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Extra resources for Brainstorm
Examina tion at this time will show engorged and purple turbinates. Such symptoms and findings, when they are present, may mislead both patient and physician into making a diagnosis of "sinus" or "allergic" headache. Another nasal symptom, which may come either towards the begin ning or at the resolution of the attack, is a profuse catarrhal secretion. It will be readily understandable that the combination of a ru nn ing nose with a sense of malaise and headache may mimic a "cold" or other viral infection, and there can be no doubt but that a number of such migraines are misdiagnosed as such.
In a red migraine, the face is dusky and flushed: in the words of an old ac count congested, with rushing and roaring in the head, bloaring, glowing, and shin ing of the face, with protrusion of the eyes • . great heat of the head and face . . throbbing of the carotid and temporal arteries . . (Peters, 1 853) A full-blown, plerhoric appearance, as Peters describes, is distinctly uncommon, occurring in less than a tenth of cases of common migraine. Patients predisposed to red migraines often have a marked propensity to flush with anger or blush with embarrassment: facial erythema, we may say, is their "style": Case 40 A 60-year-old man of irascible temperament subject to common migraines since the age of 1 8, and bilious attacks and severe motion-sickness in childhood.
Everything comes and goes, nothing is settled, and if one could take a total thermogram, or scan, or inner photograph of the body, one would see vascular beds opening and closing, peristalsis accelerating or stop ping, viscera squirming or tightening in spasms, secretions suddenly in creasing or lessening-as if the nervous system itself was in a state of indecision. Intermittency, instability, fluctuation, oscillation are of the essence in this unsettled state, this " general feeling of disorder," which runs before a migraine.