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There may be some warning of the approach of a sick headache, as mental depression, weariness, disturbances of sight, buzzing in the ears, or dizziness. The pain begins at one spot on one side of the head (more commonly the left), as in the eye, temple, or forehead, and later spreads over the whole side of the head and, in some cases, the neck and arm. The face may be pale, or pale on one side and red on the other. The headache is of a violent, boring nature, aggravated by light and noise, so that the patient is incapacitated for any exertion and is most comfortable when lying down in a quiet, dark room. Vomiting usually comes on after a while, and often gives relief. The headache lasts several hours or all day, rarely longer. The duration is usually about the same in the case of any particular individual who is suddenly relieved at a certain hour generally after vomiting, a feeling of well-being and an enormous appetite following often. Patients may feel perfectly well between the attacks, but if they occur frequently the general health suffers.

In the majority of cases there is no apparent cause discoverable save heredity, and for these the following treatment is applicable. Each case should, however, be carefully studied by a physician, if possible, as only in this way can any existing cause be found and removed.

Treatment. Any article of diet which experience has shown to provoke an attack should naturally be

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avoided. A Seidlitz powder, or tablespoonful of Epsom salts in a glassful of water, is advisable at the onset of an attack. Rubbing the forehead with a menthol pencil will afford some relief. Hot strong tea with lemon juice is sometimes of service. To actually lessen the pain one of the following may be tried: phenacetin (eight grains) and repeat once in an hour if necessary until three doses are taken by an adult; or, migraine tablets, two in number, and do not repeat; or fluid extract of cannabis indica, two drops every half hour until relieved, or until six doses are taken.

HEADACHE FROM VARIOUS CAUSES.-It is impossible to decide from the location or nature of the pain alone to what variety of headache it belongs, that is, as to its cause. It is only by considering the general condition of the body that such a decision can be attained.

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Headache from Indigestion. The pain is more often in the forehead, but may be in the top or back of the head. The headache may last for hours, or " off and on" for days. Dull headache is seen in "bilious" when the whites of the eyes are slightly tinged with yellow and the tongue coated and yellowish, and perhaps dizziness, disturbances of sight and a feeling of depression are present. Among other signs of headache due to indigestion are: discomfort in the stomach and bowels, constipation, nausea and vomiting, belching of wind, hiccough, and tender or painful eyeballs.

In a general way, treatment for this sort of headache consists in the use of a cathartic, such as calomel (three-fifths of a grain) at night, followed by a Seidlitz powder or a tablespoonful of Epsom salts in a glass of cold water in the morning. A simple diet, as very small meals of milk, bread, toast, crackers with cereals, soups, and perhaps a little steak, chop, or fresh fish for a few days, may be sufficient to complete the

cure.

Sympathetic Headaches.-These are caused by irritation in various parts of the body, which is conveyed through the nervous system to the brain producing headache. Headache from eye-strain is one of this class, and probably the most common, and, therefore, most important of all headaches. There is unfortunately no sure sign by which we can tell eye-headaches from others, except examination of the eyes (see p. 29). Redness, twitching, and soreness of the eyelids, and watering of the eyes, together with headache, after their excessive use may suggest the cause in some cases. The pain may be occasioned or almost constant, and either about the eyes, forehead, top or back of the head, and often takes the form of "sick headache." The headache may at times appear to have no connection with use of the eyes. When headache is frequent the eyes should always be examined by a competent oculist (a physician) not by any sort of an optician.

Decayed Teeth.-These not uncommonly give rise to headache.

Disorders of the Nose and Throat.-Such troubles, especially adenoids and enlarged tonsils in children, enlarged turbinates, and polypi (see Nose Disorders, p. 60) are fruitful sources of headache. In nose-headaches there is often tenderness on pressing on the inner wall of the bony socket inclosing the eyeball.

Diseases of the Maternal Organs. These in women produce headache, particularly pain in the back of the head. If local symptoms are also present, as backache (low down), leucorrhoea, painful monthly periods, and irregular or excessive flowing, or trouble in urinating, then the cause of the headache is probably some disorder which can be cured at the hands of a skillful specialist in women's diseases.

Nervous Headaches. These occur in brain exhaustion and anæmia, and in nervous exhaustion. There is a feeling of pressure or weight at the back of the head or neck, rather than real pain. This is often relieved by lying down. Headache from anæmia is often associated with pallor of the face and lips, shortness of the breath, weakness, and palpitation of the heart. Rest, abundance of sleep, change of scene, out-of-door life, nourishing food, milk, cream, butter, eggs, meat, and iron are useful in aiding a return to health (see Nervous Exhaustion, Vol. III, p. 17).

Neuralgic Headaches. The pain is usually of a shooting character, and the scalp is often exceedingly tender to pressure. They may be caused by exposure

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to cold, or by decayed teeth, or sometimes by inflammation of the middle ear (see Earache, p. 40).

Headache from Poisoning.-Persons addicted to the excessive use of tea, coffee, alcohol, and tobacco are often subject to headache from poisoning of the system by these substances. In tea, coffee, and tobacco poisoning there is also palpitation of the heart in many cases; that is, the patient is conscious of his heart beating, irregularly and violently (see Palpitation, Vol. III, p. 171), which causes alarm and distress. Cessation of the habit and sodium bromide, twenty grains three times daily, dissolved in water, administered for not more than three days, may relieve the headache and other trouble.

Many drugs occasion headache, as quinine, salicylates, nitroglycerin, and some forms of iron.

The poisons formed in the blood by germs in acute diseases are among the most common sources of headache. In these disorders there is always fever and often backache, and general soreness in the muscles. One of the most prominent symptoms in typhoid fever is constant headache with fever increasing toward night, and also higher each night than it was the night before. The headache and fever, together often with occasional nosebleed and general feeling of weariness, may continue for a week or two before the patient feels sick enough to go to bed. The existence of headache with fever (as shown by the thermometer) should always warn one of the necessity of consulting a physician.

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