Migraine

“ Hemicrania often meant trigeminal neuralgia, and nervous sick headache was generally believed to have its origin in the stomach or to be the result of biliousness. Of late years the disease has come to be better understood, and the valuable works of Liveing, Anstie, and others have given a full literature of the subject.
Various conditions predispose to migraine, and of these the foremost are period of life and hereditary influence. Sex also bears a part in the etiology. The majority of patients who are victims of migraine are females. ”

“ Migraine is a disease of youth and middle life, characterized, in its most typical form, by attacks of severe headache of a few or many hours' duration, of gradual onset and decline, ushered in by well-marked auras involving one or more of the cerebral functions, and terminating in nausea or vomiting or profuse secretion of pale urine, or in some other critical nervous outbreak. The pain is usually, but not invariably, deep-seated. It may be confined to one side of the head, most often the left, or may involve both sides, either from the outset or in the course of the attack. ”

“ Adolescents and children also suffer from periodical headaches, both of the migrainoid and of the neuralgic type. These are obstinate and important affections.9 Migraine especially, coming on in early life, points to a neuropathic constitution, and will be likely to recur at intervals through life, or possibly to give place to graver neuroses. ”

“ This tenderness is usually somewhat diffused, and not limited with accuracy to the foci of greatest pain during the attacks.
Sick headache is not uncommonly ushered in by sighings, yawning, and shuddering—symptoms which remind us of the prodromata of certain graver neuroses, to which, as we shall hereafter see, it is probably related by hereditary descent. In its severer forms, migraine is a terrible infliction; the pain gradually spreads to every twig of the ophthalmic division; the eye of the affected side is deeply bloodshot, and streams with tears ”

“ This migraine is a very terrible complaint which affects mostly the elect of the earth: those whose brains are far above the average. Women are more often affected by it than men; and in them it appears to become worse periodically and at the climacteric. ”

“ Sometimes symptoms indistinguishable from those of migraine persist for many years in cases of chronic Bright’s disease; and there is reason to suspect that it may be accompanied by some sudden constriction of an artery in the brain. In the worst cases the pain also affects the eye; and occasionally there is confusion of speech or even positive aphasia. Possibly even a stroke of paralysis may occur, and there is the usual fear of insanity that seems to accompany all nervous troubles in highly neurotic men. ”

“ A close association between cyclic vomiting in children and that form of periodic headache known as migraine has often been observed. It is sometimes found that one or both parents of a child with cyclic vomiting suffer habitually from migraine. In a few instances the one condition has been observed to be gradually replaced by the other, the child with cyclic vomiting becoming in adult life a sufferer from migraine. ”

“ Thus, a patient of the writer, a gentleman of middle life, who has had migraine since childhood and belongs to a neuropathic family, suffers on the slightest exertion from violent pain in both thighs, which comes on very gradually, beginning at the knees and spreading upward, eventually passing away after a night's rest. ”

“ With the onset of the malady symptoms referable to the nervous system appear. Headache, dizziness, and hebetude of mind are present, and now and then an attack of catarrh of the bile-ducts will have the objective signs of an ordinary migraine or sick headache. Usually, however, as the intestinal and hepatic troubles develop, headache and some mental hebetude come on, but when jaundice supervenes the headache becomes more severe, and very considerable mental depression, irritability of temper, and moroseness are experienced. ”

“ For the immediate relief of migraine, the patient should go at once to bed and drink a glass of hot water; sometimes a cup of hot tea gives great relief. No food should be taken for from six to twelve hours, according to the severity of the case. The room must be kept dark and quiet and the head high. ”

“ At times even so simple a condition as migraine so nearly simulates epilepsy of the psychical type, because of its complications and sequelae and the regularity with which it occurs, that it has been spoken of as an epileptic equivalent. There is no doubt that, in successive generations, epilepsy and migraine may have a relation to one another that is something more than merely a coincidence. ”

“ Persons whose ancestors were of a neurotic type, who suffered from neuralgias, paralysis, hysteria, insanity, etc., are particularly liable to migraine. Epilepsy is also likely to be in the family of an individual who has migraine. There has been observed by many writers the association of migraine and epilepsy in the same person. Epileptics who are predisposed to the disease by inheritance are likely to have attacks of it preceding the outbreak of epilepsy. ”

“ In the first place, he remarks that the site of the pain is by far less distinctly referred to definite foci on the outside of the skull than in trigeminal neuralgia; the patient's sensations very usually lead him to declare that the pain is in the brain itself. Secondly, he says that the points douloureux (in Valleix's sense) are almost constantly absent in true migraine. Thirdly, he specifies the character of the pain in migraine—dull, boring, straining, etc.—as differing from that of trigeminal neuralgia, which is ordinarily much more acute and darting. ”

“ In women, the exhaustion of hæmorrhageal parturition, or of [31] menorrhagia, and also the depression produced by over-suckling, are frequent causes of the recurrence of a migraine or clavus to which the patient had been subject when young. The middle period of life is very obnoxious to severe mental shocks, which are more injurious than in youth, because of the diminished elasticity of mind which now exists ”

“ The headache is frequently joined with nausea, but never with absolute vomiting, unless the stomach has been provoked with a meal that gives it more trouble than usual. The desponding frame of mind which this kind of dyspeptics always exhibit distinguishes them, in most cases, quite sufficiently (together with the unwholesome complexion, the appearance of the tongue, and the great complaints of general malaise and aching and feebleness of the limbs) from the victims of migraine, who are often persons of bright spirits and lively intelligence in the intervals of their attacks ”

“ Another cause of headaches in children is hypertrophied tonsils, which prevent the free return of blood from the brain. Children also suffer from headaches from over-eating or improper food, or from over-exercise in the sun. Migraine, as will be seen later, is a disease which often begins in early childhood, and a child may suffer from frequent attacks of headache of this nature for a long time before they are understood. ”

“ These persons are much troubled with headache from slight causes and with migraine. Nor are disturbances of vision rare, nor vertigo. Insomnia is also frequent in such individuals, and augments the other symptoms. Digestive troubles also frequently occur, notwithstanding a regular and perfectly temperate life. Such persons are often subject to hallucinations of sight and hearing, and are liable to have delirium in trifling illnesses. ”

“ For example, I should explain thus the majority of the peripheral cases of ciliary neuralgia, migraine, etc., that we meet with in poor young needle-women, especially the hypermetropic, who, at an age when they can ill afford the strain, work so constantly and strenuously at an occupation which fearfully taxes the eye. ”

“ Genuine epilepsy he holds to be due to a discharging lesion from the motor area of the cortex. During an attack of migraine the discharging lesion does not remain confined in the sensory portion of the cortex, but extends into the medulla oblongata and the cilio-spinal region of the cord, causing irritation or paralysis of some of these centres, and causing the vaso-motor and oculo-pupillary symptoms which are conspicuous during an attack. ”

“ Children who are precocious in any way are apt to be sufferers from neuralgias and headaches; but sexual precocity especially predisposes to headaches of the type of migraine. Anstie5 goes so far as to say that the existence of a severe neuralgic affection in a young child, if it be not due to tubercle or to other organic brain disease, is, primâ facie, ground for suspecting precocious sexual irritation. ”

“ It would seem that anæmia and mal-nutrition simply aggravate the tendency of existing weak portions of the nervous system to be affected with pain; just as they notoriously do aggravate lurking tendencies to convulsion and spasm. It is very common, for instance, for women to suffer severely from migraine, and other forms of neuralgia, after a confinement in which they have lost much blood. ”

“ Every year thousands are brought into the world with digestive organs so imperfect that the slightest indiscretion precipitates misery; others are tormented for life by the development of an inherited tendency to migraine, to neuralgia, or to asthma ”

“ In another group the neuralgic tendency is never lost, but the form of the attacks changes, and there is far less spontaneity in the manner of their production. It is exceedingly common to see delicate boys and girls between puberty and the age of eighteen or twenty, attacked with typical migraine, which recurs regularly every three or four weeks for perhaps two or three years, then ceases to occur at regular periods, then loses the tendency to stomach complication ”

“ In fact, by the time patients have become sufficiently ill with neuralgia to apply to a consulting physician, they have already, in the great majority of cases, got to reject all fatty foods, and have cut down their total nutriment to a very sufficient standard. Young ladies suffering from migraine are especially apt to mismanage themselves, to a lamentable extent, in this direction: this is natural enough, because the stomach disorder seems to them the origin of the pain, instead of being, as it is, a mere secondary consequence of the neurosis. ”

“ A nervous headache, or migraine, could be produced by an application to the frontal ridges or the margins of the orbit. In some instances, when pain existed, the sensation was aggravated by the augmented state of vibration into which the nerve was thrown through the shaking of the adjacent tissues. It is noteworthy that a comparatively high number of vibrations per second seems to relieve a dull, aching, or grinding pain, while an acutely pitched and quick pain is most frequently arrested by a slower movement of the instrument. ”

“ Many observant physicians believe that the so-called 'paroxysmal neuroses,' periodic headaches, migraine, epilepsy, asthma, etc., as well as hysteria, neurasthenia, 'brain-fag,' 'nervous breakdown' are very frequently caused by years of morbid ocular struggle. ”

“ G43.60 Persistent migraine aura with cerebral infarction, not intractable G43.601 Persistent migraine aura with cerebral infarction, not intractable, with status migrainosus G43.609 Persistent migraine aura with cerebral infarction, not intractable, without status migrainosus G43.61 Persistent migraine aura with cerebral infarction, intractable G43. ”

“ Skin-affections, as was long ago found, are often due to 'migraine,' and migraine, we now know, is due to eyestrain. It is remarkable how often diseases of the kidneys have been preceded by years of suffering from eyestrain. Secondarily almost any affections, even surgical diseases, may supervene, caused by the lowered nutrition, disordered blood-supply or the derouted nerve influences. ”

“ The most prominent symptom of a neuralgic attack of the superficial [p. 1212] nerves is of course the pain, and sometimes, from first to last, no other sign of disease is present. In an acute attack the pain is usually ushered in by a sense of discomfort, which the patient vainly tries to shake off, or by a feeling of weight and pressure or of numbness and prickling, or of itching. Sometimes, though far less often than in the case of migraine, there are prodromal signs of a more general character, such as a feeling of thirst2 or of mental depression or drowsiness. ”

“ And in a very large proportion of all neuralgias, wherever situated, attentive observation of the patient during the paroxysms will detect the existence of local twitching or local spasm of muscles, though these may be slight in degree.
Among the convulsive affections must be reckoned convulsive movements and tonic spasms of various portions of the alimentary canal. Vomiting is a common example of this; in migraine it is the regular and necessary climax of attacks which last with severity for a certain time ”

“ When examining the nervous system we must inquire for headaches, especially in the occipital region, migraines, and the previous occurrence of neuralgia, these being very frequent symptoms in persons with athyroidia or hypothyroidia. Most characteristic are alterations in the mental condition. Thus, memory for recent events may be gone. There may be apathy, with hesitation before every movement, such persons disliking to move about. They may sit indefinitely in the same position. ”