Headache is one of the most frequently encountered complaints in our clinical practice. A study on Global burden of diseases in the year 2019 has found that, among various diseases headache ranks second and fourth in young people and adults respectively. People commonly resort to the use of Over the Counter (OTC) allopathic pain killers to seek relief. But the inappropriate over use of allopathic Headache medicines itself tends to be the cause of Medication Overuse Headaches (MOH). Homoeopathy has always been effective in treatment of various types of headaches. This article is a review on Headache and its Homoeopathic management.
The International Classification of Headache Disorders (ICHD – 3rd Ed) classifies headaches comprehensively as in Table 1
|THE INTERNATIONAL CLASSIFICATION OF HEADACHE DISORDERS – 3|
|PRIMARY HEADACHE||Migraine (with or without aura) Tension-type headache Trigeminal autonomic cephalalgias including cluster headache Other primary headache disorders|
|SECONDARY HEADACHE||Headache attributed to trauma or injury to the head and/or neck Headache attributed to cranial and/or cervical vascular disorder Headache attributed to non-vascular intracranial disorder Headache attributed to a substance or its withdrawal including medication overuse headache Headache attributed to infection Headache attributed to disorder of homeostasis Headache or facial pain attributed to disorder of the cranium, neck, eyes, ears, nose, sinuses, teeth, mouth, or other facial or cervical structure Headache attributed to psychiatric disorder|
|PAINFUL CRANIAL NEUROPATHIES, OTHER FACIAL PAIN, AND OTHER HEADACHES||Painful lesions of the cranial nerves and other facial pain including trigeminal neuralgia Other headache disorders.|
Among the headaches, the most prevalent are Migraine and Tension type headache which will be discussed here in this review.
Primary Headaches are benign headaches where clinical examination and investigations will be normal. 90 % of the headaches are primary headaches.
Migraine is characterized by recurrent headaches (commonly unilateral) associated with nausea or vomiting, photophobia or phonophobia with or without an aura. When a patient presents with all of these typical features, then they are said to have classical migraine. But almost 80 % of patients with migraine do not experience aura. Apart from these symptoms neurological, gastrointestinal or autonomic features may also be present. Four different phases are identified namely the prodrome, the aura, the headache and the postdrome.
Females are more affected in the ratio of 3:1 (Female : Male). In the treatment of migraine, it is important to identify and avoid the migraine trigger factors. Trigger factors are usually certain food, stress or environmental factor like light, noise, etc.
It belongs to true chronic miasmatic disease and can be cured completely through constitutional and anti miasmatic treatment. The acute episodes also can be relieved promptly by selecting an acute simillimum usually belonging to the apsoric group of remedies.
TENSION TYPE HEADACHE (TTH):
This is the most common type of headache and is experienced by almost everyone at some time of their life. The pain is usually constant and may radiate forward from the occipital region. It is described as ‘dull’, ‘tight’ or like a ‘pressure’, and there may be a sensation of a band round the head or pressure at the vertex. It can of either episodic or chronic type. Stress, anxiety and depression tend to be the common cause of Tension type headache. TTH may present as acute or chronic disease and can be cured by using a similar remedy following Homoeopathic principles.
Secondary headaches are due to some underlying condition related to structural, vascular, metabolic or infective causes like sinusitis headaches, traumatic headaches, headaches along with psychiatric disorders, MOH, etc.
MEDICATION OVERUSE HEADACHES (MOH):
Among secondary headache disorders, special mention about MOH is required because the overuse of Pain medications without prescriptions has become a normal scenario in our society. It is classified under Secondary headache attributed to a substance or its withdrawal. Medication Overuse Headaches (MOH) are rebound headaches due to the excessive use of painkiller medicines in the treatment of Chronic Headaches. The medications may transform episodic headache to frequent headache.
Discontinuation of those medicines is the main treatment of choice for MOH. This method of treatment is similar to Hahnemann’s idea in treating the Artificial Chronic Diseases, which are due to the overuse of crude allopathic drugs. In Aphorisms 74 to 76 Hahnemann says that treating the artificial chronic diseases is almost impossible. All those hurtful medications must be discontinued and the Vital Force must be let alone to recover itself from such Artificial Diseases.
NEUROPATHIES, FACIAL PAINS AND OTHER HEADACHES:
This category includes headache due to nervous disorders like trigeminal neuralgias, occipital neuralgias, Burning mouth syndrome, optic neuritis, etc.
Investigations are not required for simple primary headaches that can be diagnosed clinically. But in order to rule out underlying causes for diagnosing secondary headaches investigations can be used.
- Blood investigations like CBC, ESR, CRP to rule out infectious diseases.
- CT or MRI can be used in exceptional cases where pathology is suspected.
- CSF examination can be advised in suspected cases of meningeal infection.
Identification and avoidance of precipitating factors is the first step. Maintenance of overall physical, mental and spiritual health with proper diet, exercise and rest is also very essential.
Some effectiveness is found when Non-pharmacological self-management like Cognitive–Behavioral Therapy (CBT), patient education, Relaxation and mindfulness therapy are used alongside pharmacological management.
Weight loss diets in obese headache patients, ketogenic and low-calorie diets, reducing omega-6 and increasing omega-3 fatty acid intakes are considered to have benefit as prophylaxis in headache/migraine.
HOMOEOPATHY FOR HEADACHES:
Both acute and Chronic Headaches can be effectively managed with Homoeopathy. In Aphorism 5 Hahnemann tells to find the most probable exciting cause in acute diseases and to find the Fundamental cause i.e., the Miasms in Chronic Diseases for effective treatment.
APPROACH TO ACUTE HEADACHES:
In acute Headaches, the Striking, Singular, uncommon and peculiar symptoms can be easily collected because the patient can remember and tell all the symptoms accurately. Also if the Exciting cause or Ailments from is clearly known, selection of the correct remedy becomes easy. By selecting a remedy based on the totality, the acute headaches can be successfully treated.
APPROACH TO CHRONIC HEADACHES:
Most of the acute headaches or episodes are easily treated with Homoeopathic medicines. But the Chronic recurrent Headaches requires more effort to be completely cured. In 17th aphorism Hahnemann says removal of the Totality is removal of the Disease. Removing only some troublesome symptoms partially cannot be considered as cure. So a complete case taking with mental and physical general symptoms, characteristic particulars and a thorough life space investigation is required before framing the totality.
Apart from these, identification and removal of maintaining causes and exciting causes is also required. The modern day Occupations involve many maintaining causes like eye strain, mental stress, continuous work under hot or cold environments, etc which often requires correction with patient education and simple exercise techniques. Also the social, occupational and domestic circumstances must be analyzed thoroughly to identify stressors which often become the exciting or maintaining cause of Headache.
In case of Medication Overuse Headaches, if the indicated medicines fail to work, then Tautopathic medicines can be considered. Once the effect of the allopathic medicines wears off, then proper anti miasmatic treatment is required to cure the patient completely.
The fundamental cause of Chronic Headaches will always be Miasms. A good Knowledge of Miasms will allow us to see the unseen disease in patients. Thus the totality becomes more accurate and a proper anti miasmatic treatment will cure the case rapidly, smoothly and agreeably.
In the present times almost all patients present with mixed miasmatic states that further complicate the situation. Identifying the dominant miasm is very important in such cases and the remedy selected should be mainly based on the dominant miasm though other background miasm(s) must also be considered. The following are the symptoms of the four miasms related to headache.
HEADACHE SYMPTOMS IN MIASMS:
|Frontal usually, Temporal or Tempo-Parietal, sometimes on the vertex.||Psoric headaches are sharp, severe, paroxysmal; constantly returning. Headaches with bilious attacks, nausea, vomiting. Headache with red face and throbbing. Heat in the head.||A/F – suppressed eruptions. Worse Morning. Headaches grow worse as the sun ascends and decrease as it descends Better by quiet, rest or sleep, by hot applications.||Great hunger before or during headache.|
|Usually basilar or one-sided.||Dull, heavy or lanceolating. Constant, persistent, sometimes accompanied with sensations of bands about the head||Headaches at night or the approach of night. Get better in the morning and remain better all day until evening when they grow worse as the night advances, Better towards morning. Lying Down aggravation. Headaches worse by warmth, rest or while attempting to sleep. Better by cold|
|Frontal or on vertex.||Headache with Vertigo at the base of brain similar to Syphilitic miasm.||Worse at or after mid-night, at night, lying down Worse riding, by exertion either mental or physical. Markedly Better by motion||Usually accompanied by coldness of body, sadness and prostration. In Children feverishness, restlessness, crying, fretting, and worrying|
|Headaches occurring every Sunday or on rest days||Headaches with red face and rush of blood to head. Will often last for days and is very severe, often unendurable, sometimes with sensation of bands about the head. Prosopalgia or persistent headache not easily relieved with usual treatment.||Usually worse in forenoon, riding in carriage, the least unusual activity like preparing for examination; meeting with strangers. Headaches better by rest, quiet, sleep, eating. Headache relieved by nose-bleed.||Great hunger before headache. Deathly coldness of hands and feet, with prostration, sadness and general despondency. Children strike, knock or pound their heads with their hands or against some object.|
Although many medicines are there for treatment of headache, only some of the frequently indicated remedies in clinical practice are mentioned here.
Headache with coldness. brain-fag, with general debility and trembling. Great Anxiety and apprehension. Headache from mental exertion. Bad effects of eye strain weak ciliary muscles. Diarrhea from eating sugars < warmth > cold.
Most frequently used remedy for headache. Sun headaches. Ailments from suppressed catarrhal flow, ill effects of colds, from having hair cut. Sudden onset. Heat, redness, throbbing and burning pains. Pain worse from light, noise, jar, lying down and in afternoon; better by pressure and semi-erect posture. Headache worse on right side and when lying down;
Irritable disposition with dry, parched lips, mouth; excessive thirst, bitter taste, sensitive epigastrium. Vertigo from raising the head. Pressive headache with frontal sinusitis. Stitching, tearing, bursting headache, as if everything would be pressed out; as if hit by a hammer from within; worse from motion even of eyeballs, stooping, opening eyes. Better by lying on painful side, pressure, rest, cold things.
Debility due to exhausting discharges, from loss of blood. Intense throbbing of head and carotids. Headache in vertex, pain as if bruised in sides of head. Flushed face after hemorrhages or sexual excesses. Better by pressure and in warm room. Sensitive Scalp, worse combing hair, in open air, by contact, current of air, stepping.
Bad effects from fright, fear, exciting news, Stage fright. Brain fag and anxiety of students during examinations. General prostration with dizziness, drowsiness, dullness, and trembling. Ailments from cold and damp atmosphere. Headache preceded by blindness. Heaviness of head; band-feeling around and occipital headache. Better by pressure and lying with head high, profuse urination. Pain in temple, radiating to ear, nose and chin. Headache with soreness of neck and shoulders.
Great remedy for congestive headaches. Ailments from excess of heat or cold, sun exposure.
Great lassitude with excessive irritability. Throbbing headache. Meningitis. Tendency to sudden and violent irregularities of the circulation. Sun stroke; heat on head as in workers under gas and electric light. Cannot bear any heat about head. Head heavy, but cannot lay it on pillow. Better from uncovering head. Headache in place of menses. Rush of blood to head in pregnant women. Climacteric disturbances, or due to menstrual suppression.
Headache due to emotional causes, grief, worry, from anger; worse, smoking or smelling tobacco.
Migraine. Headache with nausea. Begins with a blur before eyes, after relaxing from a mental strain. Worse from rest; Worse, in evening and at night, from rest.Better from continued motion.
Great debility caused by summer heat; chronic effects of sunstroke. Headache from slightest mental exertion, worse from sun or working under gas-light. Vertigo from exposure to sun.
Ailments from sedentary life, over indulgence, mental exertion, tobacco, alcohol, coffee or stimulants. Worse in morning, open air. Oversensitiveness. Vertigo, with momentary loss of consciousness. Intoxicated feeling. Sour taste, and nausea in the morning, after eating. Weight and pain in stomach.
Migraine. Marked association of head and eye symptoms, with muscular tiredness and weariness. Headaches from eyestrain and sexual weakness. Occipito-frontal pain in morning on waking, chiefly left side. Pain in temples and mastoid. Pain in eyeballs. sexual neurasthenia. Worse, from motion, jar, and tight clothing. Better, when undressed, when lying down on back, from cold drinks, and eating.
Headache from eye-strain. Eyes red, hot, and painful from sewing or reading fine print.
Right sided remedy. Burning of various parts. Sun headache. Periodical sick headache; pain begins in occiput, spreads upwards, and settles over the right eye. Pain better lying down and sleep. Headaches return at climacteric; every seventh day. Pain in the back of head “like a flash of lightning”. Face flushed. Neuralgia extends in all directions from upper jaw. Earache with headache.
Headache beneath frontal eminence and temples, extending to eyes. Left sided extends to eyes; pain violent, throbbing; worse, making a false step. Severe pain in and around eyes. Ciliary neuralgia. Worse from touch, motion, noise. Better from lying on right side with head high.
Headache with bursting feeling, as if temples would burst, or the eyes burst out of the sockets. Throbbing carotids.
Homoeopathy being a holistic system of medicine aims not just for temporary relief but offers permanent cures in a gentle way.Contrary to the general false belief that Homoeopathy is slow acting, headaches can be relieved very quickly that too without any side effects or risk of addiction.
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Dr. Vivek R, M.D.(Hom).,
Department of Organon & Homoeopathic Philosophy,
Yenepoya Homoeopathic Medical College and Hospital Deralakatte Post,
Karnataka – 575023