MEGRIM, MIGRAINE, OR HEMICRANIA.
Upon the first approach of a seizure, even before the advent of pain. when the eye symptoms give warning of an attack. 2o grs. Phenacetin or so grs. Antipyrine in solution should be given. Sometimes this treatment prevents the headache coming on and cuts short the attack ; more fre quently it results in so minimising the severity of the pain that. though conscious of its presence, the patient will be able to move about and attend to his ordinary duties. A second dose in 3o minutes will usually suffice to dispel it altogether.
As these large amounts are not free from the danger of depressing the heart it is advisable to have a routine pain-reliever which can be admin istered without hesitation as soon as the warnings of an attack are felt, or immediately after the patient awakes in the morning with a severe head ache. The following is a good combination : R . Phenazoni- gr. x.
Caffeince Cit. gr. vj. llisce.
Ft. pnlv. s.s. et repa. secundis horis.
5 grs. Hydrobromide of Quinine may he added to each powder. which sometimes prolongs the analgesic effect.
Difference of opinion exists regarding the relative pain-relieving power of the different coal-tar derivatives, as the analgesic which best relieves one patient may possess little influence over another. There cannot be a doubt that each one of them gradually loses its effect when frequently resorted to; the writer believes that for all purposes the combination of Antipyrine and Caffeine is the best routine. It is, however. absolutely necessary in treating severe and oft-recurring attacks of megrim to change from one drug to another from time to time to obtain the hest results and to prevent the most suitable drug or combination of drugs from losing its effects.
The physician has the choice of the following series in their approximate doses: Antipyrine, ro to 15 grs.; Acetanilide or Antifebrin, 4 grs.; Pulv. Acetanilidi Co. (Antifebrin, 7 ; Caffeine, 1; Bicarbonate of Soda. a), 5 to 6 grs.; Ammonol, 10 grs.; Antinervin, Jo grs.; Phenalgin, i5 grs.; Exalgin, 2 grs.; Lactophenin, c5 grs.; Phenacetin, i5 grs.; Citrophen, 5 to 8 grs.; Acetopyrin, 12 grs.; Migrainine, 15 grs.; Migralin, i5 grs.; Aspirin, Sala cetin, Saletin, Acetysal or Xaxa, r5 grs.; Novaspirin, 12 grs.; Salophen,
12 grs.; Apolvsin, 20 grs.; Aspirophen, i5 grs.; Methylene Blue, 3 grs.; Guraninc or Caffeine, 5 grs.; Euphorine, 5 grs.; Triphenin, r5 grs.; Salicy late of Soda, 25 grs.; Phenocoll Hydrochloride, JO grs.; Phenosal, 8 grs.; Salocoll, r5 grs.; Neurodin, io grs.; ('rvofin, io grs.; Phesin, zo grs.; Pyramidon, 5 grs.; Tolypyrin (Tolylantipyrin) and 'Folypyrin Salicylate, grs.; Salipyrin, 20 grs.
Morphia should never be employed for the relief of migraine, and the common practice of heroic purgation by calomel and large doses of salines produces no good results either in relieving the pain or in preventing the attacks. In gouty and rheumatic subjects Aspirin or the Salicylates are decidedly advantageous.
Cannabis Indica in to ?,-gr. doses of the extract is of value for the relief of the continuous headache of mild degree which sometimes remains between the acute seizures.
Nitroglycerin is useless in the ordinary type of the disease, but in a small number of cases where the attacks are closely associated with high blood pressure it is a valuable preventive, and succeeds when all the analgesics fail even during the acute seizure. Amyl Nitrite may be tried.
Bromides arc useless fur the relief of the acute attack, hut where the attacks become almost continuous—i.e., in the so-called " status hemi cranialis "— bromides are of great use. They may be advantageously combined with antipyrine.
R. Potassii Bromidi 3vj.
Phenazoni 3ij.
Caffeine Citratis 3j.
Spiritus Chlorofo; mi 3ij.
Aquce Camphom ad 5x. Misce.
Fiat mistnra. Signa.—" A large tablespoonful for a dose when the attack of headache comes on, and a dessert-spoonful every morning and evening between the attacks." In most intractable cases where analgesics had lost their effects and life had become unendurable, Whitehead states that he never failed to secure perfect relief by the introduction of an ordinary tape seton into the tissues at the back of the neck. The skin is transfixed by a scalpel, and into the wound is inserted 9 inches of household tape (1 inch wide); the free ends are tied, and the seton is moved a little every day and worn uninterruptedly for a period of 3 months.