PREFACE
Migraine is the commonest form of headache seen in younger age groups. The incidence of migraine is increasing now days probably due to modern food habits and the stresses and strains of life.

We are able to manage successfully these migrainous attacks with Homoeopathic medicines because our treatment is mainly based on subjective and other mental symptoms. So I thought it would be worthwhile to make a study on the effectiveness of homoeopathic medicines in the treatment of migraine.

The cases that I am presenting in this case study have been taken from the case records of special OP on Migraine functioning under the department of Case taking and Repertorisation at Govt. Homoeopathic Medical College Trivandrum. I believe this study will help me to treat Migraine confidently and effectively.

INTRODUCTION
HEAD ACHE
Almost 60-70% of patients presenting in the family physician's clinic for relief of pain comes in the complaint of headache. This can affect all age groups and all sexes. The common causes of headache can be divided as follows:

ACUTE HEAD ACHE
Sudden, severe, never before headache accompanied by vomiting, altered levels of consciousness and even coma is generally due to a vascular cause in the brain, most likely a bleed. This requires immediate shifting of the patient to a major health institute.

CHRONIC HEADACHE
This headache can again be classified into
> A recurring headache which is likely to be migraine or tension head ache
> A dull headache which causes most of the time and patients may get used to it. This could be due to Refractive errors or
astigmatism, Sinusitis or Cervical spondilitis leading to pain in the back of head

MIGRAINE
Simply defined , it is the worst form of headache imaginable. Often confined to one side of the head, it is preceded by distortion
of vision (aura) and accompanied by nausea and vomiting

Migraine is the commonest from of vascular headache. It is characterised by episodic throbbing hemicranias headache beginning in childhood, adolescence or early adult life which tends to decrease in intensity and frequency as age advances. These are periodic headaches which are typically unilateral and are often associated with visual disturbances and vomiting.

INCIDENCE
It is estimated that 5% of population suffers from migraine, Women are slightly more affected. Positive family history is elicit able in most cases. There are probably over five million people in India alone who suffer form this illness. In some fortunate cases, migraine only strikes 2 or 3 times in a lifetime. In most people, attacks recur again and again as frequently as two or three times a week- but fortunately for many suffers, with diminishing intensity and frequency as they get older. There is complete freedom from distress between attacks. Like backache sufferers, migraine sufferers generally get little sympathy, yet it is a condition which can disrupt marriage, affect a job and in severe cases, completely ruin living.

CLASSIFICATION OF PRINCIPAL FORMS OF MIGRAINE.
> Classical migraine" visual or sensory symptoms precede or accompany the headache.
> Common migraine- no visual or sensory features, associated with headache, nausea, vomiting and photophobia.
> Basilar artery migraine-occipital head ache preceded vertigo, diplopia, dysarthria with or without visual and sensory symptom,sometimes associated with loss of consciousness.
> Hemiplegic migraine - prolonged headache lasting hours or days followed by hemiparesis, which recovers slowly over several days.

ANOTHER CLASSIFICATION IS:
> Migraine with aura,
> Migraine without aura.

MIGRAINE WITH AURA
(Formerly Known As Classical Migraine)
In this type the pre-attack is pronounced, and accompanied by neurological symptoms mainly connected with vision flashing lights and distorted sight.

MIGRAINE WITHOUT AURA
(Formerly known as common migraine)
In this type pre attack symptoms are absent or slight. Although there can be a feeling of being unwell or irritable. Headache is often followed by nausea leading to vomiting, the time cycle in both cases usually lasts from a few hours to as long as 2 or 3 days, often followed by another days or two of exhaustion before the full recovery.

WHAT ARE THE SYMPTOMS?
In migraine with aura the sufferer often gets a warning signal. Strangely enough this can be a feeling of unusual well being on the day preceding an attack, but in most cases the warning signals only appear 30 minutes, or even only 15 minutes, before the onset of the attack.

A more common advance symptom in Migraine with aura is a gradual worsening of the eyesight, starting with blurred vision, and leading to blind spots in the center of the eye and even, in extreme cases to temporary loss of vision

In some sufferers' pins and needles or numbness in the hand or in one arm, or one side of the face, or the chin, mouth or tongue, precede an attack of migraine. This can be particularly disturbing in people with heart or circulation disorders, as they may easily misinterpret the symptoms. A common feature of all migraine attacks is acute discomfort (burning, pressing, and stabbing in one of the eyes) later leading to the actual pain.

In general, during an attack, the sufferer is weak, pale, irritable and tries to relieve the intense pain by emitting loud groans, with giddiness, partial toss of vision and difficulty m speaking correctly, the sufferer deserves full sympathy.

WHO IS LIKELY TO 6ET MIGRAINE?
Migraine can strike anyone, mate or female, at any age. although it is unusual for an older person to have their first attack
after the age of 50. Cases have been noted as young as 3 years of age, and as old as 78 years of age.

In women, there is a strong hereditary tendency and, for many a connection between the menstrual cycle, the contraceptive pill and the incidence of migraine has been established.

Stress, worry, tension and anxiety in private and business life bring on migraine in many cases, although the relaxation syndrome of weekends and days off work adversely affect others.

WHAT PROVOKES OR AGGRAVATES AN ATTACK MIGRAINE?
The most likely triggers, which can cause an attack, can be classified into five general categories.

> Physical (fatigue / over - exertion / relaxation)
> Psychological (depression / worry / shock / anxiety)
> Diet (consumption of alcohol / various type of food and drink, e.g.chocolates).
> Medical (contraceptives/ blood pressure / menstruation)
> Other factors (loud noises / glaring lights/ TV/ strong smells).

These factors cover such a wide field, that you can say that almost anything out of the ordinary might affect the position. It is therefore important and very useful that suffers keep a day to day record of such factors to determine which affects them adversely if a pattern of attack has to be identified.

MECHANISM OF MIGRAINE
Exact mechanism is unknown; it is the consensus that an attack of migraine consists or a neuromuscular disorder of the intracranial as well as extra cranial vessels. Sequential studies of cerebral blood flow shows an initial reduction, which may be localized or generalized followed by increases in blood flow later. The basic cause of these circulatory disturbances is unknown. it is found those blood levels of serotonin, histamine and norepinephrine increases during the attacks. There is also and increase in platelet aggregablity. This may account for strokes, which complicates migraine. The headache has been attributed to extreme pulsation of extracranial as well as. intracranial arteries.

There is now good evidence that in classical migraine there is extreme cerebral oligeamia at the onset of the attack. This is often occipital in site but may spread to the parietal and temporal lobes. Oligeamia may be secondary to some primary cortical dysfunction, since attack can be set off by neural stimuli like bright light or strong odors. Others believe that vasospasm is responsible for the initial dysfunction.

During headache phase there is dilatation and edema the extra cranial arteries and probably some alteration in pain sensitivity in their walls. These vascular changes may be due to fluctuation in blood 5 hydroxy tryptamine levels.

There is a genetic predisposition. Approximately three" quarters of patients who suffer form migraine have close relatives similarly affected.

Migrainious attacks may be precipitated by a variety of factors such as menstruation, flashing lights, stress and anxiety. Che6se, chocolate, sherry and red wine are all common precipitants and are all rich in tyramine, experimental ingestion of which will often provoke an attack. Reserpine, which liberates 5 hydroxy tryptaminein brain also, can cause migraine.

CLINICAL FEATURES

The condition usually starts after puberty and continues until late middle life. Attacks occur at intervals, which varies from a few days to several months. They last from a few hours to several days and leave the patient weak and exhausted.

CLASSICAL MIGRAINE
Here episode begins with prominent neurological symptom such as visual disturbances as zig zag fines, spreading scotoma homonymous hemianopia, field defects or rarely total blindness, sensory disturbances as affecting one half of body or parasthesia, disturbances of speech or hemiparesis may be present. These symptoms are associated with focal cerebral oligeamia. There is commonly a sensation of white or colored lights, scintillating spots, wavy lines or defects in visual fields. Sometimes there may be numbness of both hands and around the mouth. These symptom may last for upto half an hour and are followed by head ache which begins in one spot and subsequently involve the whole one side of head, this may be same side or side opposite to the visual or sensory disturbances.

The side affected is not constant with each attack and headache often becomes bilateral. The pain is usually severe and throbbing and is associated with vomiting, photophobia pallor sweating and prostration, which may necessitate the patient taking to bed in a dark room. All these events may last for 1-2 days. In majority of cases duration is much shorter.

COMMON MIGRAINE
Here there are no preceding neurological symptoms but there is unheralded onset of headache nausea and vomiting following the same sequence.

CLUSTER HEADACHE
(Horton's syndrome, histamine head ache)
It is a vascular headache or a migranious variant. The name cluster headache refers to its occurrence 4n bouts. Disease is more common in males. Male: Female ratio is 4:1. The headache starts within 3 hours of falling asleep, it is non throbbing unilateral and orbital In location.

Along with pain there may be lachrymation, nasal obstruction, rhinorrtioea and sometimes miosis, ptosis. flushing and edema of cheek all lasting approximately an hour or two. It tends to occur every night for weeks or months followed by complete freedom for years. Such dusters of headache may occur over years. Periods of headache are brought on by stress; prolonged strain, overwork and emotional disturbances, alcohol, nitroglycerine and tyrosine containing foods may precipitate headache.

DIAGNOSIS
> Diagnosis is made mainly from history as
> Long duration of illness
> Onset during childhood
> Positive family history
> Relief with ergot derivatives is in favor of migraine.

COURSE AND PROGNOSIS OF MIGRAINE
In majority of patients migraine tends to be chronic with periods of exacerbation's and remissions. With increasing age attack tends to come down. Complications may occur rarely in some cases and these include cerebrovascular accidents, ocular palsies and other cranial nerve palsies.

DIFFERENTIAL DIAGNOSIS OF MIGRAINE.
Chronic paroxysmal hemicranias
This term refers to brief spells of headache recurring frequently and following chronic unremitting course. It differs from cluster headache in the brevity of attacks.

Hang over headache
Headache following an alcoholic bout is thought to be due to vascular mechanism. Vascular dialatation and headache may be a feature of hypercapnia in patients with respiratory failure. Severe arterial hypertension may cause headache. In elderly localized temporal headache may be due to cranial arthritis.

Psychogenic head ache
Headache is a common symptom of psychiatric disorders. Such headaches involve the whole head or may be confined to front or vertex. It is a sort of pressure or tightness felt by the patient. Tension headache tends to occur following emotional excitement or other stresses and persists continuously for days or weeks. Prominent symptom of depression, anxiety or hypochondria's may be present.

MANAGEMENT
Physician should give full explanation of the nature and phenomena of migraine to the patient and this often relieves his anxiety and helps to relax his morale. All known precipitating factors such as emotional tension, exposure to  foods such as cheese and chocolate, bright light and oral contraceptives should be avoided.

TREATMENT
In spite of increased research, no definite cure has been found as yet. Tremendous progress has. and is, being made alt the time. As there is no single cause for migraine, there is no single drug available for all treatment. Your doctor will have to investigate your symptoms closely before deciding on which of very many forms of treatment should be prescribed. If one particular medication does not give the required relief, others are available. If the side effects are distressing, other drugs can be prescribed.

Many sufferers take such medicines at the first signs of an impending attack and, if possible, try to lie down in a quiet, darkened room. Some sufferers find relief by placing ice packs on the head or soaking their feet in hot water. It is well worth experimenting to find the best solution for relief.

REPORTORIAL REPRESENTATION

BOERICKE'S REPERTORY
HEAD- Migraine(megrim, nervous)-anac, arg n, bell, calc ac, can ind, dm, coco, coff, eye/, epiph, gels, guar, ign, iris, kali c, lac deft,lach, meli, menisp, nux vom, onos, puts, sang, scutel, sep

CONCISE REPERTORY- PHATHAK
MIGRAINE- chio, gels, ipec, kalibi, lac defl, nat mur, nat sul, onos,psor. lob, sang, spig, sil, ther

KNERR REPERTORY
Inner head- hemicrania(megrim, migraine)- Cham, sil, apis, arg nit,am, ars, asar. bar c, bry. calc, caps, clem, chin, cocc, cornus, gels,indigo, kali bi, kreos, lach, lac defl, syph, ver

BOGER'S REPERTORY
Head internal - Migraine - COLO. PULS. NUXVOM, SANG. SEP

KENT'S REPERTORY
No direct rubric
Head - Pain vomiting with
Head - Pain vomiting amel
Vision flickering - Head ache before

HOMOEOPATHIC MANAGEMENT
> Scutellaria: In nervous sick headaches, which do excitement andover-exertion cause. Frequent scanty urination.
> Tongo : Migraine and neuralgic affections.
> Chionanthus: Migraine due to acidity and sluggishness of liver.
> Damiana : An excellent remedy for migraine.
> Calcarea Lac: It is useful in T.B diathesis. Give in 3x dilution.

> Iris V : Periodical nervous sick headache, which comes on afterthe patient relaxes, form a mental strain. With schoolteachers it comes on Saturday or Sunday, and with preachers on Monday. The patient usually vomits bitter bilious substances and the vomiting gives relief to the pains in the head. Migraine of the eye with constipation. Objects could only be seen in halves. Bilious headache with burning and acidity. Throbbing and severe pain causes disturbances of vision. Vomiting which is bitter relieves pain.

> Cyclamen: fails this remedy may be tried provided migraine is accompanies with sparkling before the eyes.
> Coffea : An excellent remedy for headache caused by loss of sleep following excitement.
> Ignatia : When due to grief in hysterical patients. Frequent urination, profuse or scanty.

> Belladonna : Headache in plethoric and healthy persons. The cause is some disturbance of the circulatory system. The headache is violent, pounding and throbbing. Throbbing and bursting headache in temples with fiery red and hot face. Eyes bloodshot and red. Face flushed. The pains disappear as suddenly as they appear. Sun headache with full bounding pulse. Unconsciousness

> Iris Tenax: Headache which begins on or before rising, beginning on left eye extending thence to left half of head.

> Gelsemium: Pains beginning in the nape of neck and shift over to head, causing a bursting sensation in the forehead and eyeballs.Feels as if head is full and big. Unconsciousness. As if there is a band the head.

> Glonine: Headache due to working under gaslight, in the sun when heat falls on the head. Head feels enormously large, Sunstroke and sun headache without unconsciousness.

> Natrum Mur: When the headache increases with the rise of the sun and stops at sun-set Headache with sweat. The greater the pain the greater the sweat. Headache of schoolgirls or boys, worse on eye straining. Fiery zigzag before headache. Hammering headache as If hammers are knocking the head.

Next Page