Criterion C (unilateral, throbbing, and severe pain) was met in 37 texts (26 completely +11 partially). Criterion D (nausea, photophobia, phonophobia) was present in 21 of 37 texts. CONCLUSION: This study presents compelling evidence that the fundamental features of migraine without aura were described in Mesopotamian medical texts nearly 3000 years ago. These findings suggest that the diagnostic framework of migraine, as captured by ICHD-3, reflects the earliest documented medical traditions.