Abstract: Migraine is one of the top 20 most disabling medical illnesses in the world. Around 12.7% of India’s population depends solely on homoeopathy for their health care. Homoeopathy ensures much scope in treating migraine. Although migraine is a relapsing or recurring disorder which decreases the efficiency and output of the sufferer yet its cure becomes even difficult with the regular symptomatic approach hence a palliative treatment was tried and outcome of the cure was assessed.
Nevertheless, there are plenty of remedies in homoeopathy for the treatment and management of migraine. Scutellaria laterifolia is one of the homoeopathic medicines used to treat a number of health conditions, including those associated with mind and head. The effectiveness of Scutellaria laterifolia mother tincture was evaluated as a palliative for the management of pain of migraine in a sample of 30 patients.
Keywords: homoeopathy, migraine, MIDAS, palliative, Scutellaria laterifolia mother tincture
Abbreviations: MIDAS – migraine disability assessment score, OPD – outpatient department, IPD – inpatient department, Ø – mother tincture
A migraine is a common type of headache that may occur with symptoms such as nausea, vomiting, or sensitivity to light. The word is derived from the greek word ἡμικρᾱνίᾱ (hemicrania),” pain on one side of the head”1 from ἡμι- (hēmi-), ‘half’ and κρᾱνίον (krāníon), ‘skull’.2
Typically the headache is unilateral (affecting one half of the head) and pulsating in nature, lasting from 2 to 72 hours. Migraine headache tend to first appear between the ages of 10 and 45. sometimes they may begin later in life. Migraine occurs more often in women than men. Migraine may run in families.
A condition marked by recurring moderate to severe headache with throbbing pain that usually lasts from 4 to 72 hours (lasting longer than 72 hours known as status migrainosus), typically begins on one side of the head but may spread to both sides, is often accompanied by nausea, vomiting and sensitivity to light or sound and is sometimes preceded by an aura and is often followed by fatigue.1
Globally, migraine affects nearly 15% or approximately one billion people. It is more common in women at 19% than men at 11%. In United States, about 6% of men and 18% of women get a migraine in a given year.3In India prevalence was greater among females about 25-55 years of age.
International headache society has classified different types of headache.4
2. Cluster headache
1. Migraine headache is lateralised usually fronto-temporal may be generalised. It is associated with positive family history. It is associated with nausea, vomiting, photophobia with visual disturbances, paraesthesia with tingling and numbness etc. Females are more affected as compared to males. Presentation of migraine headache is pain, preceded by aura.
2. Cluster headache is lateralised periorbital or less commonly temporal. It usually is not associated with family history. It is associated with homolateral lachrymation, reddening of eye, nasal stuffiness and ptosis. Cluster headache has male preponderance 90%. Males are affected 7-8 times more than females. Its presentation is pain (periodic attacks 1-2/day) begins without warning.
Further, migraine has following subtypes:5
(a) Common migraine (without aura)- Characterised by headache with autonomic system dysfunction (for example, pallor, nausea and vomiting).
Usually spreads to involve one half or even the whole head.
(b) Classical migraine (with aura)- Characterised by headache heralded by a visual aura which lasts about 20 minutes.
Visual aura may consist of bright or dark spots, zig zags, heat haze distortions, etc.
Headache follows the aura and is usually hemi-cranial opposite the hemianopia.
(c) Basilar type migraine (subtype with aura)- Recurrent attack of migraine with aura in which symptoms suggest a brainstem origin (including vertigo and ataxia).
Onset is typically before 30 years of age and peaks during adolescence with female preponderance 3:1.
Migraine headache may be occipital in origin.
(d) Hemiplegic type migraine-It is a rare type of migraine. Patient with hemiplegic migraine experience paralysis or weakness on one side of the body, disturbance in speech and vision and other symptoms that after mimic a stroke.
(e) Ophthalmoplegic type migraine-It is a rare migraine variant that is most common in young adults and children. This type of migraine begins as an intense migraine pain behind the eye and indicates double vision or paralysis of the eye muscles that cause a droopy eyelid.
Some studies on Scutellaria laterifolia (skullcap):
Some studies have been done globally on the utility of Scutellaria laterifolia (skullcap) in different disease conditions including migraine. Brock et al worked on, ‘American skullcap (Scutellaria lateriflora): a randomised, double-blind placebo-controlled crossover study of its effects on mood in healthy volunteers’6. Another study by Brock et al was titled, ‘American skullcap (Scutellaria laterifolia): an ancient remedy for today’s anxiety?’7.Liao chih et al published a study on ‘the effectiveness of Scutellaria baicalensis on migraine: implications from clinical use and experimental proof’8. Jean m. bokelmann published a paper titled ‘skullcap/scullcap (Scutellariabaicalensis, Scutellaria lateriflora): above-ground parts.’9
A sample size of 30 patients of both sexes from 15 to 60 years of age were taken for the study after obtaining consent, from OPD/IPD of Nehru Homoeopathic Medical College and Hospital on the basis of clinical assessment.
All the cases were subjected to migraine disability assessment score (MIDAS) for the pre-treatment assessment. Patients having MIDAS ≥ 6 were finally selected for undertaking this study.
The remedy Scutellaria laterifolia mother tincture was given to all the 30 cases twice in a day 10 drops in a 1/4th cup of water for 1 week and placebo for another week and they were called for follow-up assessment after 2 weeks and each patient was followed up for a duration of 3 months.
Research question: Can homoeopathic Scutellaria laterifolia mother tincture produce any significant effect in the management of migraine?
1. Null hypothesis- There will be no significant changes in the variation of pain after 3 months of intervention with homoeopathic Scutellaria laterifolia mother tincture.
2. Alternate hypothesis-There will be significant changes in the variation of pain after 3 months of intervention with homoeopathic Scutellaria laterifolia mother tincture.
Conclusions were drawn using parametric paired t-test after the cases were followed up properly and results were assessed on the basis of scores on migraine disability assessment score (MIDAS).
After entering ‘t’ table at 29 degrees of freedom (n-1), we find a tabulated value of 1.70 at p = 0.1 going up to a tabulated value of 3.66 at p = 0.001. Our calculated ‘t’ value which is 8.3 exceeds value in table (1.70 @ p = 0.1, 2.043 @ p= 0.05, 2.76 @ p = 0.001 and 3.66 @ p = 0.001). Since after the analysis, calculated t-value was higher than the particular level of significance so the difference in our means is highly significant.
After computation (t29) = 8.3. as (t29) > 2.043, null hypothesis is rejected and alternative hypothesis is accepted. Therefore, the test is statistically significant.
Table 1: Showing demographic details including family history and precipitating factors
|No. of cases||Percentage|
|Precipitating factors||Lack of sleep||8||26.7%|
Table 2: Percentage improvement
|Cases of migraine post study||No. of cases||Percentage(%)|
Out of 30 cases under study, two cases showed aggravation and four cases showed no improvement whereas 24 cases showed good improvement.
Table 2: Distribution of cases according to pre-treatment and post-treatment migraine disability assessment score (MIDAS)
MIDAS scoring- In 24 cases the symptoms were relieved (80%), in 2 cases the score increased than before (6.7%) and in 4 cases the symptoms were on standstill (13.3%).
Result shows that Scutellaria laterifolia mother tincture is a good and effective alternative palliative treatment for the management of migraine.
The study was conducted to assess the effectiveness of homoeopathic medicine, Scutellaria laterifolia mother tincture, in the management of migraine. The study was conducted among the patients who have attended the outpatient department and in patient Department of Nehru Homoeopathic Medical College and Hospital, Defence Colony, New Delhi. The patients satisfying the inclusion criteria were included in the study.
A total number of 30 cases belonging to an age group of 15-60 were finally selected and details were recorded in standardized case record, pre-treatment score was calculated and then treatment with Scutellaria laterifolia Ø 10 drops twice daily was started. After that, the patients were followed up for a duration of 3 months. After the treatment, post-treatment scores were calculated.
The maximum prevalence of migraine was noted in age group of 21 to 30 years. Female predominance was noted in this study 18 out of 30 cases. Most of the cases 30 out of 30 presented with headache, 20 out of 30 presented with nausea and vomiting and 18 out of 30 presented with neck stiffness. A positive family history of migraine was noted in 8 out of 30 cases, positive family history of epilepsy was noted in 11 out of 30 and positive family history of hypertension was noted in 10 out of 30 cases. In majority of cases, 20 out of 30 cases sunlight served as precipitating factor and artificial light and weather changes in 12 and 10 out of 30 cases respectively.
When 30 cases were analysed, 18 out of 30 cases (60%) shows psora as the predominant miasm. Review of patients was done in every 2 weeks. Among the patients, reduction in symptom score to absolute zero was found in 2 cases and reduction to almost normal value in 24 (80%) cases. In two cases, the scoring increased from before treatment value, and in four cases the scoring remains same after the treatment.
These two variables the pre-treatment scores and post-treatment scores were analysed by paired “t” test. The test value was found to be greater than the t table value at 0.05 and even at 0.01 level suggesting the treatment is highly efficacious. This indicates Scutellaria laterifolia ø are effective in the symptomatological management of migraine.
This study revealed that Scutellaria laterifolia Ø is an alternative, effective and palliative mode of treatment in dealing with patients suffering from migraine, where among 30 cases after one year of intervention, improvement was found in nearly all cases, in 2 cases there were complete relief of symptoms and in 24 cases there were relief more than 75%. The results that came out were encouraging and satisfactory.
The patients were not only relieved of the headache due to migraine and associated complaints, but their productivity and day to day activities also improved.
The quality of life of patients also showed marked improvement.
Young people of the age group 21 to 30 are mostly affected. Females are more affected. Mostly presented symptoms were headache, nausea and vomiting. Most of the cases were aggravated by sunlight and artificial light. In cases without family history of epilepsy and migraine, improvement was fast. Homoeopathic medicines can improve the quality of life of the patients to a greater extent in a shorter period and in the safest way. Finally, one can conclude that, migraine causing much inconvenience to the sufferer in his day-to-day activities, can be managed. Homoeopathically in a safe and cost effective manner without strong allopathic medications and can provide a fast recovery from troubling symptoms.
Conflict of interest: Nil
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6. Brock, C., Whitehouse, J., Tewfik, I. and Towell, T. (2014), American Skullcap (Scutellarialateriflora): A Randomised, Double-Blind Placebo-Controlled Crossover Study of its Effects on Mood in Healthy Volunteers. Phytother. Res., 28: 692-698. https://doi.org/10.1002/ptr.5044
7. Brock, C., Whitehouse, J., Tewfik, I. and Towell, T. (2013), American skullcap (Scutellarialateriflora):an ancient remedy for today’s anxiety?4(1) https://doi.org/10.12968/bjow.2010.1.4.49168
8. Chung-Chih Liao, Ke-Ru Liao, Cheng-Li Lin, Jung-Miao Li, “The Effectiveness of Scutellariabaicalensis on Migraine: Implications from Clinical Use and Experimental Proof”, Evidence-Based Complementary and Alternative Medicine, vol. 2021, Article ID 8707280, 9 pages, 2021. Available at https://doi.org/10.1155/2021/8707280
9. Jean M. Bokelmann, Skullcap/Scullcap (Scutellariabaicalensis, Scutellarialateriflora), Medicinal Herbs in Primary Care, 10.1016/B978-0-323-84676-9.00070-2, (593-598), (2022). Available at https://www.sciencedirect.com/science/article/pii/B9780323846769000702?via%3Dihub
About the authors:
Dr Anuj Kumar, P.G. Trainee, Department of Materia Medica
Prof. (Dr) Neeraj Gupta, Professor, Deptt of Organon of Medicine and Deputy Medical Superintendent, Nehru Homoeopathic Medical College and Hospital