Pain in the Head

"If one should search for the human ill which has manifested itself most widely during all times and among all peoples, there can be but little doubt that headache would attain this unenviable distinction," wrote Columbia University's Professor Henry Alsop Riley last week.* Therewith he presented a 116-page summary of what is known about "the most baffling and dramatic form of pain in the head"-- migraine. Professor Riley and a half-dozen other able investigators/- are trying to solve the problem, with the Josiah Macy Jr. Foundation paying the expenses of the study. Professor Ludwig Kast of New York Post-Graduate Medical School is coordinating their work.

How Migraine Feels. The brain feels as though a hammer were pounding on the skull, or as though a drill were grinding into the bone. Or an iron hoop seems to tighten around the head. Or the bones of the skull seem about to burst apart like the staves of an overfilled cask. Usually the sickening pain stays to one side of the head. ("Migraine" comes from Latin hemicrania, "half-head.") With many victims the pain shifts around, may even travel down to the neck, shoulders, arms. The skin, particularly the scalp, may be unusually sensitive. Touch, sound, sight vex the victim.

He usually knows when he is going to get an attack of migraine. He begins by feeling lackadaisical. His whole body droops. Eyes grow dull. He cannot think clearly or quickly. He knows when his migraine attack is about over, when he begins to be nauseated. After vomiting the victim is free from sick headaches for a time.

The headache is not in every case a part of the migrainous attack. A person reasonably normal in emotional and psychic make-up may have periodic episodes in which he feels depressed, absentminded, confused. Things and ideas seem strange and unreal to him. He may act like an automaton, swear he is living in both the past and present simultaneously, add up two separate columns of figures at the same time. To be called migraine, such attacks must be short (not more than two days), periodic, not associated with unconsciousness.

Who Suffer. City dwellers more often than country dwellers; brain workers more often than muscle workers. Half the cases get their first attacks between the ages of 20 and 30. But migraine has been recognized in two-year-olds. In some people first attacks come in the 60's.

Most authorities declare that more women than men suffer from migraine. But Dr. William Allan of Charlotte, N. C. offers figures to show that migraine afflicts both sexes equally. He says that more women complain about their sick headaches because the disturbance is apt to be more severe in them. The headaches disappear while a woman bears a child, during the nursing period and after menopause.

Causes. Several theories exist to explain the cause of migrainous, headaches. The "reflex" theory predicates an irritation somewhere in the body. The eyes have been blamed as one of the chief sources of reflex irritation.

The "central" theory supposes that cerebrospinal fluid periodically collects in the skull, causes pressure on the brain. A similar reaction might follow if the head arteries carried an extra amount of blood, or if the head veins emptied themselves too slowly.

Allergy, an individual's special sensitivity to a substance, may account for migraine.

Or a sluggish duodenum may let poisons get into the system. In some cases poorly functioning livers or kidneys seem to be the blame.

Dr. Riley believes that most cases of migraine can be traced to malfunctions of the ductless glands, notably the pituitary and the ovaries. The hormones (messengers) of those glands, he believes, give mischievous information to the nerves which control the contraction & expansion of the brain's arteries. Consequently those arteries go into periodic convulsions. The convulsions make the headache.

The Cure. Since nothing is known positively about the cause or mechanism of migraine, no rational cure exists. Quiet environment, thoroughgoing change of scene or occupation, nourishing food, avoidance of controversy or other excitement, sedative drugs--these are palliatives usually recommended. A few investigators have made their patients comfortable by cutting certain nerves. But that procedure, says Dr. Riley, is dangerous if only because the surgeons do not know exactly what nerves are involved in the migraine complex. He suggests attacking the problem by trying to prevent convulsions of blood vessels within the skull. At the same time he is trying to establish a healthy balance among the migraine victim's hormones.

One point of the wholesale study of migraine which is now going on astonishes every investigator. Very few people who have had migraine have had their heads examined after death.

* In the Bulletin of the Neurological Institute of New York.

/-William Ferdinand Petersen, University of Illinois; Victor Caryl Myers, Western Reserve University; Andrew Conway Ivy, Northwestern University; George Draper, Columbia; Foster Kennedy, Cornell University Medical College; Stanley Cobb, Harvard.

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