In Context

Historical profile
Harold G Wolff
Published Online Pioneer in headache research and of biological psychiatry. It might have been under Cobb’s
July 28, 2015 influence that Wolff became interested in the distinction
http://dx.doi.org/10.1016/ psychosomatic medicine. Born in New York, NY,
between functional and organic disease; Cobb believed
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USA on May 26, 1898, he died on Feb 21, 1962, that there was no dichotomy between the mind and body,
aged 63 years. and was troubled by the attempts of medical science to
differentiate between psychic and somatic disease.
The pathophysiology of migraine has puzzled scientists and In 1928, Wolff travelled to Europe, working with two Nobel
clinicians for centuries. In the 18th century, migraine was Prize winners—Otto Loewi in Austria and, a few years later,
often attributed to dysfunction of visceral organs rather Ivan Pavlov in Russia. On his return to the USA, Wolff joined
than the brain. The origins of a neurovascular hypothesis the psychiatrist Adolf Meyer at Johns Hopkins Hospital,
of migraine can be traced back to Thomas Willis in the 17th where he revisited the issue of psychic versus somatic causes
century, who speculated that migraine headache was caused of disease. “His interest was in moving beyond the typical
by increased arterial blood flow in the meninges. Over Cartesian mind/body divide to understand how psyche,
the centuries, other proposed mechanisms have included personality, and biology could simultaneously contribute to
venous congestion, autonomic dysfunction, and even nervous disorders”, writes Joanna Kempner in her book Not
so-called nerve storms, like those described in epilepsy by Tonight: Migraine and the Politics of Gender and Health.
Edward Liveing. It wasn’t until the early 20th century that In 1932, Wolff took up the post of chief neurologist at the
neurologists such as Harold Wolff were able to investigate newly established Cornell Medical Center, where he would
systematically the underlying pathogenesis of this complex, remain for the next 30 years. It was at Cornell that Wolff
multifaceted disorder, and the era of modern headache did groundbreaking experiments on the vascular theory of
research began. migraine. He developed an experimental set-up to measure
Wolff was born in New York in 1898, the only child both intracranial and extracranial changes during a migraine
of Emma Recknagel Wolff and Louis Wolff. After some attack induced by the injection of histamine. Wolff showed
deliberation following his graduation from New York City that migraine aura could be temporarily interrupted by
College in 1918—he briefly considered becoming a priest— vasodilation. One of his medical students came to the lab
Wolff trained in medicine at Harvard Medical School, with a pre-migraine scotomata, and “Doctor Wolff had him
graduating in 1923. After completing his internship in New whiff a small amount of amyl nitrate, just enough to dilate
For Goodell’s account see York, Wolff returned to Harvard from 1926 to 1928 to work cerebral vessels with no change in blood pressure, and
Headache 1967; 6: 158–71 as a research fellow with Stanley Cobb, a pioneer in the field the scotomata disappeared—to return shortly thereafter”,
wrote Helen Goodell, Wolff’s research assistant throughout
his time at Cornell. After a visit from a flying trapeze artist,
who told Wolff her headaches were alleviated by standing
on her head, Wolff had other patients and members of his
research team stand on their heads to see what effect this
unusual intervention might have. “Never a day without an
experiment was the motto written large upon our bulletin
board”, remembers Goodell.
Courtesy of the Medical Center Archives of New York-Presbyterian/Weill Cornell

Wolff became renowned for his experiments, even

appearing on the cover of iconic Time magazine. “His
interpretation of the mechanism of migraine was a real
advance over previous interpretations, in that he added to
the idea of cranial vasoconstriction causing the aura and
vasodilation the subsequent (often throbbing) headache the
concept of posterior neck muscle tightening mediating the
later stages of the headache”, Mervyn Eadie (University of
Queensland, Brisbane, Australia) commented to The Lancet
Neurology. “There were forerunners to the vasoconstriction–
vasodilation idea, including Peter W Latham in the early
1870s, but Wolff provided good human experimental
evidence for the vascular changes that he described.”

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 In Context

Like so many migraine researchers before him, Wolff had and objectivity”, wrote Louis Hausman, president of the New For Hausman’s tribute to Wolff
migraine himself. Wolff’s belief in a psychosomatic basis York Neurological Society, at the time of Wolff’s death. “In see Bull N Y Acad Med 1962;
38: 826–29
of illness led him to propose a migraine personality, which the presentation of patients, the house staff was expected to
fitted the many patients that he saw on the wealthy Upper be brief and factual. The common neurological clichés were
East side of Manhattan, as well as friends and colleagues promptly exposed for what they were.” Wolff was held in
who were similarly afflicted. “Wolff described the migraine high regard by students and peers alike, and he trained many
personality as ambitious, successful, perfectionist, and notable neurologists, including Fred Plum (who succeeded
efficient”, writes Kempner. “Without a doubt, Wolff had him as Chief of Neurology at Cornell) and Stewart Wolf (who
his own obsessive and perfectionist tendencies in mind.” continued Wolff’s research in psychosomatic medicine).
The unrealistic expectations that the person with migraine Wolff’s life and work were prematurely cut short in 1962 by
imposed on themselves aligned perfectly with Wolff’s a catastrophic cerebrovascular thrombosis, the premonitory
vascular theory—tension caused vasoconstriction and symptoms of which he could have mistaken as migraine. At
fatigue caused subsequent vasodilation. From studies of the time of his death, Wolff held several prestigious posts and
families affected by migraine, Wolff identified a hereditary had just completed his term as President of the American
component of the disorder. “Migraine headaches commonly Neurological Association. Wolff’s Headache and Other Pain
occur when hereditarily susceptible persons attempt to became a seminal text and his theories dominated the field
control feelings of anxiety and resentment by means of of migraine research until the early 1970s. On Jan 9, 1962, in
organized and intense activity”, wrote Goodell. “Headache what was to be his last speech at the New York Academy of
is thus a cranial vascular consequence of a way of life.” Wolff Medicine, Wolff remarked rather prophetically: “…in man’s
extended his theory that the body responded to stress in a pathological reactions his goals, purposes, and aspirations
manner that was often self-destructive to other disorders are of utmost importance … the individual had best know
such as hypertension and peptic ulcer. the cost of his values … he may choose to pay the price in
A tall, gaunt figure, Wolff was an imposing presence personal comfort, health, and even survival”.
in the lecture theatre and at the hospital bedside. “His
neurological conferences were models of precision, clarity Rebecca Akkermans

Film
When films meet neurology
Whenever film meets neurology, the results can be a car rather a collection of considered essays on films selected
crash—both literally and metaphorically. In his entertaining by the author, but the work is nonetheless valuable
new book, Eelco Wijdicks (Mayo Clinic, MN, USA) examines for that. With the explosion of digital technology and
the cinematic treatments of 22 neurological conditions proliferation of tiny independent film companies, trying
presented in over 100 movies. to create a definitive work in this field is analogous to
In addition to an insightful commentary, each condition herding cats. There aren’t enough hours at the end of
has its own recommended watching list, utilising an a working day to watch and analyse the ever increasing
innovative reflex hammer rating scheme. One reflex cinematic output. Over 100 films have been released
hammer indicates an incorrect depiction of a neurological featuring epilepsy alone.
condition, whereas four reflex hammers dictate mandatory This volume is written with passion, and the author’s
viewing. In the entertaining Neurofollies in Film chapter, the real affection for the cinema seeps from every page. This
rating scheme is subverted. The reflex hammers are replaced book is not just for film buffs. It will appeal to all those Published Online
by pin picks to indicate the pain inflicted by the neurological who have watched a film with increasing incredulity, May 7, 2015
inaccuracies in each movie; from one pin prick indicating a ruining it for those around them as they snort with http://dx.doi.org/10.1016/
S1474-4422(15)00057-5
highly improbable plot, through to the multiple punctures disbelief (we’ve all been there!). The book is also a
Neurocinema: When Film
induced by preposterous cinematic presentations. These valuable teaching resource. In addition to recommended
Meets Neurology
include supernatural psychic abilities induced by a coma and clips for each condition, all young (and not so young) Eelco F M Wijdicks,
super intelligence induced by head injuries or brain surgery. neurologists will benefit from Wijdicks’ viewing Taylor & Francis Group, 2015.
However Wijdicks’ tone is never sneering, he never falls into recommendations regarding the less than flattering Pp 320. £25·99.
ISBN 978-1482242867
the trap of the medical pedant, but rather he takes his hat cinematic representations of the profession. We should
For more on epilepsy in films
off to the imaginations of these filmmakers. all watch and learn. see Historical Review
In the foreward, the author acknowledges that this is Lancet Neurol 2003; 2: 764–70
not a definitive work on how film meets neurology, but Sallie Baxendale

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