Hemicrania

HEMICRANIA, hemikraniya (from Greek he-mi- meaning half and cranion meaning skull), a peculiar disease also known under the name of migraine, characterized by attacks of headache affecting one half of the head or even part of it (temporal, occipital, or frontal regions), but sometimes spreading to the entire head. The headache is often accompanied by nausea and vomiting, and in addition, there is sometimes observed a temporary decrease or even complete cessation of functions of the most diverse motor and sensory brain centers (aphasia and others). Etiology and pathogenesis. The exact pathogenesis of H. is still unclear at present; the main etiological factor must be considered hereditary predisposition, which apparently consists of defective structure of the blood-distribution apparatus and perhaps in anomalies of the hormonal system. Usually there is direct congenital transmission from older generations, predominantly along the female line, with several members of the family becoming ill (more often women). Often the disease manifests itself from childhood or adolescence without any additional cause, but sometimes the onset of suffering is preceded by various exogenous factors that weaken the nervous system (psychological and physical fatigue, insomnia, hunger, alcohol, and especially, irregularities in sexual life). To explain the origin of attacks of H., a large number of theories have been proposed, some of which have only historical interest (reflex theory--vascular spasm on the basis of irritation from internal organs; mechanical theory--discrepancy in volume between the skull and brain in conditions of cerebral hyperemia; theory identifying H. with epilepsy; rheumatic theory, etc.). The largest number of theories connects H. with auto-intoxications and metabolic disorders (gout, etc.) on the basis of disorders of the autonomic nervous system and endocrine glands. Taking into account that the immediate cause of H. are vasomotor phenomena (hemicrania spastica et hemicrania paralytica), and the fact that the disease most often begins during puberty, i.e., during the period of most intense activity of the endocrine glands, and is also often associated with the menstrual cycle and climacterium, it must be assumed that these latter theories are closest to the truth. Clinic. Attacks of H. are often preceded by prodromal phenomena, which have much in common with neurasthenic symptoms (heaviness in the head, inability to work, apathy, dejection, general weakness, various paresthesias, etc.). The headache gradually intensifies and eventually becomes unbearable. Usually the pain begins on one side, later sometimes spreading to the entire head or, after ceasing on one side, moving to the other. In other cases, the pain is localized along the branches of the trigeminal nerve and the branches of the cervical plexus. During the attack, repeated nausea is often observed, and sometimes vomiting, after which the patient feels some relief. A characteristic symptom is scintillating scotoma, which is more often observed on one side. In rare cases, paralysis of the oculomotor and facial nerves, motor aphasia, and other phenomena of loss of brain functions may appear. The psyche also does not remain unaffected and usually reacts with a neurasthenic or depressive state, but in some cases it progresses to confusion and complete loss of consciousness, and sometimes mental disorder is even an equivalent of the attack. Vasomotor phenomena are almost never absent and are expressed in two forms: 1) the face pales, pupils dilate, temperature in the external auditory canal decreases by 0.4-0.6° (hemicrania spastica); 2) the face reddens, the pupil narrows, temperature in the external auditory canal rises, the conjunctiva is hyperemic, arteries pulsate, tear secretion increases, the affected side sweats (hemicrania paralytica). The attack lasts for several hours and often passes if the patient manages to fall asleep, but sometimes it lasts for several days and confines the patient to bed. Individual attacks, in the intervals between which the patient feels completely healthy, sometimes recur according to a definite pattern after 1, 3, 5 weeks, often coinciding in women with menstrual bleeding, but usually their frequency is very different and depends to a large extent on those harmful exogenous factors mentioned above. Beginning in early childhood, and often during puberty, H. sometimes does not leave the patient for his entire life, but often disappears for many years, manifesting itself with renewed force at the beginning of the involutionary period, only to cease completely thereafter. Diagnosis. Typical cases of H. are easily diagnosed and hardly can be confused with other diseases, but where symptoms are scarce, differential diagnosis is sometimes difficult. One of the main symptoms of H.--headache--can depend on a huge number of the most diverse causes (see Symptomatic pains, Headache). Another characteristic symptom--vomiting--is also often observed in other conditions, especially in organic diseases of the brain and its membranes (tumors, abscesses, meningitis, etc.); in these cases, one must take into account the entire complex of other phenomena. Finally, in trigeminal neuralgia, attacks are more frequent and at the same time short-lived, and in addition, there are painful points on the face. Prevention plays a huge role in H. and should be directed mainly against all those influences that disrupt the functioning of the blood-distribution apparatus. It includes: 1) restriction of meat food, 2) care for proper bowel movements, 3) prohibition of alcohol, nicotine, caffeine, and spices, 4) proper distribution of work and rest, 5) sufficient time for sleep, 6) for mental workers--physical work and sports in the fresh air, 7) regulation of sexual life (especially - in the sense of eliminating contraceptive measures) and others. Treatment of H. must be divided into two parts: 1) general treatment of the entire disease and 2) stopping or alleviating individual attacks. General treatment includes: 1) hygienic and strengthening measures; 2) treatment of existing chronic diseases and especially metabolic disorders; 3) antisyphilitic treatment (see Syphilis) at the slightest hint of syphilis in the patient himself or in his family, and 4) in other cases--antiepileptic treatment (see Epilepsy), if there are epileptics in the patient's family, but also in other cases, along with other therapy, one can try prolonged treatment with luminal (0.1-0.05 at night). For treating individual attacks in terms of stopping or reducing their intensity and shortening their duration, pharmacotherapy is mainly used. At the very beginning of the attack, the patient must be isolated from external impressions and noise, put him in a dark room, and apply heat or cold to the head (spastic or paralytic form). Orally, depending on the form of H., vasodilators and vasoconstrictors are given, many of which are also analgesics (aspirin, pyramidon, antipyrine, migrainin, phenacetin, caffeine, etc.). In spastic forms, a good effect is achieved by intravenous administration of calcium chloride (5 cubic cm of 10% solution).

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Dekhterev.