It is shocking to read over in cold blood some of the histories which I have obtained from migrainous patients, of the treatment to which they had been subjected during a large part of their lives.

A lady now of middle age

Here is the outline of a story told me by a patient not long since. This case appears to me to be a type of an exceedingly large class, in which a migraine that ought not to have outlasted the period of youth has assumed an intractable character and become associated with severe abdominal disturbance, simply because the dietetic and medicinal treatment has been thoroughly mistaken and bad. 

A lady, now of middle age, belonging to a family whose nervous health was essentially sound, was born a sickly and feeble infant about a year after her father had suffered from tropical disease of the liver.

In infancy she displayed some irritability of the mucous membranes; and her friends in general, and the family doctor in particular, seem to have seized at once on the idea that her ailments were due to inherited hepatic defects; accordingly she was treated, throughout the earlier years of her life, with frequent doses of calomel, and more lately with podophyllin.

The periodical attacks of migraine, which troubled her from an early age, are very clearly described by her. The first symptom was always throbbing pain at the top of the head, which gradually increased to a tremendous severity. After a time nausea crept gradually on, and culminated in repeated effortless vomiting: first the stomach was emptied of the food, then followed a certain amount of bile, and lastly a certain quantity of thick mucus; but she is clear that the attacks often came on during a state of fasting. At last she would fall into an exhausted slumber, and awake, after some hours, with a sore feeling all over the scalp. The attacks used to be followed by a certain amount of hypochondriac and epigastric pain, which used regularly to be referred to the liver and treated with repeated leeches and blisters.

When she was twenty years old, a very severe attack of migraine was complicated with hemiopia and general failure of vision; the former did not last long, but the mistiness of sight was bad for two years, and to this day her vision is far from perfect.

Latterly her health had gradually a good deal improved,  and was at least coincident with the use of a much smaller amount of medicine than she had formerly taken. Within the last few weeks she has had a severe relapse, originally due, as I believe to fatigue and anxiety in nursing a sick relative, but much aggravated by the mental shock caused by the accidental death of a friend. Unfortunately, as I think, she treated the earlier symptoms by taking several doses of calomel; this seems to have given some temporary relief, but at present she is exceedingly ill, and the headaches, though frequent and severe, are less formidable than the intense gastric irritability, which has so limited the possibility of nourishing her that she has become extremely exhausted.

Abstinence from fatty food

I would especially dwell upon the fact that this lady avoids nearly every kind of fatty food, from a belief that such things are “bilious”. The long-continued abstinence from all fats will at last produce  a genuine dyspepsia for such articles; and that taking of such articles will inevitably upset the stomach and probably re-induce the migraine. 

Sometimes, where cautious and skilful tentatives towards a more varied and copious diet fail of their purpose, we may make a complete change of climate and surroundings. The keen

clear air of a Swiss mountain elevation; the pleasing mental excitement of life amid strange scenes and people; circumstances where a rude and coarse diet is the only one obtainable – one or all of these influences together will sometimes effect marvels.

I shall never forget the incredible results of such a “counsel of despair” which I gave a migrainous young lady who had nearly reduced herself to the state of the horse who lived upon one bean a day. She was sent to an out-of-the-way part of Germany, where she lived among pleasant people, but where her necessary daily food consisted of  black bread, sausages, sauerkraut, and very oily salads. Mirabile dictu! She was soon energetically devouring these astounding aliments, and in twelve months her migraine was a thing of the past.