HEADACHE.
The first step must be to find out the cause of the cephalalgia and treat this cause. If, as is usual, the headache be but a symptom of a primary disease as a specific fever, kidney affection, meningitis, migraine, &c., the treatment of the headache will be found detailed under the name of the disorder which gives rise to it. Nevertheless, a brief resume may be here given of the general principles which should guide the physician in the treatment of a case where headache is a prominent symptom calling for relief.
The classification of headaches given by the author in his " Practice and Theory of Medicine," vol. i., p. 548, is a convenient one, though any attempt at a rigid classification breaks down because any two or more factors may be operating in the same patient at the same time—a fact which cannot be forgotten in the treatment.
Headache due to organic disease of the brain and its membranes, of the cranial bones or of the scalp, as a general rule cannot be freely treated by the most reliable of all pain-relievers—Opium. This drug is contra indicated in acute inflammatory conditions such as exist in the various types of meningitis, cerebral abscesses, sinus thrombosis and cerebritis. The headache of these affections calls for large doses of Bromides with Antipyrine, Phenacetin, or Aspirin, and the application of the ice-cap to the forehead and hairy scalp. Agents which relieve the increased intracranial pressure, as purgatives, counter-irritation to the nucha, leeching of the temples, spinal puncture, &c., may be also useful, and in some cases trephining will be indicated. Non-febrile cases, as cerebral syphilis and tumours, should be treated upon the above-mentioned lines.
In syphilitic cases, whether of the nature of tumour, arteritis or menin geal involvement, Iodides should be given, boldly commencing with at least a dose of zo grs., which should be increased to double or treble this amount three or four times a day combined with Bromides. If the syphilis be of comparatively recent origin, Mercury should be also given.
The headache caused by non-syphilitic tumours is often markedly relieved by the bromide and iodide combination, but Morphia hypoder mically may be cautiously tried when the pain becomes unbearable. To render the life of the patient tolerable, trephining with the removal of a large disc of bone is clearly indicated, even when there is no hope of the operation permitting of the excision of the growth. Exostoses, depressed
spiculm of bone and enlarged Pacchionian bodies causing intense headache must be treated by operative procedures.
Rheumatic fibrositis of the scalp or pericranium causing diffuse head ache will be best relieved by rs-gr. doses of Aspirin or 3o grs. Salicylate of Sodium combined with Iodides in full doses. muscular headache is described by Rose, and is closely allied, if not identical, with the last named variety; it is due to muscular hypertonus, which affects the circula tion in the jugular veins, and he recommends massage as the only reliable agent, each muscle being dealt with separately.
on al lmiddchcs so called are those which do not depend upon organic brain or cranial trouble, the most important types of which are the Toxwmic, Congestive, Neurasthenic, Reflex, Gastric and thentic or Lymphatic.
To.v,emia is the most common cause, as in Bright's disease, all fevers, gout, lithiemia, lead poisoning, excessive tea drinking and the absorption of nitro-compounds by handling high explosives; probably migraine has a toxic origin. The treatment for this form of cephalalgia. should be eliminatory; the bowels, skin and kidneys require stimulation in order to hasten the excretion of the poison, and as this is also a clear indication for the relief of the primary disease, the use of saline purgatives, diuretics and diaphoretics is resorted to. Palliatives for the symptomatic head ache must also be employed. Thus in fever Morphia may be safely em ployed to relieve the pain in the head which keeps the patient awake, and during the day small doses of any of the new analgesics may be given at short intervals. The best example of this type of headache is seen in influenza, where a few grains of Antipyrine every 2 or 3 hours com pletely relieve the intense cephalalgia, especially when combined with Caffeine, which effectually neutralises any depressant action of die drug on the heart; the cold pack, by reducing the temperature, tends to counter act the influence of the toxin on the brain centres when any tendency towards hyperpyrexia is present. I f throbbing of the temporal arteries is noticeable, the ice-cap may be employed, as in the congestive type, and a sinapism often does good when applied to the cervical spines. Com pression of the temporal arteries also occasionally affords some degree of relief.