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In every case of persistent headache, the most
complete history, family and personal, should first
be elicited vv'ith the most searching examination for
all signs tending to connect the symptoms with any
disease. Headache is one of the earliest and most
frequent symptoms of several of the most serious
pathological conditions. Mayer says: "In taking
the history Diltiazem Xr 180 Mg of a patient, many important factors may
be elicited ; a previous infectious disease that might
have left an inflammation of Diltiazem Cd 300 Mg one of the cranial
sinuses, a trauma that might have evoked a chronic
meningitis or an abscess or cyst, or an hereditary
history that would make one think of migraine or
latent or psychic epilepsy. The Diltiazem Er 240 Mg Caps occupation might
reveal the source of a toxic headache, Diltiazem Er 360 Mg the habits an
alcoholic, nicotine, or sexual origin for it ; or, again,
we may find the environment of the patient is at
fault, too many business worries, living in too close
quarters, sitting constantly near a light, having con-
stant worries or anxieties in Diltiazem Dosage Forms the family circle, liv-
ing irregularly, working late at night or eating im-
properly.'' Find the nature of the pain, its loca-
tion, its duration, the time of occurrence, nature of
work done preceding it, what Buy Diltiazem Cd aggravates and what
relieves it. its connection with any other symptoms
of any other organs, age, etc.
In this paper I shall use much material from a
svmposium bv Dr. S. D. Rislev, Dr. E. E. Maver,
Dr. J. C. Wilson, and Dr. B. A. Randall, of Phila-
delphia, each of whom treats it from its own special
standpoint, thus including every side of the ques-
tion. {Pciinsyk'aiiia Medical Joiinial, Diltiazem Xr 240 Mg December,
1907.)
Headaches may be classed :
1. Those due to diseases of nervous system:
Pres.sure headaches, hydrocephalus, tumors, ab-
scesses, C3'sts : inflammatory headaches, meningitis, ' Diltiazem Cd Dosage
purulent tuberculosis, pachymeningitis, epicranial
myositis ; circulatory headaches, an;emia and hyper-
emia, arteriosclerosis, vasomotor : traumatic head-
aches; reflex headaches; psychic headaches, hypo-
chondria, neurasthenia (exophthalmic goitre), hys-
teria, epilepsy; and habitual headaches.
2. Special senses: Eyestrain, nasal or ear dis-
ea.ses, etc.
3. Gastrointestinal : Deranged liver, constipation,
autointoxication.
4. Kidney diseases.
3. Constitutional diseases : .-\nasmia, chlorosis, dia-
betes, leucluemia, syphilis, rheumatism, malaria.
6. To.xics: Drugs, lead, nitrites, alcohol, etc.
7. Infections which include some of the above
groups.
8. Rheumatism of the scalp.
Under the first group, tlie organic headaches are
those due to intercranial disease, usually more con-
stant in their symptoms, llrain tinnor has a deep
boring jiain. The pains of tumors or abscesses are
usually more localized, while that of meningitis is
more difl'used and excrucialiug. Tlte eye condi-
lious, especially those seen with the (iphlli.-ilmnscope.
DOXOl AX: HEADACHE.
3"
help in arriving at a conclusion. In epilepsy, usual-
ly the other symptoms accompany it. Those due to
cerebral concussion or from injuries to the head
may be localized or diffuse, usually severe and pro-
tracted. There is often tenderness on percussion,
mental symptoms, lack of concentration, memory af-
fected at times, vertigo, tinnitus, etc., also eye symp-
toms. In meningitis there will be vomiting without
nausea, hyperjestliesia. delirium, vertigo, intolerance
to light, etc. Rigitlity of neck muscles with these
symptoms indicates cerebrospinal meningitis. Tuber-
culous meningitis is often first indicated by intense
paro.xysmal headache, vomiting without nausea,
constipation, and mental irritability.
The sensory nerve supply of the dura in the ante-
rior three fourths of its extent, that of the falx and
probabl}' that of the tentorium are derived from the
trigeminus, while the dura mater of the posterior
fossa is supplied with sensory fibres from the vagus.
The trigeminus is the nerve of sensation to the scalp
as far back as the vertex, while the posterior
branches of the upper four cervical nerves supply
the muscles and the skin of the back of the neck and
the occiput. Headaches are due to some changes
affecting these nerves, either disease, pressure, or
circulatory changes.
The circulatory headaches are diagnosticated from
the condition of the vessels, the anaemic being re-
lieved by a recumbent position : the congestive have
the throbbing full Diltiazem Er 300 Mg sensation. These are character-
istic of the nitrites, and very common in this local-
ity, resulting from powder smoke. There is usual-
ly a congestion of the skin vessels, a flushed face,
etc.
The neurasthenic headache is very frequent in the
morning, and can be arrived at only by exclusion.
Unfortunately, we are prone to put too many in this
class, or in Butte we find the altitude a convenient
and inexhaustible refuge for those cases in which
we fail to find the true cause. Hysteria has the cir-
cumscribed boring pain (clavus).
The habitual headaches will probably in time be
classified otherwise, but at present, with most pains-
taking examination, some few headaches still re-
main.

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