Hillier6 observes that anæmic children from seven to ten years of age frequently suffer from neuralgic headache, and that girls between eight and twelve have violent headaches accompanied by nausea and vomiting (migraine).
6 Diseases of Children, p. 194.
HEADACHE FROM DYSPEPSIA.—Persons who have indigestion have more or less headache, either in paroxysms or as a constant pain. The pain is either frontal or occipital, and may affect the whole head; but it is not confined to one side of the head, as in migraine. The pain is usually dull, and is accompanied by nausea from the beginning of the attack. The tongue is coated, and has red edges, and there are general evidences of gastric disturbance, together with a history of some indiscretion in diet. Sleeping does not always relieve the headache.
DIAGNOSIS.—The diagnosis of the different forms of headache may be made by considering the symptoms. All of the means at our command should be used to carefully distinguish the variety of headache we have to deal with. The head should be palpated for tender or swollen and soft spots, such as are found often in syphilitic headaches. Sometimes percussion of the head will give us some indications as to the kind of headache which exists. The eyes should be examined ophthalmoscopically for changes in the fundus oculi, and the vision should be tested for errors of refraction should there be any reason to connect the pain with the use of the eyes. Inquiry into the habits, occupation, and family history of the patient will aid in arriving at a correct diagnosis.
TREATMENT.—Having reached a correct diagnosis, the treatment will naturally be directed to the special form of headache with which we have to deal. The indications vary more or less with the different varieties, but in all the same object is in view; that is, the relief of pain in the paroxysms, and the breaking up of the diseased condition which leads to the attacks. The means to be used for the former will be considered in the treatment of Migraine, and are more or less applicable to the treatment of all forms of headache.
In children, if no ocular cause is present, it will often be necessary to take them from school and study, and make them take plenty of exercise in the fresh air.
In all varieties of cephalalgia change of climate and travel exert a most beneficial influence. The seashore does not always benefit sufferers from headache, and sometimes the sea air seems to increase the pain.
Migraine.
SYNONYMS.—Hemicrania, Sick headache.
This form of headache is of great importance, from the frequency with which it is met in practice. It occurs in paroxysms at longer or shorter intervals, but the attacks come at periods of tolerable regularity, and, generally speaking, the intervals are entirely free from pain. From the name hemicrania it may be inferred that the pain is confined to one side of the head. This is often the case, but is not invariably the rule.