Ergot has been used with success as a curative means, and it probably acts by contracting the vessels of the medulla oblongata. A combination of ergotin and extract of cannabis indica may be given together; and if persisted in for a long time will often be of benefit in lessening the frequency of the attacks. The prolonged use of one of the bromides is sometimes found curative.
Anstie has found the careful use of galvanism to the head and sympathetic of positive advantage in keeping off attacks, and Eulenburg has had the same experience.
In the treatment of the attack the patient should be freed from all sources of external irritation. He should lie down in a darkened room, and all noises should be excluded. If the attack is of the hyperæmic variety, the patient's head should not be low, as this must favor increase of blood to the head. In this form the patient is often more comfortable sitting up or walking about. Occasionally an impending attack can be warded off by the administration of caffeine, guarana, or cannabis indica. Purgatives are of but little value in this form of headache. The local application of menthol or of the oleate of aconitia to the brow of the affected side will sometimes prevent an attack. If a person can lie down quietly when he feels an attack coming on, one or two doses of fifteen grains each of the bromide of lithium will enable him to sleep, and wake free from pain. I have found the lithium bromide far more valuable in migraine than any other of the bromides. An effervescing preparation known as bromo-caffeine is often efficacious in aborting a paroxysm or in palliating it when it has got under way.
Quinine, in my experience, seems to be of little use in preventing or cutting short a paroxysm of migraine, although Ross11 has found that a dose of ten or fifteen grains may arrest it. Ergot has been found useful, and, as it acts by contracting the arterioles, should be given only in the angio-paralytic form. The fluid extract of ergot may be administered, but ergotin in pill form is more acceptable to the stomach.
11 Diseases of the Nervous System, vol. ii. p. 558.
Inhalations of nitrate of amyl have been used with advantage. Berger, who was the first to employ this remedy, found that a single inhalation of a few drops relieved the pain at once, and it did not return that day. It is indicated only in the sympathico-tonica type. If it is used, two or three drops of the nitrate in a glass pearl may be crushed in the handkerchief and inhaled. Nitro-glycerin may also be given in this variety of migraine.
Once the attack has begun fully, we can only attempt to mitigate the pain. Firm pressure on the head generally gives relief, and encircling the head firmly with a rubber bandage is often of great comfort. Compression of the carotids gives temporary but decided ease to the pain. Strong counter-irritation in the shape of a mustard plaster to the nape of the neck or a stimulating application, like Granville's lotion, to the vertex, will afford relief. I have found in some cases that placing a hot-water bag, as hot as could be borne, against the back of the head alleviates the pain. In other instances cold affords more relief, and an ice-bag resting upon the forehead is the most efficacious way of applying cold. Hot bottles to the feet are an accessory not to be overlooked.
In the way of medicine we may give the bromide of lithium every hour. The bromide of nickel has been recommended by DaCosta as having peculiar advantages. Cannabis indica may be given in doses of a quarter of a grain of the extract every two hours until relief is obtained. Anstie believes strongly in chloral, and says that a single dose of twenty or thirty grains will often induce a sleep from which the patient wakes free from pain. The same writer advises the administration of muriate of ammonium, but it is too nauseous a dose to be given when the stomach is as much disturbed as it usually is in an attack of migraine.
Croton chloral is preferred by some to the chloral hydrate. Ross, for example, gives it in doses of five grains every four hours until relief is obtained.
Galvanism through the head is often of relief, especially at the beginning of an attack; but this means is not often available, for it is not easy to have the suitable apparatus for the constant current at a patient's home when it is needed. Should galvanism be used, one pole should be placed on each mastoid process, and a weak current passed through the head for two or three minutes. The sympathetic may be galvanized by placing one pole over the upper cervical ganglion, just behind and below the angle of the jaw, while the other pole is held in the hand or placed upon the sole of the foot. In hemicrania spastica the positive pole is put over the ganglion, and in the angio-paralytic type the negative pole is placed in this location.