People usually say they need a hole in the head when they’re overwhelmed or dealing with something totally useless. It’s a joke. But for thousands of years, having a literal hole in the skull was a very real, very intentional medical procedure. It’s called trepanation. And honestly, it’s probably the oldest surgical trick in the human playbook.
We aren't just talking about a few weird cases in a single village. Archaeologists have found skulls with these intentional openings all over the globe—from the Andes mountains to the steppes of Russia and the islands of the South Pacific. Some of these skulls date back to the Mesolithic period, roughly 10,000 BCE.
Think about that for a second. Before humans had even figured out how to write or use a wheel, they were already comfortable enough to take a sharp stone tool to someone’s cranium. It sounds like a nightmare. It sounds like a death sentence. But the wild part? A huge percentage of these people actually survived the procedure. You can tell because the bone shows signs of healing. The edges of the hole are smooth, rounded off by the body’s natural repair process.
The Mystery of Why We Did It
Why would someone do this? Well, the "why" depends heavily on who you ask and what century you’re looking at.
In ancient times, the hole in the head was often a spiritual solution. If someone was acting "crazy" or suffering from what we now recognize as epilepsy or severe migraines, ancient healers often assumed there was a demon or a trapped spirit causing the chaos. The hole was an exit door. Once the spirit left, the person was supposed to get better. It’s a bit simplistic, sure, but it shows a basic understanding that whatever was happening was centered in the brain, not the heart or the stomach.
Then you have the more practical, "battlefield" version of the procedure. Head injuries were incredibly common in eras where people hit each other with clubs and maces. If you take a heavy blow to the head, your brain starts to swell. In a closed container like the skull, that pressure is a killer.
By drilling or scraping a hole, ancient surgeons were effectively performing a primitive craniotomy. They were letting the blood drain and giving the brain room to expand. Without it, the patient would likely die from intracranial pressure. Hippocrates, the "father of medicine," even wrote specific instructions on how to do this safely. He was adamant about not hitting the underlying membrane, the dura mater.
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The 1960s Quest for Higher Consciousness
Fast forward a few thousand years, and the hole in the head took a very strange, very modern turn. In the 1960s and 70s, a few fringe thinkers started believing that trepanation wasn't just for trauma or demons. They thought it could change how the brain processed blood and cerebrospinal fluid.
The most famous figure in this movement was Bart Huges. He was a Dutch librarian who had been a medical student. Huges became convinced that when the skull fuses shut in early adulthood, it limits the "pulsation" of the brain. He believed that by making a small hole, he could restore the brain's volume-to-pressure ratio to a more "youthful" state, leading to a permanent "high" or expanded state of consciousness.
In 1965, he used a dentist’s drill to perform the procedure on himself.
It sounds like a horror movie plot, but Huges wasn't alone. He influenced others, including Joey Mellen and Amanda Feilding. Feilding, who is now a prominent researcher in the field of psychedelics and the founder of the Beckley Foundation, filmed her own trepanation in the 1970 short film Heartbeat in the Brain.
"It's not something you do lightly," Feilding has remarked in various interviews over the decades. She viewed it as a physiological correction rather than a medical necessity in the traditional sense.
Modern neurology, for the record, doesn't really back this up. The brain’s blood flow is regulated by a complex system of autoregulation that doesn't rely on a hole in the casing. But the fact that people were willing to drill into their own heads in search of enlightenment shows just how deeply this ritual is embedded in the human psyche.
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How Modern Doctors Use the Hole in the Head Today
If you walk into a modern neurosurgery suite, you might see a version of trepanation, though doctors call it a "burr hole." It’s still a standard, life-saving procedure.
When a patient has a subdural hematoma—basically a big clot of blood pressing on the brain—the surgeon drills a small hole to let the fluid out. It’s incredibly effective. It’s fast. It saves lives every single day.
The Difference Between Trepanation and Craniotomy
It’s easy to get these confused, so let’s look at the nuance:
- Trepanation: Usually refers to the ancient or ritualistic practice of making a permanent hole that isn't replaced.
- Burr Holes: Small holes drilled in modern medicine, often used to insert drains or as a starting point for bigger surgeries.
- Craniotomy: This is when a surgeon removes a "flap" of bone to access the brain and then puts the bone back afterward, usually securing it with tiny titanium plates.
The evolution of the tools is also fascinating. We went from obsidian flakes and flint scrapers to hand-cranked "trephines" that looked like something out of a Victorian woodshop, to the high-speed electric drills used today that automatically stop the moment they sense they’ve poked through the bone. Science is amazing.
The Survival Rates are Shocking
You’d think that an ancient Peruvian with a hole in the head would have a 0% chance of survival. You’d be wrong.
A study published in World Neurosurgery in 2018 compared trepanation survival rates from the Inca Empire to those from the American Civil War. The results were mind-blowing. The Incan surgeons had survival rates around 75% to 80%. During the American Civil War, the survival rate for similar procedures was often much lower, sometimes around 50%.
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Why? Hygiene and technique. The Incas had centuries of trial and error. They knew exactly where to cut to avoid major blood vessels. They likely used coca leaves and chicha (fermented corn beer) to manage pain and antiseptic herbs to keep the wound clean. Meanwhile, Civil War surgeons were often working with unwashed hands and contaminated tools.
Why This Topic Still Captivates Us
The idea of a hole in the head taps into our deepest fears and curiosities. It’s the ultimate violation of the body’s "black box." The skull is meant to be the vault for our consciousness. Breaking that vault feels like a spiritual or biological transgression.
Yet, we keep coming back to it. Whether it's a "brain drain" in a modern ER or a Neolithic shaman trying to cure a migraine, the act of opening the skull represents a human refusal to accept a "closed system." We want to fix what's inside, and sometimes, the only way in is to make a door.
Taking Action: What You Need to Know
If you’re reading this because you’re experiencing severe, localized head pressure or neurological symptoms, don't go looking for a DIY kit. Life isn't a 1960s experimental film.
- Recognize the Red Flags: If you have a "thunderclap" headache (the worst headache of your life), sudden weakness on one side of your body, or unexplained seizures, you need an ER, not a blog post. These are signs of the types of pressure that surgeons address with burr holes.
- Consult a Specialist: If you have chronic migraines that feel like "pressure," talk to a neurologist about legitimate treatments. Modern medicine has evolved way past the "let the demons out" phase.
- Verify the Source: When researching historical medical practices, stick to peer-reviewed journals like The Lancet or Journal of Neurosurgery. There is a lot of misinformation online from "biohackers" who claim trepanation can cure depression or boost IQ. There is zero clinical evidence for this.
- Historical Context: If you're a history buff, look into the Paracas culture of Peru. They were the undisputed masters of this craft, and their work provides the best evidence we have for the efficacy of ancient surgery.
The hole in the head is a testament to human resilience and our desperate, ancient desire to understand the organ that makes us who we are. It’s messy, it’s scary, and it’s a fundamental part of our medical history.