Migraine is nowadays considered to be one of the most common conditions affecting day to day life of an individual. The appearance and the associated symptoms along with headache and the different types of presentations in different individuals make it really hard for the attending physician as well as troublesome for the patient. The various causes leading to migraine pose a challenge in controlling the attacks of migraine in an individual.
For the project, the drug used was Niccolum metallicum in 30 potency, and final assessment was carried out. The efficacy was assessed by the changes observed in the subjective feeling at the end of the treatment regimen. In the study, out of the 48 cases treated and observed, 35 cases showed positive results and reduction in symptoms.
IT – information technology, C – Centesimal.
Migraine is a primary headache disorder characterised by recurrent headaches that are moderate to severe. Typically, the headaches affect one half of the head, are pulsating in nature, and last from a few hours to 3 days. (1,2)
The word migraine is from the Greek ἡμικρανία (hemikrania), ‘pain in half of the head’, from ἡμι- (hemi-), ‘half’, and κρανίον (kranion), ‘skull’. (1,2)
Up to one-third of people affected have an aura, typically a short period of visual disturbance that signals that the headache will soon occur. Occasionally, an aura can occur with little or no headache following it. (1,2)
The understanding of migraine pathophysiology is advancing rapidly. Improved characterisation and diagnosis of its clinical features have led to the view of migraine as a complex, variable disorder of nervous system function rather than simply a vascular headache. (3)
Recent studies have provided important new insights into genetic causes, anatomical and physiological features, and pharmacological mechanisms. The identification of new migraine-associated genes, the visualization of brain regions that are activated at the earliest stages of a migraine attack, a greater appreciation of the potential role of the cervical nerves, and the recognition of the crucial role for neuropeptides are among the advances that have led to novel targets for migraine therapy. Future management of migraine will have the capacity to tailor treatments based on the distinct mechanism of migraine that affect individual patients. (3)
Migraine symptoms may begin one to two days before the headache itself which is known as the prodrome stage. Symptoms during this stage include: (1,2,4,5,6)
- food cravings
- fatigue or low energy
- frequent yawning
- neck stiffness
In migraine with aura, the aura occurs after the prodrome stage. During an aura, one may have problems with vision, sensation, movement, and speech. (1, 2, 4, 5, 6)
The next phase is known as the attack phase which is the most acute or severe of the phases when the actual migraine pain occurs. Attack phase symptoms can last anywhere from hours to days. Symptoms of a migraine can vary from person to person. (1,2,4,5,6)
After the attack phase, a person will often experience the postdrome phase. These can range from feeling euphoric and extremely happy, to feeling very fatigued and apathetic. (1,2,4,5,6)
Character of pain
People may describe pain as:
It may also occur as a severe dull, steady ache. The pain may start out as mild, but without treatment, will become moderate to severe. (1,2,4,5,6)
Researchers haven’t identified a definitive cause for migraine. However, they have found some contributing factors that can trigger the condition including changes in brain chemicals, such as a decrease in levels of the brain chemical serotonin. (1,2,4,5,6)
Other factors that may trigger a migraine include: (1,2,4,5,6)
- bright lights
- severe heat, or other extremes in weather
- changes in barometric pressure
- hormone changes in women, such as estrogen and progesterone fluctuations during menstruation, pregnancy, or menopause
- excess stress
- loud sounds
- intense physical activity
- skipping meals
- changes in sleep patterns
- use of certain medications, such as oral contraceptives or nitroglycerin
- unusual smell
- certain foods
- alcohol use
Types of migraine(1,2,4,5,6)
Two of the most common types are migraine without aura and migraine with aura. Some people have both types.
Migraine without aura
This is also called common migraine. Most people with migraine don’t experience an aura. (1,2,4,5,6)
According to the International Headache Society, people who have migraine without aura have had at least five attacks that have these characteristics:
- Headache attack usually lasting 4 to 72 hours if not treated or if treatment doesn’t work.
- Headache has at least two of these traits:
- it occurs only on one side of the head (unilateral)
- pulsating or throbbing pain
- moderate or severe level of pain
- pain worse when one moves, like when walking or climbing stairs
- Headache has at least one of these traits:
- sensitiveness to light (photophobia)
- sensitiveness to sound (phonophobia)
- nausea with or without vomiting or diarrhoea
- Headache isn’t caused by another health problem or diagnosis. (1,2,4,5,6)
Migraine with aura
This is also known as classic migraine, complicated migraine, and hemiplegic migraine. Migraine with aura occurs in 25 percent of people who have migraines. (1,2,4,5,6)
According to the International Headache Society, one must have at least two attacks possessing the following characteristics:
- An aura that goes away, is completely reversible, and includes at least one of these symptoms:
- visual problems (the most common aura symptom)
- sensory problems of the body, face, or tongue, such as numbness, tingling, or dizziness
- speech or language problems
- problems moving or weakness, which may last up to 72 hours
- brainstem symptoms, which includes:
- difficulty in talking or dysarthria (unclear speech)
- vertigo (a spinning feeling)
- tinnitus or ringing in the ears
- hypacusis (problem in hearing)
- diplopia (double vision)
- ataxia or an inability to control body movements
- decreased consciousness
- eye problems in only one eye, including flashes of light, blind spots, or temporary blindness (when these symptoms occur, it is called retinal migraine) (1,2,4,5,6)
- An aura that has at least two of these traits:
- at least one symptom spread gradually over five or more minutes
- each symptom of the aura lasts between five minutes and one hour (if one has three symptoms, they may last up to three hours)
- at least one symptom of the aura is only on one side of the head, including vision, speech, or language problems
- aura occurs with the headache or one hour before the headache begins
- Headache isn’t caused by another health problem, hence transient ischaemic attack has been excluded as a cause. (1,2,4,5,6)
Chronic migraine is also known as combination or mixed headache because it can have features of migraine and tension headaches. It’s also sometimes called severe migraine caused by medication overuse. (4,5)
Acute migraine is a general term for migraines that aren’t diagnosed as chronic. Another name for this type is episodic migraine. People who have episodic migraine attacks have headache up to 14 days a month. Thus, people with episodic migraine have fewer headaches a month than people with chronic ones. (5,6)
- Nickel is found associated with cobalt. It is said to have received its name (nickel, the devil) from the miners, who considered it as a “false ore” while they were mining for copper.
- It was proved by Nenning.
- Sir James Y. Simpson used the sulphate of nickel (NiSO4) in “periodic headaches of a very severe character,” and the provings showed that the metal and the carbonate act appropriately in this connection.
- Moser (Am. H., xxiii. 61) has cured cases when the pain is < 10 to 11 a.m., and may be so intense as to cause the patient to cry out; appears first left side, may jump to right; disappears in evening.
- Hering has mentioned it as suited to: “literary men and others who suffer from periodical nervous headaches; weak, asthenopic, weak digestion, constipation; < morning on awaking.” (7,8,9)
- Low-spirited; fears something evil will happen.Vexed and very angry from least contradiction.Anxious moroseness and inquietude.Trembling and fright with desire for solitude.Dislike to conversation.Anxiety on moving as if sweat would break out.
- Periodical nervous sick headaches, with asthenopia, weak digestion, constipation. Catarrh. Suited to debilitated, nervous, literary patients, with frequent headaches, dyspepsia and constipation.
- Cracking in cervical vertebrae when moving the head. Pain on top as from a nail. Pressure on vertex, in morning; worse till noon and in warm room. Stitches. Objects appear too large. Migraine; first on left side. Twitching of upper lip.
- Dullness, does not comprehend the conversation, and is unable to relate properly in conversation.
- Vertigo: in the morning; when rising after stooping, in evening; when awaking, with nausea and desire to vomit.
- Vertigo, with dizziness and staggering, as from weakness, < on getting up in the morning.
- Heaviness and painful fullness in head, principally in forehead (compelling to rub forehead with hand), with vertigo; in morning, as if she had not slept sufficiently.
- Headache all day, in forenoon with vomiting of bile.
- Heat in head, compelling him to seek open air, with thirst (afternoon).
- Headache, in a room, and after a walk in open air.
- Pressure on vertex as from a handas if a nail sticking in vertex.
- Pain in both sides of head, as if it were breaking.Stitches in head (when stooping).
- Tearing and shooting in head (and left eye in paroxysms).Periodical (every fortnight) headache.
- Modalities: Worse, periodically, every two weeks; yearly, forenoon. Better, in evening. (7,8,9)
HOMOEOPATHY AND MIGRAINE:-
Homoeopathy works proficiently for migraine as it gradually decreases the episodes of pain. Homoeopathy not only focusses on controlling the symptoms but also works deep inside and treats the roots as well as reduces the frequency and the intensity of attacks. Homoeopathic remedies are safe, act naturally and can be used by people of all age groups.
The best result in migraine treatment can be achieved if the strategic treatment is targetted at the root cause of migraine as well as the symptoms.
- To ascertain the role of Niccolum metallicum in migraine.
- To avoid the role of analgesics in migraine.
- To improve the quality of life of the patient.
- Adult men and women in the age group of 18 to 60 years.
- Patients who are known and diagnosed cases of migraine
- Patients who have started having the symptoms of migraine.
- Persons suffering from other disorders apart from migraine.
- Pregnant and lactating women.
- Non-complying patients who do not follow the treatment regimen.
- Patients on other medications which cannot be stopped.
The patients were clinically evaluated and treated with Niccolum metallicum as per the regimen. Subjects were told to avoid physical and mental exertion as much as possible. Any exposure to stimulants which can alter the action of medicines were to be avoided. For the project, the potency was decided as 30C in single dose. Final assessment was carried out and efficacy was assessed by the changes observed in the subjective feeling of the symptoms at the end of the treatment regimen.
Study was carried out on 48 adult men and women of the age group of 18 to 60 years and the sex ratio was kept equal.
Any deviation during the treatment period was taken into consideration and recorded separately. All completed case record forms were pooled together and used for statistical analysis. The related analysis and the evaluation were utilised for further research purposes.
Wash-out period: At least 7 days, but not exceeding 10 days before participating in the study. The subjects were withdrawn from all the medications.
The investigator may withdraw a subject from the study for any of the following reasons:
- The subject suffered from significant intercurrent illness or underwent surgery during the course of the study.
- Any subject found to have entered the study in violation of this protocol. This would include pre-study directions regarding alcohol and drug use, fasting or if the subject was non-cooperative during the study.
- Any subject who required the use of an unacceptable concomitant medicines.
- If it was felt in principal investigator’s opinion that it was not in the subject’s best interest to continue.
- Any subject who wished to withdraw his consent.
- Any other justifiable reason, which should be adequately documented.
In our study, more number of patients were found in 18-60 years of age group. A significant positive correlation between lifestyle, age, dietary habits, side correlation and incidence was observed. Majority of patients were professionals (such as engineers, lawyers, IT experts, etc.), businessman and service personnel. Similarly, majority of them worked for up to 14-15 hours but took less amount of rest. Incidence was high among persons who had less sleep, more exposure to screen time, suffering from stress, having poor dietary habits, smokers. (Table 1).
Table 1: Socio-demographic parameters affecting migraine
|Demographics range||Number of cases|
|Hours of work|
The medicine prescribed was Niccolum metallicum on the basis of its effectiveness mentioned in various literature of homeopathic materia medica in cases of migraine.
Descriptive statistics along with chi-square test (non-parametric test) were used. From the test statistics, it was observed that there was a significant reduction in pain, incidence and frequency of migraine by homoeopathic medicines (p<0.005).
During the period of counselling, there were drop outs (around 20%) due to various reasons like far distance from hospital, refusal from family members, but after the project started, there were no drop outs.
No adverse events have been reported for homoeopathic medicine. The subjects were examined throughout the study to evaluate any adverse effects after consumption of homoeopathic medicine.
There is no contraindication for Niccolum metallicum, but still to avoid the unexpected adverse event, pregnant and nursing women were not recruited in the study.
Discussion and conclusion:-
In the study, it was found that majority of the patients were in the age group of 31-40 yrs. Subjects were assessed based on the subjective feeling of the symptoms of migraine at the beginning and the end of the treatment plan.
Special attention was given to the education of patients in terms of symptoms of migraine. As the number of smokers were high in the study, it can also be considered as one of the contributing factors.
As migraine is most prevailing, dietary restrictions along with lifestyle changes, yoga and meditation can definitely improve the condition. Proper dietary habits with proper sleep can also have a positive outcome in the condition.
Homoeopathy has produced lot of successful results in cases of migraine without any side-effects. In the above study, out of the 48 cases treated and observed, 35 cases showed positive results and reduction in the symptoms with the use of the remedy Niccolum metallicum (Table 2).
|Number of patients||Relief of symptoms|
|06||Pain, frequency and incidence of migraine attacks were remarkably reduced|
|10||Pain and frequency of migraine attacks were partially reduced|
|19||Pain and frequency of migraine attacks were completely relieved|
*Remarkably reduced – As described by the patients, the intensity of symptoms was reduced by almost 75%.
*Partially reduced – As described by the patients, the intensity of symptoms was reduced by almost 30%.
The success in achieving the significant results in majority of cases is due to the specific effect of Niccolum metallicum in the said condition which helps the physician to draw significant conclusions.
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