Migraine or Hemicrania and it is a sometimes known from the Greek word for half a skull, is a common condition characterized by recurring intense headaches, which has claimed many distinguished victims, including Prince Albert, the Prince Consort, and Lewis Carroll. It is much commoner in women than men.
It usually begins at puberty and often tends to stop in middle age; eg. In women attacks often cease after the change of life. It often disappears during pregnancy. In susceptible individuals attacks may be provoked by a wide variety of causes including:
- Anxiety, worry, emotion, depression, shock and excitement.
- Physical and mental fatigue.
- Bending or stooping, as in gardening.
- Lifting heavy weights, or straining of any sort.
- Changes of routine: eg. holidays or change of job.
- Late rising, especially at weekends or on holiday.
- Change in climate.
- Changes in weather; eg. high winds.
- Fluorescent lights, car headlights, direct or interrupted bright sunlight and striped patterns.
- Prolonged focusing on television or cinema screen.
- Very hot baths.
- Noise, especially loud and high pitched sounds.
- Penetrating smells.
- Certain foods: eg. chocolate, cheese, citrus, fruits, pastry.
- Sleeping tablets.
- Prolongrd lack of food.
- Irregular meals.
- Menstruation and the premenstrual period.
- Continued use of oral contraceptives.
Indeed, it has been said that anything that can provoke a headache in the ordinary individual can precipitate an attack in a migranious subject. It seems as if there is an inherited predisposition that triggers a mechanism whereby in the migranious subject the headache, and the associated sickness persist for hours, a whole day or even longer.
The precise cause is not known, but the generally accepted view is that in susceptible individuals one or other of these causes produces spasm or constriction of the blood-vessels which also become more permeable and so allow fluid to pass out into the surrounding tissues. This combination of dilation and outpouring of fluid is held to be responsible for the headache.
An alternative theory is that the fluid contains certain substances, such as prostaglandins, which lower the threshold for pain and so increase the liability of the individual to feel pain. Recent work suggests that migraine may be due to a specific biochemical deficiency: namely, lack of a substance known as monoamine oxidase. This is an enzyme which destroys any excess which may accumulate in the body of what are known as vasoactive amines. These are substances responsible for controlling blood-vessels, causing them to dilate or constrict, and it is known that some of this vasoactive amines, including thyramine (which is found in cheese) and phenylethylamine (which is found in chocolate), can provoke attacks of migraine in susceptible people. The suggestion therefore is that these people are born with a lack of monoamine oxidase and are thus liable to develop an attack of migraine on eating cheese or chocolate. As there are other vasoactive amines that are concerned with attacks of migraine, this suggested lack of monoamine oxidase may solve the age-old mystery of why some people develop migraine.
The typical attack is very characteristic. It consists of an intense headache, usually situated over one or other eye. The headache is usually preceded by a feeling of sickness and blurring of sight. In some cases this disturbance of sight takes the form of bright lights: the so-called aura of migraine. The majority of attacks are accompanied by vomiting. The duration of the headache varies, but in the more severe cases the victim is usually confined to bed for twenty-four hours.
Hay fever, otherwise known as SUMMER CATARRH, and in America as AUTUMN CATARRH, means allergic condition of the mucous membranes of the eyes, nose and air passages, which year after year affects certain individuals during the summer and early autumn.
Hay fever is an allergic reaction in individuals who are hypersensitive to the pollens of grasses, weeds or trees. This explains the seasonal distribution of the disease.
The tendency to develop hay fever runs in certain families. What is inherited in these families is what might be described as an allergic constitution. Only some members of these families will develop hay fever, whilst others may develop other allergic manifestations, such as asthma, eczema, or food allergy.
The age of onset ranges from infancy to the 60’s but is most common in late adolescence. Spontaneous cures are not uncommon, but there may be a remission later in life.
Hay fever recurs with regularity during the summer months in those susceptible to it. It begins with an itching of the eyes and nose, followed by symptoms of a severe cold or influenza, such as headache, violent sneezing, and profuse watery discharge from the eyes and nose, together with dry, hard cough, and occasionally severe asthmatic paroxysms.
Sciatica means pain in the distribution of the sciatica nerve. It is often accompanied by pain in the back, or lumbago.
It may be due to a number of causes, such as a tumour in the spine or spinal colums, tuberculosis of the spine, ankylosing spondylitis or a tumour in one of the organs in the pelvis such as a uterus. In the vast majority of cases, however, it is due to a prolapsed intervertebral disc pressing on one or more of the nerve roots issuing from the lower part of the spinal cord that make up the sciatic nerve. The precise distribution of the pain will thus depend on which of the nerve roots are affected.
As a rule, the pain is felt in the buttock, the back of the thigh and the outside and front of the leg, sometimes extending on to the top of the foot. In other cases the pain is felt in the buttock, the back of the thigh and the calf, and then along the outer border of the foot towards the little toe. What probably happens is that degenerative changes take place in the annulus fibrosis. Ultimately this ruptures, either as a result of some special strain such as is induced by heavy lifting, or spontaneously. The cushioning disc between the two neighbouring vertebral bodies slips through the rent in a annulus fibrosus, and presses on the neighbouring roots, thus causing the pain.
The condition usually occurs in adults in adults under the age of 60. The pain may come on suddenly when the person concerned is undertaking some unusual effort, such as heavy lifting, and may be so severe that the victim faints and, when he comes to, he may be locked in one position. More commonly it comes on gradually and keeps recurring over long periods of time. In these cases the amount of pain varies tremendously: from little more than a recurrent nuisance to a pain of almost unbearable intensity.