trepanation as a treatment for migraines in the 17th century. the association between trepanation and headaches in ancient history may simply be a myth or unfounded speculation that originated several centuries later. in 1913, the world-famous american physician william osler misinterpreted the french anthropologist and physician paul broca ’s words about a set of children's skulls from the neolithic age that he found during the 1870s. these skulls presented no evident signs of fractures that could justify this complex surgery for mere medical reasons. trepanation was probably born of superstitions, to remove “confined demons” inside the head, or to create healing or fortune talismans with the bone fragments removed from the skulls of the patients. however, osler wanted to make broca’s theory more palatable to his modern audiences, and explained that trepanation procedures were used for mild conditions such as “infantile convulsions headache and various cerebral diseases believed to be caused by confined demons.” while many treatments for migraine have been attempted, it was not until 1868 that use of a substance which eventually turned out to be effective began. this substance was the fungus ergot from which ergotamine was isolated in 1918. methysergide was developed in 1959 and the first triptan, sumatriptan, was developed in 1988. during the 20th century with better study-design, effective preventive measures were found and confirmed. society and culture migraine is a significant source of both medical costs and lost productivity. it has been estimated that migraine is the most costly neurological disorder in the european community, costing more than €27 billion per year. in the united states, direct costs have been estimated at $17 billion, while indirect costs — such as missed or decreased ability to work — is estimated at $15 billion. nearly a tenth of the direct cost is due to the cost of triptans. in those who do attend work during a migraine attack, effectiveness is decreased by around a third. negative impacts also frequently occur for a person's family. research potential prevention mechanisms transcranial magnetic stimulation shows promise as does transcutaneous supraorbital nerve stimulation. there is preliminary evidence that a ketogenic diet may help prevent episodic and long-term migraine. potential gender dependency while no definitive proof has been found linking migraine to gender, statistical data indicates that women may be more prone to having migraine, showing migraine incidence three times higher among women than men. the society for women's health research has also mentioned hormonal influences, mainly estrogen, as having a considerable role in provoking migraine pain. studies and research related to the gender dependencies of migraine are still ongoing, and conclusions have yet to be achieved.