The congestive headache is often also of toxic origin; brisk purgatives must be administered to reduce the systemic pressure, and vaso-dilators like Amyl and Glonoin may be administered. Cold applications or leeches to the head and revulsants to the extremities as a hot mustard foot-bath and a sinapism to the nucha are clearly indicated. When the result of plethora dietetic measures with massage and exercises and mereurials followed by a brisk saline purge 2 or.3 times a week should be resorted to. In cirrhotic kidney the headache may be entirely congestive; oftener it is both toxic and due to increased blood-pressure, and will yield to purga tion and vaso-dilators.
Anemic headache yields to the opposite treatment, and the blood pressure may be too low. Dietetic methods which improve the quality and increase the quantity of the blood should be employed. Iron stands first amongst drugs, and it may he regarded as a food in this condition. Often the anaemic headache is distinctly of a neuralgic nature, and excellent results may be obtained by combining Arsenic and Phosphorus or Glycerophosphates with the iron.
Neurasthenic headache is often most severe and intractable, and can only be relieved by a prolonged rest from all mental strain and excessive muscular exertion. Like hysterical cephalalgia, it will yield to Weir Mitchell treatment, but as a rule in these types as well as in the anaemic form the coal-tar derivatives— antipyrine, phenacetin—should not be used except in emergencies.
Reflex -headaches can only be diagnosed after patient and exhaustive investigation, and their treatment cannot be undertaken with any prospect of success except by the use of remedial agents which remove the exciting cause.
Eye-strain due to ocular troubles, the chief of which is hypermetropic astigmatism, affords the most typical example of this type of cephalalgia; it usually disappears promptly when the errors of refraction are skilfully corrected by appropriate glasses. Weakness of the ciliary muscle and of the globe rotators, iritis and glaucoma also cause headache, which can only be relieved by removing the primary cause. The reflex cephal algia of the cyclist or motorist and the " academy " headache are of the same nature, and must be treated on the same principle—i.e., by
the removal of the strain.
Nasal diseases and affections of the sinuses of the frontal, ethmoidal, sphenoidal or maxillary bones or disease of the turbinates and the presence of adenoids all may produce severe reflex headache, which yields speedily on removal of these exciting causes. As a carious tooth may be the origin of true aching inside the cranium without itself being the seat of pain or even of tenderness, so all the above conditions may likewise remain quiescent. Oral sepsis may act reflexly or as a toxemic agent.
Vansant recommends the flushing of the 'nasal accessory sinuses with a stream of hot dry air in all cases of frontal headache. In frontal sinus headache the nostril should be swabbed with Cocaine solution and flushed out with Boric solution, and finally insufflated with Ferrier's snuff.
Gastric headache is either reflex or toxic, being most frequently of the latter type, in which case the brain is irritated by poisonous products formed during retarded digestion in the stomach or intestine. The treatment should obviously be that of the primary dyspepsia, and should be carried out on the lines suitable for the management of various neuroses or structural stomach diseases. In most cases an emetic or lavage will afford speedy relief.
Hamic, or so-called lymphatic headache, has been long overlooked, having been supposed to be of neurasthenic or hysterical origin. This type is found to be commonly associated with chilblains and an erythe matous or urticarial condition of the skin, accompanied by slight cedema of the legs. The headache is most persistent and often very severe. It is due to deficiency of lime salts in the blood, and yields steadily to the free administration of Chloride or Lactate of Calcium, which should be persevered with in interrupted courses of 14 days' duration.
Under the heading of Megrim will be found discussed the list of anal gesic drugs and other remedial agents, such as electricity and setons, employed for the relief of headache, most of which are suitable for the palliation of every form of cephalalgia when the primary cause is un discoverable or irremovable.