404 THE TREATMENT OF DISEASES. 



Atmospheric changes, changes of season or weather, are regarded by some as 

 exciting causes of the seizures. Our patient is always very bad when it is frosty, 

 particularly if there should happen to be a cold, cutting wind blowing at the same 

 time. When at home she always goes about with her head done up in flannel. 

 The slightest exposure to the sun would be sure to bring on an attack. She is often 

 afraid to open the door to any one when the sun is shining, for she knows that 

 directly it falls on her head her sufferings begin. A bright light never affects her 

 in any way it must be the sun. Heat, she says, is very unpleasant to her, and the 

 heat of the fire would be sure to bring it on. She cannot even do a bit of toast 

 without holding something in front of her to ward off the fire. Cold is with her 

 almost as bad as heat. Any little exposure of the head to cold or draught would be 

 sure to excite it; even going out of the kitchen into the scullery for a minute 

 would do it. 



The susceptibility to megrim is aggravated by anything tending to lower the 

 standard of health for example, exhausting discharges, prolonged indigestion, or 

 disordered bowels. Mental exertion, if too close or continuous, has a similar effect 

 indeed, the complaint is not unfrequently developed by excessive study, coupled with 

 a deficiency of out-door exercise. 



We must now describe more fully the headache which is so conspicuous a feature 

 of megrim. The pain presents every variety in different individuals, and sometimes 

 in different attacks, but in the majority of cases it is for a time at least very severe. 

 Occasionally it exhibits that intense and agonising character often met with in 

 neuralgia. It is generally moderate w"hen first felt, and gradually rises, sometimes 

 very quickly, to a great pitch of intensity ; this is maintained for a certain time, and 

 then it begins to decline again. With some there seem to be something like remis- 

 sions and exacerbations ; the pain does not always maintain the same degree of 

 severity throughout its course ; it is often extreme for some minutes, then subsides, 

 to return again with the same intensity. The pain may be stabbing or darting in 

 character, but it is differently described by different people. They are all agreed, 

 however, that when it reaches its full development it is most distressing, and very 

 hard to bear. Most sufferers state that it is terribly aggravated by movement of 

 any kind. When at its height, light and noise are most unbearable, and the patient 

 is compelled to be still and keep the room as dark and quiet as possible. In ex- 

 ceptional cases, however, the pain may be of that intolerable character, that to keep 

 in one position for any length of time is impossible, and the patient has to get up 

 and move about. Sometimes the headache is limited strictly to one side, but more 

 commonly it oversteps the median line. The pain, however, seldom affects the 

 whole head, but one particular part of it, most commonly the forehead, over one 01 

 both eyes. Next to the brow the temple is the most common seat of the pain. In 

 some cases it seems to be focussed on one spot, and then it is that it attains its 

 maximum severity. In cases in which the pain has been most agonising, it has 

 often been confined to a little spot over one eyebrow or temple. As a rule the 

 excessive violence of the pain lasts only a few hours; mostly, however, it is not until 

 from eight to twelve hours that the pain becomes bearable. It may be twenty-four 

 hours or even longer before the last of the uneasiness disappears. 



