784 PERCY FRIDENBERG 



Vagotonic Headache and Migraine. The complaint association of more 

 or less marked pain about the eyes and brow, over the vertex, or in the 

 occipital region, radiating at times to the neck and shoulders, and included 

 in the term of headache, is so usual in ametropia and eye^strain that it 

 deserves more than passing mention and some study from the endocrin- 

 ological standpoint. 



As a purely ophthalmological consideration we must bear in mind 

 that eye-strain with the largely spastic local and reflex symptoms sched- 

 uled above is predominantly a legacy of hyperopia with or without astig- 

 matism. Furthermore, it is significant that small degrees of refraction 

 error and of muscular imbalance are often attended with what seems to be 

 a quite disproportionate amount of suffering, and that even the most care- 

 ful correction of the ametropia even to quarter-dioptries and half de- 

 grees of cylinder axis not infrequently fail to relieve. In vain, as has 

 been said, do we pile prismatic Pelia on nasal Ossa. The patients come 

 to us with a bushel of spectacles, all carefully fitted, and persistent head- 

 ache and eye-strain. On the other hand, we are often surprised to find 

 decided refraction error in the course of examination of patients who say 

 they have never had a headache in their lives. This may be explained 

 in part by the fact that minimal errors interfere but slightly with vision 

 and what is more important, with the effort to obtain perfect vision. 

 In the more marked ametropias, especially the myopic forms with decided 

 deterioration of vision, there is 110 incentive, if it may be so called, to 

 strain the muscles of fixation or of accommodation. On the contrary, 

 the choice of short range eye work by these subjects brings about an auto- 

 matic adjustment between visual exertion and visual acuity which is 

 beyond the range of the hyperop whose troubles increase as his work is 

 brought nearer to the eyes. 



These optical factors do not, however, account for all the phenomena 

 of 'ocular headache, eye-strain and its reflexes, or of the vertigo and, most 

 significant of all, of the migraine with which it is so frequently associated. 

 This symptom has some decidedly vagotonic ear marks, including its ex- 

 quisite and familial and hereditary character noted by Barker, who 

 also calls attention to its frequency in hypertensives whose tendency to 

 migraine is a constitutional inferiority based 011 a labile vasomotor nerv- 

 ous system. 



Migraine and related types of headache seem to affect by preference 

 individuals of a certain eiidocrin type and inheritance. The females of 

 this species are relative hypothyroids, with much pigment, hair,, and fat 

 irregularly and abnormally distributed, a viraginoid or frankly masculine 

 (adrenal-pituitary) make-up both structurally and temperamentally, and 

 invariably show late, scanty and painful menstruation. The lack of thy- 

 roid immunizing hormone is indicated by tendency to pimples and other 

 skin infections ; the adrenal dominance, by hair on the shins and upper lip, 



