Synonyms.—Hemicrania; Sick Headache.

Definition.—This is a neurosis characterized by severe paroxysmal attacks of headache, and generally attended by nausea and vomiting.

Etiology.—Females are more frequently affected than males, and those of a nervous temperament rather than those of a sanguine or lymphatic type. The disease shows strong hereditary tendencies, usually on the mother's side. It seems to be closely associated with wrongs of the female reproductive apparatus; thus menstrual derangements and ovarian disturbances go hand in hand with migraine.

Among the exciting causes may be mentioned gastro-intestinal disturbances, naso-pharyngeal wrongs, dental irritation, emotional excitement, grief, shock, eye-strain, or anything that tends to impair the nervous system of those predisposed. An important and often overlooked cause is peripheral irritation, as seen in rectal diseases, urethral lesions, and the nerve waste that follows lacerations of the uterine cervix and perineum.

Pathology.—There is no characteristic lesion found, and the pathology is therefore obscure. Various theories have been advanced, but none proven. Vaso-motor disturbances are thought to be the chief wrongs, while arterio-sclerosis has been found present in others.

Symptoms.—There are generally premonitory symptoms that give the warning note. These vary, and may consist of malaise, chilliness and flashes of heat, or dizziness. Sometimes there is mental depression and confusion of ideas, or the opposite condition, that of excitation. Not infrequently there will be perverted vision, as flashes of light, zigzag lines, balls of fire, or visions of animals. Numbness of face and tongue, followed by pallor, may usher in an attack.

The pain is generally unilateral, the left side being more frequently affected, though, if long continued, the whole head becomes involved. A favorite starting point is over the eye, gradually extending as the disease grows more severe. There may he tenderness over the affected region, and sometimes twitching of the muscles. In most cases the headache is accompanied by gastric disturbances. It may be extreme nausea without vomiting, or there may be persistent emesis. Not infrequently a short period of unconsciousness supervenes. Permanent local gray-ness of the hair is not uncommon where the paroxysms have been of unusual severity.

The duration of the attack varies, usually subsiding in twenty-four hours, though it may last two or three days. An attack causes great prostration, which soon passes away after the paroxysm is over.

The disease continues for years, and sometimes for life, though it is apt to disappear after the age of fifty.

Diagnosis.—This is readily made by the history, of the case and the symptoms already described.

Prognosis.—So far as life is concerned, the prognosis is favorable, and where due to reflex causes and they can be removed, many will permanently recover.

Treatment.—In all cases of migraine, a careful search should be instituted for the cause. It so frequently arises or is continued by irritation at the various orifices, that the rectum, urethra, vagina, uterine cervix, and nasal passages should be examined. Any wrongs must be corrected if we are to expect any permanent benefit.

The patient should be placed on a dry diet, which should consist principally of fruits, cereals, and vegetables. Constipation should be overcome.

For the attack, where the pain is intense and the heart's action good, a five-grain antikamnia powder will usually give relief. I have one patient that only obtains relief by a hypodermic of a quarter grain of morphia. Passiflora in half-teaspoonful doses will sometimes give relief. In some of these patients there seems to be a rheumatic or uric-acid diathesis, and the salicylates and anti-rheumatics will be indicated. Where due to malaria, arsenate of quinia, gelsemium, chionanthus, and uvedalia should be tried. Dr. Webster speaks highly of melilotus in such cases. With the first prodromal symptoms, a thorough washing out of the stomach will frequently abort the attack or materially lessen its force. A thorough emetic is the best means of accomplishing this object.

The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.