DISORDERS IN RELATION TO THE EYE 785 



and the occurrence of pigmented moles ; vasoconstrictor influence, by cold 

 extremities, inability to stand Winter weather. These migrainettes are 

 spasmophilic to excess, have a pituitary mentality, with a mind for music 

 and rhythm, order and system, business and management, and a tempera- 

 ment to match, which is domineering, suspicious, inquisitive, and often 

 jealous. 



Migraine is, however, by no means limited to, or disproportionately 

 frequent in females. If there is any predilection, it is for the stu- 

 dent, the sedentary, the middle-aged, in short, for the scholar, who is in 

 all three groups. It is remarkable how many scientists, comparatively, 

 have been subjects of migraine. A number of them have described their 

 own history and symptoms with the accuracy and minute attention to de- 

 tail one would expect. Airy was one of the first. 



The vagotonic connotations of migraine as a spastic phenomenon akin 

 to retinal angio-spasm and epilepsy, refer to the analogous spasms in 

 tetany, and to a possible dyscrinism in similar angio-spasms, of which 

 morbid pallor and morbid blushing are the physiological prototypes, such 

 as erythromelalgia, angina cordis, thrombo-angeitis obliterans, and pos- 

 sibly, symmetrical gangrene. The effects of fear, cold, fatigue, via the 

 sympathetic system, on vascular balance, are well known (Bard). The 

 relation of the acidotic and spasmophile factors is indicated in the vascular 

 changes, hemorrhages, and resulting trophic disturbances, particularly 

 of the extremities in scurvy, pellagra, and diabetes. 



The spasmophilic character of migraine is accentuated by its occur- 

 rence in formes frustes, in which there is tonic or clonic spasm of the 

 retinal arteries which might be called an intermittent claudication. These 

 attacks have been observed during ophthalmoscopic examination. It is 

 suggested further, to my mind, by the incidence of a migraine attack with 

 such a vagotonic manifestation as acute indigestion with stomach cramp. 



These considerations, observations accentuate the difficulty of deter- 

 mining in the given case whether headache and migraine are due to an 

 actually determined refraction error or whether they are coincidental 

 to a certain largely pituitary type. For practical purposes of therapy 

 and, possibly, of prophylaxis both factors should be borne in mind. 



To sum up, headache with migraine is one of many vagotonic dis- 

 turbances in clinical ophthalmology, occurring in vagotonic (hypothyroid) 

 individuals, of a vagotonic (hyperopic) eye form, associated with other 

 vagotonic manifestations (spasmophilia) which we have called reflex, 

 and often relieved less by lenses and prisms than by belladonna or other 

 cycloplegic alkaloids which may have been instilled primarily for the 

 purposes of ophthalmoscopic examination and accurate determination of 

 refraction, but which incidentally, but none the less effectually, overcame 

 the vagotonia, ocular and systemic. 



