MEGRIM, OR SICK-HEADACHE. 401 



can expose himself with impunity to certain injurious influences which before would 

 nave brought on the migraine to a certainty. 



This, as we have said, is a very simple form of the malady, and in the majority 

 of cases the phenomena are much more severe. Very frequently the pain continues 

 to increase from the moment of onset until it is almost unendurable, and the patient 

 seems almost as if he would go out of his mind. This is often accompanied by an 

 intolerable sense of nausea, and sooner or later by repeated vomiting. The condition 

 is at this time one of great misery and depression, the suffering closely resembling 

 that of a person thoroughly sea-sick. The attack is often accompanied by affections 

 of sight and other phenomena which will subsequently occupy our attention. 



Megrim undoubtedly occurs more frequently in women than in men ; or, at all 

 events, women apply for relief more frequently than men. The first attack often 

 makes its appearance at the age of seven or eight, or it may be earlier. The age at 

 which the second teeth are cut appears to be especially favourable for its onset. It 

 is not uncommon for women to tell us that the headaches first came on about the 

 age of thirteen or fourteen, "when the periods began." Even in those cases in 

 which the attacks commenced early, and have persisted in a severe form throughout 

 the greater part of life, they are generally found to abate when the patient attains 

 the age of fifty or thereabouts, and they usually cease completely before the onset of 

 old age. It is rare to meet with this malady in old people, and often the attacks 

 appear to reach a maximum of severity about the age of thirty, after which they 

 gradually decline in frequency. In women the seizures may become more severe 

 about the change of life, and diminish again when the critical period has passed. 

 Megrim is in a large number of cases hereditary, and nothing is more common than 

 for the patient to assure you that it is "a family complaint." In one instance with 

 which we are acquainted, the mother and all four daughters suffer from headache. 

 There seems to be in these cases some inherited condition of the nervous system 

 which favours the development of megrim. Sometimes, however, the children do 

 not suffer from the same nervous affection as the parent, but from some allied 

 disorder. For instance, one member of the family may have megrim, a second may 

 be the victim of neuralgia, a third may be subject to fits, a fourth may be a hay- 

 asthmatic, and so on. 



Sick-headache is essentially a paroxysmal or intermittent affection. The malady, 

 it is true, is permanent, and may last a lifetime we know of a case where it has 

 lasted twenty-nine years but it is only manifested at more or less distant intervals, 

 in distinct attacks or seizures of well-defined character and limited duration, the 

 sufferer, as a rule, enjoying good health* in the intervals. The duration of the 

 paroxysm is in different cases very variable, although, in the same individual, it is 

 pretty constant. In some people it lasts only three or four hours, in others seven or 

 eight, whilst it is not uncommon for it to last the whole of the day. We 

 should say that the average duration was from six to twelve hours. In 

 exceptional cases the suffering continues for two or three days, during whict 

 it ebbs and flows, the patient recovering a little, then getting worse again, 

 and so on. A lady recently under treatment assured us that on one occasion 

 she had an attack lasting almost continuously for over a month. The seizures 

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