Brainstorm

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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.

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