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February 1940

PRODUCTION AND LOCALIZATION OF HEADACHE WITH SUBARACHNOID AND VENTRICULAR AIR

Author Affiliations

Assistant Professor of Neurology, Boston University School of Medicine; Instructor in Neurology, Harvard Medical School; Assistant Visiting Neurologist, Boston City Hospital; Intern in Neurology, Boston City Hospital; Senior Physician, Boston Psychopathic Hospital BOSTON

From the Neurological Unit, the Boston City Hospital, and the Department of Neurology, Harvard Medical School.

Arch NeurPsych. 1940;43(2):326-333. doi:10.1001/archneurpsyc.1940.02280020134011
Abstract

"Arterial" experimental headaches have been produced by intravenous and intra-arterial injections of histamine phosphate1 and by direct electrical and mechanical stimulation of the larger cerebral and meningeal arteries at operation.2 "Dural" headaches have been produced by mechanical, electrical and thermal stimulation of the dura during craniotomy.3 "Pressure" headaches have been produced by sudden alterations of intracranial pressure.4

Although it is common surgical knowledge that the brain and its leptomeninges are insensitive to mechanical, electrical and thermal stimuli, both ventriculography and encephalography are painful procedures. The former causes only mild discomfort,4b, c but encephalography causes severe localized, referred and, finally, generalized pain. Alterations of intracranial pressure occur in both ventriculography and encephalography. Air acts as an irritant on the ventricular walls in both. In encephalography additional irritation occurs by exposure of the main vascular channels and leptomeninges to the air. The headache due to encephalography has

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