A system of practical medicine. By American authors. Vol. 5

by Unknown

It is not possible to give in a few pages a complete treatise on headache, and it is therefore intended merely to describe the most common types of this malady.

Many forms of headache are symptomatic of some organic cerebral disease, like tumor of the brain or syphilitic diseases of the skull. Headache also constantly accompanies fevers of all kinds. A great number of cases are met with in which no cause for the headache can be discovered, and in which the pain is the only symptom. In these there must be some disordered state of the sensory nerves within the cranium, but just what the nature of the abnormal condition is it is impossible to decide.

The character of the pain in headaches is various. In some cases there is a violent general pain over the entire head. In others the pain is localized in one particular spot, feeling as if a nail were being driven into the skull. This is called clavus, and is often met with in hysterical patients.

Patients sometimes describe the head as feeling as if it were splitting open, or, again, as if it were being compressed. The pain may involve one side of the head alone, hemicrania, or it may be only in the back of the head. The top of the head is a frequent seat of pain, especially in women who have uterine disorders. In short, the pain may be in any or every portion of the head, or it may move about from place to place.

In almost all varieties of headache the pain is aggravated by noises or strong light. Any movements of the patient increase it, and coughing, sneezing, or straining—as, for instance, at stool—adds to the suffering. Tapping on the head usually does not increase the pain, and in some instances alleviates it.

Accompanying the headache is a variety of other symptoms: some of them are nervous, while others are not. There are often disturbances of vision, such as bright spots or zigzags before the eyes; and there may be ringing in the ears; palpitation or slowing of the heart. Nausea occurs in most varieties of headache, and a feeling of general prostration or nervous excitability is often experienced both during and after an attack.

The duration of an attack of headache varies from a few minutes to days or even months: one occasionally sees a patient who says she has not known what it is to have been without pain in the head for years.

The character of the pain may be either a dull aching or it may be excessively intense, so as to cause temporary aberration of mind. As to the structures within the cranium in which the pain is located, it is a mooted question. Some writers believe the dura mater may be the seat of pain in headaches, while other observers have declared this membrane to be insensitive. Probably the intracranial branches of the fifth pair of nerves are the principal site of pain.

We will now consider particularly the different varieties of headache most commonly met with.

ANÆMIC HEADACHE.—The pain is of a dull kind, often diffused over the head, but frequently in the vertex or temples. It occurs in weak, thin-blooded persons, and is relieved by the recumbent position. If the patient is sitting or walking, the pain becomes worse, and there is a sense of faintness or dizziness. Women are the most common sufferers from this form of cephalalgia, and uterine diseases or disorders of menstruation are connected with it. It is associated with palpitations of the heart, difficulty of breathing, a tendency to faint, and general weakness. Anything which exhausts the nervous system, like over-study or anxiety, loss of rest and sleep, is likely to bring on an attack.