A CLINICAL PRESENTATION ON MIGRAINE

AND ITS HOMOEOPATHIC MANAGEMENT

Presented By
DR. SABA PERWEEN PG Scholar
Batch 2024-2027
Dept. of Practice of Medicine
Under the Guidance of
[Link] Kumar Shail M.D (Hom.)
([Link]. Practice of Medicine )
RBTS GOVT. HOMOEOPATHIC MEDICAL COLLEGE AND HOSPITAL
MUZAFFARPUR BIHAR – 842002
VENUE- DEPARTMENT of PRACTICE OF MEDICINE
DATE- 31/01/2025 , TIME – 11:00 A.M.
 CONTENTS
1) DEFINITION
2) RISK FACTORS
3) CAUSATIVE FACTORS
4) PHASE
5) CLASSIFICATION
6) CLINICAL FEATURES
7)TYPES
8)DIAGNOSIS
9) DIFFERENTIAL DIAGNOSIS
10) INVESTIGATION
11) COMPLICATION
12) PROGNOSIS
9) GENERAL APPROACH AND MANAGEMENT
10) HOMOEOPATHIC APPROACH
11) HOMOEOPATHIC THERAPEUTICS
12)CASE PRESENTATION
13)BIBILOGRAPHY
DEFINITION:
Migraine is a type of headache characterized by recurrent attacks of moderate to
severe throbbing and pulsating pain on one side of the head. The pain is caused by
the activation of nerve fibers within the wall of brain blood vessels traveling inside the
meninges (three layers of membranes protecting the brain and spinal cord)

It is the second most common cause of headache and the most common headache –
related and indeed neurologic cause of disability in the world, afflicts 15% of women
and 6% of men over a 1 year period.
It is usually an episodic headache characterised by
• Untreated attacks last from four to 72 hours.
• Increased sensitivity to light, noise, odors, motion accompanied by Nausea and
Vomiting
• Routine physical activity, or even coughing or sneezing can worsen the pain
• Migraines occur most frequently in the morning, especially upon waking.
• Some people have migraines at predictable times, such as before menstruation or
on weekends following stressful week of work.
• Many people feel exhausted or weak following a migraine but are usually symptom-
free between attacks.
 RISK FACTORS
 Migraines occur in both children and adults but affect adult women three
times more often than men.
 Migraines are genetic. Most migraine sufferers have a family history of the
disorder.
 They also frequently occur in people who have other medical conditions.
Depression, anxiety, bipolar disorder, sleep disorders, and epilepsy are
more common in individuals with migraine than in the general population.
 Individuals who have pre-migraine symptoms referred to as aura have a
slightly increased risk of having a stroke.
 Migraine in women often relates to changes in hormones. The headaches
may begin at the start of the first menstrual cycle or during pregnancy.
Most women see improvement after menopause, although surgical
removal of the ovaries usually worsens migraines. Women with migraine
who take oral contraceptives may experience changes in the frequency
and severity of attacks, while women who do not suffer from headaches
may develop migraines as a side effect of oral contraceptives.
  Low blood sugar
 Sudden changes in weather or
environment  Skipped meals
 Too much or not enough sleep  Tobacco
 Strong odors or fumes  Depression
 Emotion  Anxiety
 Stress  Head trauma
 Overexertion  Hangover
 Loud or sudden noises  Some medications
 Motion sickness  Hormonal changes
 Standing in sunlight for long duration  Bright or flashing lights
 PHASES

Migraine is divided into four phases, all of

. which may be present during the attack:
[Link] symptoms occur up to 24 hours prior to developing a migraine.
These include food cravings, unexplained mood changes (depression or euphoria),
uncontrollable yawning, fluid retention, or increased urination.

[Link]—Some people will see flashing or bright lights or what looks like heat waves
immediately prior to or during the migraine, while others may experience muscle
weakness or the sensation of being touched or grabbed.

[Link]—A migraine usually starts gradually and builds in intensity. It is

possible to have migraine without a headache.

[Link]—Individuals are often exhausted or confused following a migraine.

The postdrome period may last up to a day before people feel healthy again.
 CLASSIFICATION OF MIGRAINE - The two major types of
migraine are:
 Migraine with aura, previously called classic migraine,
includes visual disturbances and other neurological symptoms
that appear about 10 to 60 minutes before the actual headache
and usually last no more than an hour. Individuals may
temporarily lose part or all of their vision.

 Migraine without aura, or common migraine, is the more

frequent form of migraine. Symptoms include headache pain
that occurs without warning and is usually felt on one side of the
head, along with nausea, confusion, blurred vision, mood
changes, fatigue, and increased sensitivity to light, sound, or
noise
 Clinical Features
Visual complaints before the start of the attack-
 blurring of vision or visual hallucinations
 zig zag lines
 scotoma or hemianopia
Pulsatile or throbbing headaches
Photophobia – Eye discomfort in bright light
Phonophobia – Persistent, abnormal, and unwarranted fear of sound
Nausea
Even the smell or sight of food makes the patient pukish
Duration of attack: 4-72 hours
Average duration of the attack: 24hours(approx.) also called one day
illness
Disabling in character- an important factor
Usually begins at puberty and there is often a family history
TYPE AFFECT SYMPTOMS
ABDOMINAL mostly affects young children It involves moderate to severe pain in the middle of the abdomen
MIGRAINE lasting one to 72 hours, with little or no headache .
Many children who develop abdominal migraine will have migraine
headaches later in life.

BASILAR-TYPE mainly affects children and Symptoms include partial or total loss of vision or double vision,
MIGRAINE adolescents ,often seen in teenage girl may dizziness and loss of balance, poor muscle coordination, slurred
be associated with their menstrual cycle speech, a ringing in the ears, and fainting. The throbbing pain may
come on suddenly and is felt on both sides at the back of the head

HEMIPLEGIC Though rare, when it runs in families the Affect one side of the body prior to or during a headache.
MIGRAINE disorder is called familial hemiplegic Symptoms such as vertigo, a pricking or stabbing sensation, and
migraine (FHM). problems seeing, speaking, or swallowing may begin prior to the
headache pain and usually stop shortly thereafter.

MENSTRUAL Affects women,around the time of their Symptoms may include migraine without aura, pulsing pain on one
MIGRAINE period, also have migraines at other times of side of the head, nausea, vomiting, and increased sensitivity to
the month sound and light.
MIGRAINE Affect anyone It is characterized by visual problems or other aura symptoms,
WITHOUT nausea, vomiting, and constipation, but without head pain.
HEADACHE
OPHTHALMOPLE Affect anyone an uncommon form of migraine with head pain, along with a
GIC MIGRAINE droopy eyelid, large pupil, and double vision that may last for
weeks, long after the pain is gone.
STATUS Affect anyone,it is a rare and severe type of Disabling pain and nausea can last 72 hours or longer. The pain
MIGRAINOSUS acute migraine and nausea may be so intense that people need to be hospitalized

RETINAL Affect anyone It is characterized by attacks of visual loss or disturbances in one

MIGRAINE eye. These attacks, like the more common visual auras, are usually
associated with migraine headaches.
 DIAGNOSIS
 MEDICAL HISTORY
 HEADACHE DIARY
 MIGRAINE TRIGGERS
 INVESTIGATION:
 EEG
 CT SCAN
 MRI
 CBC
 IgE
 ESR
The MIDAS(Migraine Disability Assessment) questionnaire was put
together to help measure the impact of headaches on life. It is useful
to determine the level of pain and disability caused by headaches to
determine the treatment
INVESTIGATION
 DIFFERENTIAL DIAGNOSIS
The following should be considered in a patient with a migraine:

 Tension-type headache
 Cluster headache
 Intracranial Tumor
 Cerebral aneurysms
 Chronic paroxysmal hemicrania
 Encephalitis
 Subarachnoid/intracranial hemorrhage
 Meningitis
 Temporal/giant cell arteritis
 COMPLICATIONS OF MIGRAINE

 Status migrainosus is a debilitating migraine attack that lasts more

than 72 hours.

 Persistent aura without infarction is an aura that persists for more

than one week without evidence of infarction on neuroimaging.

 Migrainous infarction is one or more aura symptoms associated with

brain ischemia on neuroimaging during a typical migraine attack.

 Migraine aura-triggered seizure occurs during an attack of migraine

with aura, and a seizure is triggered.
 PROGNOSIS
 A migraine is a chronic condition that can revert to episodic
migraine in 26 to 70% of patients.

 Prolonged remissions are common; however, some patients have

a pattern of leaving and returning to chronic states.

 The severity and frequency of attacks can diminish with age.

 Episodes increase during puberty but continue to climb until 35

to 39 years of age, decreasing later in life, especially after
menopause
 GENERAL APPROACH AND MANAGEMENT
• Lifestyle changes reduce or prevent migraine attacks

• Obesity reduction

• Quick steps to ease symptoms may include:

 Napping or resting with eyes closed in a quiet, darkened room
 Placing a cool cloth or ice pack on the forehead
 Drinking lots of fluid, particularly if the migraine is accompanied by vomiting
 Small amounts of caffeine may help relieve symptoms during a migraine’s
early stages
 HOMOEOPATHIC APPROACH
Homoeopathic treatment is based on “INDIVIDUALISED EXAMINATION OF THE CASE ” and the guide
for simillimum is the TOTALITY OF SYMPTOM of the [Link] commonly used homeopathic remedies for
headaches include:
HOMOEOPATHIC THERAPEUTICS
1)Belladonna: This remedy is often used for intense, throbbing headaches that come on suddenly and are
accompanied by redness and heat in the face.
2)Bryonia: This remedy is often used for headaches that feel like a pressure or tight band around the head,
worsened by movement or coughing.
3)Nux vomica: This remedy is often used for headaches caused by overindulgence in food, alcohol, or drugs.
The headache is often accompanied by nausea, vomiting, and sensitivity to light and noise.
4)Natrum muriaticum: This remedy is often used for headaches that occur in the morning or after emotional
stress and are accompanied by a feeling of heaviness or pressure in the head.
5)Gelsemium: This remedy is often used for headaches that occur with vertigo, dizziness, and a feeling of
weakness, especially during a cold or [Link] is important to note that homeopathic remedies should be taken
under the guidance of a qualified homeopath, who can help to select the appropriate remedy and dosage for the
6)Sanguinaria: This medicine given for Periodical sick headache, begins in the
morning increases during day lasts until the evening, headache begins in
occiput,spreads upwards and settles over right eye
7) Silicea: Ascending from nape of neck to vertex, locating in ome eyes esp
right agg. Uncovering head ,amel. By pressure and wrapping up warmly.

8)Spigelia : Beggining in morning at base of brain, spreading over head and

locating in eye, orbit and temple of left side, pain pulsating ,violent, throbbing

9) Iris Versicolor: Frontal headache with nausea and vomiting accompanied by

acidity, right temples especially affected. Sick headache,worse rest, begins with
a blur before eyes

10) Glonoine: Sunstroke and sun headache, increases and decreases everyday
with sun, headache in place of menses, or headache occurring after profuse
uterine hemorrhage, rush of blood to head in pregnant women

11) Usnea Barbata: Pain over entire head or front head with feelings as if
temples would burst or eyes burst out of sockets
 REPERTORY
 Direct rubrics in relation to migraine are compailed from different [Link] are as follows:
 [BBCR] [Head] Internal, Migraine: ARS, Asar, Bell, Bry, Calc-c, Caps, Cham, Chin, Chi- s, Cocl,
COLO, Guai, Ign, Ip, Lyc, merc, NUX-V, Pru-s, PUL, SANG, SEP, sil. (22)
 [BOERICKE] [Head] Headache cephalagia: Type: Migraine, megrim, nervous: Am, c., Am. val.,
Anac., Anhal., Arg. n., Aspar., Avena, Bell., Bry., Caff. citr., Calc. ac., Calc. c., Can. ind.. Carb. ac., Ced..
Chionanth., Cim., Cocc., Coff., Crot. casc., Cycl., Epiph., Gels., Guar., Ign., Indigo, Iris, Kali bich., Kali c.,
Lac d., Lach, Meli., Menisp.. Nat. m., Niccol., Nux v., Onosm., Paul., Plat. mur., Puls., Sang., Saponin,
Scutel., Sep., Sil., Spig., Stann., Sul., Tab., Thea, Ther., Verbasc., Xanth., Zinc. sul., Zinc. v., Zizia. (56)
 [PHATAK] Migraine: Cahin, Gels, Ip, Kali-bi, Lac-d, Nat-m, Nat-s, Onos, Psor, Rob, Sang, Sil, Spig, Ther
 [MURPHY] [Headaches] Migraine, headaches acon, AGAR, anac, ANT-C, apis,arg, arn, ars, ASAF,
asar, aur, bell, BRY,cact, calad, calc, calc-p,caust, cedr, cham,chel, CHIN, cic, cimic, cina, cocc, COFF,
coloc, eup-per, GELS, glon, graph, IGN, IP, IRIS, kali-bi,kali-p, LAC-C,lach, lyc, NAT-M,nat-s, NUX-V, op,
PHOS, PULS, SANG, scut,sep. SIL, spig, stram, sulph, tab, tarent, ther, THUJ, valer, ZINC
 [SYNTHESIS] [Head] Migraine (see Head - Pain)
 Synthesis of rubric - In all the repertories there may not be direct or diagnostic rubrics, in that case
there is a need to synthesis the rubric.
 CASE PRESENTATION
A Female patient with OPD Registration no-A48511/51701, aged 25 years , Religion-
Hindu, resident of Mushari , Muzaffarpur dated 16/12/2024 visited OPD-1 of RBTS
GHMC and Hospital with Complaint of :-

Severe pain in head since 7 months started gradually aggravates after any mental exertion
L- starts from right side of head spread to whole head
S- throbbing
< noise,light , motion of head
>pressure,darkness
Associated symptoms- nausea( aggravated by drinking water)
HISTORY OF PRESENTING COMPLAINT
Patient was apparently well, gradually headache started and it increases in intensity and
frequency. Pain felt more since 2 months
Treatment taken- allopathic pain killer
PAST HISTORY
Typhoid- 5 years back
PERSONAL HISTORY
Occupation- College Student

FAMILY HISTORY
Father – healthy ,alive
Mother – healthy ,alive

GENERAL PHYSICAL EXAMINATION

Built :- Average
Outlook :- Dull
Height :- 154 cm
Weight :- 55 kg
Icterus :- absent
Pallor :- absent
Clubbing :- absent
Tongue :- Clean , Moist
Face – flushing, redness on face
 PHYSICAL GENERALS
 Appetite :- 3 meals / day(adequate )
 Desire :- sweet
 Aversion :-N.S
 Thirst :-2 -3 L /Day in Summer(cold water) but quantity decreased in winter
 Stool :- Day ( once ) Night (0), satisfactory , normal consistency ,No peculiar odour
 Urine :- Day ( 5 ), night (1 ) , clear , Normal Stream , No Peculiar odour
 Perspiration :- mostly during summer ,whole body , Non – staining , No Peculiar odour
 Thermal Reaction :- hot patient

MENTAL GENERALS
 Head complaint started after any mental exertion, patient having increase in irritability and mood
swing during complaint, got angry on family members
 Sleep :- usually 6 -7 hour , refreshed , lie mostly on back but disturbed during the time of headache
 ADVICE – CBC , ESR , IgE, CT Scan, MRI
PROVISIONAL DIAGNOSIS –MIGRAINE(ICD – 8A80)
Analysis of Symptoms
S. N Mental Generals Physical Generals Particulars
1 Head complaint started after any Thermal Reaction – hot patient Severe pain in head since 7 months
mental exertion . L- started from right side of head spread
to whole head
S- throbbing
< noise,light , motion of head
>pressure,darkness
Associated symptoms-
nausea( aggravated by drinking water)

2 Patient having increase in irritability Desire -sweet

and mood swing during complaint.
 TOTALITY OF SYMPTOMS

 Head complaint started after any mental exertion .

 Thermal Reaction – hot patient
 Headache started from right side of head spread to whole head
 Headache < noise
 Headache >pressure,
 Headache >darkness
 Associated- nausea which is aggravated by drinking water
 Evaluation of Symptoms

S. Symptoms Common Uncommon Grading Maisam

N
1 Head complaint started after any + +2 Sycotic
mental exertion
2 Thermal Reaction – hot patient + +2 Syphilitic

3 Headache right sides + +1 Sycotic

4 Headache< noise + +1 Psoric
5 Headache >darkness + +1 Syphilitic

6 Headache >pressure + +1 Sycotic

7 Headache accompanied by + +1 Psoric

nausea
8 nausea which is aggravated by + +1 Psora
drinking water
This case cover all miasam but sycotic miasm is predominant
 REPERTORISATION
Repertory Used :-Synthesis
CONVERSION OF SYMPTOMS TO RUBRIC
SYMPTOMS RUBRICS
1-Head complaint started after any mental exertion - 1-MIND – AILMENTS FROM-mental exertion
2-Thermal Reaction – hot patient 2-GENERALS-HEAT-sensation of

3-Headache right sides 3-HEAD –PAINS-sides-right

4-Headache< noise 4-HEAD-Pain-noise-agg

5-Headache >darkness 5-HEAD-Pain -darkness-amel

6-Headache >pressure, 6-HEAD-PAI- pressure -amel

7-Headache accompanied by nausea 7-HEAD-PAIN-accompanied by-nausea

8-nausea which is aggravated by drinking water 8-STOMACH-NAUSEA-drinking water -agg

 REPERTORIAL RESULT
 Belladonna–14 /6
 Calcarea carb – 12/6
 Bryonia – 11/6
 Silicea – 11/6
VISIT DATE PRESCRIPTION

FIRST VISIT 16/12/24 1)Belladona 30/ ½ dr BD

2)PL 30/1dr/ BD

SECOND VISIT 09/01/25 1)Belladona 30/ ½ dr BD

2) PL 30/ 1dr/ BD

THIRD VISIT 29/01/25 1) PL 30 1 dr/ BD

 JUSTIFICATION FOR SELECTION FOR Belladona

 WHY NOT CALCAREA CARB - Calcarea carb suitable for particularly those who are
flabby and obese, who sweat easily and take cold easily. On the other hand,
Belladonna is suitable for bilious ,lymphatic ,plethoric constitution with tuberculous
patient with intense violent pain

 WHY NOT SILICEA- Silicea is suitable for nervous, irritable ,sanguine temperament,
psoric diathesis , who sweat easily and take cold readly. On the other hand,
Belladonna is suitable for bilious ,lymphatic ,plethoric constitution with tuberculous
patient with intense violent pain

 WHY NOT BRYONIA- Bryonia is suitable for for those who are having a robust
constitution, with tendency to leanness and irritability .The patient has stiching type
of pain and there is dryness of mucous membrane
 CONCLUSION

 The Patient has visited the OPD with Complaint of headache.

 Detail Case taking was done and his Totality of Symptoms Was Evaluated Based on Individualisation
of the Case , Repertorisation was done and Final Similimum was Selected with reference to Materia
Medica.

 The Patient has Shown Gradual Improvement in her complaint with general well-being of her health
with Homoeopathic Treatment.
 BIBILIOGRAPHY

1. Harrison’s Principles and Practice of Medicine Mc Graw Hill, New York, 20 th Ed.
2. Davidson’s Principles and Practice of Medicine, International Edition, 24e
3. [Link]
4. [Link]
3. Boericke W. Pocket Manual of Homoeopathic Materia Medica & Repertory: Comprising of the
Characteristic and Guiding Symptoms of All Remedies (clinical and Pahtogenetic [sic]) Including
Indian Drugs. B. Jain publishers; 2002.
4. HC. Allens Keynotes Rearranged & Classified. B. Jain Publishers; 2002.
5. Dudgeon R.E., Boericke William, Hahnemann S. Organon of medicine. B. Jain publisher; 2005, 5 th
and 6th edition.
6. Dr. Subrata Kumar Banerjee; Miasmatic Prescribing; New Delhi; JAYPEE Publishers 2018 11th
edition.
[Link] Kent. Repertory of the Homoeopathic Materia medica. Ravenio Books; 2008, 6th revised Edition.
THANK YOU