Migraine, the second most common cause of disability in the world, afflicts approximately 15% of women and 6% of men over a 1-year period.It is usually an episodic unilateral throbbing type of headache associated with certain features such as sensitivity to light, sound, or movement; nausea and vomiting often accompany a headache. It has a genetic disposition with female preponderance. Holistic approach of homeopathic treatment adjunctively with lifestyle modifications can prove to be highly efficacious in the successful treatment of acute and chronic conditions of migraine.
Migraine, headache, neurological, homeopathy.
Migraine is the neurological disorders manifesting symptoms such as intense throbbing unilateral episodic headache coexisting with nausea,vomiting, sensitivity to light, noise etc.The word ‘migraine’ comes from the Greek word ‘hemikrania’ which means ‘pain in half of the head’ where hemi means half and krania means skull.Bilateral pain is particularly common in those who have migraines without an aura. It can last from 4 hours to 3 days and usually happen on one to four times a month.Migraine is the public health issue with serious social and economic consequences.
A genetic component to migraine is indicated by the fact that approximately 70% of patients have a first degree relative with a history of migraine.The potential migraine triggers identified include the following:
Diet (food habits)
Sensory stimuli (eg, flashing lights, strong odors from perfumes)
Hormonal factors, particularly menstruation
Fluctuating estrogen levels, hormone therapy and oral contraceptives are a potent migraine trigger.
CLASSIFICATION OF MIGRAINE
The international classification of headache society (ICHS) has classified migraine as a primary headache disorder along with cluster headache and tension headache.
According to the international classification of headache society they are broadly classified into-
Migraine without Aura (common) – In this the premonitory/prodrome phase along with aura is absent.
Migraine with Aura (classic) – Aura precedes the attack, a series of sensory and visual changes that can range from seeing black dots and zig zags to tingling numbness on one side of the body, phonophobia, photophobia.
Chronic migraine – 15 or more headache days per month over a period of more than 3 months implicates increased frequency of attacks oftener.
Probable migraine(migrainosus attack) – Mostly migraine attacks, or attacks treated early, often do not achieve all characteristics necessary for a migraine attack diagnosis but nevertheless respond to specific migraine treatments.
Complications of Migraine – status migrainosus, persistent aura without infarction, migraine with infarction, migraine aura triggered seizures.
Episodic syndromes /migraine variant that may be associated with migraine – It includes cyclical vomiting, midline abdominal pain, benign paroxysmal vertigo, torticollis.
Migraine Variants includes childhood Periodic syndromes,late life migrainosus accompaniments,basilar migraine,hemiplegic migraine ,retinal migraine.
Several theories suggest the role of calcitonin gene related peptides, vascularity, serotonin, neurotransmitters etc. in the causation of migraine but the exact cause is yet to be identified. Mostly genetic disposition with female preponderance is noted.
The exact cause of migraine is unknown but there is an increasing evidence that the aura is due to dysfunction of ion channels causing a spreading front of cortical depolarization(excitation) followed by hyperpolarization(depression of activity).This process spreads over cortex at rate of about 3mn/minute, correspondung to auras symptomatic spread.The headache phase is associated with vasodilatation of extra cranial vessels and may be relayed by hypothalamic activity.Some of the research advancements in migraine implicated that the action of the trigeminovascular system is probably important.
The symptoms may be classified with respect to the four different phases of Migraine.It’s not necessary for all to go through all these phases on every attack.
PHASES OF MIGRAINE-
Prodome/Premonitory Phase -This phase starts up to 24 hours before you get the migraine.You may have malaise, irritability or behavioral change, neck stiffness, frequent yawning.
Aura(Precedent of attack)-Mostly visual consisting of fortification of spectra,which are shimmering, silvery zigzag lines that March across the visual fields for up to 40 minutes sometimes leaving a trail of temporary visual field loss(scotoma).In some there is a sensory aura of tingling followed by numbness or transient speech disturbance spreading over 20 to 30 minutes from one part of body to another.
Headache- Starts gradually and then becomes more severe. Severe and throbbing or pulsating pain with photophobia, phonophobia and vomiting lasting from 4 to 72 hours.
Postdrome phase (Following the headache) – You may feel exhausted, weak, and confused after a migraine. This can last up to a day.
The diagnosis of migraine is clinical in nature, based on criteria established by the International Headache Society are that patients must have had at least 5 headache attacks that lasted 4–72 hours (untreated or unsuccessfully treated) and that the headache must have had at least 2 of the following characteristics:
Moderate or severe pain intensity
Aggravation by or causing avoidance of routine physical activity (eg, walking or climbing stairs)
In addition, during the headache the patient must have had at least 1 of the following:
Nausea and/or vomiting
Photophobia and phonophobia.
In severe cases where the headache(secondary headaches) is reluctant to any pharmacological treatments then the following Imaging studies like
CT SCAN ; MRI; Electroencephalography(for seizures),blood biochemistry should be advised by the physician.
The remedy is selected on the basis of theory of individualization and symptom totality of a person.Detailed case taking eliciting the characteristics symptoms of the patient can be more efficacious in the successful treatment of both acute and chronic conditions of migraine.
ACONITE NAPELLUS – Congestive headache, vision obscured, pressing and contracting pains in the upper part of forehead, face swollen, pale, aggravated by light, noise, motion, relieved by lying quietly in a dark room, by nosebleed, by copious urination.
BELLADONNA- Pains commence suddenly gradually increase to great severity and cease suddenly. Right side frontal or temporal aggravated when lying down with head low, open air ameliorated by bending head backward, by covering the head; head hot and feet cold.
BRYONIA ALBA– Congestive or neuralgic headache, mainly frontal or occipital. Shooting, stitching, bursting and throbbing pains; headache as a concomitant with gastric disturbances; worse from slightest jar or motion even movements of eyelids, talking, even effort of thinking, morning , stooping, better by lying down quietly, hot fomentation.
COCCULUS INDICA – headache during menses with vertigo and nausea;pain extends from the occiput to nape of neck.sensation as if the occiput were opening and shutting. They are worse from mental effort, riding in a carriage and are better indoors and during rest.
CYCLAMEN- Blind headache with glittering sparks before eyes, great vertigo in chlorotic women. Migraine with scintillations before the eyes; as vision returns, head seems about to burst. Shootings in the left temple, forehead with dizziness.
GELSEMIUM SEMPERVIRANS – Blindness before the headache. Sick headache, principally right temple, beginning in the morning and increasing during day; worse from motion and light; better after lying down; by sleep or vomiting. Neuralgic headache, beginning in upper cervical spine; numbness of occipital region; pains extend overhead, causing a bursting pain in forehead and eyeballs. Great heaviness of the head, relieved by profuse micturition.
GLONINUM- Violent headache with menses worse by motion better from bandaging head, by warmth. Headache from recent exposure to sun, long lasting occipital headache must lie down. Violent supraorbital congestions from a great variety of causes, in all of which there is a strong pulsation in the head with every beat of the heart.
IGNATIA AMARA – Headache, as if a nail was driven out through the side, relieved by lying on it. Pressive headache, esp. above the root of the nose, and often accompanied by inclination to vomit, worse by stooping. The headaches are worse by coffee, tobacco smoke, noise, strong smell, from reading and writing; from the sunlight; from moving the eyes; better when changing the position and lying on the painful side.
IRIS VERSICOLOR- Sick headache of gastric and hepatic origin always beginning with blur before eyes and followed by intensely sour vomiting. right temporal region pain Worse for cold air, rest, violent motion or coughing and better for gentle motion.
KALI-BICHROMICUM – Blindness before headache which disappears as headache increases. Semilateral headache in small spots, sharp stitches in bones.
LAC-CANNINUM-Migraine from nape to forehead, icy coldness of body, not relieved by heat .Alternating side pains. Blurred vision, nausea and vomiting at height of attack of headache. Occipital pain, with shooting extending to forehead.
LACHESIS MUTANS -Blue vision precedes headache, pain relieved as soon as menses flows; Burning in vertex during climaxes, frontal headache, faints on raising, mental and physical exhaustion.
MELILOTUS ALBA – Sick and nervous headache especially in winter, Throbbing headache in occiput and vertex with sensitiveness of cervical and dorsal vertebrae alternating between forehead and occiput.
NATRIUM MURIATICUM- Headache anemic, of school girls ; from sunrise to sunset; left sided clavus; as if bursting; with red face, nausea and vomiting before, during and after menses; as though a thousand little hammers were knocking in the brain during fever; better by lying down with head high, by perspiration. Headache; beginning with blindness; with zigzag dazzling, like lightening in eyes, ushering in a throbbing headache; from eye strain worse at 11am, sea shore, heat of sun, motion.
NUX VOMICA – Headache over the left eye, nausea, vomiting, a sour taste in the mouth and a history of over-indulgence.Symptoms are worse in the sunshine, from bending over, coughing, moving the eyes and from mental exertion, and are better after a nap, at rest and from strong pressure.
PULSATILLA NIGRICANS -Gastric and neuralgic headache, violent unilateral pain as if a nail driven in it ameliorated by the application of cold, by external pressure, and by slow motion, aggravated by lying and sitting quiet, evening, stooping, motion of eyes. Periodic sick headaches, with vomiting of sour food.
SANGUINARIA CANADENSIS- Right supraorbital pain associated with distention of temporal veins, nausea, vomiting. migraine every seventh day, hyperesthesia of all senses. Symptoms are worse from looking up and rapid motion of the head, and better for sleep.
SCUTELLARIA LATERIFOLIA -Vertigo: soon after breakfast, with photophobia.Sensation as if cranial contents were confined in too small a space.Before rising, hemicrania, most severe over right eye, better moving about in open air.
SEPIA OFFICIANALIS- Left side headache in terrific shocks; at menstrual nisus, with scanty flow; in delicate, sensitive, hysterical women; pressing, bursting worse by motion, stooping, mental labor, better by external pressure, continued hard motion. Great falling of the hair, after chronic headaches or at the climacteric.
SILICEA TERRA – Blindness after headache from nervous exhaustion will power strong. (pulsating and beating, most violent in forehead and vertex, with chilliness).The headaches are worse by mental labour, talking, stooping, noise, jarring, light, and cold air, and are better in warm room; from wrapping head up warmly; from binding head tightly, urination.
SPIGELIA – Neuralgic and Rheumatic headache, eyeballs involved worse by stooping headache rises and declines with the sun. Gouty pains and stiffness of joints.
Avoid overuse of Medications-Abortive and preventive medicine like analgesics,NSAID,opiates etc for a prolonged period use can cause multi organ damage.
Reduction of migraine triggers- Patients should avoid factors that precipitate a migraine attack (eg, lack of sleep, fatigue, stress, certain foods, use of vasodilators).Drink water and stay hydrated. Dehydration is a very common migraine trigger.
Lifestyle management includes – Don’t skip meals or change sleep patterns .Do exercise of low impact Regularly. Manage the weight accordingly.
Nonpharmacologic therapy- These therapies can be tried alone or in combination behavioral therapy,biofeedback, acupuncture, yoga, tai chi, massage; relaxation techniques for stress management like breathing, visualization and meditation; hypnotherapy etc.
Migraine is the primary headache disorder which is frequently encountered in medical practice and is very often misdiagnosed and with improper medical treatment and management results in many complications.The physician’s correct diagnosis and appropriate use of imaging studies like CT scan or MRI can help us to identify the causative factor of sudden intense headache which are reluctant to preventive therapy or lifestyle modification strategies. Homoeopathic approach of treatment with proper lifestyle modification and non-pharmacological therapy together can successfully cure migraine attacks of different clinical variants and reduce the frequency and severity of symptoms thus alleviating both acute and chronic sufferings of the patient with less complications and no side effects.
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