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"Cerebral symptoms were noted early by many patients. Headache
was the most frequent. The study of significance of headache has
been beset with many complications, for a surprisingly large
number of these patients have been subject to migraine throughout
life. Some patients have been able to name a definite date when
the character of the headache changed completely; others have
noted a greater severity of the paroxysms. In still others,
headache has appeared for the first time with the onset of
vascular disease. So commonly have patients described to me a
particular kind of headache that I have almost come to look on it
as a typical nephritic or hypertensive symptom. This headache is
one which appears on awakening, or wakes the patient during the
early morning hours, has its greatest intensity before arising,
and passes away either immediately after breakfast or during the
course of the morning, to reappear in the same manner, day after
day for considerable periods. The intensity of the pain and its
location have varied somewhat, the most severe being similar to
bad migraine, and in a few cases it is attended by nausea and
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