Menstrual Migraine and Homoeopathy: A Case Study
Abstract:
The following case study is of a 27-year female complaining of headache especially before and after her menstrual cycle. The intensity of pain was so severe that she had to take two tablets of painkiller in a day and about 10-12 tablets for getting relief. She got relieved after administration of Pulsatilla nigricans.
Keywords:
Migraine, menstrual migraine, hormonal headache, periodic headache
Abbreviations:
Tab- tablets, TB- tuberculosis, HTN- hypertension, IBD- irritable bowel disease, TDS- thrice in a day, S/L- Saccharum lactis, COVID – coronavirus disease
Introduction:
Headache is very common in any age group and mainly occurs due to vasodilation, muscle contraction or due to any psychological stress.¹ Menstrual migraine is the headache related to menses that may be beginning before or during or after menstruation. Menstrual migraine usually missed to diagnose or can be considered as simple migraine. The pathophysiology of migraine is the trigemino-vascular system; the sensory afferents originating from the trigeminal ganglion and upper cervical dorsal roots. The migraine pain involves front and back of head and also the upper neck. Mainly seen between the ages of 15 and 19 and between 30 to 40 years of age. Menstrual migraine usually triggered by decrease in estrogen levels. In result when oestrogen levels decrease, serotonin concentration also decrease as estrogen modulates the balance between excitatory and inhibitory neurotransmission.
In homoeopathy, there are multiple medicines for treating headache- either in school going headache or headache before, during or after menses, after stress, morning headache or according to time and location modalities. More than 100 rubrics and sub-rubrics under the heading head pain and relation with menses.²
Case:
An unmarried female, age of 27 years came with the complaints of headache mainly seven days before and after menses, also during the first day of menses with vertigo during menses since past five years, took several treatments but had no such relief. Headache began from right side covering the right eye with pain in neck with vomiting 3-4 times per day, and vomiting ameliorate. The pain used to start suddenly and worsened over the time.
| Location | Sensation | Modalities | Concomitant |
| Head (in general) | Pain – sudden and worse by time Nausea vomiting | < menses (before, during, and after) Ameliorate by vomiting | Vertigo |
Past history–
- COVID in April 2021, home isolation with allopathic treatment. After COVID, she having hairfall
- In 2013, she suffered from pulmonary TB, underwent treatment for 9 months, and was relieved
Family history:
Mother- HTN since 2 years and IBD since many years
Father- Died in road accident 20yrs before
Physical generals:
She was chilly. Appetite normal, 2 chapattis per meal and three times in a day. Very thirstless, hardly drank two glasses in a day. She craved and desired for spicy food and had intolerance to sweets as it caused nausea. Motion was normal once in a day and satisfactory but she had no urge for stools 3-4 days for just before the onset of menses. Urine normal. She had scanty perspiration during exertional activity.
Mental generals:
She was very emotional, used to weep easily even having tears while narrating the symptoms and highly wanted sympathy and surrounded by some company.
Menstrual symptoms:
Last three months cycles:
| 26/08/2021 28/07/2021 30/06/2021 | 28/4-5days cycle, Regular, 2-3 pads per days with backache Severe intensity of headache before, during and after menses |
Diagnosis:
Diagnosis was based on clinical and particular symptoms. Menstrual migraine headache is typically migraine without aura. Headaches are sudden in onset, persistent, worsen over time and severe after onset.¹ If the character of pain is changed in its pattern or in frequency (like constant regular pain), or severity even worsen after treatment then will advise for the MRI – brain for further rule out. ¹
Case analysis:
Analysis and evaluation of symptoms-
Mental generals: • Emotional and weeping easily
• Tears in her eyes while narrating her symptoms
• Wants company always and sympathy from all
Physical generals: • Thirstless
• Desire for spicy foods
• Intolerance for sweets
• No urge to stool before onset of menses
• Chilly patient
Particular symptoms: • Headache with nausea and vomiting
• Relieved by vomiting
• < before, during and after menses
• vertigo during menses
Rubrics
Head- PAIN -menses – before
Head – PAIN – menses- during
Head- PAIN – menses- after
Vertigo – MENSES- during
Stomach- thirstless
Repertorial
chart
³
Miasmatic analysis: she shows the complete picture of psora- covering the mental general and as well headache complaints ⁴.
Prescription:
Rx Pulsatilla nigricans 30 single dose (4globules) given on september 21, 2021 followed by sac lac (4 globules) TDS for 15 days
The choice of remedy was Pulsatilla nigricans as it is chilly, want sympathy, emotional, weeping 5, and covering all the symptoms which she said.
Follow up:
| Date | Symptoms | Prescription |
| 14 october – 2021 | Heaviness in head LMP 8/10/21 ; scanty and slight offensive 30% better in nausea and vomiting; vomiting intensity reduced – only once during cycle No significant change in head ache No backache during this cycle | Rx Pulsatilla nigricans 30 one dose6 followed by S/L TDS for 15 days |
| 30 october -2021 | Has relief No episode of headache | S/L TDS for 15 days |
| 15 November 2021 | Headache only on the first day of menses LMP 2/11/21 minor sensation of nausea, no vomiting occured | S/L TDS for 15 days |
| 19 December 2021 | LMP 3/12/21, Better in all complaints, no headache before, during and after the cycle Her hairfall that was after COVID also relieved. | S/L TDS for 15days |
Conclusion:
Homoeopathy since beginning was very popular for pain either symptomatology or curing the condition. Pulsatilla nigricans itself has very good action in management of pains, also very familiar for the female hormonal remedy. This patient is improving well and still under the treatment.
Reference:
- Fritz MA, Speroff L. Clinical gynecologic endocrinology and infertility. 11th ed. India: Wolters-Kluwer; 2011
- Kent JT. Repertory of the Homoeopathic materia medica. Indian ed: B.Jain; 2007
- Shah J. Hompath electronic resource. Mumbai: Firefly; 2015
- Patel RP. Chronic miasma in homoeopathy and their cure with classification of their rubrics/symptoms in Dr Kent’s Repertory. Indian edition: Hahnemann Homoeopathic Pharmacy; 1996
- Boericke W. Pocket manual of Homoeopathic Materia Medica & Repertory. B.Jain; 2010
- Dudgeon RE. Organon of medicine. Fifth edition: Bhains Publishers; 2011
About the author
Dr Nupur Kumari, BHMS, MD (Hom.) Part I
Department of Homoeopathic Pharmacy
Swasthya Kalyan Homoeopathic Medical College and Research Centre, Jaipur (Raj.)
