Walter Clement Alvarez

Walter Clement Alvarez (1884-1978). Signed photograph from the Clendening Library Portrait Collection (see here)

"I have been much impressed with the need for writing about the migrainous scotoma because scores of patients, much alarmed by their experience with this phenomenon, keep telling me that they described it to a half-dozen physicians without finding one who had any idea as to what it was."

(Alvarez, 1960a, p. 489)

"My scotomas. In my own case, for a while I will wonder what has gone wrong with my vision. My sight will be a bit fuzzy as if I could not focus my eyes sharply. Usually, after a minute or two, on closing my eyes, I will see a bright dot. Rarely I will have to wait five minutes before I can be sure of this. Soon the dot will extend into a luminous zigzag line which runs almost always vertically. A few persons tell me that in their case it runs horizontally. On one occasion mine started horizontally but it soon became erect and then bowed out to one side as it always does. Another time I saw a fine zig-zag line running up and down and a coarse one running below it, horizontally. Later, the two ran together, end to end, and bowed out to the right. The line resembles a snake fence, or an old-style fortification with projecting angles. In some spells the line is so brilliant one can see it easily with the eyes open. It is claimed that the first man to call this a 'scintillating scotoma' was M. Dianou[x]. His Paris Thesis (1875) was called, 'Du scotome scintillant.'

The line pulsates rapidly as if it were a tiny rubber tube through which some fluid was being pumped with rapid impulses. The whole line will also rotate a bit on its axis, and it will move up and down a little. The rate of pulsation is so fast I have never been able to count it, but I think it is around 180 beats a minute [3 Hz]. In 1835, Serre d'Alais, in an excellent description of his own scotomas, said that the pulsation was between 190 and 200 throbs a minute [3,2 – 3,3 Hz].

Some persons, in occasional spells, will see rainbow colors, usually or perhaps always, on the inner side of the zigzag line. Occasionally, I have seen such colors, usually purple and yellow. D'Alais saw green, yellow, and blue. Sometimes I see a black zigzag line which, strange to say, is luminous. It lies alongside of the white line. I wondered if the presence of these colors can help us decide the location of the storm in the brain or the retina.

As minutes pass, the line keeps bowing out more and more widely toward one or other side until it seems to disappear beyond the edge of the field of vision. With this, the acuity of vision returns to normal. I have timed dozens of my scotomas and they lasted from 20 to 28 minutes. Most of my patients agree that scotomas last 20-25 minutes, but an occasional man or woman said it lasted five or 10 minutes."

(Alvarez, 1960a, p. 490-491; additions in square brackets by Klaus Podoll)

"I feel it a disgrace to the medical profession that many of us physicians and even many ophthalmologists do not recognize a 25-minute migrainous scotoma, the minute the patient tells the typical story.

It is a disgrace also that few men seem to be able to recognize the bright, eager, attractive, quick-moving migrainous woman at a glance. It is a shame so many physicians do not dare diagnose migraine when perhaps the headaches are on both sides of the head, or there is no nausea or vomiting, or the woman has 2 or 3 types of headache."

(Alvarez, 1965, p. 36)

References

Alvarez WC. Was there sick headache in 3000 BC? Gastroenterology1945; 5: 524.
Alvarez WC. Aberrant types of migraine seen in later life. Geriatrics 1958; 13: 647-652.
Alvarez WC. Some characteristics of the migrainous woman. NY State J Med 1959; 59: 2176-2184.
Alvarez WC. Migraine plus epilepsy. Neurology 1959; 9: 487-491.
Alvarez WC. The migrainous scotoma as studied in 618 persons. Am J Ophthalmol 1960a; 49: 489-504.
Alvarez WC. Desensitizing factors cases of migraine. J Lancet 1960b; 80: 33-36.
Alvarez WC. Some important features of migraine. Headache 1961; 1: 22-24.
Alvarez WC. Migraine made severe by some other disease. Neurology 1962; 12: 427-433.
Alvarez WC. Notes on the history of migraine. Headache 1963; 2: 209-213.
Alvarez WC. A life-time study of migraine. Headache 1965; 20: 35-37.

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