“Migrânea” and “enxaqueca”: not opposite, but complementary words

ABSTRACT In this opinion paper, the authors discuss historical and etymological aspects of the term “migrânea” and refute the most common criticisms regarding its adoption by the Brazilian Headache Society in the official translation of the International Classification of Headache Disorders.

The word "enxaqueca" has been used for countless years in Brazil, Portugal and other Lusophone countries to denominate the disorder known as migraine by English speakers. Nonetheless, in 1997, the Brazilian Headache Society (SBCe) adopted the term migrânea in the authorized Brazilian Portuguese translation of the "Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain", which was the first edition of the International Classification of Headache Disorders 1,2 . The Brazilian Portuguese version 3 was elaborated by a group of three neurologists leaded by Dr. Edgar Raffaelli Jr., a pioneer of the headache field in Brazil and one of the founders of the International Headache Society 4,5 .
Since then, even though the expression "migrânea" is absent from Brazilian dictionaries and from the Vocabulário Ortográfico da Língua Portuguesa (Portuguese Language Orthographic Vocabulary, a Brazilian Portuguese lexicon published by the Academia Brasileira de Letras) 6 , it was maintained in the official translations of both the second and the third editions of the International Classification of Headache Disorders 7,8 .
The term "migrânea" was coined by Raffaelli Jr. in 1984 as a substitute for "enxaqueca", because the latter expression was considered by him at that time as having been trivialized to the point of becoming a synonym for nonspecific headache, both among lay people and within the medical community 9 . In his view, the new denomination would help doctors and patients to modify their view of migraine, from a simple headache to a neurological disorder per se 4 . Since then, the term "migrânea" has been gradually adopted by the Brazilian medical community 10,11 , although its use is questioned from time to time on the grounds of being an unnecessary neologism/foreign import or an expression not recognized by lay people. Although this criticism ignited harsh debate among many Brazilian Headache Society members, the use of the term "migrânea" has been maintained by its successive executive boards since then.
Here, we aim to clarify some aspects of this subject in order to reinforce the use of the term "migrânea" in Brazil, by refuting some points frequently stressed by those who criticize its official use. The Portuguese term "enxaqueca" and the Spanish word "jaqueca" (also written in the past as "xaqueca") came from the Arabic "al-saqïqa" or "sâqïqa" 12 , meaning "half part of the whole" or "halved", which is understandable considering the long period under which the Iberian Peninsula lived under Moorish rule, which lasted up to the 15 th century 9,13 . On the other hand, the English language borrowed the word "migraine" from French, at first as "migreime", changing to "megrim" in the 15th century and to the present form only in the 18 th century. Migraine comes from the term "hemicrania", used by Latin and Greek speakers, originated from the Greek word "ημικρανíα/hemicrania", meaning half cranium 14,15 . While Greek and Arabic derived expressions coexist in Spanish -"migraña" and "jaqueca", respectively -in most other Western languages, the Greek root dominates, e.g. in German, Italian, Polish and Swedish.
The Portuguese medical lexicon contains a vast quantity of Hellenic terms and, like other languages, the Portuguese language has not been immutable over time. On the contrary, it is in a state of continuous elaboration, with the need to change in order to remain an instrument of communication. This makes borrowing of foreign words necessary and useful for the development of linguistic relations 16 . Raffaelli Jr. always stressed that, instead of being an outrage to Portuguese, the expressions "migrânea" and "migranoso" were neologisms endorsed by history and were cognates to the terms usually present in the international scientific literature. Therefore, the case against the foreignness of the word "migrânea" is not justified.

OBJECTION 2: "COMMON PEOPLE DOESN'T RECOGNIZE THE TERM "MIGRÂNEA", WHILE THE TRADITIONAL EXPRESSION "ENXAQUECA" IS WIDELY ACCEPTED BY THE BRAZILIAN POPULATION AND THEREFORE SHOULD BE USED"
This common criticism disregards two important facts: first of all, it should be considered that the specific reason Raffaelli Jr. had in mind when coining the term "migrânea" was the trivialization and loss of meaning of the traditional word "enxaqueca". So, the use of a word that is new and consequently unknown by the patients is not completely undesirable. Moreover, the two terms can be used interchangeably when talking to patients, while "migrânea" is preferable in the medical or scientific environment. There is nothing new about this concept. For example, doctors use "kidney stones" or "nephrolithiasis", when communicating to patients or to other doctors, respectively.

OBJECTION 3: "A WORD THAT IS NOT IN THE DICTIONARY DOES NOT HAVE A PLACE IN FORMAL LANGUAGE"
According to Valadares 16 , "use of foreign words becomes necessary as [and when] the linguistics community considers it so". Therefore, since being present in the dictionary does not necessary lead to effective use of a loanword, the fact that a word is not included may show only that a variation is in the initial phase of implementation. The use of the term "migrânea" is not the result of error or language degradation caused by chance or ignorance, but instead is the result of a deliberate search for an adequate term for use by the medical community, made by an expert in the field.
Our conclusion is that the use of the word "migrânea", adopted by the Brazilian Headache Society in the official translation of the International Classification of Headache Disorders, is legitimate and should be stimulated among Brazilian medical professionals and, especially, within the neurological community. Going back after so many years, on the basis of personal preferences or through unproven assumptions, would be, in our opinion, an unjustifiable setback. The term "migrânea" is already in use by the new generation of Brazilian neurologists and should be, in the near future, fully adopted by the medical establishment, as has occurred with the term "cefaleia em salvas" [cluster headache], also opportunely coined by Raffaelli Jr. and in current use both in Brazil and Portugal 8,17,18 .