Periodic Migrainous Neuralgia.

Periodic migrainous neuralgia is a clearly defined syndrome and excellent descriptions of it have been given by a number of authors (Harris, 1926, 1936 ; Horton et al., 1939 ; Horton, 1941 ; Ekbom, 1947; Kunkle et al., 1952; Symonds, 1956; Bickerstaff, 1959). Its clinical features are usually so characteristic that its diagnosis should present no more difficulty than that of trigeminal neuralgia or classical migraine. Various treatments have been advised in the past, and, in particular, Ekbom (1947), Symonds (1956), and Bickerstaff (1959) have described their experience with prophylactic ergotamine preparations. Bickerstaff (1959) suggested that the syndrome was well defined but not widely recognized and that it is often misdiagnosed. He suggested that by describing it in a medical journal with a wide circulation it should become better known and many of the diagnostic difficulties would disappear. We discovered that in our patients the average time from onset of symptoms to diagnosis was 6.5 years; hence it is clear that no remarkable change has occurred in the speed of diagnosis since Bickerstaff's paper appeared, and we therefore decided to review our own experience. We have done this in two ways: first, we give a brief review of the clinical picture as we have seen it, and then the results of treatment are reviewed. The best description of the essential features of the syndrome