Page images
PDF
EPUB

irritation arising from such conditions is sufficient to afford permanent relief to the nervous suffering.

The number of cases of chronic headache* in the private practice of the author, in which examinations of the ocular conditions have been made, is twelve hundred and eighty. For nearly all these, advice in regard to the correction of the ocular defects has been rendered; but, inasmuch as the period during which these examinations have been made extends through several years, it is manifest that it is impossible to know the result of this advice in all cases. A very large proportion of these are transient cases, in which a single consultation has concluded the relation of physician and patient, and as many of the cases reside in cities distant from the residence of the writer, some even of those who receive treatment for a longer time are lost to observation. In order, however, to arrive at some basis of facts from which one not in the constant observation of these phenomena may be enabled to draw some conclusion as to their value, an analysis of the results in one hundred consecutive cases of chronic headache is here given. The list extends backward from December 31, 1882, to the 2d of June of the same year. This, while allowing sufficient time to have elapsed since the most recent date, to determine the permanent results, is also sufficiently recent to enable a recollection of the cases in some measure to supplement the written record.

Proceeding, then, to the analysis of these cases, it

* Chronic in the sense of continuing during more than one and in general during several years.

is found that of the number, nothing is known of the patients after their first consultation in twenty-two cases. In five other cases, in which more than a single visit was made, no knowledge of the subsequent history is possessed. Sixty-one are known to have obtained permanent relief. Nine are known to have received temporary and marked improvement, while in three cases no improvement resulted.

If we exclude the twenty-seven cases the history of which, since the examinations or after a very few calls, are unknown, we shall find that the proportion to one hundred is as follows:

[merged small][merged small][merged small][merged small][ocr errors][merged small][ocr errors][merged small]

It should be observed, in passing, that the cases upon which these statistics are based are in all respects typical cases of chronic headache, of which the illustrative cases given above are fair examples. No cases of simple asthenopia or of temporary headaches are included.

It should be further remarked that in these cases drugs have not been administered, except in rare instances, for temporary relief of some other symptom, and in no case can the influence of drugs be regarded as a factor in the result of the treatment. This statement will also apply to classes of cases hereafter to be reported. In fact, the results in these cases must be attributed solely to the removal of the

difficulties incident to the performance of the visual act.

As has already been said, every oculist recognizes the fact that asthenopia is a complaint resulting generally from ocular defects or insufficiencies of the ocular muscles. Yet it is equally well known that this more immediate and much less severe form of irritation does not always yield to the means employed for its treatment. But if we compare the results of treatment of asthenopia with the results obtained in the treatment of headaches by similar means, we can not fail to see that the latter form of complaint yields as often to treatment directed to correction of anomalies of refraction and accommodation or of muscular insufficiencies as does the former. Hence we may logically draw the conclusion that headaches are as generally the result of disturbing ocular conditions as is asthenopia.

It is to be further observed that the relief is not the result of temporary stimulation of nervous energy, such as might result from the use of electricity, or of certain drugs, or a change of air or surroundings. Either or all of these measures might bring relief in certain cases, but if the fundamental cause remains, it is only relief, and can not be properly regarded as a cure, of the predisposing tendency.

In cases of temporary nervous disturbance, resulting in headaches, the agencies above mentioned may be used with advantage, but they certainly have no power to remove an hereditary cause.

Further consideration of the treatment of this

special class of troubles may be reserved for consideration under the general discussion of therapeutical measures in nervous complaints.

Nearly related to this class of troubles is migraine, a complaint often classed with neuralgia, but which has characteristics so clearly defined that it may well rank as a distinct form of nervous disturbance.

MIGRAINE, OR SICK-HEADACHE.

Paroxysms occur with greater or less regularity in respect to time, the intervals being in some cases only a few days, in others a month or more. The attack commences in most cases with a feeling of lassitude and dull headache, the eyes are painful, and the act of turning them quickly or far is attended with distress. The effect of light is disagreeable, and there is mental disquietude. In some instances the attack is ushered in by great disturbance of vision, sometimes described as glimmerings and confusion. At other times the visual defect assumes the form of hemiopia, or even of complete blindness. The visual disturbance lasts from a few seconds to an hour, and such attacks are known as "blind headaches."

The subject of an attack, after a few hours of these premonitory symptoms, resorts to the bed, the pain over and through the eyes becoming more and more intense, and the effect of light more tormenting. Slight sounds or feeble currents of air are often unendurable, and nausea and vomiting supervene. The pain is in many cases confined to one side, and in some uniformly to the same side, in various attacks. In others the

pain is alternately located on one or the other side, and, in case of visual disturbance of one eye only, the headache is often situated upon the opposite side of the head to the eye affected. The headache as well as the visual disturbance may, however, be bilateral.

In a few cases of "blind" headaches, in which the fundus of the eyes have been examined with the ophthalmoscope during the period of visual disturbance, the retina has been found pale and brilliant, the optic disc unusually white, and the main arteries somewhat irregularly contracted in their course. In these cases the field of vision has been found to be contracted in a striking manner, in some instances one half of the field being completely lost, while in others the central field was gone, imperfect sight only remaining at the periphery.

A night's sleep may bring relief, or the paroxysm may continue for several days, during which delirium or loss of consciousness may become prominent symptoms.

The attack being over, there may remain some symptoms of the nervous prostration for a day or two, but the patient is soon more than usually well for a period of one or several days, and the subjects of the complaint are often extremely vivacious and energetic in the intervals between the attacks. This is, however, not always the case, as a certain proportion of the subjects of this malady are rarely free from a dull headache, pains at the spinous process of the lower cervical vertebra, and at the lower angles of the

« PreviousContinue »