Clavus hystericus, sometimes called “hysterical headache,” is the clearest example of a gendered diagnostic category in this time period. In his Treatises on the Diseases of the Nervous System, James Ross describes hysterical headache as a variation of hysteria: “Hysterical Headache is met with in females, and is generally accompanied by other symptoms of hysteria. This form of headache is on the one hand closely allied to trigeminal neuralgia, and on the other to true migraine. The pain is sometimes diffused and deep-seated, but it is more frequently limited to one spot, and feels as if a nail were being driven through the skull; hence it is called ‘clavus.’ Hysterical headache is increased in severity during the menstrual period and by mental worry, whilst it is removed by amusement and anything which engages the attention.” “Hysterical tendencies” could distinguish the pain of clavus hystericus from other headache disorders, although authors were usually vague about what, exactly, constituted these symptoms. In his 1888 monograph on headache disorders, Allan Mclane Hamilton suggests only one objective distinction: “Hysterical women are very apt to complain of very great diffused hyperaesthesia of the scalp, so that the simple act of brushing the hair causes great distress.” (This complaint might now be diagnosed as allodynia, which is a pain condition associated with migraine.) Knowing which of his patients had what Hamilton called “neuralgia,” which is described in his book as having a solid biological basis, and which were merely hysterical was important for treatment, as hysterics “are more apt than any others to form the opium habit, or that of alcoholism, and great care should be taken lest, by yielding to their demands, we foster something worse than the headache or hysteria.”
Today’s discussions of the opioid epidemic and chronic pain, whose pain is real, and who deserves treatment echoes some very old discussions.