MIGRAINE, OPHTHALMIC MI GRAINE, or SICK HEADACHE, a very widespread affection, also known as megrim, hemicrania or bilious headache. It is a vaso motor disturbance; in other words, one in which the nerves which expand or contract the arteries and blood vessels are affected, thus restricting the flow of blood. The number of happenings which may cause this malady is ex ceedingly great, including such diverse causes as the merely physical ones of severe blows, falls, fast movements, sudden alteration of temperature or of atmospheric pressure. Migraine may also be caused by chemical stimuli such as nicotine, and by the secretions of various glands of the body such as the thyroid. It is often, too, caused by some other deep physiological alteration, such as that ex perienced in extreme fatigue, or that coming from some other disease such as meningitis or tumors. It may also have as chief cause some undue emotional strain as in great anger, in fear (which produces important changes in metabolism, q.v.), in disappointment or in chagrin. The vital point about the mental causes is that they may not always be in con sciousness, but may be solely in the uncon scious, and will therefore be quite unknown and unknowable to the average person, unless he can receive treatment at the hands of an experienced psychoanalyst. (See PSYCHO ANALYSIS). If the causes act through the cere bral sympathetic nervous system, they may produce spasms of the vaso-motor muscles such that the blood pressure is increased in the brain.
The study of the worst forms of the disease alone has enabled investigators to correlate the multiform symptoms into a consistent picture. Fortunately the worst forms are not the com monest, which may be termed abortive forms. In these abortive forms now one and now another of the symptoms appear in individual cases, some having many or most of the symp toms, but in different attacks. One patient, for instance, is on record who in 15 years had at different times all the variations of the disease which have been reported.
The commonest abortive attacks of migraine, begin with chilliness, sometimes accompanied by cold feet and pinched face. Apprehension, depression and general wretchedness then fol low, sometimes accompanied by a peculiar de fect of sight which is known as scotoma. This is a spot in the visual field, quite distinct from the quite ordinary °blind spot," but one which interferes with the sight to a varying extent, and goes through different phases, sometimes within the short space of 20 minutes, constitut ing, in the cases where it does occur, the pre lude to the actual pain in the head. The scotoma begins only as a slight blurring, notice able especially when reading. The attention directed to it shows a cloudy spot which shifts with the eye, as it changes its direction. Gradually the spot expands into more or less crescent shape, usually being found in the left eye. The interference in vision is however sometimes found to affect only the upper half of the field of vision, while in rarer instances a temporary total blindness occurs.
Another important disturbance associated with migraine is that of speech. Not only is the ability to pronounce certain words affected, but the comprehension is also sometimes in terfered with. Inability to write is not unknown and also a disturbance of the auditory images used in singing. A case has even been described
in which unsteadiness of gait was coupled with a sensation that the body or particular parts of it were doubled.
The headache itself is, however, the most important symptom and has an infinite varia bility as to its location, its quality, its duration and its intensity. The commonest form appears a quarter or a half an hour after the appear ance of the other phenomena including the scotoma, and is generally confined to one side of the head, hence its name : migraine (from hemicrania, Greek for "half head"). But cases occur where it involves both sides or may be in the front or back of the head. In many cases the eyes alone are the seat of the pain, while in others the pain may be in the neck. The qual ity of the pain is described generally as lancinating. Some sufferers become hysterical, rolling on the floor and holding their heads with both hands, and shrieking with pain. Others with less acute suffering describe the pain as beating or thumping, particularly when stooping or requiring to do any violent exer cise. All the phenomena of the pain indicate a change in pressure of blood within the brain, a change which may be either an increase or a decrease. The pain is aggravated in diverse ways in different patients, sometimes increasing on the taking of alcohol, on smoking, on eat ing, which sometimes on the contrary helps, on being subjected to sudden and loud noises, or to strong light. It has been found, too, that certain odors increase the pain, such as that of cooking and of certain drugs like chloroform or ether. The vaso-motor disturbances which accompany all cases of migraine are manifested in the coldness, paleness and gooseflesh, evi dences of constriction in the calibre of the blood vessels, or in the redness of skin and even discharge of blood from various parts of the body. The secretions are frequently affected.
The connection between migraine and the mental factors which are above enumerated as among its causes is a matter which is being investigated at the p sent day through the technique of psychoanalysis (q.v.), which has unearthed much material going to show that the left sided headache represents an unconscious conflict relating to some love affair, while those on the right side are associated with fantasies concerning the nutritive libido. As a prelimi nary to the onset of the sickness the general conscious situation of the patient may show a slight or almost unnoticeable or even a pro found change, varying from violent agitation to mild depression. In the observation of one specialist 25 per cent of the patients showed psychical symptoms, and while others show a smaller proportion, the presence of the purely mental element indicates that an important if not exclusive factor in the causation of the malady is the unconscious conflict. Treatment consists in removing as far as possible all the physical causes known to produce migraine, such as eye-strain, adenoids, diseased turbinates, constipation, dysmenorrhea, etc., or gastro intestinal disorders, and if the migraine still persists, there is very good reason to believe that the condition is the result solely of the unconscious conflict. In this case the patient should receive analysis from an experienced psychoanalyst.