UNDERSTANDING MIGRAINE AND ITS HOMOEOPATHIC MANAGEMENT
Dr. Abhilasha Pramanik
MD Scholar, Department of Organon Of Medicine and Homoeopathic Philosophy, Bakson Homoeopathic Medical College and Hospital, Greater Noida, U.P.
Headache is one of the commonest medical complaints for which any person seeks medical assistance. Migraine is one of the most disabling neurological disorder, under primary headache disorders. This article is an attempt of explaining migraine with its aetiopathogenesis, clinical features and complications along with its homoeopathic management.
Keywords: – Migraine, homoeopathy, miasm, headache.
Headache is an extremely common symptom and collectively headache disorders are among the most common of nervous system disorders. Some headaches are extremely debilitating and have significant impact on an individual’s quality of life, imposing huge costs to healthcare and indirectly to the economy in general. The vast majority can be effectively treated by a primary care physician or generalist with correct clinical diagnosis that requires no special investigation. Primary headache disorders – migraine, tension headache and cluster headache – constitute nearly 98% of all headaches; however, secondary headaches are important to recognise as they are serious and may be life threatening.
Migraine is a class of disabling primary headache disorders, characterized by recurrent unilateral pulsatile headaches, benign and recurring syndrome of Headache, Nausea, Vomiting and/ or other functions of neurologic dysfunction in varying admixtures like:
• Light Headedness
• Scalp tenderness
• Visual disturbances
• Fortification Spectra
• Alteration of Consciousness
• Confusional State
Migraine is the second most common form of headache, often described as recurrent throbbing or pulsating, moderate to severe, and often unilateral pain that lasts 4–72 hours with complete freedom between the attacks (episodic). The headache is associated with nausea, vomiting and/or sensitivity to light, sound or smell. The patient prefers to lie still in a dark and quiet room, and to avoid physical activity. Around one-third of patients perceive an aura, described as a progressive focal neurological symptom lasting 5–60 minutes. Visual aura, in the form of zigzag lines or spreading scintillating scotoma (diminished sight), is by far the most common, although unilateral sensory disturbances and/or dysphasia may occur either at the same time or sequentially. Sometimes, particularly in older individuals, aura may occur without headache (migraine equivalent) and must be differentiated from transient ischaemic attack. Typically, a migrainous aura evolves over a few minutes and marches from one area to the other.
It is now widely accepted that migraine should be viewed as a complex brain network disorder with a strong genetic basis that involves multiple cortical, subcortical and brainstem regions to account for the pain and the wide constellation of symptoms characterizing the attack.
CLINICAL FEATURES OF MIGRAINE
PRODROME: -Patient feels irritability and depressed, fatigue, yawning, excessive sleepiness, craving for foods like chocolate, occasional hunger.
AURA: -It is comprised of focal neurological phenomenon that precedes or accompanies the attack. They appear gradually over 5 to 20 minutes and usually subside just before the headache begins.
VISUAL AURA: Disturbance of vision consisting usually of unformed flashes of white or rarely of multi colored lights, which is known as photopsia, or formations of dazzling zigzag lines, arranged like the battlements of a castle, hence the term “fortification spectra or Teichopsia”.
SOMATOSENSORY AURA: Lingual or oral paresthesias, a feeling of pain needles experienced in the hand and arm as well as in the ipsilateral nose and mouth area. Paresthesia migrates up the arm and then extends to involve the lips and tongue.
HEADACHE: The typical migraine headache is unilateral, throbbing and moderate to severe, can be aggravated by physical activity. The pain peaks and then subsides, and usually lasts between 4and 72 hours in adults and 1 to 48 hours in children. Pain starts above one orbit and spread over entire side of head to the occiput and neck or beginning back of head and move forward.
Gastrointestinal- Anorexia, nausea, vomiting, diarrhea.
Special senses- Photophobia, phonophobia, osmophobia.
Brainstem features- Vertigo, ataxia, diplopia, dysarthria.
Autonomic disturbances- Hypertension, hypotension, tachycardia, bradycardia, nasal congestion.
Mind-Psychological upset and confusional state.
-Drained out, exhausted and depressed feeling after headache and may have impaired concentration, scalp tenderness or mood changes.
-Patient experiences a sense of buoyancy and wellbeing.
MAJOR TYPES OF MIGRAINE
1. MIGRAINE WITHOUT AURA:
Other names: Common migraine, hemicrania simplex.
Description: Recurrent headache disorder manifesting in attacks lasting 4-72hours. Typical characteristics of headache are unilateral location, pulsating quality, moderate or severe intensity, aggravation by routine physical activity and association with nausea and/or photophobia and phonophobia.
2. MIGRAINE WITH AURA:
Other names: Classic or classical migraine, ophthalmic, hemiparaesthetic, hemiplegic or aphasic migraine.
Description: Recurrent disorder manifesting in attacks of reversible focal neurological symptoms that usually develop gradually over 5-20 minutes and last for less than 60 minutes. Headache with the features of migraine without aura usually follows the aura symptoms. Less commonly, headache lacks migrainous features or is completely absent.
Complications Of Migraine
1) CHRONIC MIGRAINE:
Migraine headache occurring on 15 or more days per month for more than three months in the absence of medication overuse. History, physical and neurological examinations do not suggest other disorders and other disorders are ruled out by appropriate investigations.
2) STATUS MIGRAINOSUS:
A debilitating migraine attack lasting for more than72 hours. Headache is of severe intensity. Interruption during sleep is disregarded. Short lasting relief during medication is also disregarded.
3) PERSISTENT AURA WITHOUT INFARCTION:
Aura symptoms persisting for more than one week without radiographic evidence of infarction. Aura are often bilateral and may last for months or years.
4) MIGRAINOUS INFARCTION:
One or more migrainous aura symptoms associated with an ischemic brain lesion in appropriate territory demonstrated by neuroimaging. Neuroimaging demonstrates ischaemic infarction in a relevant area. This includes the cerebral infarction occurring during the course of a typical migraine with aura attack.
Effective management of Chronic migraine is multifactorial. Medications alone are not adequate management. Other elements of management that should be incorporated include:
• Education- Learning about disease in general
• Treating any co morbid disorders that might impact migraine.
• Identification and avoidance of precipitants or exacerbating factors may prevent attacks.
Treatment of an acute attack consists of simple analgesia with aspirin or paracetamol with an antiemetic.
In homoeopathic system of medicine, more importance is given to the patient than the disease per se because the patient is sick holistically even in localized disorder. Every case has to be individualized as per his mental, physical, particular symptoms and the underlying miasm. When a medicine is selected on holistic basis, it strikes at the very root cause of disease, whatsoever it may be, and brings about health in sick person.
An understanding of the miasm should be the ultimate concern of the physician, because it involves nothing less than a maximum understanding of the human, both with respect to the qualities which lead him to persist to realize his full potential, and with respect to those defects which hinder him.
MIASMATIC ANALYSIS OF MIGRAINE SYMPTOMS
Location-Frontal/temporal regions or over whole head. Often felt only externally.
Sensation- Sharp, paroxysmal, Severe pain appearing on one side only and is often longstanding and of functional character.
Modality-Increase and decrease with sun.rest, quiet, sleep, warmth, natural
Concomitant-Mental symptoms such as fear, anxiety And apprehension. Red face with throbbing of carotids. Sweat on forehead during sleep. Vertigo <looking up suddenly, rising from sitting or from emotional disturbances.
Location-Frontal and vertex regions and also Occipito parietal.
Sensation-Dull, aching pain, head heaviness and reeling sensation.
Modality-motion, violent exercise, warmth, abnormal discharges
Concomitant-Urogenital Symptoms. Crossness. Jealousy, Restlessness, Vertigo which appears on closing the eyes and disappears on opening them. Congestion leading to stagnation causing the arteries to become sluggish.
Location- Mostly occipital or Temporal although Occasionally they occur in base of brain, internal head and meninges.
Sensation-Constant, persisting pain often occurs at the base of brain on one side only. Pain may be stitching,
tearing, boring, digging maddening, sharp or cutting etc.
Modality-cold applications, Changing places motion, nose bleed.
Concomitant-Suicidal tendencies. Imbecility. Deficient blood supply.
Homeopathic Management of Migraine
Great weakness and weariness. Coldness. Blinding Headache. Aches as if a thousand little hammers were knocking on the brain in the morning on awakening, after menstruation, from sunrise to sunset. Anaemic headache in school girls; nervous, discouraged, broken down. Chronic Headache, semi-lateral, congestive, from sunrise to sunset, with a pale face, nausea, vomiting; periodical; from eye strain; menstrual. Before attack, numbness and tingling in the lips, tongue and nose, relieved by sleep.
It is a remedy which has a headache commencing with blindness especially for headaches due to eye strain. Dull aching headache extending down back of neck or over on one side, generally the left; there is strained stiff sensation in the corresponding eyes. Occipital headaches, which are dull and dragging, often find their remedy in Gelsimium (Cocculus). A characteristic of Gelsimium is a sensation of a band around the head just above the ears. Its also suits “tobacco headache”. Headache relieved by copious urination; accompanied with visual troubles, such as double vision, squinting and dim sight. Headache relieved by sleep, and dizziness may accompany.
Migraine, which had existed for years in women with profuse leucorrhoea, is often cured by Sepia. It corresponds to the left eye and the left temple and the pain extends backward. Headache worse Fasting, worse menopause or before or during menses. Yellow or brownish saddle across the nose. Stinging pain from within outward and upwards mostly on the left side, or in the forehead, with nausea vomiting(migraine); worse indoors and when lying on painful side.
Mentally, the emotional element is the uppermost and coordination of function is interfered with. Head feels hollow, heavy; worse stooping. Headaches as if a nail were driven out through the side. Cramp- like pains over the root of nose. Congestive headaches following anger or grief; worse smoking or smelling tobacco inclines head forward.
Headaches, often migraines, which occur at the last hour of the menstrual flow. Headaches worse menopause, worse heat, worse sun, worse exertion, worse after emotional stresses. Headaches better open air, cold or cold applications and pressure. Headaches often are pulsating or pressing outwards.
Headache from the excessive use of alcohol, the morning ‘big head’, tobacco, coffee, headache from digestive troubles, constipation, and especially auto-intoxication and hepatic insufficiency. The dull, wooden, bursting feeling of the head following a debauch is most characteristic of Nux Vomica. Headache of high livers. A headache“all over the head” is also characteristic of Nux. Pressing pain as if nail is driven in. Frontal headache, with desire to press the head against something. Headache in sunshine.
Sick headache, the pain begins in the morning and in the occiput; it comes up over the head and settles in the right eye. The pain increases in severity until there is vomiting of blood and then the ache is relieved. Noise and light are unbearable and sleep relieves. The pain will be so intense at times that the patient will frantically bore her head into the pillow for relief. Veins in the temples are distended. Pain better lying down and sleep. Burning in eyes. Pain in the back of head “like a flash of lightening.
Headache and migraines, often begin in the occiput and radiate to forehead or right side of the head. Headaches worse from cold and drafts, worse from mental exertion, worse menses, worse uncovering the head. Headaches better lying with eyes closed and in the dark, better from warming or wrapping the head.
Nervous headache caused by excessive mental exertion. The face is pale at the commencement of the headache, but gets flushed as if pain becomes intense; body chilly. It is supra orbital and worse over the right eye, the pains coming up from the back of the head noise, motion and jarring aggravate. Warmth relieves.
Sun headaches, with headache, flickering, dim vision, very pale face. Headache relieved by the onset of a discharge (menses or nasal catarrh).68 Left sided complaints or moving from left to right. Headache with very pale face, and the patient sleeps into the headache; dreads to go to sleep because she awakens with such a distressing headache.
Remedies For Acute Pain
Throbbing is the great keynote, but violent shooting pains in head, driving patient almost
wild, are scarcely less characteristic.
The pains are neuralgic in character, settle over the left eye, and they are apt to follow the course of the sun, beginning in the morning, reaching the acme at noon and subsiding at sunset.
The iris headache characteristically commences with a partial blindness, or blurring of vision and it is especially a remedy for gastric or bilious headache.
A great remedy for congestive headaches, hyperemia of brain from excess of heat or cold. Terrible bursting headache. Bluish face.
Physical and mental restlessness, and fright are most characteristic manifestations of Aconitum. Acute sudden violent invasion, with fever. Complaints and tension caused by exposed to dry, cold weather, draught of cold air, checked perspiration, also complaints from very hot weather.
A remedy for migraine. Headaches from eye strain and sexual weakness. Neuralgic pains. Dull, heavy, dizzy, pain pressing upward in the occiput. Occipito-frontal pain in the morning on waking, chiefly left sided. Pain the temples and mastoid.
Migraine is a common disabling primary headache disorder. Most often, migraine diagnosis is easy and treatment straightforward but, in a small number, it can be complex and debilitating. In some, migraine can progress from being an episodic disorder to a chronic form, where it can be more difficult to manage. According to homeopathic principles chronic diseases are caused by dynamic infection of chronic miasm. Thus, to achieve homoeopathic cure one has to remove the underlying miasm.The study of the chronic miasms provide invaluable insight into the dynamics of health and disease. Perceiving the miasmatic basis of disease is a way to understand disease at its very roots, a vision that constitutes a tremendous privilege in cases of chronic diseases in general and migraine in particular.
1. ICD-10-CM Diagnosis Code G43.909.2018 [INTERNET] Available from:https://www.icd10data.com/ICD10CM/Codes/G00-G99/G40-G47/G43-/G43.909 Accessed on August 2, 2018.
2. Harrison’s Principles of Internal Medicine. Volume 1,19th Edition, United States of America. McGraw-Hill Professional Publishing, 2015 pg. no. 2586.
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4. Clarke, John. Condensed Homoeopathic Materia Medica and Repertory. New Delhi: B. Jain Publishers;2001
5. Speight, Phyllis. A comparison of the Chronic miasms, foreword by Noel Puddephatt, Kent Cottage, Sussex
6. Dewey, W.A. Practical Homoeopathic Therapeutics. New Delhi: Pratap Medical Publishers; 1934.