Diagnosis.— The diagnosis of mi graine is without especial difficulty, the presence of the characteristic headache and other clinical symptoms above men tioned being all sufficient. It is to be remembered that neuralgia aud other forms of headache may occur in pa tient who suffers from migraine.
Prognosis.—Even frequent recurrence of migraine seems to have little un favorable effect upon the general health, and life. is not endangered nor probably shortened by the affection. The disease, as above said, often.spontaneously sub sides after middle life. Many cases are improved by treatment, in that the at tacks are diminished in number and in severity, and the individual paroxysms may be aborted or quickly relieved.
complete cure—i.e., to the extent of entirely preventing recurrence of the headaches—is, however,. rarely obtained by any mode of treatment yet devised. The outlook. is more favorable where there is obvious, but removable, impair ment of health or some removable source of reflex irritation, such as eye-strain. The most unfavorable and intractable cases are those in which strong heredi tary predisposition exists.
Etiology and Pathology.—Regarding the pathology of the affection there are some differences of opinion. There are no discoverable anatomical lesions. The most tenable theory is that of Liveing: that the affection is a neurosis in whose course there occur periodical sensory dis charges analogous to the motor dis charges of epilepsy. Tt is, however, by some regarded as a neuralgic affection of the ophthalmic division of the fifth nerve, and others look upon it as a "vasomotor neurosis." Migraine in the majority of instances is of toxic origin, and not a dep.enerative neurosis. The largest number of eases among hrain-workers and those fol lowing sedentary occupations. Sailors, truckling'. and others who lead an out door life associated with muscular exer tion are almost exempt,. In migraine there is usually a passive congestion in the portal circulation. This leads to fermentation in the intestine and ab sorption of toxic products, with the de velopment of the explosive headaches. 'rile marked hereditary element in these ea:-;es is explained by the theory that all disorders of the alimentary tract haVC a tendency to pass from parents to off spring. IV. H. Thomson (Medical Rec
ord, 16, 1901). • _Hereditary predisposition is the most frequent and important etiological fac tor. Wonien of neurotic families are the greatest sufferers from the disease, al though the affection is by no means un common in nien. It is more common among the educated upper classes than among the laboring class. It generally makes its first appearance at or near puberty; rarely, if ever, after middle life. Overwork at school or in business, worry, lack of open-air exercise, wasting, and diathetic diseases predispose to the affection, and reflex causes are often traceable, especially disorders of the female generative organs and refractive errors and ocular muscular insufficien cies. The exciting causes immediately preceding the paroxysm are manifold and various, it being also remembered that even when there is no exciting cause the rhythmical recurrence of the seizures will not be broken. As a rule, when the usual time between attacks has nearly or quite passed, any suddenly produced nervous impression will pre cipitate the attack.
The common exciting- causes are: in discretions in eating, excitement, fa tigue, emotional outbursts (anger, grief, etc.). loud disturbing, noises, visual im pressions of moving objects (as of rail way-trains, passing crowds, a rapidly moving field in microscopical work, riding backward), etc. Toothache from carious teeth and the presence in chil dren of adenoid growths in the naso pharynx act also as immediate causes, as do gastro-intestinal disorders and leuco maine or ptomaine poisoning.
Migraine believed to be due to de fective or insufficient excretion, partly of the liver, but mainly of the kidneys. The severity of the headache is directly proportionate to the acidity of the gas tric fluids, and this can be greatly less ened by the free use of alkaline draughts. Treatment may be begun twelve or twenty-four hours in advance of the time the migraine is expected to begin, with a view to abort it. Alexander Wal lace (Lancet, Jan. 14, '93).