Females are more prone to sick headache than males. The attack frequently comes on early in the morning. The patient gets out of bed feeling dull and indisposed for mental or bodily exertion; she looks heavy, dejected, and miserable. Then the headache begins, and after a time a sense of nausea supervenes which usually ends in a more or less severe attack of vomiting. If the patient has taken any food it will probably come back almost unchanged; if she has not taken food, she usually brings up some mucus with great straining and retching, and finally the vomit contains bile, yellow or green, and occasionally streaks of blood. The headache attains its greatest intensity during the vomiting, which may be repeated several times. The patient cannot bear any light, or noise, or the least shaking of the bed, and is usually very prostrate and almost collapsed. After the vomiting ceases she will probably go to sleep and may wake up refreshed and feeling very nearly in her usual health.

As a rule no food or drink can be tolerated during the attack. The patient should be put to bed, the room darkened, and have some evaporating fluid applied to the head. An evaporating lotion, or plain spirit (gin) and water, answers the purpose very well; but most patients prefer eau de Cologne, eau de Florida, or other perfumed waters. Vinegar and water is not to be despised and its aromatic odour is very refreshing. Sometimes a tight bandage round the head gives relief, but more relief is obtained by pressure with the thumb over the temporal artery on the painful side. As soon as the patient can be induced to take anything, she should have a teacupful of very strong tea or coffee, some guarana (Brazilian cocoa), or a glassful of kola wine, all of which contain caffein, an alkaloid which is well calculated to relieve the pain and sickness, and at the same time act as a restorative. The treatment of sick headache should be carried on between the attacks. The cause must be sought. If it is due to constipation or duodenal catarrh it is a comparatively simple matter. But some of the cases, more properly called migraine, are not so readily cured. Nevertheless a large proportion of them are curable where proper steps are taken. The treatment usually includes a modification of the diet. In some instances it is advisable for the patient to abandon the use of meat entirely and live upon milk, eggs, white bread, cheese, oatmeal, potatoes, butter, green vegetables, and fruit. This is practically a purin-free dietary and must be persisted in for many months. In other cases a fruitarian dietary is valuable and, consisting of fruit and nuts, is considered more palatable than the former. But none of these diets should be taken without medical advice, and the physician should arrange a diet sheet, in which the nuts and fruits are those which go well together. If this is not done the dietary may fail, not because it is of the wrong kind, but because the items are not arranged so as to form a properly balanced diet.