GENERAL ARTICLES

It's a Headache

Migraine, tops in misery, is often hereditary but the doctor can help you to help yourself

HERBERT WHEELER April 1 1945
GENERAL ARTICLES

It's a Headache

Migraine, tops in misery, is often hereditary but the doctor can help you to help yourself

HERBERT WHEELER April 1 1945

It's a Headache

Migraine, tops in misery, is often hereditary but the doctor can help you to help yourself

HERBERT WHEELER

AT THIS very moment there are thousands of people looking for a quiet, dark nook where they may lie down and be alone. They are wretchedly uncomfortable, and, like the seasick sailor, their greatest fear is not that they will die but rather that it will take them a long time to do so. Of course they never do die of their illness but that is small consolation to them at the moment. They are in the midst of an attack of migraine.

Migraine is a headache! But it is a rather special kind of headache, one might say—the aristocrat of headaches. It is an affliction which is usually found in people of a high-strung, sensitive and artistic temperament. These individuals will frequently tell you that they were carsick or trainsick as children. They are frequently the ones who had allergic rashes, or hay fever, or asthmalike episodes.

Migraine headaches have ancestral pride. They appear to be familial, so that one may trace their heredity through several generations of relatives. They are almost a family ghost, and much more uncomfortable.

Migraine is peculiarly a disease of civilization. As daily living becomes increasingly more complicated there is a corresponding increase in the incidence of migraine. As a rule it seems to affect individuals of somewhat more than average intelligence. They have great ambitions and expend large amounts of energy in accomplishing their purpose. The banker is more likely to succumb than his teller; the managing director rather than the filing clerk; the dress designer rather than the seamstress.

This illness is more common among women than men. It usually appears during adolescence, and rarely lasts beyond the menopause—change of life. Thus it affects the most active and productive years of a person’s life. Finally, it should be added, it is more than likely that the victim will tend to be prematurely grey.

Now what is this disease? Can it be differentiated

from other types of headaches? What can be done to treat it?

Migraine exhibits a number of symptoms which could be caused by any one of a number of different disturbances and abnormalities in the body. There are excellent authorities in the medical profession who feel that migraine is primarily a psychological illness. That is, it is a group of symptoms resulting from emotional disturbance. Its treatment, according to these doctors, is primarily psychiatric. They assist the patient to discover what his deep, underlying personal problems are, and help him to face and solve them. By so doing they feel they can relieve the tensions and the anxieties—the emotional turmoil— and remove the headaches which had resulted.

However, another eminent group of physicians believe that migraine is a purely allergic disease, and its management is therefore directed along lines which will determine the substances to which the patient is allergic. He should then be desensitized to these substances so that they can no longer cause symptoms.

A third group, the internists, feel that the disease is caused by spasmodic contractions and dilations of the blood vessels of the brain. And the neurologists tend to believe that an instability of part of the nervous system is at fault. At the present time most physicians are inclined to feel that all of these factors are involved in greater or lesser degree.

The symptoms of migraine are variable in severity and in number in different individuals, but the outstanding and cardinal symptom is headache. This is usually located in the same area of the head with each attack, and is usually one-sided—involving either the right or left side, or front or back, rather than the whole head. The headache is usually accompanied by nausea, vomiting, disturbances of vision, bowel and bladder upsets, chilliness, and intolerance to noise and light. Preceding the attack of headache the patient may have an aura, a warning, in the form of ringing in the ears or spots before the eyes. During the attack there may be restlessness, depression, or even confusion. Following it there may be extreme fatigue or a feeling of well-being.

The attacks occur irregularly, without any definite frequency or rhythm. Frequently they are preceded by an unusually refreshing sleep the night before. Then, when the victim feels his best and is ready to take the world by the horns, they sneak up to throw him over. They are literally storms that break the calm flow of daily life.

Typical Case History

THE typical attack of migraine could perhaps best be illustrated by the case of Lenore G. She was a young woman of 22 who had obtained a position as a teacher in one of the best private schools two months before her first attack. Review of her past history

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It’s a Headache

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revealed her to have come from a highly respectable, closely knit family. For lack of funds she had had to work her way through school. Being a betterthan - average student and a hard worker, she had been granted a scholarship through college. It had always been her ambition to become a teacher and now she had achieved her goal.

All her life she had been a highstrung, restless person, continually on the go. As a child she had suffered from carsickness, so that every trip she made in an automobile was an ordeal if it lasted more than 10 minutes. In high school she had been subject to asthmalike episodes, and had been found to be allergic to several different substances. She was desensitized to these.

There was a strong familial tendency toward headaches on her mother’s side. Her mother and grandfather, as well as several of her cousins, were victims of migraine headaches.

As mentioned before, Lenore’s first attack of migraine occurred two months after she began to teach. One morning, after a particularly refreshing night’s sleep, she suddenly had a vague, peculiar feeling. Within a few moments she noticed black spots floating and shimmering before her eyes, with colored lights shooting through. She became frightened and tense. Then her hands became numb, she became pale, and she felt chilly. About 10 minutes later there began a severe throbbing headache, involving the right half of her head only. She became very irritable and was distressed by the ordinary whispering of the children in her class. She had to be relieved of her class, and lay down in the teachers’ lounge, with all the shades drawn. After a half hour of this misery she felt nauseated, and this increased as her headache increased in intensity. Finally, an hour later, she became so ill that she had to vomit. No sooner had she vomited than her headache improved, and she was completely free of it a short while later. Now, however, she was markedly exhausted and had to be taken home. She immediately fell into a deep sleep, and then wakened, feeling as well as ever. Thereafter the attacks came at inconstant intervals, but always followed the same pattern. It was only after she consulted a physician and received treatment that she could find sufficient relief to return to normal living.

Suspicious Symptoms

Any patient who presents himself with complaints of headache on one side of the head, associated with some of the above-mentioned symptoms, should be suspected of having migraine. This suspicion may be further strengthened by obtaining a history of headaches of a similar sort in other members of the family. Then, after thorough physical and neurological examination to make certain there is no illness like high blood pressure, no sinus infection or eye trouble, and no disease of the brain such as tumor, the doctor may feel reasonably certain that he is dealing with migraine.

One further test may be performed before a diagnosis of migraine is made. This is a histamine sensitivity test. Histamine is a chemical which is normally formed in the body in all individuals. Some people are especially sensitive to it, and may have various symptomatic disturbances from it. One of these is headache. To determine whether the patient is unduly sensitive to histamine the doctor simply injects a

liny drop cf a very dilute solution of histamine into the skin. If the person is sensitive a blister will appear, with irregular projections streaking from the centre, and lasting about half an hour. Such a patient may be suffering from the type of headache called histamine cephalalgia, rather than from migraine. The doctor may cure him by repeated injections of increasing quantities of histamine, thereby desensitizing him so that he no longer reacts to the drug, and suffers no more headaches.

Method of Treatment

Now if all other causes of recurring headaches have been excluded and you find you really have migraine, what can be done for you, and what can you do for yourself? First of all your personal hygiene should be overhauled. Are you living quietly and sanely, without excesses? Are you eating a balanced diet and maintaining normal weight? Are you working and recreating regularly? Do you get enough exercise and sufficient sleep? You should avoid undue excitement as much as possible and indulge sparingly in alcoholic beverages. You should develop a circle of congenial friends and a diversity of interests and hobbies, so that you can obtain satisfaction both at work and at play. All this will diminish the number of attacks.

Both the physician and you, the patient, should obtain a sympathetic understanding of your personality and life situation. By regarding your physician as a trusted confidant, and raspecting his judgment, you will be able to discuss your emotional difficulties with him. You will find that intelligent discussion with your doctor will aid you in uncovering and recognizing many deep-seated problems and attitudes causing the worry and unhappiness which are distressing you. Once these are aired and understood they may be solved efficiently and satisfactorily. It will be the difference between living in a comfortable home or in a dilapidated house haunted by imaginary ghosts.

As an example of the psychiatricaspect of this disease the story of Martin C. may be cited. He had had typical symptoms of migraine headaches for four years, since the age of 19. He had visited many doctors and taken innumerable medicines, with only slight relief. One day he consulted a physician who was not satisfied simply to listen to his recital of symptoms and of past remedies tried and discarded. He also enquired of Martin’s personal life. They talked of Martin’s work, his interests, his hobbies, his ambitions, his pleasures and

his worries. Martin revealed he had been courting a girl since they were in high school together. They both wanted to marry but were unable to do so because Martin was supporting his mother and invalid father. He had two brothers and a sister but they were all married and did not participate in the financial care of their parents.

After a number of interviews Martin recognized the relation between his headaches and the emotional turmoil engendered by a frustrated love affair. Further discussion led him to recognize that the responsibility for his parents was not solely his but must also become the concern of the other children. His next step was to insist that they contribute a fair share and relieve him of part of the burden. That accomplished he was able to marry. Martin is now the father of two children—and his last attack of migraine occurred six years ago.

Chemical Therapy

Beside these hygienic measures there are two excellent medications now available for use during the attack. One of these is a substance called ergotamine tartrate. It should be administered by injection under the skin as soon as possible after an attack has started. In the majority of these patients this medicine will relieve or completely stop the attack. Within a short time you can be taught to administer the injection to yourself as soon as you feel an attack coming on. Some physicians prescribe this drug in the form of tablets, to be taken by mouth, in an attempt to prevent an episode of headache. The drug is not habit forming and is not expensive, but should be taken only under supervision of a doctor, for it may cause unpleasant reactions if taken in improper dosage.

The second measure which may be employed to relieve the attack is the use of oxygen. The patient is given 100% oxygen to breathe through an oxygen mask for about half an hour. Many people who are not helped by ergotamine tartrate respond excellently to oxygen therapy. If this is found to be the case, the doctor may advise the patient to purchase one of the small oxygen kits on the market and have it readily available when needed.

Migraine need not rob you of days of useful work, of hours of pleasure and contentment. No longer need you dread each morning for fear that day will bring another attack. Between ergotamine tartrate and a re-education in sensible living most patients can recognize and overcome their symptoms. Migraine is a headache, but it can be controlled!