NEURASTHENIC HEADACHE is more or less allied to the hysterical headache. It is met with in persons who are run down in their nervous system by mental worry or overwork—in other words, in persons who are suffering from neurasthenia. Such patients describe the pain as being constant and deep-seated—seldom acute, but dull and throbbing. It is accompanied by a sense of weight and pressure on the vertex, and sometimes by a feeling of constriction. Mental effort increases the pain, and the patient usually prefers solitude and quiet on account of the relief he obtains. The headache of neurasthenia often persists after other symptoms of the affection have disappeared.
SYMPATHETIC HEADACHE is generally connected with disorders of the digestive and sexual organs. The headache of ovarian disease is well known to gynæcologists, and most of us have experienced the pain in the head associated with gastric disturbances. The headache from eye-strain may be considered in this connection, and deserves careful consideration. Many persons have suffered from headaches for years from this cause without its being suspected. Weir Mitchell brought prominently to notice the frequency with which headaches may be caused by defects of vision.3 The fact had been long known to oculists that disorders of the refractive apparatus of the eye would give rise to cerebral discomfort and pain, but it had not before occurred to physicians to look to defects of the eye to explain headaches whose cause was obscure. The points made by Mitchell were—1, that many headaches are caused indirectly by defects of refraction or accommodation; 2, that in these instances the brain symptom is often the only prominent symptom of the eye trouble, so that there may be no ocular pain, but the strain of the eye-muscles is expressed solely in frontal or occipital headache; 3, that long-continued eye troubles may be the unsuspected cause of insomnia, vertigo, and nausea; 4, that in many cases the eye trouble becomes suddenly injurious, owing to break-down in the general health or to increased sensitiveness of the brain from mental or moral causes.
3 Med. and Surg. Reporter, Aug. 1, 1874, and Amer. Journ. of the Med. Sci., April, 1876.
Occasionally the form of headache produced by eye-strain is a migraine, but most commonly there is a steady frontal or occipital pain, which comes on after undue use of the eyes, which are defective as to refraction or accommodation. Accompanying the pain are sometimes nausea and occasionally vertigo. It is not only over-use of astigmatic eyes in reading or other near work which causes the cerebral disorders, but the use of the eyes in the ordinary walks of life may produce pain in a sensitive brain should there be any imperfection in refraction or accommodation.
HEADACHE FROM SUNSTROKE.—A person who has had an attack of sunstroke often suffers from headache for years. The attacks are most likely to occur from exposure to the sun and in summer months, but they are brought on in some individuals even in winter should they be in the sun. Sometimes heat-exhaustion or exposure to the influence of the sun in hot weather, even should there be no actual sunstroke, is followed for a long time by violent headaches. Persons who have suffered in this way have to be extremely careful about exposing themselves to the sun or they will have severe and prostrating pains in the head. The cephalalgia in these cases is probably from congestion of the cerebral meninges or some disturbance of the submeningeal gray matter of the brain. The pain is usually frontal or on the top of the head. Sometimes it is confined to one side of the head. Mitchell4 has seen two cases in which this form of headache was relieved by ligature of the temporal arteries.
4 Med. and Surg. Reporter, July 25, 1874.
HEADACHE OF CHILDHOOD.—Children often suffer from headaches unconnected with meningitis or other organic brain trouble. Over-use of the brain in study is a frequent source of headache, in children especially, if associated with worry or anxiety. If a child complains of headache after study, it is always important to examine the eyes for defects of vision; but while this is often found to be the cause of the headache, in many cases there will be discovered no errors of refraction sufficient to account for the pain; and here the only relief will be to take the child from school and give him plenty of exercise and fresh air.
Another cause of headaches in children is hypertrophied tonsils, which prevent the free return of blood from the brain. Children also suffer from headaches from over-eating or improper food, or from over-exercise in the sun. Migraine, as will be seen later, is a disease which often begins in early childhood, and a child may suffer from frequent attacks of headache of this nature for a long time before they are understood.
Children who are precocious in any way are apt to be sufferers from neuralgias and headaches; but sexual precocity especially predisposes to headaches of the type of migraine. Anstie5 goes so far as to say that the existence of a severe neuralgic affection in a young child, if it be not due to tubercle or to other organic brain disease, is, primâ facie, ground for suspecting precocious sexual irritation.
5 Neuralgia and Diseases that Resemble it, p. 31.