Principal causes of migraine are ar thritism, the nervous diathesis, chlorosis, anmmia, and all conditions which weaken the resistance of the nervous system. Clauss (Jour. d'Accouche., Sept. 2, '94).
-Migraine attributed to two principal causes: (1) poisoning, of gastric origin; (2) cerebral fatigue. W. Hind (Provin cial Med. Jour., Oct. 2, '94).
Migraine regarded as a toxminic con dition, the toxins (probably albumoses) being absorbed from the gastro-intestinal canal. In seven patients the contents of the stomach were examined during the paroxysm, and in these there was evi dence of complete arrest of gastric di gestion. C. E. Herter (Jour. of Nerv. and Mental Dis., Jan., '97).
The occurrence in migraine of almost constant vomiting, frequent attacks of diarrhcea, and polyuria or increase in other secretions is proof that many eases of this affection depend upon intoxica tion. It is also probable that many at tacks are clue to the uric-acid diathesis.
Stekel (Wiener med. Woch., Nov. l3, '97).
Treatment.—When, as is often the case, the patient is aware of the causes which produce the paroxysms the first requisite is a rigid avoidance of these causes. In this way the number of attacks may be materially diminished, although no amount of care will alto gether prevent occasional recurrences. In children the first attack of hemi crania should suggest a careful search for ocular insufficiencies or other pos sible reflex cause, and in all children of neurotic families haying a predisposition to migraine especial hygienic precau tions, as to avoidance of eating excess ively, long hours of study, etc., should be observed.
Prevention of migraine: 1. Red meats are to be rigidly excluded; fish, bacon, brains, sweetbreads, and eggs are al lowed. Rich and highly-spiced dishes are to be avoided. Coffee; tea, and alcoholic beverages are to be excluded. Sweets should be reduced; but when meats a,re excluded a moderate amount is well borne. Water may be taken very freely. Meals to be taken at regular intervals, and overloading of the stomach to be avoided. 2. As much out-door exercise is to be taken as possible—undue fatigue to be avoided; rooms always should be well ventilated, both by day and night; and hot baths taken two or three times a week. In some cases the Turkish bath
is beneficial; and in others the morning cold sponge-bath is directed. 3. The medicinal treatment aims to regulate the bowels, to promote intestinal antisepsis, and to stimulate the liver, the great organ for completing the oxidation of the products of metabolism and protect ing the body from. poisoning. The same end may be attained in many ways. The various salieylates are all useful. ln obstinate cases an occasional mercurial is required. The best results have been obtained by the long,-continued 118C of a formula recommended by Dr. RaeIl ford:— a Sodium sulphate (crystals), 120 gra ins.
Sodium phosphate, 30 grains,. Sodium salicylate, 10 grains. Tincture of mix vontica, 3 drops. Distilled water, enough to make 4 ounces.
This dose is to be taken before break fast. each morning. and is best taken in a glass of -.--eltzer; or, better still, the ingredient, are made up in these propor tions in largi• siphon bottles charged with carbonic acid. The proportions are 11101.11110d ill diiIVICIlt eases. E.
Mitchell (Jour. Amer. Med. Assoc., Feb. ipoi t.
When an attack supervenes the first requisite is absolute mental and phys ical rest and quiet, and this in mild cases may be sufficient to give relief within an hour or two. Usually other remedies are required.
Of drugs the most valuable are the coal-tar derivatives, singly or in combi nation with one another, and caffeine, sodium salicylate, guarana, ammonium chloride, bromides, chloral, cannabis Indica, and a long list of similar drugs. Antipyrine is sometimes quite effective. Acetanilid (antifebrin) has also been recommend ed Prophylaxis is the main indication in the treatment of migraine; but for the attacks themselves, when severe, the fluid extract of er,e-ot given in drachm doses with a drachm of elixir of cin chona in water, by stomach or by rec tum, is the most certain agent to cut short the attack. The patient should lie perfectly still after taking it till all pain passes off, and in some cases the dose may be repeated after two or three hours. Thomson (Aledical Record, Nov. 1(3, 1901).