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Migraine Liemicrania

headache, disease, attacks, unilateral and feature

MIGRAINE (LIEMICRANIA) Migraine presents a form of hereditary degeneracy, the subjects of which arc classified among the superior degenerates; in other words, the disease does not represent a more or less uniform, disabling degenera tion affecting the entire personality, but rather a practically isolated affection. It is well known that many persons of unusual mental gifts have suffered from migraine.

Migraine manifests itself in periodic attacks which, while they may vary in certain respects, all have as a characteristic feature the occur rence of more or less exclusively unilateral parmsthesias presumably due to cerebral processes. A complete attack is composed of an aura, followed by headache and vomiting. Instances in which the attacks are incomplete or partial are, however, more common. This very incom pleteness of the attack often makes it difficult to recognize the disease as migraine, and if, with Henoch and II. Neumann, we admit that the headache need not necessarily be unilateral and that in children it is usually localized in the forehead or even in the occiput, the dividing line between hernicrania and other forms of headache becomes more uncertain and arbitrary. The only characteristic feature we then have left is the periodic return of violent headache, more or less constantly attended by nausea and vomiting and followed by sleep lasting several hours, after which the patient feels perfectly well.

The uncertainty of the diagnosis is no doubt responsible for the marked discrepancies in the literature in regard to the frequency of migraine in childhood. Oppenheim, for example, states in his Lehrbuch

der Nervenkrankheiten that migraine usually begins at the period of puberty; while II. Neumann reports that in 9 out of 43 cases which he observed it occurred between the second and fifth year, in 21 between the sixth and tenth, and in I3 between the eleventh and fifteenth year of life.

According to our own experience, and the material in the Breslau Children's Hospital (Herrmann), hemicrania is exceedingly rare in child hood; but this may be due to local conditions. As migraine, probably more so than any other nervous disease, is produced by direct homologous inheritance, especially from the mother's side, we made a point, in taking the histories, to question the mothers in regard to their own previous diseases, and in innumerable instances were told that they- had had "head cramp" and all kinds of atypical attacks of headache; but rarely obtained a clear description of unilateral pain.

In view of this state of affairs, we shall have to content ourselves with merely stating the conflicting opinions, leaving the distinction between migraine and nervous headache to individual judgment. In typical cases, such as undoubtedly occur in older children, as shown, for example, by the trustworthy reports of Sachs, the disease is in every respect so like the migraine of adults that we are justified in omit ting a more detailed discu.ssion.