Diagnosis.—Periodical attacks of headache, preceded by disorder of sight—these attacks lasting several hours and passing off completely, leav ing the child well until the next recurrence—may almost always be ascribed to megrim. Children comparatively rarely suffer from dyspeptic head aches, although sometimes during attacks of acid indigestion in young subjects dull pain in the temples and soreness of the eyeballs may be complained of. These attacks are, however, very different from megrim. The pain is much less intense and is preceded by symptoms of gastric de rangement ; the tongue is foul ; the bowels are confined ; the patient looks heavy, ,and his complexion is usually sallow. In megrim the pain is intense and throbbing, the face is white, and vomiting, if it occur, is a late symp tom, coming on towards the end of the attack. The attacks, too, often occur in the night, so that the patient, when he wakes up, finds the headache fully developed, although he had retired to rest in perfect health.
Children who are much exposed to vitiated air, especially to air made unwholesome by gas-jets, often suffer from headaches, but in these cases the pain can be traced to the evident cause of the attack. Again, hyper metropia is a not uncommon cause of cephalalgia in young people. This form of headache is not noticed until the education of the child is entered upon and he begins to pursue regular studies. He is then forced for some hours together to exert the full focussing power of his eyes in order to remedy his natural defect, and the consequent strain upon his muscles of accommodation gives rise to a frontal headache which is often very dis tressing. But this headache always comes on at about the same time in the day, and is evidently connected with the act of reading. It ceases at once directly the hypermetropia is remedied by the use of suitable glasses.
In headache due to cerebral disease, such as tumour of the brain, there are usually other symptoms connected with the brain which continue be tween the attacks of paroxysmal suffering. Squint, or nystagmus, is often an early symptom, and persistent lesions of special sense soon begin to be observed. These are not limited to the seizures, but continue after the headache has subsided.
the actual attack the child should be allowed to lie quietly in a room shaded from a too bright light. If he be chilly a thin coverlet may be thrown over him, and if his feet feel cold they should be warmed by a hot-water bottle. The best remedy at this stage is the guarana powder, which is to be given in a dose of ten grains (to a child of ten years old) in a little sweetened water. This remedy is said
to succeed best in cases where there are very distinct premonitory symp toms, especially disorders of vision, but even in these cases the adminis tration of the powder is often followed by no relief. Other remedies which sometimes have the effect of cutting short an attack are the bromide of potassium (gr. x.-xx.) with sal volatile, chloride of ammonium (gr. x.-xv.) with spirits of chloroform, and compound tincture of lavender. Various antispasmodics, as valerian, assafcetida, tincture of henbane, and the fetid spirits of ammonia, have also been recommended. In many cases—in most, perhaps, occurring in young subjects—the attack is very decidedly shortened by a dose ( rrt, xv.-xx.) of the liquid extract of ergot given with spirits of chloroform in camphor-water.
If sickness occur and prove obstinate, it may be often arrested by a saline effervescing draught containing a couple of drops of dilute hydro cyanic acid (P. B.).
After the attack is at an end the child should, if possible, avoid close rooms and headwork, and should be made to spend as much of his time as possible in the open air. In the case of school-boys, however, it is impor tant that their education should be proceeded with, and we must endeavour to arrest the tendency to the attacks without any intermission of study. Few cases will be found to resist the combination of strychnia and extract of ergot already referred to in the treatment of the two cases which have been narrated. y I was led to employ these remedies in this complaint from noticing their useful effects in some cases of epilepsy, and since beginning to treat megrim in the young subject by this method I have met with very few obstinate cases. Often from the time of beginning to take the medicine the attacks have ceased altogether. I usually order two or three drops of the strychnia solution (P. B.) and ten or fifteen of the liquid extract of ergot with spirits of chloroform to be taken three times a day. I believe the combination of the two drugs to be more efficacious than either given alone, but in some cases strychnia given with iron has been found of value.
The child's bowels must be kept regular with some mild aperient, such as the compound liquorice powder, and the diet should be regulated, taking care that he does not take an excess of sweets or fruit.