Acute Gastric Dilatation of Stomach During Attack of Migraine

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Abstract
MIGRAINE has been defined as an affection characterized by paroxysmal attacks in which a distinctive type of headache, usually unilateral, is the most constant feature, commonly accompanied by nausea and vomiting. This condition is more common in females and occurs preponderatingly in neurotic families. The immediate exciting cause of an attack in individuals who are predisposed to it is any undue fatigue or excitement of the nervous system. These patients very often show symptoms suggestive either of an irritation or paralysis of various components of the sympathetic system. The close relationship of the stomach to the autonomic nervous system accounts for the marked frequency of gastric symptoms in cases of migraine. The etiology is considered by some authorities to be due to local angio-spasms causing focal symptoms in the brain; by others, to be due to recurring auto-intoxication, refraction anomalies, nasal disease, etc. Goldzieher (2), in discussing headache of the migraine type, states that it may be on a definite endocrine basis, and that recent investigations have added new indirect evidence that headaches of the migraine type are related to increased intracranial pressure. Such patients show the appearance of the anterior pituitary hormone in the urine prior to the onset of the headache. Hyperfunction of the anterior lobe and spilling of the hormone in the urine are constant features of increased intracranial pressure, which is probably due to water accumulation in the brain tissue. Hunt (1) investigated 60 cases of migraine, 40 of which had symptoms referable to the gall bladder. In 17 cases, oral cholecystography showed evidence of gall-bladder or hepatic disorders. He found that gall-bladder disorders were more frequently encountered in patients with migraine than in normal patients, and consequently stressed the importance of inquiring about migraine in patients with gall-bladder disease. Vaughan (4) reported 33 cases of migraine, 36 per cent of which were due to allergenic foods. More than one-half of these patients complained of vomiting. Mackintosh and Anderson (5), in discussing migraine, state that nausea and loss of appetite occur in the large majority of cases and that as a rule any food taken is not digested, all digestive and absorptive processes in the alimentary canal appearing to be in abeyance in severe attacks. We present the following case because of the graphic manner in which it demonstrates the marked changes that the stomach can undergo through nervous stimuli, and because it stresses the importance of a thorough clinical history before any conclusion can be drawn from the x-ray examination. F. H., female, aged 35 years, married, was referred for radiographic examination because of repeated attacks of migraine associated with nausea and vomiting. The family history is important, in that the patient has a sister who suffers from ærophagia.

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