(SICK HEADACHE)
=Migraine= or sick headache is a neurosis, characterized by a
paroxysmal pain in the head, usually unilateral and periodical, with
nausea, frequently vomiting, and disorders of vision.
=Osteopathic Etiology.=—The disease usually begins in the first half
of life, rarely earlier than puberty and is slightly more frequent
in females. Some weakened or depressed condition of the nervous
system, due to lesions of the upper cervical vertebræ, lesions of the
inferior maxilla, anxiety, overfatigue, anemia, digestive derangements,
=eye strain= and menstrual disorders, is generally the cause. The
hereditary factor is very important. This is frequently associated with
derangement of the =large bowel=, especially cecum and ascending colon,
resulting in toxemia.
It is supposed by some to be a =vasomotor= disturbance, because
there are symptoms, as pallor and flushing of the skin, which show
an involvement of the sympathetic system. It is possible a spasm of
cerebral arteries, followed by vascular dilatation, takes place. The
seat of the pain is believed to be in the meninges of the brain.
Possibly in many cases where the atlas is found involved and causing
the affection, some meningeal fiber of the fifth nerve is impinged by
the lesion. Caries of the teeth and =nasal troubles= are causes of the
disease in children.
=Symptoms.=—A =paroxysmal= headache is the principal feature of
migraine. The attack may occur without warning, although there are
usually malaise, restlessness and a disturbed vision preceding the
headache. The =prodromal= symptoms vary to a great extent. Other
prodromal symptoms besides those given, may be vertigo, spots before
the eyes, tinnitus, chilliness, etc. The pain is of a sharp and
stabbing nature and is oftentimes limited to the temporal region of one
side. Others describe the pain as of a binding or of a boring nature.
It is continuous. It may be in the occiput instead of in the side of
the head.
=Hyperesthesia= of the surface is noticed, but the tender points of
neuralgia of the fifth nerve are absent. The patient is sensitive to
light and noise. Flashes of light occasionally attend the pain in
the head. Hemianopia is not infrequent. The temporal artery may be
contracted, the face pale and the pupil large. In others the eye is
dilated, the face flushed and the pupil small. Nausea and vomiting
are frequent, with loss of appetite. In some cases where the stomach
is full, vomiting the contents will relieve the attack. Should the
stomach be empty, vomiting of mucus may occur, and is later followed by
vomiting of bile. Tenderness is commonly found about the region of the
occipital and upper cervical muscles. Attacks rarely occur oftener than
once in ten or fifteen days. During the intervals the patient may be
quite well. The =duration= is anywhere from a few hours to several days.
=Diagnosis.=—The sensory symptoms, the paroxysmal character, the
severity and definite course, usually readily distinguish migraine.
=Growths= of the =brain= may be the cause of symptoms closely
simulating migraine. In such cases an ophthalmoscopic examination may
reveal a choked disc.
=Prognosis.=—Is usually favorable when the attacks are light and of
short duration. Cases of long standing and of great severity are not so
easily cured, although in most instances great relief can be given the
patient. There are very few cases in which the severity and frequency
of attacks cannot at least be lessened. Oftentimes attacks of migraine
cease after middle life.
=Treatment.=—The =atlas= or one of the =upper cervical= vertebræ is
almost invariably subluxated. This is not always the direct cause of
migraine, but it is an important factor in the causation. =During= the
=attack= many cases can be completely, or at least partially relieved,
by a careful treatment in the upper cervical region. But there are some
cases where treatment of the cervical region is entirely unsuccessful,
and, in fact, aggravates the attack. The details of treatment vary in
every case. If any defects in general health or any error in the mode
of living can be found, these of course must receive first attention.
Rest, diet (a vegetable diet is best) and regularity of meals are
usually to be specially considered. Anything that is known to induce
an attack must be carefully avoided. In some patients the attacks
cease so long as they remain free from mental work, but as soon as they
return to their studies the paroxysms occur.
Every case should be thoroughly examined before a course of treatment
is laid down. Causal conditions can generally be found, and the
correction of such usually results in a cure, or at least in great
relief. Errors in diet; digestive disturbances, as a disordered biliary
tract; disorders of the pelvic organs; eye strain; nasal disorders;
mental and physical fatigue, and affections of the nose may induce
attacks.
A beneficial treatment for many, aside from adjusting the spinal
lesions, especially the cervical and usually a rigid splanchnic area,
is to place the patient in the knee-chest position and thoroughly raise
the bowels of the right side beginning in the right iliac, loosening
possible adhesions, etc.
The earlier the treatment, the more likelihood of a cure. Cases of long
standing are generally harder to cure. Preceding a paroxysm, relief can
usually be given, but after the paroxysm has reached its height it is
harder to give relief. The patient should rest in a quiet room which
is darkened and well ventilated. Besides the indicated osteopathic
treatment (generally a cervical one), hot applications to the nape
of the neck and keeping the extremities warm are helpful. The nerves
involved are the vasomotor, occipital, frontal and temporal. A free
evacuation of the bowels will relieve a few cases, while washing out
the stomach will help others. Hot fomentations over the splanchnics
for thirty minutes may be beneficial. During the intervals, valuable
adjuncts will be found in the use of systematic exercises and frequent
bathing. Do not fail to have the eyes examined.