NEURALGIA AND MIGRAINE.- The several forms of neuralgia and headache bear a close etiological and pathological relationship to one another, being the outcome of functional or neu ritic disorder of the centres or periph eral portions of the sensory' cranial or spinal nerves. The differentiated vari eties of these painful neuroses arise from location and function of the nerve af fected, and from complicating or under lying morbid states.
Neuralgia.
Definition and Varieties.—Nenralgia is a functional or mild neuritic disorder of the sensory nerves or their centres, characterized, as the name indicates, by pain. The affection may be idio pathic—depending upon some func tional disturbance alone, or it may be, symptomatic—due to some organic dis ease of the nerve or to some disease or pathological state outside of the nervous system, stich as neuritis, anmmia, and toxmmia. The tendency of later years is to diminish the number of idiopathic neuralgias by the discovery of organic. disease with demonstrable pathological changes in the nerve-trunks.
Neuralgias are classified according t() their causes, as "neuritic," "toxic," "gouty," "rheumatic," etc.; or accord ing to their location, as "trigeminal," "sciatic," "intercostal," "cervico-occipi tal," etc. The general features of the disorder will be first discussed, and after this the more important clinical varieties will be briefly described.
Symptoms.—Pain is the chief and .characteristic symptom, the onset of the pain being sometimes preceded by soreness and stiffness in muscles and tissues of affected part, sometimes de veloping suddenly- and without warning. The pain is intermittent or paroxysmal, of a darting, stabbing character, accom panied sometimes by burning and ting ling sensations. There is usually tender ness over the entire nerve-trunk, with certain "painful points" at which the tenderness and pain is greatest. The par oxysms of pain may occur only at long intervals, but usually, for some hours, they occur every few minutes; in aggra vated cases may be nearly continuous for hours or days. In occasional cases there may be some pain continuously for months or even several years. In some instances the pain is greatest at a certain time each day, the seeming pe riodicity being most marked in malarial cases, although seen where there can be no thought of malarial influence.
Trophic and vasomotor disturbances in affected arca, such as coldness, erup tions, falling out or changes in color of the hair, etc., are occasionally seen. In
some forms of neuralgia twitching or spasm of adjacent muscles accompany the paroxysms.
Numerous eases of parfesthetic neu ralgia have been recorded by Roth and others, in which there is gradual de velopment of burning pain and uneasy feelings, and sometimes anxsthesia in the antero-lateral portion of one thigh noted. The pain may he sufficient to prevent walking. The condition has been thought t,o be due to compression of the external cutaneous nerve either by the psoas muscle or otherwise. Three somewhat similar eases where there was rnonocrural parresthesia personally re corded. In each case the physical exami nation was negative. The duration of the afTection varied in these cases from one month to eight years. Osler (Jour. of Nerv. and Mental Dis., Mar., '97).
Diagnosis.—The diagnosis of neural gia is simple, the presence of the char acteristic pain being sufficient. The only practical difficulty is in distinguish ing between neuralgia and neuritis; and here, since the conditions shade into one another, it may be impossible to draw a sharp dividing line. Generally speaking, the pain in neuritis is more constant in location than is the pain of neuralgia; it does not shift nor dart from one nerve to another; there is in neuritis much more muscular weakness, stiffness on movement, and relaxation of tissues, and absence of the history of re peated attacks.
From therapeutic point of view it is 1 important to distiuguish two classes of facial neuralgia: the first transitory and usually due to cold and peripheral irritation, tho second refractory and perhaps incurable. First torn): Pain during attacks is less intense, but is sel dom entirely absent between them. Onset is sudden, then there is an acme and a decline. Second: Tie douloureux is completely paroxysmal, pain being entirely absent in intervals; its maxi mum intensity is reached quickly, and it ceases as suddenly as it eame, the whole attack being of short duration. There may be ten to one hundred attacks in the day, which nre often brought on by physiological acts or come on spon taneously. Patients compress the pain ful spot, and the face is contorted. Sec ondary vasomotor symptoms nre injec tion of eye, (-edema of eyelids, discharge from one nostril, ete. If the lingual nerve is affected the 11101101 fills with a copious secretion. Herpes along the I en:. is )lost often the neural Lists some time eeks or months), mid thin litaishes complt tely for a period.