Abstract
We enjoyed reading the recent article by Jones about famous people with headaches (1). The author selected headache sufferers from a book which ranks the hundred most influential people in history (2). In addition, the German philosopher Nietzsche was chosen because ‘his headaches had the highest likelihood of influencing the course of history’. We like to draw attention to another famous headache sufferer, who had no influence on politics or the course of history, but who had great influence on the development of music in the 20th century: Gustav Mahler. Apart from our own description in Dutch (3), we are not aware of any previous description in the medical literature of the headaches of this great musician
The Austrian composer and director Gustav Mahler lived from 1860 to 1911. His work includes nine completed symphonies, one unfinished symphony and various songs with orchestra. He died as the consequence of endocarditis, caused by a throat infection. Remarkably, he was one of the first patients in history in whom bacteria were cultured from blood, but as penicillin was not yet available, this discovery was equal to a death-sentence.
In the many letters Mahler wrote to his wife Alma, and consequently also in Alma's memoirs, Mahler's headaches have been frequently mentioned. His headaches often occurred during train journeys, and were accompanied by nausea and vomiting. No mention is made of phonophobia or photophobia, but it seems unlikely that these could have been important in view of the description below. For the headache Mahler would often take ‘aspirin’ (not further specified), but the headache would usually only disappear when he walked in fresh air for some hours (often in train stations where the train had to wait). Sleep would also relieve his headaches. Some quotations: ‘I have rolled with my eyes and grunted because of the pain’, and ‘I have not spent a Kreutzer (penny) at all, headaches are always very cheap’ (about the lack of appetite during an attack).
Like many headache sufferers, Mahler refers to his own headaches as ‘migraines’, but unlike most of them Mahler was probably right. His headache attacks lasted between several hours and one day, were accompanied by vomiting, impaired daily activities, and would resolve after sleep. The tendency to move during the headache attacks is not typical of migraine, but has been described by other migraine sufferers.
Mahler's migraine surely did not influence history. There is also no proof that it influenced his compositions. Nevertheless, Alma Mahler considered her husband's headaches a very important feature of his life and death. She called Mahler's migraine ‘Horrible hours of tragical agony’, and her final conclusion was that ‘It was one of the self-intoxications of which he suffered until the end, and which are the cause of his last fatal illness’. There is however no proof that Mahler's migraine had any relation to his fatal endocarditis.