ON MIGRAINE.

(By DR. CLOTAR MULLER.)

IF I designate this ailment as a female disorder, I must certainly add, at the same time, that it is not so in the strict sense of the word, inasmuch as men also suffer from it not so very seldom either; and that in an intense degree. It is, however, the female sex that is particularly often visited with it, and sex thus constitutes a decided predisposition to the complaint.

I omit here, purposely, all pathological and symptomatic details : the latter, as sufficiently known to the readers of this periodical; the former, as hitherto entirely devoid of importance and result. Only I may be allowed to make some brief remarks on its nature and cause.

It seems to me an undoubted fact, that here, as probably in very many similar disorders, the causes and origin of the ailment are many and various. According to my view, it is very seldom, and with the lowest degree of probability, that organic changes of the brain and its membranes ought to be so considered, as some pathologists are inclined, out of partiality to materialistic views. The thickening of the arachnoid, profuse exudations from the glands of Facchioni, adherence of the membrane, &c., where they really are found, and where their connection with migraine can he shown, are much rather the consequences than the causes of the ailment. But, still oftener, these post mortem discoveries doubtless have no direct connection whatever with migraine; and, in fact, irrespective of other grounds, for this very reason, viz., that, notoriously, migraine in advanced age often abates or ceases entirely; which could hardly be the case if it were solely occasioned by these disorganizations in the brain, which not only continue, but always go on increasing, in advanced age.

Quite as unwarranted is the supposition that the migraine is a pure neuralgia of the trigeminus, or facial nerve ; though the typical commencement, and (at least, in many cases) the very circumscribed localization of the pain on the supra-orbital or temporal region, might favour this theory. For, in the first place, it is only the far smaller number of cases that show such a limitation of the pain to the parts in question, though the conditions are otherwise in strict accordance; and, in the second place, on closer inspection, there is still always presented a most essential difference between real attacks of trigeminal and facial neuralgia (tic-douloureux) and migraine, even when this also confines itself entirely to a circumscribed spot. The most probable and simplest theory, after all, is to look for the cause of migraine in the brain itself; and, in fact, in an exaltation of the central cerebro-spinal system (hyperaesthesia of the brain, cerebral irritation, cerebral neuralgia).

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