Should all of the above means fail, we may resort to morphia hypodermically. Jewell12 favors the administration of morphia and atropia, either by the mouth or hypodermically, from the beginning of an attack until the pain is eased; but I believe that morphia, except as a last resort, is very undesirable in migraine. Although a small dose hypodermically will usually promptly bring relief, there are the unpleasant after-effects of opium felt, and the patient feels more prostrated and with more disordered digestion than had no morphia been used. Besides, the morphia habit is liable to be formed, especially in women, when the drug has once begun to be taken.
12 Journal of Nervous and Mental Diseases, 1881.
It is for this reason that I prefer to use the bromides, and if a patient is seen at the beginning of a paroxysm, given a fifteen-grain dose of bromide of lithium, his feet put in hot mustard-water, and he then goes to bed, he will almost always cut his attack short, and on waking from sleep will feel refreshed and able to take food.
I am strongly convinced of the importance of arresting or shortening the paroxysms of migraine, especially in the young, at the beginning of the disease. By this means the habit of long attacks is prevented, and their prostrating after-effects are avoided. Should we succeed in checking the first few attacks, we may by tonics and regimen improve and fortify the constitution so as to eradicate or modify the neuralgic tendency.
VERTIGO.
BY S. WEIR MITCHELL, M.D.
DEFINITION.—The clinical meaning of vertigo has gone, as is common, far beyond what the term implies. We may define vertigo to be a sense of defective equilibrium, with or without actual disturbance of position, and accompanied by varying amounts of subjective feelings of motion of external objects, of the body itself, or of the contents of the cranium.