Headaches.

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FINLEY ELLINGWOOD, M. D., CHICAGO

Perhaps there are no more puzzling conditions to contend with than those of headaches. They depend upon so many different causes and so many different conditions that each one is almost a separate study in itself. In an article in a recent number of the Journal of the A. M. A. an observation was made of 1700 cases from which the following conclusions were drawn:

  1. A neuropathic diathesis is an essential condition of the occurrence of almost all the chronic headaches of the class discussed, the only exceptions being cases in which other causes exist to an excessive degree.
  2. In the great majority there is, in addition to the neuropathic diathesis, some local irritation to the nervous system, often manifesting itself by the headache alone.
  3. A minority of patients are sufferers from anemia or toxemia, in addition to the neuropathy, which may manifest itself in no other subjective symptom of importance.
  4. The more marked the neuropathic tendencies, the less need be the degree of anemia or toxemia, and vice versa.
  5. In some cases, often the most severe ones, a local irritation of the nervous system is reinforced by a toxemia.
  6. There are a number of what may be called composite headaches, in which two or more local irritations combine to intensify sufferer's neuropathic tendencies and cause the headache.

The authors find the location of the headache the most useful single symptom for pointing out its cause. They class headaches as (1) frontal, (2) temporal, (3) occipital, (4) vertical, (5) parietal, (6) circular, (band around the head), and (7) general headaches.

Mixed forms however, are not uncommon, and very severe headache tends to become widely diffused. The true type in such case is often indicated by the point of greatest tenderness to pressure, or, better, by the point where it began.

The local irritations are, approximately, in the order of their frequency:

  1. Irritation from the eyes, (a) frontal, usually due to astigmatism; (b) occipital, often due to muscular imbalance; (c) temporal, muscular imbalance or hypermetropia; (d) or deep seated in the eyes from retinal irritability.
  2. Irritation from the nose and accessory sinuses, usually frontal, more liable to be unilateral than in those due to eye-strain, and confined often to a definite limited spot over the root of the nose or on one side of the forehead.
    These are apt to be morning headaches, and the pain is often duller and deeper seated than that from eye-strain.
  3. From pelvic disorders in women; vertical when due to disease of the lining of the body of the uterus, and occipital when due to retro-displacement, posterior parametritis, or ovarian disease. These headaches are practically always bilateral, and may be aggravated or relieved by menstruation.
  4. Gastric headaches, from indigestion, hyperacidity, hypoacidity, etc. These are practically always frontal or bilateral, and more commonly located in the upper portion of the forehead than are headaches due to the eyes or nasopharynx.
  5. Irritation from the teeth, especially decayed teeth in the upper jaw, and the eye teeth and third molar in particular. They are usually temporal when from diseased molars, and frontal when from the eye teeth. They are frequently unilateral.
  6. A few cases due to the ears, sometimes to the mere presence of wax or stoppage of the Eustachian tube. They are almost the only parietal headaches from local irritation, and may be unilateral or bilateral. The characteristic headache of anemia is vertical.

Toxemic headaches are commonly described as of the whole upper part of the head, or as band-like or constricting. Their occurrence has frequently a relation to the time of absorption of the poison, and it may correspond with some nervous distribution, as of the occipital or upper division of the fifth.

Migraine is treated of at some length, and the authors consider it practically always due to eye-strain in neuropathic individuals, but the immediate cause of the attacks may be recurring conditions of toxemia which would so affect a less neurotic individual.

Special directions are given as to thoroughness in the examination of the eyes in this condition, as well as regards the treatment. The authors consider the removal of local irritation the fundamental part of the treatment in headache, though general measures, tonics, hygiene, gymnastics, etc., as well as medicinal agents, are not to be neglected.

Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.