Migraine: A Psychosomatic Headache

Abstract: Migraine is a complex neurological disorder that manifest with recurrent headaches, photophobia , sensitivity to sound and associated with nausea and  vomiting.It is the most common of the primary headache disorders .Migraine affects both male and female. The diagnosis is made mainly from the history. This article reviews knowledge about psychological aspects, mechanism and homoeopathic management of this disorder.
Keywords:Migraine,Homoeopathic management,Psychosomatic headache ,Psycho therapy,Biofeed back behavioural technique
Introduction
Homeopathic medicine for migraine – Migraine, the second most common cause of head ache, and the most common head ache –related and indeed neurologic, 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 head ache associated with certain features such as sensitivity to light, sound or movement; nausea and vomiting often accompany the head ache. Migraine can often be recognised by its activators, referred to as triggers such as Stress and Anxiety, Hormonal changes  (menstruation and ovulation), Visual stimuli  (bright light and glare), Auditory stimuli (loud  noise  or music),Olfactory stimuli ( perfumes and certain odours) , Sleep (too much or too little) and Hunger⁽¹⁾ .               
Migraine is one among the two main type of psychosomatic headache. These patients have a family history of similar disorder in two-third of cases. The personality of this patient is usually obsessive with overly controlled and suppressed anger. Genetically predisposed to such type of headaches, they develop symptoms under severe nonspecific emotional stress⁽²⁾.  In aphorism 225, Dr Hahnemann  talks about mental diseases originate and are kept up by    emotional causes ,such as continued anxiety, worry, vexation ,wrongs and the frequent occurrence of great fear and fright⁽³⁾. Psychosomatic headaches are autonomic responses to conscious or unconscious conflicts and that are not symbolic in nature.
Homeopathic medicine for migraine – Psychosomatic affection is a bodily disorder whose nature can be appreciated only when emotional disturbances (i.e psychological happenings )are investigated ,in addition to physical disturbances(i.e somatic happenings).Psychosomatic theory holds that emotional change in human beings are accompanied by psychological changes and that if these emotional changes are persistent or frequent ,then pathological physical factors can help to maintain or aggravate the disease, or to trigger relapses. Psychological stress usually exacerbates headaches, whether the primary cause is physical or psychological⁽³⁾.
Mechanism of migraine
Current thinking has moved away from vascular disregulation as a primary cause of migraine. It is now believed that vasodilatation and vasoconstriction are probably epiphenomena and that neurological dysfunction is the possible primary driver in the pathophysiology of the disorder. Specifically activation of the trigeminovascular system, cortical spreading depression and neuronal sensitization are seen as important roles in migraine pathophysiology.Sensory neurons from the trigeminal ganglion and upper cervical dorsal roots innervate dural-vascular structures (e.g.pial vessels,dura matter and large cerebral vessels).
Common clinical types
Migraine with aura or classical  Migraine:Here the episode begins with prominent neurologic symptoms(auras)such as visual disturbances like dazzling zig-zag lines, spreading scotoma, homonymous hemianopia, field defects or rarely total blindness ,sensory disturbances affecting one-half of the body, disturbances of speech or hemi paresis. These neurologic symptoms last for 15-30 mts and usually merge into a hemicranial or generalized throbbing headache with nausea and vomiting, all of which may last even for 1-2 days.
Migraine without aura or common migraine: Here there is no preceding neurologic symptom ,but there is unheralded onset of headache ,nausea and vomiting following the same sequence.
Diagnosis
Diagnosis of both classic and common types of migraine is made mainly from history. Long duration of illness, onset during childhood, positive family history and relief from ergot derivatives are in favour of migraine. Migraine has to be differentiated from other organic disorders such as raised intracranial tension, subarachnoid haemorrhage and arteriovenus malformations.
Course and prognosis
In the majority of patients, migraine tends to be chronic with periods of exacerbation and remission. With increasing age, the attacks tend to come down. Complications may occur rarely in some cases. These include cerebrovascular accidents, ocular and other cranial nerve palsies⁽⁴⁾.
Homoeopathic management.
Homoeopathic management includes general management and specific management (by homoeopathic medicines)
General management
All known precipitating factors such as emotional tension, exposure to cold, foods such as cheese and chocolate should be avoided.Hypoglycemia is a common precipitating factor and this should be avoided by proper timing of meals⁽⁴⁾.         
In Aphorism 226, Dr Hahnemann gives the direction of treatment for mental diseases originates and are  kept up prolonged emotional causes,  by means of psychical remedies such as display of confidence, friendly exhortations, sensible advice, and often by a well –disguised deception⁽³⁾.  Migraine is a psychosomatic headache in which along with similimum Psychotherapy and Biofeed back behaviour technique,may be helpful in decreasing the symptoms⁽²⁾.
Repertorial approach
Symptoms related to migraine from different repertories have been given below.
1. Homoeopathic Materia Medica and Repertory – Dr W. Boericke

1. Head-Headache (cephalgia)-cause: emotional disturbances
2. Head-Headache (cephalgia)-cause: mental exertion or nervous exhaustion
3. Head-Headache-menstrual
4. Head-Headache-migraine, megrim, nervous
5. Head-Headache-semilateral (hemicrania)
6. Head-Headache-throbbing,beating,hamerring, pulsating⁽⁵⁾
   
   2. Synthesis repertory

1. Head –pain-pulsating
2. Head-pain-menses-during
3. Head-pain-mental exertion –aggravation
4. Head-pain-accompanied –nausea
5. Head-pain-noise-aggravation
6. Head-pain-temples-right
7. Head-pain-temples-left⁽⁶⁾

3. Homoeopathic medical repertory: Dr Robin Murphy
1. Headaches-migraine headaches⁽⁷⁾
4. Concise repertory –Dr S.R. Phatak
1. Hemicranias (head-affections in general-one sided)⁽⁸⁾
Some of the medicines found to be useful in cases of migraine are discussed below, but they should be prescribed according to symptom similarity.

Homeopathic Management:
1.Cyclamen
Grieves over duty neglected. Depression, with weeping desire to be Alone. Aching in morning, with flickering before eyes. One -sided headache⁽⁵⁾. Rush of blood to  head with anxiety and confusion.Obscuration of vision; dizziness; general coldness after dinner⁽⁹⁾.
2.Natrum muriaticum
For the bad effects; of  anger (caused by offense);of grief; fright ,vexation, mortification or reserved displeasure. Head ache beginning with blindness; with zig zag dazzling, like lightning in eyes. Throbbing head ache. Left sided. Head ache before during after menses; > by perspiration⁽¹⁰⁾.
3.Gelsemium sempervirens
Bad effects from fright fear, exciting news and sudden emotion. Head ache preceded by blindness ,>by profuse urination. Vertigo ,spreading from the occiput ;with diplopia,dim vision,loss of sight; seems intoxicated when trying to move⁽¹⁰⁾.
4.Belladonna
Head pain especially in forehead ,occiput and temples. Pain worse light ,noise,jar,lying down and in afternoon⁽⁵⁾. Rush of blood to head and face. Head ache, congestive, with read face,throbbing of brain and carotids⁽¹⁰⁾.
5.Ignatia Amara
Persons mentally and physically exhausted by long concentrated grief. Ill-effects from bad news,vexation with reserved displeasure,from suppressed mental sufferings. Head ache as if a nail was driven out through the side, relieved by lying on it⁽¹⁰⁾. Congestive head ache following anger or grief. Worse ,smoking or smelling tobacco⁽⁵⁾.
6.Onosmodium
Headaches from eye strain and sexual weakness. Loss of memory.Confused,dull heavy ,dizzy,pressing upward in occiput.Occipito –frontal pain in morning on waking,chiefly left side.Pain in temples and mastoid⁽⁵⁾.
7.Spigelia
Nervous head ache. Pain beneath frontal eminence and temples, extending to eyes. Semi-lateral ,involving left eye.pain violent throbbing;worse making a false step. Pain as if a band around head⁽⁵⁾.
8.Sanguinaria
Worse right side, sun headache. Periodical sick head ache; pain begins in occiput,spreads upwards,and settles over eyes especially right.veins and temples are distended. Pain better by lying down and sleep. Headaches  return at climacteric ;every seventh day⁽⁵⁾.
9.Glonoine
Sun head aches; increases and decreases with the sun. Head ache in place of menses. Effects of sunstroke.head heavy ,but can not lay it on pillow. Can not bear any heat about head. Better by uncovering head. Throbbing head ache⁽⁵⁾.
10.Nux vomica
Headache in occiput or over eyes ,with vertigo. Frontal head ache, with desire to press the head against something. Head ache in the sunshine. Bruised sensation of brain, generally onesided (rt) better by lying on pain less side⁽⁵⁾. Tearing headache after eating, with a feeling of heat in cheeks and a chilly sensation over body, at least in hands⁽⁹⁾.
11.Bryonia
Bursting, splitting headache, as if everything would be pressed out. Head ache as if hit by a hammer from within. Worse from motion,stooping,opening eyes. Head ache becomes seated in occiput.Headache worse on motion even, of eye balls⁽⁵⁾.
12.Coffea cruda
Bad effects of sudden emotions,surprises,joy.Intolerance of pain ,driving to despair.Tight pain in head worse from noise,smell,narcotics.seems as if brain were torn to pieces.pain as if nail were driven in head.Worse in open air. Sensitive hearing⁽⁵⁾.
Discussion and conclusion
Migraine is a complex neurological disorder,which is more predominantly found to be associated with people who were undergoing  prolonged emotional conflicts;and express through symptoms like recurrent headaches, photophobia, sensitivity to sound and associated with nausea and  vomiting Homoeopathic medicines when prescribed on the principle of similarity and individualisation can prove to be effective in relieving the symptoms and reaching at the cure. Some of the homoeopathic medicines found to be useful in treating migraine include Cyclamen,Natrum muriaticum,Gelsemium sempervirens,Belladonna,Ignatia amara,Onosmodium,Spigelia,Sangunaria,Glonoine,Nux vomica,Bryonia,Coffea cruda, etc.
Medicines should be selected properly following the laws and principles of Homoeopathy ,consulting Materia Medica, Repertory and Organon of medicine, the trio of basis of homoeopathic prescription.
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