CERVICO-OCCIPITAL NEURALGIA. 333 



retching, vomiting, by which quantities of a very bitter greenish fluid 

 are evacuated. Patients who have frequent attacks of migraine, usu- 

 ally long for the commencement of vomiting, and even try to excite 

 it by irritation of the pharynx. Generally, toward evening, rarely 

 earlier, the patient falls asleep, and awakes next morning free from 

 pain, although much depressed. The disease never threatens life; 

 but, although the attacks sometimes occur at shorter or longer inter- 

 vals, patients rarely entirely recover from the disease. In women 

 alone, particularly those who have the migraine at their menstrual pe- 

 riods, the disease occasionally ceases at the change of life. 



Watson asserts that " four to six drops of liquor arsenicalis, given 

 three or four times daily, with attention to the digestion, effected a 

 cure in ten cases of hemicrania ; " but this assertion is a solitary one ; 

 most other observers say that the disease generally resists all treat- 

 ment. Nor have I seen any decided benefit from arsenic, pulsatilla, 

 marsh-trefoil, or from the very expensive citrate of caffein (which is 

 also called a specific), of which we prescribe pills (I caffein citr. gr. x, 

 ext. grani [Triticum repens] &] ; ft. pil. 10), and, to cut short the at- 

 tack, give one or two of these pills every hour on the first symptoms, 

 or from the paulinia sorbilis, which is prescribed in the form of pasta 

 guarana Qss ^j. One patient prepared for herself an infusion of 

 unroasted coffee, and, as long as she drank this daily, appeared to have 

 the attacks more rarely and less severely. Another patient escaped 

 the attacks as long as she took sea-baths at Ha'ringsdorf ; but, when 

 she returned home, they began again. In most cases we can do noth- 

 ing but attend to existing disturbances of the general health and of 

 the digestion, and the chances of benefit from treatment are much 

 greater where we can discover any such disturbances. During the 

 attack we should spare the patients from the use of any remedies, and 

 let them take nothing but water. It is best for the patient not to trv 

 to defy the attacks, but to go to bed early. 



CHAPTER VI. 



CERVICO-OCCIPITAL NEURALGIA. 



CERVico-occrPiTAL neuralgia, or neuralgia of the sensory nerves of 

 the occiput, neck, and nape of the neck, which originates from the first 

 four cervical nerves, is far more rare than facial neuralgia. The cases 

 known, up to the present time, are not sufficiently numerous to give 

 us any thing definite concerning the etiology. From the observations 

 of Vatteix, according to which the disease often began after prolonged 

 exposure to cold, and from one case where relapses often occurred, and 



