RELATION OF URIC ACID TO MIGRAINE
Journal of the American Medical Association (JAMA)
It is not strange that the causal relation of uric acid to migraine has repeatedly suggested itself to the minds of physicians, for the etiology of migraine has always been to the clinician what the origin and significance of uric acid has been to the physiologic chemist\p=m-\amatter of speculation. The enthusiasm which has arisen in the past decade or more in the study of the secretions and excretions of the living organism, has again awakened investigations referring to the effect of uric
... effect of uric acid on the human body, and its relations to disease. So thorough has been this awakening that the foundation principles of pathology and therapeutics seem to have been threatened. Diseases, the etiology and pathology of which were thought to be beyond question, are now considered with reference to uric acid formation. Remedies which were formerly given because they overcame disease, are now given because they counteract the formation, and increase the elimination of uric acid. Among the many diseases which have been etiologically considered with reference to uric acid, may be mentioned rheumatism, gout, migraine, epilepsy, asthma, and melancholia. Some investigators have become so im¬ pressed with the effect of uric acid on the human system that they have attempted to account for a man's dis¬ position, his emotions, and even his character, by re¬ ferring to the amount of uric acid which he retains in his system. It would seem from the writings of some that philosophy and religion, as well as medicine, would have to be considered anew from the standpoint of the uric acid diathesis. The study of the relation of uric acid to migraine has, probably, received the most attention. Migraine has been called "the uric acid headache," because ex¬ aminations of the urine, during and after the attack, seemed to show that the normal relation of uric acid to urea had been disturbed. That is, the amount of uric acid excreted, relative to the urea, is increased dur¬ ing the attack, while after the attack it is normal in quantity for a time, or diminished. "The greater the relative excess of uric acid, and the greater its absolute excretion per hour, the more severe the headache." (Haig.) From this it is concluded that uric acid is the cause of migraine. With this theory in mind, I have for the past three years turned my attention to the study of the urine with special reference to the relation of uric acid and urea, in the cases of migraine which have come under my ob¬ servation. In order that there may be no misunder¬ standing in reference to the results obtained, it will be necessary for me to describe briefly the methods em¬ ployed in this study. For the estimation of urea, Liebig's method was em¬ ployed, which, though not as reliable as Kjeldahl's, for clinical purposes is deemed sufficiently accurate. The uric acid was estimated according to Hopkin's method, described by Von Jaksch, in his "Clinical Diagnosis," with this modification, however. Instead of titrating with the unstable potassium permanganate solution, a deeinormal solution of sulphuric acid was used, with methyl orange as the indicator. This was suggested to me by a private student from the laboratory of phys¬ iologic chemistry, directed by Dr. E. C. Herter, of the University of Berlin, and has been found to be reliable. The urine was collected at the severest period of the headache, and quantitative estimates were made for uric acid and urea. After the headache had entirely disap¬ peared, the urine was collected for the same length of time as before, and subjected to the same analysis. Com¬ parisons were then made between the relation of the uric acid and urea of these two analyses. The patient was instructed when the headache began, to save the urine of each urination in separate vessels during the entire period of the attack. From these numerous specimens, the one which was voided at the time of the greatest intensity of the headache, was se¬ lected fur chemical investigation. After the headache had entirely disappeared, the second specimen was col¬ lected. It was thought that if these headaches were due to a uric acid disturbance, it ought to be manifest in the urine at the height of the attack ; and, on the other hand, that if the uric acid disturbance which so many investi¬ gators have found associated with the headaches, was a result of the attack, it ought to be manifest immediately after the headache had disappeared. Of the investigations conducted in this way the report of three eases will be sufficient. Case 1.-Miss H., aged 40, a bookkeeper, has had dull, constant headache from childhood, which, at about 20 years of age, developed into paroxysms beginning over the right eye. The headaches, which are very severe, seem to be induced by overwork, or by slight colds. They are likely to occur during the menstrual periods, which have been frequent and profuse for the past ten years, but occur also at other times. Aside from the headaches, she gives symptoms of neurasthenia, but more of diges¬ tive disturbance. She has never had a serious illness.