CONGESTIVE (HYPERÆMIC) HEADACHE.—In this variety of headache, which is common, the pain seems to affect the whole head and is of a dull, throbbing character. The recumbent position aggravates it, as does coughing or straining. During the paroxysm the face is flushed, the eyes suffused, and the arteries throb violently. Sleep relieves the pain of a hyperæmic headache for a time, but as soon as the patient begins to move about, or even to exercise the mind, the pain returns. Erb1 speaks of a violent pain in the brow and temple, with a sense of pressure and fulness in the head, and heat and redness in the face and ears. This form may come in regular paroxysms. He has seen one case of this kind in which there was violent pain accompanied by fainting, and intense redness of the brow and vertex was observed.
1 Cyclopædia of the Practice of Medicine (Ziemssen), vol. xiv. p. 140.
THE HEADACHE OF HYSTERIA is usually seen in females, although it may occur in males. It is sometimes general throughout the head, but is often located in one spot (clavus), and is very intense. The seat of clavus hystericus is at the top of the head to one side of the sagittal suture. The pain is described as boring, gnawing, and burning. The headache is more severe at the menstrual period, and is increased by worry or trivial excitement. Nervous and hysterical subjects complain of headache which never ceases.
TOXIC HEADACHES are the result of the introduction into the system of various kinds of poisons. The headache following alcoholic excesses is a well-known instance of this kind. The pain, which is deep-seated and often intense, is supposed to be in the sensory nerves of the dura mater. Other forms of chronic poisoning give rise to headache. Lead, when retained in the system, produces headache, and so do many of the narcotic drugs. In some persons the administration of iron always causes pain in the head. The headache following a dose of opium is familiar to all. The excessive use of tobacco is often followed by dull headache next day. The intense pain in the head caused by uræmic poisoning is a well-marked symptom of this condition. Seguin has lately well described the headache of uræmia.2
2 Archives of Medicine, vol. iv. p. 102.
RHEUMATIC HEADACHE is often violent, and the pain seems to be located in the head-muscles. It occurs in rheumatic subjects. It is brought on by exposure to cold, and is increased by damp changes in the weather. In acute rheumatism there are sometimes met with attacks of intense headache. Headache also is associated with the gouty cachexia, and is accompanied usually by depression of spirits and sometimes vertigo.
PYREXIAL HEADACHES.—In all of the acute fevers headache is a prominent initial symptom, and usually continues throughout the course of the disease. The pain is generally dull and deep-seated, and is probably congestive in character. The headache of typhoid fever is constant, and often precedes the fever by many days. Following an attack of typhoid fever, it is not infrequent to find headache persisting for months or even for years.
SYPHILITIC HEADACHE is one of the most violent forms of headache. The pain is diffused or limited to one part of the head, and is associated with tenderness of the scalp. It becomes most severe at night, but never entirely intermits. The nocturnal exacerbations, although very common, do not always occur. The pain is so violent and so constant that the patient is unable to do any work or to occupy himself in any way. There is great mental depression, and the patient becomes gloomy and morose. The pain may be dull and heavy or acute and lancinating; sometimes it is like a succession of heavy blows on the skull. During a severe paroxysm of pain the scalp becomes so sensitive that the lightest touch cannot be borne. The sufferer is unable to sleep, and presents a worn, haggard appearance. Often he has hallucinations at night. Syphilitic headache is often a forerunner of some form of organic cerebral disease. One of the characteristic features of syphilitic headache is its constancy. It never ceases entirely, although at times there are paroxysms in which the pain is so intense as to cause great agony. During the little sleep the patient is able to get he is moaning or tossing about his bed. Minute doses of mercury, repeated at short intervals, have been found to afford great relief in headaches of this kind.
ORGANIC HEADACHE may be described as the headache which accompanies organic disease of the brain or its membranes. Violent pain, seated in one spot and constant in character, is one of the most unvarying symptoms of tumors within the cranium. Brain tumors may exist without headache, but rarely. The pain may be situated in any part of the head: sometimes it is occipital and sometimes frontal, and occasionally it extends over the entire head. It does not always correspond to the seat of the disease. The pain is constant and lasting, and, like syphilitic headache, is liable to exacerbations of excessive violence. These often occur at night. Localized tenderness of the scalp is often present, and percussing the skull over the seat of the disease will increase the pain.
Disease of the membranes of the brain, such as meningitis or new growths in the dura mater, will give rise to persistent headache. So will caries or any syphilitic affections of the skull. Catarrhal inflammation of the frontal sinuses causes dull frontal pain. In inflammatory diseases of the ear there is often headache. In these latter conditions the cephalalgia is probably reflex.