HEMICRANIA OR SICK-HEADACHE.

UNDER the name of cephalalgia, or headache, are included several complaints, having their seat in different parts of the cranium and its contents-viz., the bones, brain, or membranes. There are also various kinds of functional and temporary headaches, associated for the most part with disorders of the abdominal viscera, or symptomatic of all forms of fever. It would be highly instructive to consider all these varieties, with their causes, and they will be necessarily alluded to under special diseases; but there is one form which I shall dwell upon for a short time because it is so common and peculiar in its nature that it deserves a place by itself, and because, as far as I know, a good description of it has not yet found its way into Medical literature. The reason of this omission probably is that Medical men have cared little to make such a study of a mere functional disorder as they would of a more marked or tangible malady, and perhaps also because, personally, they have had no conception of the symptoms attending it. I once knew a very eminent Medical man of the melancholic temperament, who told me he had no conception of what was meant by the term headache. I am sorry to say that this is not my case, and therefore I take this opportunity to draw your attention to a malady the particulars of which are, for the most part, gathered from personal experience. I am alluding to the affection popularly known as sick-headache, or technically as hemicrania or migraine. Like many other complaints, it is hereditary, and in a most marked degree. Thus it is a complaint met with in members of particular families, and transmitted from father to son, whilst there are other families of different temperaments in which a headache is unknown. All the members belonging to a particular family may suffer, both male and female, and therefore the complaint is not to be considered as identical with the clavus hystericus, although the latter, I have no doubt, owns the same immediate cause. This might be included with hemicrania under the term nervous headache; but if, because styled hysteric, it be regarded as a trifling disorder, there can be no doubt that the true hemicrania is a reality of the gravest kind, unfitting its victim, while it lasts, for all the avocations of life.

Being so frequently associated with stomach disturbance, it is often styled a sick headache; head and stomach disorders standing in the relation of cause and effect, though constantly changing places. Remembering, however, that the gastric disturbance is often greatest when the primary cause is in the brain, the term hemicrania is not an unfit one; for, as a rule, although the pain may reach far over the head, it is most usually fixed to one spot, or is more concentrated on one side than the other. It may commence as a dull pain over the forehead, then, as it increases, pass down to one eye, and so to the temple, where it remains fixed. Exceptionally the pain is at the top or back of the head. The pain is sometimes so violent as to deserve the name of neuralgia, but generally it is somewhat duller and of a most sickening character. Its great peculiarity is the throbbing that occurs with each beat of the heart, aggravated by every movement of the body, and more especially of the head itself. The movements required for washing and dressing on rising can scarcely be endured. The sufferer walks slowly, since everything which tends to make his arteries beat a degree more violently adds to his misery; in his head he perpetually hears or feels "throb," " throb,' "throb," and his only relief is to support the head against a pillow or rest it on the hand, and avoid all possible excitement. His whole attention is distracted by the painful throbbing, and he becomes utterly incapacitated for business; every movement, every word spoken aggravates the pain. His only desire is to be let alone and be unspoken to. During this time he looks exceedingly ill, very pale, with a dark margin round the eyes, and the pupils contracted; there is a general feeling of chilliness over the whole body, excepting the head; the pulse at the wrist is feeble, whilst that in the head is strong. The anorexia is complete; the loathing of food so great that it is often impossible to swallow a single mouthful of food, and sometimes there is actual vomiting. In a bad attack the VOL. I. 1869. No. 966.

stomach generally refuses food for twenty-four hours. There may have been no error of diet to account for the attack, nor any constipation of the bowels, as is often thought; although a disturbance in these parts is often one of the symptoms of the complaint. The duration of a bad attack is generally several hours. If the person awake with it, the headache persists during the day, and it is only after another night's rest that he rises free. If it should come on during the day, it gradually increases in force, and then the night brings little comfort, for the throbbing, aching head entirely precludes · sleep. When the attack is less severe, there is, fortunately for the sufferer, a strong disposition to slumber--he lays his head against any surface, and readily sleeps. I have observed in my own case that if, during the evening, I feel sleepy, and on lying down, very quickly become insensible, on the following morning I rise with the headache. How far the sleepiness induces the subsequent attack, or how far it is a mere symptom of the approaching disorder, I am uncertain, but I am inclined to think the latter.

Now, as to the cause of this misery, I have already said that whilst the body is cold the head is hot, and that whilst the radial artery is small the carotid is full; in fact, if the term determination of the blood to the head is applicable to any malady, it is assuredly to this. This irregularity in the circulation due to nervous influence has created much interest of late years, as I have already told you in describing various diseases. It has been clearly shown that the blood-vessels are regulated in calibre by the sympathetic nerves, and that the supply of blood is immediately under nervous control. Now, in this complaint of which I am speaking, the carotid on one side with its branches is dilated, throbs inordinately, and sends too much blood to the brain and its coverings. The fact I knew when quite a boy, for when leaning my head on my hand I distinctly felt the increased size of the throbbing temporal artery on the side of the pain, which would be sometimes on the right and sometimes on the left side. I remember mentioning the circumstance to more than one Medical man, and they received the statement with incredulity. I knew it, however, to be a fact, nevertheless, and am sorry to say I have been too fully aware of it up to the present day. The fact is, that in this dilated throbbing carotid and its branches lies the source of the trouble. The vaso-motor nerve on one side is for the time paralysed, the vessels of the head dilate, more blood is sent to it; and thus the increased heat, throbbing, and pain which the patient has to suffer until the tone of the nerve is restored. The most important question to solve is the immediate cause of the function of the nerve being thus temporarily in abeyance. Since a stomach derangement usually accompanies the hemicrania, it is very frequently thought that the source of the trouble is always gastric, and that medicine of a particular kind will relieve. That this is partially true is no doubt correct, but just as frequently the complaint arises from a direct influence on the nervous system. Besides, if arising from the stomach, the cause is not the same as that which operates injuriously in the mass of people from over-indulgence in eating and drinking, and which produces a more general headache in consequence, but the cause is a slighter one, and dependent upon a number of trivial circumstances which the sufferer himself alone could detail. It may be said, no doubt with truth, that gastric derangement is a very common exciting cause in those who are subject to the complaint, but very frequently no cause for the attack is apparent, and certainly none attributable to the stomach. When the cause is evident, it is very often one which has acted directly on some portion of the nervous system, and to the nonsusceptible would scarcely be credited with so powerful an operation. Thus all worry, excitement, or overwork will readily produce a headache; walking in the sun is a very sure method of inducing an attack; strong impressions on the olfactory nerve, as the smell of paint, and in some persons the odour of spring flowers; also impressions on the retina, as long use of the microscope, or a protracted visit to a picture gallery. An atmosphere overcharged with carbonic acid is one of the most fruitful sources of headache, as that of a crowded assemblyroom, and what would affect myself at once and in the most intense degree would be the presence of unconsumed carbon from candles or lamps. Loud noises in the ear will also cause a headache; and, in fact, it would seem that a strong impression made upon any part of the nervous system is sufficient to induce an attack. Probably derangements of any organ might also bring it on, as of the stomach, which we constantly see, and in women the uterus, more especially at the catamenial periods. Some of the most violent attacks which we witness are in women at these periods. There are those who are doomed