The treatment in the intervals between the attar ks is an important duty. That there is a strong hereditary or congenital factor in most cases which establishes what may be regarded as a migrainous diathesis is beyond doubt. This permanent condition in the absence of an exciting cause may rarely or never manifest itself, hence it is of the greatest consequence that in every case a close investigation of the exciting cause of the seizures should be made. When this is discovered and remedied the attacks may be entirely prevented, and never return unless some other severe unavoid able stimulus be brought into operation.
Eye-strain due to errors of refraction (astigmatism, &c.) is a very common exciting cause, and when by suitable glasses these are corrected complete relief follows; but a violent emotional disturbance such as a sudden outburst of passion or grief, or a prolonged mental strain, will precipitate a seizure. Deprivation of sleep and physical exhaustion act like anxiety and grief, and when possible should be avoided. All reflex sources of irritation in the mouth, naso-pharynx, ovaries and intestinal tract should be dealt with. An open-air life with free exercise, and the avoidance of heated, ill-ventilated rooms and irregular hours for rest, must be insisted upon.
Dietetic errors should be corrected, but the part played by the intestinal tract in megrim has been greatly exaggerated. Every migrainous subject discovers that the attacks are as liable to supervene when the bowels are actively working as when constipation exists; nevertheless constipation should be avoided for general hygienic reasons. The toxic effects of certain articles of diet, when not imaginary, must be ascribed to idio syncrasy, as one migrainous subject can live upon a dietary which another considers to be most injurious. Eggs are an example of this, and it is not unusual for a patient to affirm that this article of diet invariably brings on an attack, whilst investigation elicits the fact from her relatives that the patient often partakes freely, without knowing it, of puddings and dishes containing eggs in large amount, and no harm results.
Strong coffee as a beverage is always useful, and many patients un accustomed to its use are enabled to ward off mild attacks by drinking a large cupful of the strong infusion on awaking in the morning with pre monitory symptoms of a seizure. The diet during the seizure is a simple matter, as the patient is usually unable to take any kind of food; a cup of weak tea may be permitted.
Insomnia between the attacks should he guarded against, as a sleepless night is almost certain in migrainous subjects to be followed by an attack of severe headache next day. A large dose of Bromide with 55 grs. Chloral Hydrate is the most suitable hypnotic; caffeine should not be prescribed for this class of patient unless it be administered early in the morning.
No drug is known which exercises a specific preventive action, but many authorities regard Arsenic in doses as of value. It may be given in pill in combination with I gr. Extract of Indian Hemp, and Little adds to each gr. Ext. Belladonna and 2 grs. Valerianate of Zinc.
One of the best routine methods of treating megrim between the attacks is to administer 3o grs. Bromide and 20 grs. Salicylate of Soda every night before retiring to bed.
Electricity in every form has been vaunted in static, galvanic, Faradic and high-frequency currents; the writer has observed good effects by passing a weak continuous current through the head, using 3 or 4 Leclanche cells with one moistened pole over the occiput and the other on the fore head.
In some cases a complete change of environment, with a long holiday in a bracing, mountainous district or a sea voyage may be necessary.