OBSERVATIONS ON 500 CASES OF MIGRAINE AND ALLIED VASCULAR HEADACHE

TLDR

Headache is the most common neurologic complaint, with roughly 12 % of patients at the Northcott Neurological Centre presenting with vascular headaches, and migraine’s definition remains debated, encompassing phases of intracranial vasoconstriction and extracranial vasodilation. The authors attribute both simple and complex vascular headaches to shared hereditary and other causal factors, with similar pathophysiological mechanisms. Experimental studies confirm that migraine and other extracranial vascular headaches share a common pathophysiological mechanism, placing the cases in this series within that broader concept.

Abstract

Headache is probably the most common complaint referred to the neurologist for investigation.Approximately 12 % of all patients seen at the Northcott Neurological Centre during the past six years were found to suffer from vascular headaches.At this Centre facilities for investigation are avail- able without involving the patient in additional expense so that clinical observations are supported in most cases by electroencephalographic and radiological examinations.The exact definition of the migraine syndrome is difficult and debatable and not all the patients in this series would fall within the narrow concept of a paroxysmal disturbance of cerebral function associated with unilateral headache and vomiting.The term "migraine" might reasonably be restricted to a disorder consisting of two separate phases, intra- cranial vasoconstriction, accompanied or followed by dilatation of the extracranial vessels.Clinical experience has shown, however, that the same patient may have attacks produced by either phase singly as well as in combination.While the term migraine is derived from "hemicrania", it is not unusual for patients to experience pain over the entire head with the same accompaniments as in their unilateral attacks.The essential characteristic of all these vascular headaches is their paroxysmal nature, and Gowers (1888) pointed out that the same patients may have simple headaches at one period of their life and the more complex series of symptoms at another period. "The simple headaches have the same characters, and occur under the same causal conditions of heredity, etc..as those in which there are in addition other sensory symptoms. "The experimental studies of Wolff and his colleagues (Wolff, 1948(Wolff, , 1955) ) have established the similarity of the patho-physiological mechanism underlying migraine and other extracranial vascular headaches.The cases presented in this series come within this wider concept. 23Aetiological Factors Sex Incidence.Our series comprises 300 females and 200 males.This female preponderance of 60% is slightly lower than the figure quoted by Kinniet Wilson (1940) who summarized 13 published series with a total of 3.278 cases and found that 716% were female.Age of Onset.-Theage at which the first attack occurred in 496 cases is shown in Fig. 1.The figure of 21 %" beginning under the age of 10 years is a little less than Gowers' estimate of one-third and that of Balyeat and Rinkel (1931), who found an onset in the first decade in 30% of their 202 cases.Krayenbuhl and Heyck (1955), on the other hand, state that only 12°' of their 170 cases started in the first decade.The first four decades account for 92O% in our series.The youngest age reported for the first 150z i06 too lo