“EFFECT OF HOMOEOPATHIC MEDICINES IN THE TREATMENT OF MIGRAINE “
DISSERTATION SUBMITTED TO
Dr. HAHNEMANN HOMOEOPATHY MEDICAL COLLEGE AND RESEARCH CENTRE, RASIPURAM. IN PARTIAL FULFILMENT OF INTERNSHIP PROGRAMME FOR THE AWARD OF THE DEGREE OF
BACHELOR OF HOMOEOPATHIC MEDICINE AND SURGERY
BY STUDENT NAME
S.VIJAYA SHANKAR (CRRI) SESSION: 2008-2009 Under The Guidance of
Dr.V. R. NAIDU M.D (HOM) HOD DEPARTMENT OF HOMOEOPATHIC MATERIA MEDICA
DR. HAHNEMANN HOMOEOPATHY MEDICAL COLLEGE AND RESEARCH CENTRE RASIPURAM. DR. M.G.R. MEDICAL UNIVERSITY, CHENNAI TAMIL NADU
1
CERTIFICATE This is to certify that the dissertation captioned EFFECT OF HOMOEOPATHIC
MEDICINES
IN
THE
TREATMENT
OF
MIGRAINE has been prepared by Mr. S. VIJAYA SHANKAR under the direct supervision and guidance of in partial fulfillment of the regulations for the award of the degree of “BACHELOR OF HOMOEOPATHIC MEDICINE AND SURGERY”of Dr.M.G.R. Medical university,Chennai,Tamil nadu.
I am fully satisfied with the dissertation work submitted.
PRINCIPAL Dr. Hahnemann Homoeopathy Medical College And Research Centre, Rasipuram.
CERTIFICATE
2
This is to certify that the dissertation captioned EFFECT OF HOMOEOPATHIC
MEDICINES
IN
THE
TREATMENT
OF
MIGRAINE has been prepared by Mr. S. VIJAYA SHANKAR under the direct supervision and guidance of Dr. V. R. NAIDU M.D (HOM) in partial fulfillment of the regulations for the award of the degree of “BACHELOR OF HOMOEOPATHIC MEDICINE AND SURGERY” to be awarded by RAJIV GANDHI UNIVERSUTY OF HEALTH SCIENCES.
I am fully satisfied with the dissertation work submitted.
Dr. V. R. NAIDU M.D (Hom) Department of Homoeopathic Materia Medica
Dr. Hahnemann Homoeopathy Medical College and Research Centre Rasipuram.
DECLARATION
3
I here by declare that this dissertation EFFECT OF HOMOEOPATHIC MEDICINES IN THE TREATMENT OF MIGRAINE has been
prepared by me under the direct guidance of Dr. V. R. NAIDU M.D (HOM) DR. HAHNEMANN HOMOEOPATHIC MEDICAL COLLEGE AND RESEARCH CENTRE, RASIPURAM . as part of my study for the award of the
BACHELOR
OF
HOMOEOPATHIC
MEDICINE
AND
SURGERY.
Place:Rasipuram
Student Name.
Date:
DEDICATED 4
TO MY TEACHERS & PARENTS
ACKNOWLEDGEMENT I wish to convey my gratitude to my Principal Dr. N. Subramaniyan M.D (Hom), of Dr. Hahanemann Homoeopathy Medical College, Rasipuram, for his encouragement to do this thesis.
I am immensely indebted to Dr. V. R. NAIDU M.D (HOM) Department of Homoeopathic Materia Medica, Dr. Hahnemann
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Homoeopathy Medical College and Research Centre Rasipuram. His keen and personal interest made me to complete our work.
S.VIJAYA SHANKAR
CONTENTS
SL NO
PARTICULARS
1. INTRODUCTION 2. AIMS AND OBJECTIVES 3. REVIEWOFLITERATURE 4. MATERIALSANDMETHODS 5. OBSERVATIONANDRESULTS 6. SUMMARY 7. CONCLUSION 8. BIBLIOGRAPHY ANNEXURES
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PAGE NO
08 09 10 40 85 95 96 98
ANNEXURES I-Case proforma
41
ANNEXURES II-Summary of cases
95
ANNEXURES IV-Master chart
97
Introduction Migraine
Headache is one of the most common and difficult clinical problems in medicine. In the majority of patients the cause is trivial and reversible and a careful clinical history and examination often allows a specific diagnosis there by avoiding unnecessary investigation.
Migraine is characterized by episodi c headache, which is typically unilateral and often associated with vomit ing and visual disturbance. The single most charac teristic feature is the episodic nature of the headache.
Prevalence of migraine usually starts after puberty and continues until late middle life. Frequently women notice an aggravation of migraine symptoms during peri-menstrual phase or in patients taking oral contraceptives. Approxi mately half of patients who suffer from migraine have an affected relative, suggesting a genetic predisposition.
Recurrent episodes of this disease having a predisposing factors of dietary factors, including chocolate , cheese, and alcohol may precip itate attacks.
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AIMS & OBJECTIVES OF STUDY:
01. To study the mode of clinical presentation of MIGRAINE.
02. To assess the efficacy of homoeopathy in the Treatment of MIGRAINE.
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REVIEW OF LITERATURE DEFINITION: “Migraine'' is a neurological diseases disease, of which the most common symptom is an intense and disabling episodic headache. Migraine
headaches are usually characterized by severe pain on one or both sides
of the
head and are often accompanied by photophobia (hypersensitivity to light), hyperacusis (hypersensitivity to sound) and nausea. The word ''migraine'' is French in srcin and comes from the Greek language |Greek ''hemi crania '' (as does the Old English term ''megrim''). Literally, ''hemicrania'' means "only half the head."
SIGNS AND SYMPTOMS:
The signs and symptoms of migraine vary among patients. Therefore, what a patient experiences before, during and after an attack cannot be defined exactly. The four "signs and symptoms" below are common among patients but are not necessarily experienced by all migraine sufferers: 1. The prodrome, which occur s hours or days before the headache. 2. The aura, which immediately precedes the headache. 3. The headache phase. 4. The postdrome.
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1. The first phase or prodrome:
Prodromal symptom s occur in 40% to 60% of migraineures. This phase consists of altered mood, irritability, depression or euphoria, fatigue, yawning, excessive sleepiness, craving for certain food (e.g., chocolate), and other vegetative symptoms. These sympto ms usually precede the headache phase of the migraine attack by sever al hours or days and experience teaches the patient or observant family that the migraine attack is near.
2. The second phase or the”Aura”:
The migraine aura is comprised of focal neurological phenomena that precedes or accompany the attack. They appear gradually over 5 to 20 minutes and usually subside just before the headache begins. Symptoms of migraine aura are usually sensory in nature. Visual aura is the most common of the neurological events. There is a
disturbance of vision consisting usually of unformed flashes of white
or rarely
of multicolored lights (photophobia) or formations of dazzling zigzag lines (arranged
like the battlements of a castle, hence the term
fortification
spectra or teichopsia). Some patients complain of blurred or shimmering or
cloudy vision, as though they were looking through thick or smoked glass. The somatosensory aura of migraine consists of digitolingual or cheiro-oral paresthesias, a feeling of pins-and-needles experienced in the hand and arm as well as in the ipsilateral nose-mouth area. Paresthesia migrates up the arm and then extend to i nvolve the face, lips and tongue.
3. The third phase: The Headache:
The typical migraine headache is unilateral, throbbing, and moderate to severe and can be aggravated by physical activity. Not all of these features
are necessary. The pain may be bilateral at the onset or start on one side and become generalized, usually alternates sides from one attack to the next. The
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onset is usually gradual. The pain peaks and then subsides, and usually lasts between 4 and 72 hours in adults and 1 to 48 hours in children. The frequency of attacks is extremely variable, from a few in a lifetime to several times a week, and the average migraine experiences from one to three headaches a month. The head pain varies greatly in intensity. The pain of migraine is invariably accompanied by other features.
Anorexia is common,
and nausea occurs in almost 90 percent of patients, while vomiting occurs in about
one
third
of
patients.
Many
patients
experience
sensory
hyperexcitability manifested by photophobia, phonophobia, osmophobiaand seek a dark and quiet room. Blurred vision, nasal stuffiness, diarrhea, polyuria, pallor or sweating may be noted during the headache phase. There may be localized edema of the scalp or face, scalp tenderness, prominence of a vein or artery in the temple, or stiffness and tenderness of the neck. Impairment of concentration and mood are common. Lightheadedness, rather than true vertigo and a feeling of faintness may occur. The extremities tend to be cold and moist.
4. The postdrome phase:
The patient may feel tired, "washed out", irritable, listless and may have impaired concentration, scalp tenderness or mood changes. Some people feel unusually refreshed or euphoric after an attack, whereas others note depression and malaise.
PATHOPHYSIOLOGY:
Research scientists are unclear about the precise cause of migrain e headaches. There seems to be general agreement, however, that a key element is blood flow changes in the brain. People who get migraine headaches appear to have blood vessels that overreact to various triggers.
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Scientists have devised
one theory of
migraine
which explains
these
blood
flow
changes and also certain biochemical changes that may be involved in the
headache process. According to this theory, the nervous system responds to a trigger such as stress by causing a spasm of the nerve-rich arteries at the base of the brain. The spasm constricts several arteries supplying blood to the brain, including the scalp artery and the carotid or neck arteries. As these arteries constrict, the flow of blood to the brain is reduced. At the same time, blood-clotting particles called platelets clump together& dash, a process which is believed to release the neurotransmitter -
Serotonin
Serotonin acts as a powerful constrictor of arteries, further reducing the blood supply to the brain. Reduced blood flow decreases the brain's supply of oxygen . Neurological symptoms signaling a headache, such as distorted vision or
speech, may then result, similar to symptoms of stroke. Reacting to the reduced oxygen supply, c ertain arteries within the brain open wider to meet the brain's energy needs. This widening or dilation spreads, finally affecting the neck and scalp arteries. The dilation of these arteries
triggers
the
release
of
pain-producing
substances
called
prostaglandins from various tissues and blo od cells. Chemicals which cause
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inflammation and swelling, and substances which increase sensitivity to pain, are also released. The circulation of these chemicals and the dilation of the scalp arteries stimulate the pain-sensitive receptors. The result, according to this theory: a throbbing pain in the head. More recent neuro imaging techniques seem to show that migraine is primarily a disorder of the brain (neurological), not of the blood vessels (vascular). A spreading depolarization (elec trical change) ma y begin 24 hours before the attack, with onset of the headache occurring at about the time of maximum brain coverage. The effects of migraine may persist for some days after the main hea dache has end ed. Many sufferers repo rt a sore feeling in the area where the migraine was, and some report impaired thinking for a few days after the headache h as passed. In 2005, a research was made and published indicating that in some people with a patent foramen ovale (PFO), a hole between the upper chambers of the heart, migraine might result and that the occurrence of migraines might end if the hole were blocked.
MIGRAINE TRIGGERS:
Migraine is irregularly episodic, so there needs to be some explanation for why a particular migraine episode occurs at a particular time and not at another time. A migraine trigger is any factor that on exposure or withdrawal leads to the development of an acute migraine headache. Triggers may be categorized as behavioral, environmental, infectious,dietary, chemical, or hormonal. The trigger theory supposes that exposure to various environmental factors precipitates, or triggers, individual migraine episodes. Many people report that one or more dietary, physical, hormonal, emotional, or environmental factors precipitate their migraines. The most-often reported triggers include Stress (medicine) stress over-illumination or glare, alcohol , foods, too much or too lit tle sleep , and weather. Somet imes the mig raine occurs with no apparent “cause.”
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Migraine patients have long been advised to try to identify personal headache triggers by looking for associations between their headaches and various suspected trigger factors. Patients are urged to keep a “headache diary” in which to note what they eat and when they get a headache, to look for correlations, and to try to avoid headache by avoiding factors they identify as triggers. Typically this advice is accompanied by a list of trigger factors.
1. Food
Some suspected dietary trigger factors appear to genuinely promote or precipitate migraine episodes, but many other suspected dietary triggers have never been demonstrated to trigger migraines. The review authors found that alcohol, caffeine withdrawal, and missing meals are the most important dietary migraine precip itants. The authors say dehydra tion deserves more attention, and that some patients are sensitive to red wine. The authors found little or no demonstrated evidence that notorious suspected triggers chocolate, cheese, or that histamine, tyramine, nitrates, or nitrites normally present in foods trigger heada ches. The artificial sweet ener asparta me
has not bee n
shown to trigger headache. Dr. David Buchholz, who treats headaches as a neurologist at Johns
Hopkins, has a longer list of susp ected migr aine trig gers.
Once again, he
recommends eliminating the triggers from the diet altogether, and then reintroducing them s lowly after many weeks to me asure the effects. His list includes: Caffeine (including decaf), chocolate, monosodium glutamate, processed meats and fish (aged, canned, preserved, processed with nitrates, and some meats which contain tyramine), che ese and dairy products (the more aged, the worse), nuts, citrus and some other fruits, certain vegetables (especially onions), fresh risen yeast baked goods, dietary sources of tyramine (including the foods listed above), and “ whatever gives you a headache”.
2. Weather:
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Several studies have found some migraines are triggered by changes in weather. It has been noted that 62% of the subje cts in the study though t that weather was a factor; in fact 51% were actually sensitive to weather changes. While those whose migraines did occur during a change in weather, often the subjects picked a weather change other than the actual weather data recorded. Most likely to trigger a migraine were, in order : 1.
Temperature mixed with humidity.High humidity plus high or
low temperature was the biggest cause. 2.
Significant changes in weather
3. Changes in barometric pressure
Another study says, Chinook winds (warm westerly winds occurring in Alberta, Canad a) are a migraine trig ger.
Many patients had increased
incidence of migraines immediately before and/or during the Chinook winds. TREATMENT:
Medication that is used is quite different between attacks as compared to during an attack. During a migraine attack non steroidal anti-inflammatory drugs (=NSAIDs) and dihydroergotamine or sumatriptan, which stimulate serotonin receptors, are used. Drug dependency issues on narcotics have to be discussed frankly with the patient because of the danger of rebound migr aines that are triggered by the continued use of narcotics. Sumatriptan can be given intranasally, but overuse and dependency on this medication also must be monitored by the physic ian and in males there is a higher risk for heart attacks as a side-effect of the medication. Prochlorperazine (brandname: Stemetil) can be given intravenously in the Emergency Room as a drip and can abort a migraine. Between migraine attacks there is a number of preventatives that are effective. They consist of beta-blockers such as propranolol, metoprolol, timolol and others; NSAIDs such as ASA, naproxen or ketoprofen; calcium channel blockers such as verapamil or flunarizine; antidepressants such as amitriptyline.
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Gabapentin, which is used for treatment of chronic pain, has been found useful as well in the treatment of migraines as shown in several smaller studies. Gabapentin(brand name: Neurontin) releases GABA in some parts of the brain and inhibits the NMDA pain receptors. This link describes the use of it in the Pain of complex regional pain syndrome. Dr. Stephen Clarke, Clinical Assistant Professor in the Div. of Neurology of the University of BC/Vancouver/Canada, reviewed the use of gabapentin at a conference in Vancouver/BC in November 2004 Other medications for headache prevention are the anticonvulsant gabapentin; the MAO inhibitor phenelzine and the serotonin stimulating drugs methysergide and cyproheptatine. Unfortunately many of these medications do not work 100% and there is a lack of good randomized studies to prove effectiveness. It is important to include in the regimen of anti-migraine measures non drug regimens such as avoidance of triggering factors like certain foods (choco late, red wine, certain cheeses and strong smells) or bright lights and noises. Consistent sleeping patterns and meal times need to be established. Counseling when emotional factors play a role, relaxation techniques like yoga, self hypnos is and biofeedback methods are all helpful as well. The more complex cases should be referred to a neurologist or even a multidisciplinary headache clinic.
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Conventional treatment focuses on three areas: trigger avoidance, symptomatic control, and preventive drugs.
Patients who experience
migraines often find that the recommended treatments are not 100% effective at preventing migraines. 1. Trigger avoidance:
Patients can attempt to identify and avoid factors that promote or precipitate migraine episodes. Moderation in alcohol and caffeine intake, consistency in sleep habits, and regular meals may be helpful. Beyond an often pronounced placebo effect, general dietary restriction has not been demonstrated to be an effective approach to treating migraine.
2. Symptomatic control to abort attacks:
Migraine sufferers usually develop their own coping mechanisms for intractable pain. A cold or hot showe r directed at the head, a wet washc loth, less often a warm bath, or resting in a dark and silent room may be as helpful as medication for many patients, but both should be used when needed. A simple treatment that has been effective for some is to place spoonfuls of ice cream on the soft palate at the back of the mo uth. Hold them there with yo ur tongue until they melt.
This directs cool ing to the hypotha lamus, which is
suspected to be involved with the migraine feedback cycle, and for some it can stop even a severe headache very quickly.
For patients who have been diagnosed with recurring migraines, doctors recommend taking painkillers to treat the attack as soon as possible. Many patients avoid taking their medications when an attack is beginning, hoping that "it will go away". However in many cases once an attack is underway, it can become intensely painful, last for a long time (sometimes even for several days), and become somewhat resistant to medical treatment. In contrast, treating the attack at the onset can often abort it before it becomes serious, and can reduce the frequency of subsequ ent attacks in the near-term. 1. The first line of treatment is
over-the-counter abortive
medication. Doctors start patients off with simple analgesics, such as
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paracetamol, aspirin and caffeine .They may provide some relief, although they are not effective for most sufferers. Some patients find relief from taking Benadryl or anti-nausea agents. Narcotic pain killers (for example, codeine , morphine or other opiates ) provide variable relief, but their side effects, the possibility of causing rebound headaches or analgesic overuse headache, and the risk of addiction contraindicates their general use. 2. If over-the-counter medications do not work, the next step for many doctors is to prescribe a
barbiturate and caffeine.
Anti-emetics may be needed in cases where vomiting dominates
the symptoms. The earlier these dr ugs are taken in the attack, the better their effect. Sumatriptan and related selective serotonin receptor agonists
are now the therapy of choice for severe migraine attacks that cannot be controlled by other means. They are highly effective, reducing the sym ptoms or aborting the attack within 30 to 90 minutes in 70-80% of patients. Some patients have a recurrent migraine later in the day, and only one such recurrence in a day can be treated with a second dose of a triptan. They have few side effects if used in correct dosage and frequency.
Evidence is accumulating that these drugs are effective because they act on serotonin receptors in ner ve endings as well as the blood vessels. This leads to a decrease in the release of several
peptide , including CGRP and
Substance.
PREVENTIVE DRUGS:
Patients who have more than two headach e days per week are usually recommended to use preventatives and avoid overuse of acute pain medications. Preventive medication has to be taken on a
daily basis, usually for a
few weeks, before the effectiveness can be determined. It is used only if attacks occur more ofte n than every two weeks. Supervision by a neurologist
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is advisable. The effectiveness of individual medications varies widely from one patient to the next. The most effective prescription medications include several classes of
medications
including
beta
blockers,
antidepressants,
and
anticonvulsants. Alternative approaches:
Because the conventional approac hes to migraine prevention are not 100% effective and can have unpleasant side effects, many seek alternative treatments. 1. Physical therapy:
Many physicians believe that exercise for 15-20 minutes per day is helpful for reducing the frequency of migraines. Massage therapy and physical therapy are often very effective forms of treatment to reduce the frequency and intensity of migraines. However, it is important to be treated by a well-trained therapist who understands the pathophysiology of migraines. Deep massage can 'trigger' a migraine attack in a person who is not used to such treatments. It is advisable to start sessions as short in duration and then work up to longer treatments. Chiropractic adjustments to the upper cervical spine are very effective in treating migraine headaches. There is research to support these claims. One study found that the upper cervical adjustment was just as effective as drug therapy for chronic cases. It is also noted that routine spinal adjustments help prevent the frequency, duration, and intensity of the headaches.
2. Prism eyeglasses:
British studies have shown a relationship between the use of eyeglasses containing prism and a reduction in migraine headaches. In that study, Dr.Turville suggests that many patients were provided with complete relief from migraine symptoms with proper eyeglass prescriptions that included prescribed prism.
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Most optometrists avoid prescribing prism because, when incorrectly prescribed, it can cause headaches.
3.Herbal and nutritional supplements:
50 mg or 75 mg/day of
butterbur
(''Petasites hybridus'') rhizome
extract was shown in a controlled trial to provide 50% or more reduction in the number of migraines. Cannabis was a standard treatment for migraines from the mid-19th
century until it was outlawed in the early 20th century in the USA. It has been reported to help people through an attack by relieving the nausea and dulling the head pain. There is some indication that semi-regular use may reduce the frequency of attacks. The plant feverfew (''Tanacetum parthenium'')is a traditional herbal remedy believed to reduce the frequency of migraine attacks. Clinical trials have been carried out, and appear to confirm that the effect is genuine (though it does not completely prevent attacks). Kudzu root (''Pueraria lobata'') has been demonstrated to help
with menstrual migraine headaches and cluster headaches. While the studies on menstrual migraine assumed that kudzu acted by imitating estrogen, it has since been shown that kudzu has significant effects on the serotonin receptors. Magnesium citrate has reduced the frequency of migraine in
an experiment 4. Non-drug medical treatments: Botulin toxin has been used by some sufferers in an attempt to
reduce the frequency and/or severity of migra ine attacks Spinal Cord Stimulators are an implanted medica l device sometimes used for those that suffer severe migraines several days each month
5.Other alternatives:
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Some migraine sufferers find relief through acupuncture which is usually used to help prevent headaches from developing. Sometimes acupuncture is used to relieve the pain of an active migraine headache. TYPES OF MIGRAINE 1.Basilar type migraine:
'''Basilar type migraine (BTM)''' is an uncommon type of migraine with aura that occurs in the brainstem. To meet the criteria for d iagnosing BTM, aura symptoms must include at least two of the following:
diplopia ,
simultaneous bilateral nasal and temporal visual changes, hypacusia (impaired hearing), tinnitus , dysarthria , ataxia , vertigo , simultaneous bilateral paresthesia s, or Unconsciousness decreased level of consciousness . Muscle weakness (called "motor weakness") is not part of the aura of BTM. BTM aura symptoms are reversible, and a migraine headache occurs either during the aura or within 60 minutes. Other neurological disorders may also cause these types of symptoms, so further evaluation is generally needed. This type of migraine is also called '''Basilar artery migraine''', '''Basilar migraine''', and '''Bickerstaff syndrome'''. 2. Familial hemiplegic migraine:
Familial hemiplegic migraine '''FHM''' is a type of migraine with a genetic component. These headaches typic ally last 1-3 days and are caused by calcium channel mutations, whic h occur in the pore and elsewhere. There are slightly different symptoms associated with the disorder depending on the location of the defect. 3. Acephalalgic migraine:
Acephalalgic migraine is a neurological syndrome. It is a variant of migraine in which the patient may experience aura, nausea , photophobia , hemiparesis
and other migraine
symptoms
but does not experience
headache . Acephalalgic migraine is also referred to as '''amigrainous migraine''', '''ocular migraine''', '''optical migraine''' or '''scintillating scotoma'''. Sufferers of acephalalic migraine are more likely than the general population to develop classical migraine with headache.
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The prevention and treatment of acephalalgic migraine is broadly the same as for classical migraine. However, because of the absence of "headache," diagnosis of acephalalgic migraine is apt to be significantly delayed and the risk of misdi agnosis significantly increased
Visual snow
might be a form of acephalalgic migraine. Migraine and stroke risk:
Recent studies have suggested that migraine sufferers may be at increased risk of stroke in later life. Young adult sufferers and women taking the
oral co ntraceptive pil l
at par ticular ris k. Th e mechanism of an y
association is unclear, but chronic abnormalities of cerebral blood vessel tone may be involved. HOMOEOPATHIC VIEW POINT
There is a vase difference between the fundamental concept of disease evolution of the so called modern medical science (Allopathy) and Homoeopathy. Homoeopathy deals with the principle of individualization. It treats the man, rather th an the disease. It individualization is the integral part of Homoeopathic treatment. No two persons are alike in health or in disease. Every individual is characterized by some unique features which serve to denote that a particular individual is different from another individual belonging to the same class of group. Dr. Hahnemann first introduced the concept of individualization in performing cures. According to him unique features that are present in a person serves to the purpose of individualization. This very approach is the basis of the homoeopathic system of medicine. Individuality is unit of nature. It is hub around which the whole system revolves. In the drug proving, in the study of the materia medica complied from those proving, in examination of patient, in study cases, in selection of remedy and in conduct of whatever auxiliary treatment when required, we seeks always to individualize. The question of individuality is due to the individual variation of susceptibility the individuality is best manifested through personality reactions and in their emotional temperament, likes and dislikes. No two persons are alike in this world hence the exact character of disease varies from patient to patient while
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suffering from the same disease from the nosological point and they require individualization for their treatment. Disease individualization is not merely disease determination it is more relevant for therapeut ic purpose. Diseas e determination
is
enough
for
the
diagnostic
purpose
but
diseases
individualization is indispensable for trea tment purpose. In sec 118 of organon tells about the individualization of the medicines. It is crystal clear that the pathogenetic power varies in each medicine hence there can be no question of substitution and the doctrine of the substitution can not be entertained at any cost. The success of cure depends on the accuracy of person, disease and
drug
individualization. THE PRINCIPLES AND PRACTICE OF HOMOEOPATHY –Richard Huegs:
HEADACHE:
It is one of the glor ies of Hom oeopathy tha t it has
brought within the range of curative treatment a multitude of minor ills hitherto thought unworthy of the practitioner's attention. Who ever
contributes
to the LANCET and its fellows a case of chronic or recurrent Headache successfully treated? It is one of the most prevalent of complaints, especially in women; but it has come to be regarded as a necessary evil, and neither physicians nor patients think of it as curable. It is just the reverse with Homoeopathy. Our literature abounds with cases of the cure of Headache-Dr. Peters had collected 169 in his treatise on the subject; and the relation of many of our medicines to this form of pain is accurately fixed. For full details I refer you to the "Treatise on headaches" by Dr. Peters, which I have mentioned; to the admirable papers "on Headaches" by Dr. Black in the Fifth Volume of the BRITISH JOURNAL OF HOMCEOPATHY; and to a semi. popular but really excellent sketch of the subject by Dr.Shuldham, entitled "Headaches; their Causes and Treatment." I will myself Endeavour to sketch for you the treatment of the leading forms of the malady.
TOUMIC (Syphilitic, Gouty, and Rheumatic) and SYMPATHETIC Headaches I need not speak particularly. Their treatment must be that appropriate to the blood-poison or the disordered organ on which they
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depend. Nor will I deal here with Migraine. Rec ent of this affection has given it a place among the n euroses, with whic h we shall consider it. The three great types which come under our present notice are the NERVOUS, the CONGESTIVE, and the "SICK" Headache. INDIVIDUALIZATION OF DRUGS:
Homoeopathy recognizes the individually of each drug and substance in nature. Its method of testing or proving drugs upon the healthy human beings is designed and used for the purpose of bringing out the individuality of each drug so that its full power and relations are established. During homoeopathy drug proving the effect of a drug is closely studied on all parts of the body and in large number of people. This gives us the full range of action of the medicine. The crude sensations and symptoms like pain abdomen, colic, diarrhoea etc. are not much use to homoeopathy and in homeopathy drug proving much finer symptoms are elicited. For e.g if a medicine produces headache during a homeopathic drug proving, then the symptom is completed with the location of pain, type of pain (throbbing, aching, burning etc.), aggravating and ameliorating factors, concomitant symptoms etc. The complete information allows us to differentiate various medicines producing pain abdomen in drug -proving or to say in other words the informationallows us to differentiate various medicines capable of curing headache. In aphorism 118 of organon of medicine Dr. Hahnemann writes:
"Each medicine exhibits peculiar action on the human frame which is not produced in exactly the same manner by other medicinal substance of different kind. Again in the footnote of the aphorism 119, Dr.Hahnema nn writes: Anyone who has a through knowledge of, and can appreciate the remarkable difference of effects on the health of man of every single substance from that of every other, will perceive that among them there can be no equivalent remedies no surrogates.
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It means there are no substitutes in the selection of a remedy. Eithe r a medicine is indicated in a case or it is not. Symptomatic comparisons between similar drugs are carried out to find their individually.
Manifestation of symptoms in various miasms H.A.Roberts: Psoric Manifestation:
Modern medicine tells us that migraine has as its underlying cause emotional disturbansces . In other words, this is a verification of Hahnemann’s teaching on the disturbances roused in the psoric patient by grief, sorrow or other harrowing emotions. Syphilitic Manifestation:
These headaches usually come on in the night and are almost always in the back of the head; they will ache all night, get better in the morning, only to come on again at night. The headaches are dull, heavy, yet lancinating; they are persistently constant at the base of the brain or on one side. The headaches that come on Sundays or when they are away from their usual vocations are usually psoric and syphilitic combinations. Syphilitic headaches are usually < riding, > by motion, < by exertion, either mental or physical. They are usually accompanied by a great deal of coldness of the body, sadness and prostration. They are < by warmth or heat and> by cold applications; < by quiet rest, by lying down at night and by sleep, and> by nosebleed. (Note the indications for the syphilitic headache as being almost exactly opposite those of the psoric type, which are> by rest, by lying down, > by hot applications; the psoric headaches come on in the daytime while the syphilitic are manifest at night).
Sycotic Manifestation:
The headache in the v ertex is sycotic in its origin; or there may be frontal headache. These are < lying down and at night, especially < after midnight. There are feverish headaches of children. This patient is restless
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and wants to be kept in motion, which>. The head symptoms resemble the syphilitic in that they have the night aggravations, and there is the same type of vertigo at the base of the brain.
REPERTORIAL REFERENCESFOR MIGRAINE Rubrics related to migraine inKent’s repertory: Chapter – Head . Pain in head on one side :
one side: Aeon., resc., reth., agar., agn., Alum., ambr., am-c., am-m.,
anac., ang., ant-c., ant-t., apis, arg-m., Arg-n., arn., ars., ars-i., arund., asaf., asar., aur., bar-c., bar-m., bell., bism., bor., bov., bry., bufo., caet., cale., calcp., eamph., eann-i., cann-s., canth., caps., carb-an., earb-s., carb-v., caust.,
cham., chel., chin., chin-a., chin-s., de., cina, einnb., clem., cocc., coif., eoleh., coloc., con., cop., corn., eroe., erot-h., cupr., cycl., dig., dios., dros., dulc., elat., elaps, eug., euph., euphr., eup-per., ferr., ferr-ar., ferr-i., ferr-p., gels.,
glon., graph., guaj., hell., hyos., ign., iod., ind., ip., iris, kali-ar., kali-bi., kalibr., Kali-c., Kali-i., kali-n., Kaii-p., kali-s., kalm., kroos., lac-d., lach., laet., laur., led., lye., mag-c.," mag-m., mane., mang., meny., mere., mez., mil., mosch., murx., mur-ae., nat-a., nat-c., nat-m., nat-p., nice., nit-ae., nux-m.,
murx., olnd., par., petr., Ph-ac., phos., phyt., Plat., plb., psor., Puls., ran-b., ran-s., rheum, rhod., rhus-t., rota, rob., sabad, sabin., samb., sang., Sars., selen., seneg., sep., sil., Spig., spong., squil., stann., staph., stict., stram., stront., sulph., Sulph-ac., syph., tab., tarax., tarent., teuer., lhuj., ustiI., valer.,
verat., Verb., viol-o., viol-t., Zinc., zing.
Pain in right side :
Alum., arg-m., ars., asaf., Bell., bism., bov., bry., bufo, eaet., Calc., carb-an., Carb-v., eaust., cham., ehel., chnic., dna, cist., coca, coc-c., coff., can., croc.,
crot-c., crot-h., cyc1., euph., ferr-ar., gels., gins., gran., graph., grat., guaj., hep., Ign., iod., Iris., jac., kali-c., lach., lye., rnag-c., meny., mere., mere-i-r., mez., mil., mosch., nat-m., nit-ac., nux-m., ol-an., plat., plb., ran-b., rat., rheum, rhod., rhus-t., ruta, Sabad., sang., Sep., sil., spong., suIp!t., tarax.,
26
tarent., thuj., urt-u., verat., zinc.
Pain in left side :
Aloe, alum., ambr., al/t-e., ars., ars-i., asaf, asar., bell., bism., bov., Brom., bry., calad.,.cale., calc-p., cann-s., canth., carb-s., carb-y., caust., cham., ehil/., chin-a., chin-s., cimic., cina, eoloe., can., cony., eroe., crot-h., cupr., cycl., eup-pur., euph., ferr., ferr-i., fl-ac., graph., guaj., gymn., ham., hydr., ign.,
iod., kali-e., lac-c., lach., lac-ac., lil-t., lith., lob., lye., mag-c., med., mere., merc-i-f., merc-i-r., murx., nat-m., /lit-ae., /lux-m., ol/ld., pall., par., phel.,
phos., plan., plat., plb., ptel., ran-b., ran-s., rhodo., rhus-t., sabad., samb., sec., sel., Sep., Spig., sulph., tab., tarax., thuj., trom.. yerat-v., viol-a., viol-t., xanth., zinc., zing., ziz.
Head ache from noise :
noise, from: Aeon., agar., anac., anan., ang., arg-n., am., ars., ars-i., bapt., barc., bar-m., Bell., bor., bry., bufo, cact ., calad., Calc., calc-s., cann-s., caps., carb-an., carb-v., caust., chin., chin-a., cie.,cocc., coff., eoleh., con., ferr-p., gels., graph., hell., hyos., ign., iod.,. kali-ar., kaIi-bi., kali-s., 1ac-c., lac-d., lach., lye., lyss., mag-m., mane., mere., mere-i-f., mur-ae., Nat-a., nat-c., nat-p., Nit-ac., nux-v. ph-ac., phos.; ptel., sang., sanie., sil., sol-n.,
spig., stann., stiet., tab., Ther., yue., zinc) Head ache from odors :
Odors, from strong: Acon., Anac., arg., aur., bell., cham., chin., coff., colch., graph., ign., lyc., nux., phos., selen., sil., sulph. Periodic headache:
Act-sp., O!th., aloe, Alum., ambr., ammc., anac:, apis, aran., arn., Ars., ars-i., asaf., belL, benz-ac., cact., calc., calc-s., carb-v., Cedr., cham., Chin., chin-a., Chin-s., Coloc., cupr., eup-per., ferr., ferr-ar., ign., kali-ar., kali-bi., kreos., lac-d., lach., laur., lob., lyc., mur-ac., nat-a., nat-c., Nat-m., nat-p., nat-s"
27
nicc., Nit-ac., Nux-v., phos., plat., prun., puis., rhus-t., Sang., sel., Sep., Sil.,
spig., stram., sulph., tab., rub., zinc.
Paroxysmal pains :
Acon., agar., ambr., ant-t., arn., ars.,
asaf., Bell., bufo, calc., carb-v., cedr.,
cham., chin., chin-a., cocc., colch., coloc., crot-t., cupr., dig., ferr., ferr-ar., ferr-p., ign., kali-ar., kali-c., kaJi-n., kali-p., kalln., Lach., lye., mag-p., mosch., mur-ac., murx., nat-a., nat-c., nat-p., nice., nit-ac., nux-m., petr., phac., plat., psor., ran-b., Sang., sars., sep., sil., spig., spong., squil., stann.,
stram., stront., thuj., valer., verat., viol -t., zinc
Head ache from light :
Acon., agar., aloc., anan.,
ant-t., arg-n., arn., ars., Bell., bor., bry.,
bufo.,
cact., Calc., chin., cocc., coff., enphr., ferr-p., gels., ign., kali –bi., kali-p., lacc., lac-d., lyc., nat-a., nat-c., nat-m., nat-p., nux-v., ph-ac., phos., Poda., sang., sanic., sep., sil., sol –n., stict., stram., sulph., tab., tarent.,ziz.
Head ache> by lying in a dark room:
Acon., Bell., Brom., bry., lac-d., podo., sang., sep, sil.
Head ache > by darkness:
Con., arn., bell., borm.,chin., hipp., lac-d., mag-p., mez., sang., sep., sil.,
stram., zinc.
Head ache with blindness: Asar., aster., bell., caust., Cycl., ferr-p., gels., Iris., lac-d., Lill-t., nat-m petr.,
Phos., psor., sil., stra., sulph.
Head ache with vomiting :
Arg-n., asar., calc., cycl.,gels., glon., kali-bi., lach.,lac-d., manc., op., raph.,
sang., sep., sil., stann., sul-ac., tab.
28
Rubric Related to Migraine in Boenninghausan’s Therapeutic Pocket Book. Chapter – Head . One-sided in General: Acon., AGAR., Agn., ALUM., Ambr., Am. carb., Am. m., ANAC., Ant. cr.,
Ant. t., ARG., ,Arn., Ars., ASAF., Asar., Aur., BAR. C., Bell., Bism., Bor., Bov., Bry., CALC. C., Camph., Cannab. s., CANTH., Caps., Carbo an.,
Carb
V., Caust., Ced., Cham., Chel., Chin., Cic.; CINA, Clem., Cocc., Coif., Coleh., Coloc., Con., Croc., Cup., Cvc.; Dig., Dros. DULC... Euphorb., Euphr., Fer."
GraPh., GUAI., Hell., Hep., 'Ryos., Ign., lod., K. CARB., K. nit., re., Lach., Laur., Led., Lye., Mag. c., Mag. m., .MAN.G., Mar., Meny.,' Merc., M%Z., "Mos., MUR. AC., Nat. C., Nat. m., Nit. ac., Nux m., Nux V., OLEAND., PAR., Petrol., PHOS., PHO. AC., PLAT., pb.., Pit Is. , Ran. b., Ran. S., Rheum, Rhodo., Rhus, Ruta, SABA., SABI;,Samb., SARS.,Sele., Seneg., Sep., Sil, SPIG., Spo., Squ., Stan., STNPU" Smo., SuI., SUL. AC.,
Tar., Thuj.,
Valer., Verat. a., VERB., Vio. o., Vio. t., Zing.
Left Side:
Acon., Agar., Alum., Amnc., Anac., Ant. cr.,ANAC., Aur., Bell., Bar.. Brom.. BRY., CALC. C., CANTH., Caps.,CARB. AN., Carbo V., Caust., Cham., Chel., CHIN., CLEM., Cocc., Coloc., DIG., DULC., Euphorb., GRAPR., Rep., lod., K. carb., K. nit,. Laur., Lye., Mag. C., Mag., m., Mang., Meny., MERC., Mere. c., Millef., Mur. DC., Nat. c., NAT. oM., Nit. ac., Oleand., Onos.,
Petrol., PROS., Pho. ac., Plat., Rhodo., Rhus, RUTA, Seneg., Sep., Sil., spig., Staph., Stro., SUL., Tar., THUJ." Verb., Vio. t., Zinc. Right Side:
AGAR., Agn., Alum., Ambr., Am.. carb., Am. m., ANAC., Aur., Bell., Bar., Brom., BRY., CALC. C., CANTH., Caps., Carbo an., Carbo V., Caust., CHEL., Chin., Clem., Coloe., CON.. Dig., DROS., Graph.,
29
Guai., Hep., lod.,
K. CARB., K. nit., Kre., Laur., Led., Lye., Mag. m., Mang., MENY., Merc:,
Mez., Mur. ac., Nat. c., Nat. m., NIT. AC., Petrol., Phos., Pho. ac., Plat., Pso., PULS., Ran. b., Ran. S., Rhodo., RHUS, Sab.it., SARS., SEP., SIL., Spig.,
Spa., Stan., STAPH., Stro., Thuj., Verat. a., Via. t., Zinc.
Rubric related to Migraine in Boericke’s Repertory Chapter – Head. Migraine:
2 Marks anac, arg.n, bell, calc, can.ind, cim, cocc, coff, gels, gnar, ign, iris, kali.c, lac.d, lach, melt, menisp, nux.v, onosm, puls, sang, scutel, sep, zinc.sul. 1 Mark am.c, avena, bry, citr, carb.ac, indigo, kali.bich, nat.mur, plat, sil, spig, stann, sul, thea, ther, verbasc, xanth.
Periodical head pain.
2 Marks ars, bell, ced, cinch, sang, spig. 1Mark acon, am.pic, arg.n, cact, gels, ign, mag.m, sep, zink.v.
Headache associated with blindness or visual disturbances:
2 Marks cycl, gels, iris, kali.bic k, lac.d, nat.m, sang, ther. 1Markbell, ign, kali.c, lac,c, nux.v, pic.acid, pod, psor, sil, spig, zinc.s. Headache associated with nausea:
2 Marks ant.c, bry, cocc, ipec, iris, nux.v, puls, sang, sep, tab. 1Mark aloe, ars, ferr.m, gels, lac.c, naja, nat.mur, petrd, sil
30
Headache associated with vomiting:
2 Marks ars, bry, ipec, iris, lac.d, nux.v, sang. 1Mark arg.n, cham, cinch, cocc, glon, lac.c, lob, nat.m, puls, robbin, sep, sil, tab, ver,a, zinc.s Headache aggravated by noises:
2 Marks bell, ign, nux.v, phos.ac, sil. 1Mark acon, ars, coff, ferr.p, lac.d, nit.ac, phell, spig, tab.
< Bright objects:
2 Marks bell, sil 1Markoreodaph, phos. ac. > Rest, Quit:
2 Marks bry, gels, sang, sil. 1Mark bell, cocc, lith.c, meryanth, nux.v, puls, spig. Murphy’s repertory: Headache - Migraine.
Agan, Ant.c, Bry, China, Coffee, gels, Ign, Ipecal, Iris, Nux Vom,Phos, Puls, Sang, Silicea, Phuja, Zincum.
THERAPEUTIC PART
31
1.Nat.mur:
Headache comes in the morning or at 10 am lasting until 3 pm or evening. The headache are periodical. It is preceded by partial blindness (Iris, gels, Kali bic, psorinum, silic etc.) sensation as if there were little hammers beating in the skull similar to psorinum. 2. Belladona: Violent hyperemia with throbbing carotids red face, intolerance of least ,
noise or jar. Hemiopia, retinal blindness, slight paralysis of tongue even transitory hemiplegia. < Afternoon or evening before or during menses > in a dark room 3. Sepia:
Migraine which had existed for years with profuse leucorrhoea has been cured with sepia. It is usually left sided and pain extends backwards. Deep stitching pain seems to be in the membranes of the brain. It is so severe that it extorts cries and frequently ends in vomiting. It is < by motion light, noise or by thunderstorm > sleep, rest in dark room. It get worse during menstrual periods. 4. Sanguinaria:
Right sided headache. Pain comes from the occiput. They increases and decreases with the course of the sun, reaching their height at midday. The paroxysms and with profuse urination (sil, gels, vera alb). They recover at every 9th day. Sanguinar ia also has a menstrual headache, which attends a profuse flow in contrast to sepia, where the menses will be scanty.
5. Iris Versicolor:
When the attack begins with blurring of sight (gels, Kalibic , Nat.mur, pson, Lac.def) are attended with sour watery vomiting. Pain involve the infra orbital and dental nerves, with stupid stunning head ache. Mostly right sided. It is
32
useful remedy for Sunday headache, which occurs in teachers, scholars, professors etc, in which a relief of the strain of the preceding six days; produces the head ache. In sick headache with continuous nausea, it is one of our most useful remedies, and when the headache are produced by eating sweet things, iris is probably the remedy.
from moderate motion, open air 6. Pulsatilla:
Pulsatilla is very similar to sepia. Both are indicated by scanty menses, bursting, throbbing, boring or stitching pain on one side of the head obscuration of sight, white tongue, nausea & vomiting pulsatilla has more vomiting, and thickly furred tongue with clammy with mouth and relief from cold air. The pains are shifting in nature and associated with chilliness in the evening. 7. Nux Vom:
Nux vom is more suited to man than in sepia. The attack commences early in the morning and generally increa se to a frantic degree. Headache can be caused by tobacco, coffee, alcohol intake, digestive troubles, constipation and hepatic insuffic iency. It suits the gouty and haemarohoidal subjects. Headache is usually left sided, and is associated with sour taste or perhaps nausea and violent retching. The dull, wooden, busting of head following a debauch is most characteristic of Nux vom. Headache of high livers, business men. < stooping & coughing, Moving the eyes & motion is general. A headache all over the head is also characteristic of Nux. vom.
8) Arsenic alb:
Causes a throbbing, stupefyi ng headache over the left eye. The arsenicum headache is temporarily relieved by the application of cold water. 9)Theridion :
33
Flickering before eyes, then blurring. The nausea is made worse by closing the eyes and also by noise. 10. Silica:
Headache after any unwanted exertion. The pains excite nausea and fainting. The peculiarity is that there will be obscuration of vision after headache. Headache is decreased by urination. 11. Argentum nitricum:
It is a deep seated neurotic disease and by some it is supposed to be of epileptic in nature. It comes periodically. There is frequently boring pain in the head, which is worse in the left frontal eminence. The boring is relieved by tight bandaging. It is excited by any a mental emotion or by anything that depreciates the nervous system, as loss of fluids, loss of sleep or mental strain. Sometimes the pain becomes as severe that the patient loses his consciousness. The paroxysms frequently end in vomiting of bile or sour fluid. 12. Gelsimium;
Headache commencing with blindness and especially it is also a remedy for headache due to eyestrain (onos). Pain commences in the occiput and comes up over head and settles over eyes. (Cocculus is another remedy for occipital pain). Headache get worse with sun begins at 2 or 3 am and reaches its height at afternoon. It is associated with stiff neck. The patient cannot think effectively or fix his attention. Copious urinatio n relieves the headache and the headache is accompanies with visual troubles such as double vision, squinting and dim sight. Gelsimium head ache are relieved by sleep. A characteristic of gels is a sensation a band around the h ead just above the ears. It also suits “tobacco headache” HA > Urniation ( Silica Ign) 13. Kali bic:
The patient is affected with blindness objects become obsc ured, the headache then begins. It is violent and is assoc iated with aversion to light and noise and the sight returns as the headache grows worse. It can be compar ed with
34
psorinum. In psorinum blindness, before headache and the sight returns before the pain begins. 14. Oleum animale
Migraine with polyuria the urine being perfectly clear. Eyes heavy and blood shot can hardly lift the eyelids. Speech is thick unwield y. 15. Cocculus;
Migraine with vertigo and nausea, occipital pain is characteristic. Sick headache from riding in a carriage, boat train or cars. headache at each menstrual period with nausea and inclination to vomit. Headache from loss of sleep. Juglans cinerea is one of the important remedies for occipital headache with hepatic complaints. 16. Spigelia:
Left sided sun headache. Noise and jarring of bed will aggravate the headache. Stooping and change of weather also make the pain worse. 17. Lac defloratum:
Frontal migraine in anemic women with nausea, vomiting and obstinate constipation. Hyperesthesia of sight and hearing. Icy coldness of body even near the stove. Deathly sickness of stomach. Sometimes vomiting < during menses
18. Lac caninum: Pain over left eye < noise and talking
>rest and cold water Neuralgic pain in left side of head followed by a film over right eye. Intense darting. pain around left eye. 19. Melilotus:
Intense frontal headache preceded by hot flushed face epitaxis &Menstrual flow
35
20. Glonoine:
Hemicrania from excessive use of wine. Nausea Dimness before eyes like a cloud followed by most violent headache > by vomiting. 21. Epiphegus:
Headaches are neurasthenic in type, brought on by strenuous exertion. Such as going on a visit, doing a days shopping etc. Visions get a little blurred. It is worse on rising from supine positio n and in the open air. There is a decided relief offer a sound sleep pressive pain in the temples traveling inwards. < from working in open air. Headache is caused by mental and physical exertion and they are preceded by hunger. 22. Scrutallaria:
In nervous sick headache which is caused by excitement and over exertion with frequent scanty urination. Assoc iated with restless sleep and night terrors. Worse over right eye, aching in eye balls. Explosive headache of school teachers < Noise, odor, light > Night, rest 23) Tongo:
Used in migraine with neurological affections. Tearing pain in supra orbital nerve with beat and throbbing pain in head. Tremblin g in right upper lid. The symptoms are < by rest, when seated > by movement & pressure
24) cyclamen: Migraine is accompanied by sparking before eyes. One sided headache.
Vertigo things turn in a circle, better in a room worse open air. Frequent sneezing and itching of ears. 25) Picric acid:
Headache from over study or over work occipital pain. Relieved by bandaging tightly worse from slightest mental exertion
36
26. Damiana:
It is an excellent remedy for migraine. 27. Chionanthus;
Migraine due to acidity and sluggishness of liver. 28. Carbolic acid:
For migraine in children - Tight feeling in head as if compressed by a rubber band headache. better by green tea, while smoking. 29. Cannabis Indica:
Migraine attack preceded by unusal excitement with loquacity. Headache with flatulence. Feels as if top of head were opening and shutting and as if calvarium were being lifted. 30. Lobelia in flota:
Periodical headache that comes on in the afternoon and continues to increase till midnight every third attach being more violent than the two previous attacks. Gastric headache with nausea, vomiting and prostration.
31. Lithium carb:
Headache of females, brough on by sudden ceasation of menses, and it is always better when the patient eat something 32. Prunus spinosa:
Right sided migraine shooting pain from right frontal bone through brain to occiput pain in right eye ball as if it would burst. 33. Verbascum thapus;
Sensation as if the temples were crushed together. neuralgic pain in the zygoma tempero maxillary joint and ear, particularly of left sided, with lachrymatioh, coryza and sensation as if parts were crushed with tongs. Talking, sneezing and change of temperature aggravate the pain also pressing
37
teeth together. Pain seems to come in flashes, excited by least movement, occurring periodically at some hour in the morning and afternoon each day.
MATERIALS AND METHODS:
The subject of this study was taken from OPD & IPD of Dr. Hahnemann Homoeopathy Medical College & Research, Rasipuram. The cases were collected from both IPD and OPD. In marked improvement cases both physical, mental generals and particulars reduced. Complaints feels better.In mild improvement cases particulars reduced. METHODS OF COLLECTION OF DATA ;
1. Inclusion criteria a) Patients of all ages and both sexes are selected. 2. Exclusion criteria a) Subjects with active treatment for any other chronic disease. 3. Diagnosis based on clinical presentation. 4. Cases were treated by keeping the Holistic \ Individualistic concept of mind and due importance was given to the Characteristic symptom, General and Particular symptoms. 5. Case proforma that has been used in the study is given in annexure. 6. All cases were Analysed, Evaluated and Repertorised according to the case presentation. 7. Management: •
General management
Therapeutic management is based on repertorial analysis
38
CASE PROFORMA: OP. No: RELIGION: MARITALSTATUS: FINANCIAL STATUS:
NAME: AGE/SEX: OCCUPATION: ADDRESS:
1. PRESENTING COMPLAINTS: 2. H/O PRESENTING COMPLAINTS: 3. PAST HISTORY: 4. FAMILY HISTORY: 5. PERSONAL AND SOCIAL HISTORY: a) Born and brought up: b) Education: c) Diet: d) Marital status: e) Socio economic status: f) Domestic relationship: g) Occupation: 6. OBSTETRICAL HISTORY: 7. GENERALITIES: PHYSICAL GENERALS: APPETITE:
LIKES/CRAVING: THIRST: SLEEP & DREAMS: SEXUAL FUNCTION: ELIMINATIONS: a) STOOL: b) URINE: c) SWEAT: d) MENSTRUATION:
39
MENTAL GENERALS:
GENERAL EXAMINATION: Appearance: Nutrition: Anaemia: Jaundice: Pedal oedema: Koilonychia: Height:
Body proportion: Skin to touch: Cyanosis: Clubbing: Lymphadenopathy: Hair & Nails: Weight:
VITAL SIGNS: Pulse: /Min. B.P: mm Hg.
R.R: /Min. Temp: F
SYSTEMIC EXAMINATION: CVS: RS:
GIT: GUT: CNS: LOCOMOTOR: SKIN : Inspection: Type of eruption: Scaling: Discoloration: Scar marks: Pus formation: Palpation: Peeling of scales:
Indurations: LAB INVESTIGATIONS: FINAL DIAGNOSIS: ANALYSIS OF SYMPTOMS: EVALUATION OF SYMPTOMS: TOTALITY OF SYMPTOMS:
40
MIASMATIC CLEAVAGE:
FUNDAMENTAL MIASM: DOMINANT MIASM: TYPE OF DISEASE: REPERTORIAL TOTALITY:
CHOICE OF REMEDY: BASIS OF PRESCRIPTION: PLAN OF TREATMENT: GENERAL MANAGEMENT: FIRST PRESCRIPTION:
Case- 1 NAME
: Mrs.C. Anjagam
41
OP.No: 17075
AGE/SEX OCCUPATION ADDRESS
:45yrs/F : House wife :Rasipuram
FINALDIAGNOSIS:
MIGRAINE
1. PRESENTING COMPLAINTS: Headache on and off since 4 years Pain in left lower limb since 10 days
2. H/O PRESENTING COMPLAINTS: Headache on and off since 4 years Gradual onset. Pain in right side of the temple bursting type of pain < from 10AM to 4 PM, cold drinks. > by hot water applications, sleeping.Assoc iated with nausea. Pain in left lower limb since 10 days. sudden onset. Pain in lower limb.Aching type of pain pressure, hot applications. PHYSICAL GENERALS: Appetite: Good, and satisfied. Thirst: Good, and satisfied Aversions : Nothing specific
Desires : Sour thing Disagrees : Fatty foods causes headache Sleep & Dreams: Good, refreshing sleep. Eliminations: a) Stool: Regular and satisfied. b) Urine: Normal. c) Sweat: Normal. Menstruation: 3/30 days cycle, bright red colour, some times pain lower abdomen. 3. PAST HISTORY: No H/O major illness in the past. 4. FAMILY HISTORY: No H/O similar and major illness among the family members. 5. PERSONAL AND SOCIAL HISTORY: a. Born and brought up: Salem. b. Diet: pure - veg. c. Habit- No habit of betal nut chewing and tobacco chewing. d. Marital status: Married. e. Socio economic status: MIG. f. Domestic relationship: Good. GENERAL EXAMINATION: Appearance: Normal
Body proportion: Equal.
42
in
Nutrition: Good. Anaemia: mild anaemic Jaundice: not jaundiced Pedal oedema: no pedal oedema. Koilonychia: Absent. Height:158cm.
Skin to touch: Normal. Cyanosis: not cyanosed. Clubbing: no clubbing. Lymphadenopathy: Absent. Hair & Nails: Normal. Weight:64kg.
VITAL SIGNS:
Pulse: 76/Min. B.P: 120/70mm Hg. Built – Well
R.R: 18/Min. Temp: 98.6F Complexion – Dark.
SYSTEMIC EXAMINATION: CVS: S1 & S2 heard Normally in all four cardiac areas. No murmurs heard. RS: Normal vesicular breath sound is heard all over lung field. No added sounds. GIT: Abdomen soft. No mans on palpation. GUT: No deviation in the urinary tract. CNS: Clinically normal LOCOMOTOR: No inflammatory signs seen. No deformity. Normal gait. LAB INVESTIGATIONS:
Blood: Hb: 10.2g%. TLC: 8900cells/cu mm of blood. DLC: N- 59%, L- 47%, E- 4%, B- 0%, M- 0%. ESR: ½ hr- 8mm. 1 hr- 15mm. FINAL DIAGNOSIS
Urine: Sugar: Nil. Albumin: Nil.
: Migraine
ANALYSIS OF SYMPTOMS: Physical Generals: Descries - Sour things fatty foods Disagrees - fatty foods Causes headache Particulars: Pain in right side of the temple, brushing type of pain < cold applications associated with nausea. Pain in left lower limb, aching type of pain < exertion> pressure , hot applications. EVALUATION OF SYMPTOMS: Desire for sour things Disagrees for fatty foods. Bursting type of pain < from 10. AM to 4 PM. cold drinks. > sleeping hot water applications sleepi ng. associated with nausea.
43
Pain in left lower limb since 10 days. sudden on set . Pain in lower
limb. Aching type of pain pressure, hot applications. TOTALITY OF SYMPTOMS: Desire for sourthings. Disagrees for fatty foods Bursting type of pain in right side of the temple. Aggravation 10AM to 4PM cold drinks.
Amelioratedwith by sleeping, Associated nausea hot application . Pain in left lower limb < exertion. > Pressure, hot application .
MIASMATIC CLEAVAGE: S.No 1.
Expression Desire for sour things
Psora
-
Sycosis -
-
Syphilis -
Tuber -
-
-
-
-
2.
Burstingtypeofpain
3.
4.
5.
>Warmth
-
-
-
6.
>Pressure
-
-
-
7.
Pain in lower limb
-
-
-
8.
< 10 am to 4 Pm
-
-
-
-
-
FUNDAMENTAL MIASM: Trio miasmatic. DOMINANT MIASM: Psora. TYPE OF DISEASE: Dynamic chronic fully symptoms developed miasmatic disease.
REPERTORIAL TOTALITY:
44
Symptom 1 Desire Sour things .
Section Stomach
2 Disagrees for fatty . foods
Stomach
Disorded fatty foods
487
Head
Pain bursting in right
180
S.No
3 Bursting pain in right .
Rubric Desires Sour Things
temple
Page 486
temple
4 <10AMto4PM .
Head
5
Paininhead10AM to 4 PM
Head
134
Paininheadfrom cold things
138
6 >Sleeping .
Head
Paininheadamen sleep
147
7 Associated with . Nausea
Head
Pain in head with Nausea
150
Pain in left lower limb
1062
8 Pain in left lower limb .
Extremities
9 Exertion .
Extremities
Paininleftlower limb
1063
1 >Pressure 0 .
Extremities
Paininleftlower limb>Pressure
1064
CHOICE OF REMEDY: Pulsatilla . BASIS OF PRESCRIPTION: Repertorial totality, Generalities. PLAN OF TREATMENT: Curative. FIRST PRESCRIPTION: •
Pulsatilla 30/ 1d
•
Placebo/ 7dose
FOLLOW UP 25.07.08 Patient feels better 31.07.08
45
Patient feels better •
Placebo/ 7dose
CONCLUSION : The case showed marked improvement
NAME AGE/SEX OCCUPATION ADDRESS
CASE – 02 : Mrs. Mariammal :39yrs/F : Weaver : Iyyampalayatharkadu Moolapallipatty, N,pattai.
FINALDIAGNOSIS:
OP.No: 16886
Migraine
PRESENTING COMPLAINTS: Headache since 2 years on and off H/O PRESENTING COMPLAINTS: Headache since 2 years on and off. Paroxysmal type of headache. Pain in right temple, pulsating type of pain, < eye strain, noise > pressure, tight clothing, associated with vomiting & dimness of vision causation: Eye strain, noise PAST HISTORY: No History of similar complaints and major illness in the past. FAMILY HISTORY: Father is suffering from Diabetes Mellitus. PERSONAL AND SOCIAL HISTORY: Born and brought up: Rasipuram. Diet: Non-veg. Marital status: Married. Socio economic status: MIG. Domestic relationship: Good. GENERALITIES: PHYSICAL GENERALS: Appetite: Decreased Thirst: Increased for hot water frequently for large quantity. Aversion: Nothing specifics Desires: Sweets Disagrees: Nothing specifics. Sleep & Dreams: Good, refreshing sleep. Eliminations:
46
a) Stool: Normal, r egular, sat isfied. b) Urine: Normal. c) Sweat: Normal. d) Menstruation: 3/28 days cycle, regular, bright red flow, not clotted MENTAL GENERALS: Easily gets anger Grief about her complaints GENERAL EXAMINATION: Appearance: Normal Nutrition: Good. Anaemia: not anaemic Jaundice: not jaundiced Pedal oedema: no pedal oedema. Koilonychia: Absent. Height:160cm.
Body proportion: Equal. Skin to touch: Normal. Cyanosis: not cyanosed. Clubbing: no clubbing. Lymphadenopathy: Absent. Hair & Nails: Normal. Weight:58kg.
VITAL SIGNS: Pulse: 74/Min. B.P: 110/70mm Hg.
R.R: 19/Min. Temp: 98.6F
SYSTEMIC EXAMINATION:
CVS: Normal S1 & S2 heard in all four cardiac areas. No murmurs heard. RS: Normal vesicular breath sound is heard all over lung field. No added sounds. GIT: No visible swelling, No tenderness, No organomegaly. Normal bowel sounds heard. GUT: No inflammatory signs. No visible swelling. CNS: clinically normal LOCOMOTOR: No inflammatory signs seen. No deformity. Normal gait.
LAB INVESTIGATIONS:
Blood: Hb: 9.2g%. TLC: 8900cells/cu mm of blood. DLC: N- 59%, L- 47%, E- 4%, B- 0%, M0%. ESR: ½ hr- 8mm. 1 hr- 15mm. FINAL DIAGNOSIS: Migraine ANALYSIS OF SYMPTOMS: Mental Generals: Easily gets anger
47
Urine: Sugar: Nil. Albumin: Nil.
Grief about her complaints Physical Generals: Appetite: decreased Desire: sweets Particulars: Headache Paroxysmal type of headache. Pain in right temple, pulsating type of pain, < eye strain, noise > pressure, tight clothing, associated with vomiting & dimness of vision EVALUATION OF SYMPTOMS: Easily gets anger Grief about her complaints Appetite: Decreased Desire: Sweets Paroxysmal type of headache. Pulsating pain in right temple, < eye strain, noise > pressure, tight clothing, Headache associated with vomiting & dimness of vision TOTALITY OF SYMPTOMS: Easily gets anger Grief about her complaints
Appetite: decreased Desire: sweets Paroxysmal type of headache. Pulsating pain in right temple, < eye strain, noise > pressure, tight clothing, Headache associated with vomiting & dimness of vision
MIASMATIC CLEAVAGE: S.No 1.
Expression Easily get angered
Psora
Sycosis -
Syphilis -
Tuber -
2.
Grief
-
-
-
3.
Desire for sweets
-
-
-
4.
Paroxysmal head ache
-
-
-
5.
Pulsating
-
-
-
6.
< eye strain
-
-
-
7.
< Noise
-
-
-
8.
> Pressure
-
-
-
48
9.
>Fight clothing
-
-
-
FUNDAMENTAL MIASM: Trio miasmatic. DOMINANT MIASM: Psora. REPERTORIAL TOTALITY:
S.No 1 2 3 4 5
6
Symptom Easilygetangered Grief Appetite decreased Desireforsweets Paroxysmalheadache
Section Mind Mind Stomach Stomach Head
7
Pulsating pain in right temple
Head
8
Head
9
>Pressure
Head
10
>Tight Clothing
Head
11
Associated with dimness of vision
Head
Head
Rubric Anger GriefAilmentsfrom Appetite decreased Desiresweets Paininhead Paroxysmal Head pain in right temple Paininheadfrom straining eyes Paininheadfrom noise Paininheadpressure amel Pain inhead>binding head Paininhead blindness
CHOICE OF REMEDY: Nat mur BASIS OF PRESCRIPTION: Repertorial totality, Generalities. PLAN OF TREATMENT: Curative. FIRST PRESCRIPTION: •
Nat mur 30\ 1d FOLLOW UP 12.06.08 Patient feels better •
Nat mur 30\ 1d
•
Placebo/ 7dose
18.06.08 Symptoms worsened 22.06.08 Patient feels better
49
Page 02 51 476 486 145
146 149 144 145 127 137
CONCLUSION : The case showed marked improvement
NAME AGE/SEX OCCUPATION
CASE – 03 : Mr.Varadharajan :45yrs/M : Teacher
ADDRESS
: 73. V.Nagar, Rasipuram
FINALDIAGNOSIS:
OP.No:13302
MIGRAINE
PRESENTING COMPLAINTS: Headache on and off since 5 years cough with expectoration since 3 days H/O PRESENTING COMPLAINTS: Headache on and off since 5 years Gradual onset. Periodical type of headache, comes 10 days once, pain in left side of forehead, throbbing type of pain < heat of sun, anger > rest, sleep, Associated with dimness of vision Cough with expectoration since 3 days rattling cough white , thick
expectoration < night > . Pain in lower limb, aching type of pain expectoration causation : Heat of sun Anger
PAST HISTORY: His elder son also have similar complaints for 2 years. FAMILY HISTORY: No H/O similar and major illness among the family members. PERSONAL AND SOCIAL HISTORY: Born and brought up: Rasipuram. Diet: pure - veg. Habit- No habit of bettal nut chewing and tobacco chewing. Marital status: Married. Socio economic status: MIG. Domestic relationship: Good. PHYSICAL GENERALS: Appetite: Good, and satisfied. Thirst: Good, and satisfied Aversions : Nothing specific Desires : Spicy foods Disagrees : Nothing specific
50
Sleep & Dreams: Good, refreshing sleep. Eliminations:
a) b) c)
Stool: Regular and satisfied. Urine: Normal. Sweat: Normal.
MENTAL GENERALS : Irritable with anger . GENERAL EXAMINATION: Appearance: Normal Nutrition: Good. Anaemia: No Jaundice: not jaundiced Pedal oedema: no pedal oedema. Koilonychia: Absent. Height:172cm.
Body proportion: Equal. Skin to touch: Normal. Cyanosis: not cyanosed. Clubbing: no clubbing. Lymphadenopathy: Absent. Hair & Nails: Normal. Weight:64kg.
VITAL SIGNS: Pulse: 76/Min. B.P: 120/90mm Hg.
R.R: 18/Min. Temp: 98.6F
Built – Well
Complexion – Dark.
SYSTEMIC EXAMINATION:
CVS: S1 & S2 heard Normally in all four cardiac areas. No murmurs heard. RS: Normal vesicular breath sound is heard all over lung field. No added sounds. GIT: Abdomen soft. No mans on palpation. GUT: No deviation in the urinary tract. CNS: Clinically normal LOCOMOTOR: No inflammatory signs seen. No deformity. Normal gait.
LAB INVESTIGATIONS:
Blood: Hb: 13g%. TLC: 8900cells/cu mm of blood. DLC: N- 59%, L- 47%, E- 4%, B- 0%, M0%. ESR: ½ hr- 8mm. 1 hr- 15mm. Blood sugar (Fp)90/mg/dl FINAL DIAGNOSIS: Migraine
51
Urine: Sugar: Nil. Albumin: Nil.
ANALYSIS OF SYMPTOMS: Physical Generals: Desires : Spicy foods Mental Generals : Irritable with anger Particulars: Headache on and off since 5 years Gradual onset. Periodical type of headache, comes 10 days once, pain in left side of forehead, throbbing type of pain < heat of sun, anger > rest, sleep Associated dimness of vision Cough with with expectoration since 3 days rattling cough white , thick
expectoration < night > . Pain in lower limb. aching type of pain - expectoration Causation: Heat of sun Anger EVALUATION OF SYMPTOMS: Desires : Spicy foods Mental Generals : Irritable with anger Headache on and off since 5 years Gradual onset. Periodical type of headache, comes 10 days once, pain in left side of forehead, throbbing type of pain < heat of sun, anger > rest, sleep, associated with dimness of vision with expectoration sincein3 lower days rattling cough type whiteof, thick cough expectoration < night > Pain limb, aching pain expectoration causation : Heat of sun Anger TOTALITY OF SYMPTOMS: Desires : Spicy foods Mental Generals : Irritable with anger Headache on and off since 5 years Gradual onset. Periodical type of headache, comes 10 days once, pain in left side of forehead, throbbing type of pain < heat of sun, anger > rest, sleep, Associated with dimness of vision Cough with expectoration since 3 days rattling cough white , thick expectoration < night > . Pain in lower limb. aching type of pain expectoration Causation : Heat of sun Anger
MIASMATIC CLEAVAGE:
52
S.No 1.
Irritable
Expression
Psora
Sycosis -
Syphilis -
Tuber -
2.
Desire for spicy foods
-
-
-
3.
Periodical head ache.
-
-
-
4.
-
5.
< Anger
6.
>Rest
7.
Head ache associated with
-
dimness of vision.
-
-
-
-
-
-
-
-
-
FUNDAMENTAL MIASM: Trio miasmatic. DOMINANT MIASM: Psorasyphilitic. TYPE OF DISEASE: Dynamic chronic fully symptoms developed miasmatic disease. REPERTORIAL TOTALITY: S.No 1.
Symptom Irritable
2.
Desire for spicy foods
3.
Pain in right side of
Section Mind
Stomach Head
5.
headache Pain in right side of the head
Head
6.
Head
7.
>Sleep
Head
8.
Rattlingcough
cough
9.
Cough
4.
Head
53
Rubric Irritabilityduring headache Desire pungent things
Page 59
486
Pain in head periodical Pain in head right side Pain in head < from Headachefrom anger Headached>sleep Coughrattling Cough
145 169 149 136 148 801 780
CHOICE OF REMEDY: Pulsatilla . BASIS OF PRESCRIPTION: Repertorial totality, Generalities. Reportorial Result : Natrum Mur PLAN OF TREATMENT: Curative. FIRST PRESCRIPTION: •
Pulsatilla 30/ 1d
•
Placebo/ 7dose
•
Placebo/ 7dose
FOLLOW UP 20.08.08 Patient feels better 27.08.08 Patient feels better
CONCLUSION : The case showed marked improvement
CASE – 04
54
NAME AGE/SEX OCCUPATION ADDRESS
: Mrs. Parameshwari :37yrs/F : House wife(Tailor) : 13,ParamesuNagar, Pattanam
FINALDIAGNOSIS:
OP.No: 13361
MIGRAINE
PRESENTING COMPLAINTS: Headache since 5 years on and off H/O PRESENTING COMPLAINTS: Headache since 5 years on and off. Pain in right side of the head. Pricking type of pain,p ain extended from nape of the neck to right eye. rest associated with Nausea sleep. PAST HISTORY: H/O typhoid before 5 years and taken allopathic treatment. FAMILY HISTORY: Her father known hypertension patient. PERSONAL AND SOCIAL HISTORY: Born and brought up: Pattanam. Diet: Non-veg. Marital status: Married. Habits: No habits of tobacco and bettle nut chewing Domestic relationship: Maintaining good domestic relationship GENERALITIES: PHYSICAL GENERALS: Appetite: Good and Satisfied. Thirst: Good and Satisfied.
Aversion: Milk and Milk products. Desire: Sweets. Disagrees: Nothing specifies. Urine: Normal Stool: Regular bowel habit. Sleep & Dreams: Good, refreshed sleep. Menses: 4/30 days cycle, regular, bright, red flow, no clotted, no associated complaints. GENERAL EXAMINATION: Appearance: Normal Nutrition: Good.
Body proportion: Equal. Skin to touch: Normal.
55
Anaemia: not anaemic Jaundice: not jaundiced Pedal oedema: no pedal oedema. Koilonychia: Absent. Height:160cm.
Cyanosis: not cyanosed. Clubbing: no clubbing. Lymphadenopathy: Absent. Hair & Nails: Normal. Weight:51kg.
VITAL SIGNS: Pulse: 72/Min.
R.R: 18/Min.
B.P: 176/98mm Hg.
Temp: 98.6F
SYSTEMIC EXAMINATION:
CVS: Normal S1 & S2 heard in all four cardiac areas. No murmurs heard. RS: Normal vesicular breath sound is heard all over lung field. No added sounds. GIT: No visible swelling, No tenderness, No organomegaly. Normal bowel sounds heard. GUT: No inflammatory signs. No visible swelling. CNS: Patient is conscious. Higher functions normal. Sensory and motor functions normal. LOCOMOTOR: No inflammatory signs seen. No deformity. Normal gait.
LAB INVESTIGATIONS:
Blood: Hb: 11.6g%. TLC: 8900cells/cu mm of blood. DLC: N- 62%, L- 47%, E- 1%, B- 0%, M- 0%. ESR: ½ hr- 8mm. 1 hr- 12mm.
Urine: Sugar: Nil. Albumin: Nil.
FINAL DIAGNOSIS: Migraine ANALYSIS OF SYMPTOMS: Physical Generals: Aversion to Milk and Milk products. Desire for sweets Particulars: Head ache since 5 Years Pain in right side of the head, pricking type of pain, pain extend from nape of the neck to right eye. r est sleep associated with Nausea. EVALUATION OF SYMPTOMS:
56
Aversion to Milk and Milk products. Desire for sweets Pain in right side of the head, Pricking type of pain, Pain extend from nape of the neck to right eye. Rest sleep Associated with Nausea
TOTALITY OF SYMPTOMS: Aversion to Milk and Milk products. Desire for sweets Pain in right side of the head, Pricking type of pain, Pain extend from nape of the neck to right eye. Rest sleep Associated with Nausea MIASMATIC CLEAVAGE: S.No 1.
Expression Aversion to Milk
2.
Desire for sweets
3.
prickingtypeofpain.
4.
< Eye stain.
5.Rest < 6.
>Crowedlace
7.
Psora
Sycosis
Syphilis -
Tuber -
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
FUNDAMENTAL MIASM: Trio miasmatic. DOMINANT MIASM: Psora. TYPE OF DISEASE: Dynamic chronic fully symptoms developed Miasmatic disease. REPERTORIAL TOTALITY:
57
S.No 1. 2. 3.
4.
Symptom AversiontoMilk Desire for sweets Pain in right side of the head Priching pain
Section Stomach Stomach Head
5.
Pain extend from
6.
Nape of neck to right eye
Head
7.
> Sleep
Head
8.
Associated with Nausea
Head
Rubric AversiontoMilk Desire for sweets Pain in head, right side. Pain stitching right side
Page 481 486 169
209
Head
Head
Paininheadfrom straining eyes Pain in head > Sleep Pain in head with Nausea
CHOICE OF REMEDY: Pulsatilla BASIS OF PRESCRIPTION: Repertorial totality, Generalities. PLAN OF TREATMENT: Curative. FIRST PRESCRIPTION: •
Sanguinaria 30/1d
•
Placebo \ 7d
•
Sangu 30/ 1dose
FOLLOW UP 24.08.08 Patient feels better 28.08.08 Symptoms worsened 04.08.078 Patient Improved •
Placebo \ 7d CONCLUSION: The case showed marked improvement CASE – 05 NAME : Mr. Thambidurai OP.No: 11940. AGE/SEX :22yrs/F OCCUPATION :B.E(Student) ADDRESS : 112, Car street,Rasipuram. FINAL DIAGNOSIS:
MIGRAINE
58
149 148 150
PRESENTING COMPLAINTS: Headache since 2 years on and off. Eruption in the face since 1 month. H/O PRESENTING COMPLAINTS: Headache since 2 years on and off. Pain in left side of the head. Pulsating type of pain, no extension of pain Pressure, rest. since Associated with dimness of vision. Eruption in the face 1 month, small eruptions in the
face, no itching, no dischar ge from that eruptions red in nature looks like pimples, oily face.
PAST HISTORY: No history of major illness in the past. FAMILY HISTORY: No history of major illness and similar complaints among the family members. PERSONAL AND SOCIAL HISTORY: Born and brought up: Rasipuram. Diet: Non-veg. Marital status: Unmarried. Habits: Habit of cigarette smoking for 3 yrs.4-5 cigarette per day. Domestic relationship: Maintaining good domestic relationship. GENERALITIES: PHYSICAL GENERALS: Appetite: Good and Satisfied. Thirst: Good and Satisfied. Aversion: Nothing specifies. Desire: Oily foods, spicy foods. Disagrees: Lemon juices causes headache. Urine: Normal. Stool: Regular and satisfied. Sleep & Dreams: Good, refreshed sleep.
MENTAL GENERALS: _ GENERAL EXAMINATION: Appearance: Normal Nutrition: Good. Anaemia: Not anaemic Jaundice: Not jaundiced Pedal oedema: No pedal oedema.
Body proportion: 120/80mm of hg. Skin to touch: Normal. Cyanosis: Not cyanosed. Clubbing: No clubbing. Lymphadenopathy: Absent.
59
Koilonychia: Absent. Height:160cm.
Hair & Nails: Normal. Weight:51kg.
VITAL SIGNS: Pulse: 76/Min. B.P: 120/80mm Hg.
R.R: 19/Min. Temp: 98.6F
SYSTEMIC EXAMINATION:
CVS: heard.Normal S1 & S2 heard in all four cardiac areas. No murmurs RS: Normal vesicular breath sound is heard all over lung field. No added sounds. GIT: No visible swelling, No tenderness, No organomegaly. Normal bowel sounds heard. GUT: No inflammatory signs. No visible swelling. CNS: Patient is conscious. Higher functions normal. Sensory and motor functions normal. LOCOMOTOR: No inflammatory signs seen. No deformity. Normal gait.
LAB INVESTIGATIONS:
Blood: Hb: 11.6g%. TLC: 8900cells/cu mm of blood. DLC: N- 62%, L- 47%, E- 1%, B- 0%, M- 0%. ESR: ½ hr- 8mm. 1 hr- 12mm.
Urine: Sugar: Nil. Albumin: Nil.
FINAL DIAGNOSIS: MIGRAINE
ANALYSIS OF SYMPTOMS:
Physical Generals: Desire for oily and spicy foods. Lemon causes headache. Particulars: Headache since 2 years on and off, pain in left side, pulsating type of pain, no extension of pain. Pressure, rest associated with dimness of vision. Eruption in the face since 1 month, small eruptions redness, no discharge, no itching, oily face.
60
EVALUATION OF SYMPTOMS: Desire for oily and spicy foods. Lemon causes headache. pain in left side, Pulsating type of pain, no extension of pain. Pressure, rest Associated with dimness of vision. Pimples in the face
TOTALITY OF SYMPTOMS: Desire for oily and spicy foods. Lemon causes headache. Pain in left side, Pulsating type of pain, no extension of pain. Pressure, rest Associated with dimness of vision. Pimples in the face
MIASMATIC CLEAVAGE: S.No 1.
Expression Desire for oily foods
Psora
Sycosis -
Syphilis -
Tuber -
2.
Pain and head
-
-
-
3.
Pulsating pain
-
-
-
4.
< Eye strain
-
-
-
5.
< After 11.00 AM
-
-
6.
Pimples in face
-
-
-
FUNDAMENTAL MIASM: Trio miasmatic. DOMINANT MIASM: Psora. TYPE OF DISEASE: Dynamic chronic fully symptoms developed miasmatic disease. REPERTORIAL TOTALITY: S.No 1.
Symptom Desire for spicy foods
Section Stomach
61
Rubric Desire for s picy foods
Page 486
2.
Head
headpainfrom lemonade Pain in right side
4.
Lemon causes head ache Pain in right side of Head Pulsatingpain
Head
Headpainpulsating
5.
Head
Head pain from straining eyes,
6.
7.
>Rest
Head
8.
>Pressure
Head
Pain > Pressure
146
9.
Associated with dimness of vision
Head
Pain with blindness
137
3.
Head
Head
Headache11.am pain > rest
CHOICE OF REMEDY: BASIS OF PRESCRIPTION: Repertorial totality, Generalities. PLAN OF TREATMENT: Curative. FIRST PRESCRIPTION: •
Pulsatilla 30/ 1d
•
Placebo/ 7dose
•
Placebo/ 7dose
FOLLOW UP 28.07.08 Patient feels better 05.08.08 Patient feels better
CONCLUSION : The case showed marked improvement CASE – 06 NAME AGE/SEX OCCUPATION ADDRESS
::32yrs/F Mrs. Krishnaveni : Housewife :Salem.
FINAL DIAGNOSIS:
OP.No: 14754.
MIGRAINE
PRESENTING COMPLAINTS: Headache since 3 years on and off. H/O PRESENTING COMPLAINTS:
62
141 169 146 149 134 146
Headache since 3 years on and off, gradual in onset. Pain in right side of the head. Stitching type of pain, Pain extend from occiput to forehead
PAST HISTORY: H/O Chickungunea before 1 year and taken allopathic medicine. Took allopathic treatment for the similar complaint got the temporary relief. FAMILY HISTORY: Her father known diabetic patient. PERSONAL AND SOCIAL HISTORY: Born and brought up: Salem. Diet: Non-veg. Marital status: Married. Habits: No habits of bettel nut chewing and tobacco chewing. Domestic relationship: Maintaining good domestic relationship. GENERALITIES: PHYSICAL GENERALS: Appetite: Good and Satisfied.
Thirst: Good and Satisfied. Aversion: Nothing specifies. Desire: Sour things. Disagrees: Nothing specifies. Urine: Normal. Stool: Regular and satisfied. Sleep & Dreams: Good, refreshed sleep. Menses: 4/30 days cyc le, regular, bright, red flow, associated with lower abdominal pain in first day of menses. Other Discharges: White discharge per vagina, watery, white, scanty in nature not offensive, not acid, no itching.
_
GENERAL EXAMINATION: Appearance: Normal Nutrition: Good. Anaemia: Not anaemic Jaundice: Not jaundiced Pedal oedema: No pedal oedema. Koilonychia: Absent. Height:154cm.
Body proportion: 120/80mm of hg. Skin to touch: Normal. Cyanosis: Not cyanosed. Clubbing: No clubbing. Lymphadenopathy: Absent. Hair & Nails: Normal. Weight:51kg.
VITAL SIGNS:
63
Pulse: 76/Min. B.P: 126/82mm Hg.
R.R: 19/Min. Temp: 98.6F
SYSTEMIC EXAMINATION:
CVS: Normal S1 & S2 heard in all four cardiac areas. No murmurs heard. RS: Normal vesicular breath sound is heard all over lung field. No addedNo sounds. GIT: visible swelling, No tenderness, No organomegaly. Normal bowel sounds heard. GUT: No inflammatory signs. No visible swelling. CNS: Patient is conscious. Higher functions normal. Sensory and motor functions normal. LOCOMOTOR: No inflammatory signs seen. No deformity. Normal gait.
LAB INVESTIGATIONS:
Blood: Hb: 11.6g%. TLC: 8900cells/cu mm of blood.
Urine: Sugar: Nil. Albumin: Nil.
DLC: N- 62%, L- 47%, E- 1%, B- 0%, M- 0%. ESR: ½ hr- 8mm. 1 hr- 12mm.
FINAL DIAGNOSIS: MIGRAINE
ANALYSIS OF SYMPTOMS: Physical Generals: Desire: Sourthings White discharge per vagina. < heat of the body
Particulars: Headache since 3 years on and off gradual in onset. Pain in left side of the head, Stitching pain extend from occiput to forehead. Hot applications associated with vomiting. EVALUATION OF SYMPTOMS: Desire: Sourthings Pain in left side of the head. Stitching pain in head, Pain extend from occiput to forehead.
64
> Hot applications TOTALITY OF SYMPTOMS: Desire: Sour things Pain in left side of the head. Stitching type of pain, Pain extend from occiput to forehead Hot applications MIASMATIC CLEAVAGE: S.No 1.
Expression Desire : Sourthings
Psora
Sycosis -
Syphilis -
2.
Stitchingpaininhead
-
-
3.
< Mental exertion
-
-
4.
> Hot application
-
-
5.
< Tension
-
-
FUNDAMENTAL MIASM: Trio miasmatic. DOMINANT MIASM: Psora. TYPE OF DISEASE: Dynamic chronic fully symptoms developed miasmatic disease.
REPERTORIAL TOTALITY: S.No 1.
2. 3. 4. 5.
Symptom Desire for sour things
Chapter Stomach
Rubric Desire Sour things
Pain in left side of head StitchingPaininhead
Head
Paininleftside
Pain extend from occiput to forehead < Exertion
Head Head Head
65
Painstitching Pain extend occiput to fore head Pain in head
Page 486
169 209 211 140
6.
>Hotapplication
hot application
Head
146
CHOICE OF REMEDY: Silicea BASIS OF PRESCRIPTION: Repertorial totality, Generalities. PLAN OF TREATMENT: Curative. FIRST PRESCRIPTION: •
Silicea 30\ 1d
•
SL 30\ 7d
•
Silicea 200/ 1d
FOLLOW UP 28.08.08 Compliant reduced 02.08.08 Improved persist
CONCLUSION: The case showed marked improvement
NAME AGE/SEX OCCUPATION ADDRESS
CASE – 07 : Mrs. Muthulakshmi :21yrs/F : B.Sc(student) : koneripatti, 1st ext, Rasipuram
FINAL DIAGNOSIS:
OP.No: 12620.
MIGRAINE
PRESENTING COMPLAINTS: Headache since 1 year on and off. H/O PRESENTING COMPLAINTS: Headache since 1 year. on and off, gradual in onset. Pain in left side of the head. Throbbing type of pain, Pain extend from occiput to
66
forehead Tight bandage Associated with redness and burning in the eyes. PAST HISTORY: No H/O Major illness in the past. FAMILY HISTORY: Her father known diabetic patient. PERSONAL AND SOCIAL HISTORY: Born and brought up: Rasipuram Diet: Non-veg. Marital status:Un married. Habits: No habits of bettel nut chewing and tobacco chewing. Domestic relationship: Maintaining good domestic relationship. GENERALITIES: PHYSICAL GENERALS: Appetite: Good and Satisfied. Thirst: Good and Satisfied. Aversion: Milk. Desire: Sweets.
Disagrees: Nothing specifies. Urine: Normal. Stool: Regular and satisfied. Sleep & Dreams: Good, refreshed sleep. Menses: 4/30 days cyc le, regular, bright, red flow, associated with lower abdominal pain in first day of menses.
MENTAL GENERALS:
_
GENERAL EXAMINATION: Appearance: Normal
Body proportion: 120/80mm of hg.
Nutrition: Good. Anaemia: Anaemic Jaundice: Not jaundiced Pedal oedema: No pedal oedema. Koilonychia: Absent. Height:151cm.
Skin to touch: Normal. Cyanosis: Not cyanosed. Clubbing: No clubbing. Lymphadenopathy: Absent. Hair & Nails: Normal. Weight:46kg.
VITAL SIGNS: Pulse: 76/Min. B.P: 116/80mm Hg.
R.R: 19/Min. Temp: 98.6F
SYSTEMIC EXAMINATION:
67
CVS: Normal S1 & S2 heard in all four cardiac areas. No murmurs heard. RS: Normal vesicular breath sound is heard all over lung field. No added sounds. GIT: No visible swelling, No tenderness, No organomegaly. Normal bowel sounds heard. GUT: No inflammatory signs. No visible swelling. CNS: Patient is conscious. Higher functions normal. Sensory and motor functions normal.No inflammatory signs seen. No deformity. Normal LOCOMOTOR: gait.
LAB INVESTIGATIONS:
Blood: Hb: 09.8g%. TLC: 8900cells/cu mm of blood. DLC: N- 62%, L- 47%, E- 1%, B- 0%, M- 0%. ESR: ½ hr- 8mm. 1 hr- 12mm.
Urine: Sugar: Nil. Albumin: Nil.
FINAL DIAGNOSIS: MIGRAINE
ANALYSIS OF SYMPTOMS: Physical Generals: Desire: Sweets. Aversion :Milk.
Particulars: Headache since 1 year on and off gradual in onset. Pain in left side of the head, throbbing pain extend from occiput to forehead. Tight bandage. Associated with redness and burning in the eyes. EVALUATION OF SYMPTOMS: Desire: Sweets. Pain in lef t side of the head. Throbbi ng pain in head, Pain extend from occiput to forehead. Hot applications, Tight bandage associated with redness and burning in the eyes. TOTALITY OF SYMPTOMS: Desire: Sweets.
68
Pain in lef t side of the head. Throbbi ng pain in head, Pain extend
from occiput to forehead. Hot applications, Tight bandage associated with redness and burning in the eyes. MIASMATIC CLEAVAGE: S.No
1. 2. 3. 4. 5.
Expression
Psora
Sycosis
Desire : sweets Throbbing paininhead < Mental exertion > Hot application < Noise
Syphilis
-
-
FUNDAMENTAL MIASM: Trio miasmatic. DOMINANT MIASM: Psora. TYPE OF DISEASE: Dynamic chronic fully symptoms developed miasmatic disease.
REPERTORIAL TOTALITY: S.No 1. 2.
4.
Symptom Desire for sweets Pain in left side of head throbbing Pain in Head Pain extend from
5.
occiput to forehead
Head
6.
>Hotapplication
Head
3.
CHOICE OF REMEDY:
Chapter Stomach Head
Rubric Desire sweets Paininleftside
Head
Painthrobbing
Head
Pain extend occiput to fore head Pain inhead hot application
Belladonna
BASIS OF PRESCRIPTION: Repertorial totality, Generalities. PLAN OF TREATMENT: Curative.
69
Page 486 169
209 211 140
146
FIRST PRESCRIPTION: •
Belladonna 30\ 1d
•
SL/7 dose
•
SL / 7 dose
FOLLOW UP 15.07.08 Compliant reduced 22.07.08 Improved persist
CONCLUSION: The case showed marked improvement
NAME AGE/SEX OCCUPATION ADDRESS
CASE – 08 : Mrs. Dhnalakshmi :43yrs/F : House Wife : No.10. V.Nagar Rasipuram
FINAL DIAGNOSIS:
OP.No: 12139.
MIGRAINE
PRESENTING COMPLAINTS: Headache since 3 years on and off. H/O PRESENTING COMPLAINTS: Headache since 3 years. On and off, gradual in onset. Pain in right side of the head. Pulsating type of pain, No extension of pain Pressure, rest, sleep Associated with blindness . PAST HISTORY: No H/O Major illness in the past. H/O Using oral contraceptive since 3 years. FAMILY HISTORY: No history of major illness and similar complaints among the family members. PERSONAL AND SOCIAL HISTORY: Born and brought up: Rasipuram
70
Diet: Non-veg. Marital status: Married. Habits: No habits of bettel nut chewing and tobacco chewing. Domestic relationship: Maintaining good domestic relationship. GENERALITIES: PHYSICAL GENERALS: Appetite: Good and Satisfied.
Thirst: Good and Satisfied. Aversion: Nothing specific Desire: Salty things Disagrees: Nothing specifies. Urine: Normal. Stool: Regular and satisfied. Sleep & Dreams: Good, refreshed sleep. Menses: 4/30 days cyc le, regular, bright, red flow, associated with lower abdominal pain in first day of menses.
MENTAL GENERALS:
_
GENERAL EXAMINATION: Appearance: Normal Nutrition: Good. Anaemia: Anaemic Jaundice: Not jaundiced Pedal oedema: No pedal oedema. Koilonychia: Absent. Height:151cm.
Body proportion: 110/80mm of hg. Skin to touch: Normal. Cyanosis: Not cyanosed. Clubbing: No clubbing. Lymphadenopathy: Absent. Hair & Nails: Normal. Weight:54kg.
VITAL SIGNS: Pulse: 76/Min. B.P: 116/80mm Hg.
R.R: 19/Min. Temp: 98.6F
SYSTEMIC EXAMINATION:
CVS: Normal S1 & S2 heard in all four cardiac areas. No murmurs heard. RS: Normal vesicular breath sound is heard all over lung field. No added sounds. GIT: No visible swelling, No tenderness, No organomegaly. Normal bowel sounds heard. GUT: No inflammatory signs. No visible swelling. CNS: Patient is conscious. Higher functions normal. Sensory and motor functions normal.
71
LOCOMOTOR: No inflammatory signs seen. No deformity. Normal gait.
LAB INVESTIGATIONS:
Blood: Hb: 09.6 g%. TLC: 8900cells/cu mm of blood.
Urine: Sugar: Nil. Albumin: Nil.
DLC: L- 47%, E- 1%,NB-62%, 0%, M0%. ESR: ½ hr- 8mm. 1 hr- 12mm.
FINAL DIAGNOSIS: MIGRAINE
ANALYSIS OF SYMPTOMS: Physical Generals: Desire: Salty things Particulars: Headache since 3 years. On and off, gradual in onset. Pain in right side of the head. Pulsating type of pain, No extension of pain Pressure, rest, sleep Associated with blindness EVALUATION OF SYMPTOMS: Desire: Salty things Pain in right side of the head. Pulsating type of pain, No extension of pain Pressure, rest, sleep Associated with blindness TOTALITY OF SYMPTOMS: Desire: Salty things Pain in right side of the head. Pulsating type of pain, No extension of pain Pressure, rest, sleep Associated with blindness MIASMATIC CLEAVAGE: S.No Expression Psora 1. Desire:Saltythings 2. Pulsating 3. Pressure FUNDAMENTAL MIASM: Trio miasmatic. DOMINANT MIASM: Psorasyphilitic.
72
Sycosis -
Syphilis
-
TYPE OF DISEASE: Dynamic chronic fully symptoms developed miasmatic disease. REPERTORIAL TOTALITY: S.No 1.
Symptom Desire for Salty things
2.
Pain in right side of
3.
head pulsatingPaininHead
4.
5.
< sun heat, after noon
6.
>Pressure
Chapter Stomach
Rubric Desire salty things
Head
Paininrightside
169
Painpulsating
206
Head Head Head Head
Paininhead Pressure
CHOICE OF REMEDY : Natrummur BASIS OF PRESCRIPTION: Repertorial totality, Generalities. PLAN OF TREATMENT: Curative. FIRST PRESCRIPTION: •
Natrummur 30\ 1d
•
SL/7 dose
FOLLOW UP 21.08.08 Compliant reduced 28.08.08 The case Improvement persist •
SL / 7 dose
CONCLUSION: The case showed marked improvement
73
Page 486
149 143 145
NAME AGE/SEX OCCUPATION ADDRESS
CASE – 09 : Mr. Ponnusamy :46yrs/M : Farmer : Singalanthapuram
FINAL DIAGNOSIS:
OP.No: 15039
MIGRAINE
PRESENTING COMPLAINTS: Headache since 2 years on and off. H/O PRESENTING COMPLAINTS: Headache since 2 years. On and off, gradual in onset. Pain in right side of the head. Pulsating type of pain, No extension of pain. Soreness on the scalp < sun heat, after noon., me ntal exertion > Pressure, rest, sleep Associated with dimness of vision.
PAST HISTORY: No H/O Major illness in the past. H/O Chickun gunea before 1 year and taken allopathic treatment FAMILY HISTORY: No history of major illness and similar complaints among the family members. PERSONAL AND SOCIAL HISTORY: Born and brought up: Sinalanthapuram Diet: Non-veg. Marital status: Married. Habits: Habits of bettel nut chewing occationally. Domestic relationship: Maintaining good domestic relationship. GENERALITIES: PHYSICAL GENERALS: Appetite: Good and Satisfied. Thirst: Good and Satisfied.
74
Aversion: Nothing specific Desire: Spicy things Disagrees: Nothing specifies. Urine: normal. Stool: Regular and satisfied. Sleep & Dreams: Good, refreshed sleep.
MENTAL GENERALS: Grief about his son GENERAL EXAMINATION: Appearance: Normal Nutrition: Good. Anaemia: Not Anaemic Jaundice: Not jaundiced Pedal oedema: No pedal oedema. Koilonychia: Absent. Height:170cm.
Body proportion: 130/80mm of hg. Skin to touch: Normal. Cyanosis: Not cyanosed. Clubbing: No clubbing. Lymphadenopathy: Absent. Hair & Nails: Normal. Weight:68kg.
VITAL SIGNS:
Pulse: 76/Min. B.P: 130/80mm Hg.
R.R: 19/Min. Temp: 98.6F
SYSTEMIC EXAMINATION: CVS: Normal S1 & S2 heard in all four cardiac areas. No murmurs heard. RS: Normal vesicular breath sound is heard all over lung field. No added sounds. GIT: No visible swelling, No tenderness, No organomegaly. Normal bowel sounds heard. GUT: No inflammatory signs. No visible swelling. CNS: Patient is conscious. Higher functions normal. Sensory and motor functions normal. Locomotor: No inflammatory signs seen. No deformity. Normal gait. LAB INVESTIGATIONS:
Blood: Hb: 12.6 g%. TLC: 8900cells/cu mm of blood. DLC: N- 62%, L- 47%, E- 1%, B- 0%, M- 0%. ESR: ½ hr- 8mm. 1 hr- 12mm.
Urine: Sugar: Nil. Albumin: Nil.
75
FINAL DIAGNOSIS: MIGRAINE ANALYSIS OF SYMPTOMS: Physical Generals: DESIRE: Spicy things
Particulars:
Headache sincePulsating 2 years. On and off, gradual in onset. right side of the head. type of pain, No extension ofPain pain.in Soreness on the scalp < sun heat, after noon., me ntal exertion > Pressure, rest, sleep Associated with dimness of vision EVALUATION OF SYMPTOMS: DESIRE: Spicy things Pain in right side of the head. Pulsating type of pain, No extension of pain. Soreness on the scalp < sun heat, after noon., me ntal exertion > Pressure, rest, sleep Associated with dimness of vision TOTALITY OF SYMPTOMS: DESIRE: Spicy things Pain in right side of the head. Pulsating type of pain, No extension of pain. Soreness on the scalp < sun heat, after noon., me ntal exertion > Pressure, rest, sleep Associated with dimness of vision MIASMATIC CLEAVAGE: S.No 1. 2. 3. 4. 5. 6.
Expression Desire : Spicy things Pulsating < Mental exertion < sun heat, after noon > Pressure >Rest
Psora
Sycosis -
Syphilis
-
FUNDAMENTAL MIASM: Trio miasmatic. DOMINANT MIASM : Psora. TYPE OF DISEASE: Dynamic chronic fully symptoms developed miasmatic disease. REPERTORIAL TOTALITY: S.No 1.
2. 3.
Symptom Desire for Spicy things Pain in right side of head pulsatingPaininHead
Chapter Stomach
Head Head
76
Rubric Desire Spicy things
Page 486
Paininrightside
169
Painpulsating
206
4.
5.
< sun heat, after noon
6.
>Pressure
7.
Associated with
Head Head Head Head
Pain in head < Mental exertion Pain in head < sun heat, after noon Paininhead> Pressure Pain with blindness
Dimness of Vision CHOICE OF REMEDY: Iris BASIS OF PRESCRIPTION: Repertorial totality, Generalities. PLAN OF TREATMENT: Curative. FIRST PRESCRIPTION: •
Iris 200\ 1d
•
SL/7 dose
FOLLOW UP 19.08.08 Compliant reduced 23.08.08 The complaint again appear •
Iris / 1 dose
CONCLUSION: The case showed mild improvement
77
135 143 145 137
NAME AGE/SEX OCCUPATION ADDRESS
CASE – 10 : Mr. Srinivasan OP.No: 14871 :42yrs/M : Weaver :Pattanam
FINAL DIAGNOSIS:
MIGRAINE
PRESENTING COMPLAINTS: Headache since 4 years on and off. Discharge from nose since 3 days H/O PRESENTING COMPLAINTS: Headache since 4 years. On and off, gradual in onset. Pain in right side of the head. Pricking type of pain, pain extent from occiput to forehead. < mental exertion > Hot application, rest, sleep Associated with vomiting. Discharge from nose since 3 days, watery in nature, no acridity no nose blocks. PAST HISTORY: No H/O Major illness in the past.
FAMILY HISTORY: No history of major illness and similar complaints among the family members. PERSONAL AND SOCIAL HISTORY: Born and brought up: Pattanam Diet: Non-veg. Marital status: Married. Habits: Habits of cigarette 2 per day since 4 years . Domestic relationship: Maintaining good domestic relationship. GENERALITIES: PHYSICAL GENERALS: Appetite: Good and Satisfied. Thirst: Good and Satisfied. Aversion: Nothing specific Desire: Spicy things Disagrees: Nothing specifies. Urine: Normal. Stool: Regular and satisfied. Sleep & Dreams: Good, refreshed sleep.
78
MENTAL GENERALS: GENERAL EXAMINATION: Appearance: Normal Nutrition: Good. Anaemia: Not Anaemic Jaundice: Not jaundiced
Body proportion: 120/78mm of hg. Skin to touch: Normal. Cyanosis: Not cyanosed. Clubbing: No clubbing.
Pedal oedema: No pedal oedema. Koilonychia: Absent. Height:170cm.
Lymphadenopathy: Absent. Hair & Nails: Normal. Weight:68kg.
VITAL SIGNS: Pulse: 76/Min. B.P: 120/78mm Hg.
R.R: 19/Min. Temp: 98.6F
SYSTEMIC EXAMINATION:
CVS: Normal S1 & S2 heard in all four cardiac areas. No murmurs heard. RS: Normal vesicular breath sound is heard all over lung field. No added sounds. GIT: No visible swelling, No tenderness, No organomegaly. Normal bowel sounds heard. GUT: No inflammatory signs. No visible swelling. CNS: Patient is conscious. Higher functions normal. Sensory and motor functions normal. LOCOMOTOR: No inflammatory signs seen. No deformity. Normal gait.
LAB INVESTIGATIONS:
Blood: Hb: 12.8 g%. TLC: 8900cells/cu mm of blood. DLC: N- 62%, L- 47%, E- 1%, B- 0%, M- 0%. ESR: ½ hr- 8mm. 1 hr- 12mm.
Urine: Sugar: Nil. Albumin: Nil.
FINAL DIAGNOSIS: MIGRAINE
ANALYSIS OF SYMPTOMS: Physical Generals:
79
Desire: Spicy things Particulars: Headache since 4 years. On and off, gradual in onset. Pain in right side of the head. Pricking type of pain, pain extent from occiput to forehead. < mental exertion > Hot application, rest, sleep Associated with vomiting. Discharge from nose since 3 days, watery in nature, no acridity no nose blocks.
EVALUATION SYMPTOMS: Desire:OF Spicy things Pain in right side of the head. Pricking type of pain, pain extent from occiput to forehead. < mental exertion > Hot application, rest, sleep Associated with vomiting. Discharge from nose since 3 days, watery in nature, no acridity no nose blocks TOTALITY OF SYMPTOMS: Desire: Spicy things Pain in right side of the head. Pricking type of pain, pain extent from occiput to forehead. < mental exertion > Hot application, rest, sleep Associated with vomiting. Discharge from nose watery in nature, no acridity no n ose blocks MIASMATIC CLEAVAGE: S.No 1.
Expression Desire : Spicy things
Psora
Sycosis -
Syphilis -
2.
Pricking
-
3.
< Mental exertion
-
-
4.
> Hot application
-
5.
>Rest
FUNDAMENTAL MIASM: Trio miasmatic. DOMINANT MIASM: Psorasyphilitic. TYPE OF DISEASE: Dynamic chronic fully symptoms developed miasmatic disease.
80
REPERTORIAL TOTALITY: S.No 1.
Symptom Desire for Spicy things Pain in right side of head
Chapter Stomach
3.
PrickingPaininHead
Head
4.
Head
5.
>Pressure
Head
6.
Associated with vomiting >Rest
2.
7.
Rubric Desire Spicy things
Head
Head
Paininrightside
169
PainPricking
206
Pain in head < Mental exertion Paininhead> Pressure Pain with vomiting
Head
Pain>Rest
148
CHOICE OF REMEDY: Silicea BASIS OF PRESCRIPTION: Repertorial totality, Generalities. PLAN OF TREATMENT: Curative. FIRST PRESCRIPTION: FOLLOW UP 11.06.08
•
silicea 30\ 1d
•
silicea200/1 dose
•
silicea / 1 dose
Compliant s till persist
17.06.08 The complaint slightly reduced
CONCLUSION: The case showed no improvement
OBSERVATION AND RESULTS
81
Page 486
135 145 156
The study includes 10 patients of Eczema between the age group of 10-50 years.
AGE INCIDENCE: In 10 patients all age groups were divided in to sub groups for the purposes of analytical study..
NO AGE GROUPS
NO.OF.PATIENT
PERCENTAGE
S 1
10-20
1
10%
2
21-30
1
10%
3
31-40
3
30%
4
41-50
5
50%
10
100%
Total
Discussion: As shown in the table, the maximum incidence was between the age group of 41- 50 yrs accounting 50% in 5 cases.. The youngest patient in the study was 17 and the oldest was 46.
82
Age Incidence 60
No. Of Patient
Percenta ge
50
50 s e s a C f O . o N
40 30 30 20 10
10
10 0
1
1
0 -2 10
0 -3 21
3
Age
83
0 -4 31
5
0 -5 41
INCIDENCE IN SEX Both sexes were taken for the study. The statistical analysis is done based on the data obtained from these groups of patients
SEX
S.NO
NO.OF.
PERCENTAGE
CASES 1
Male
4
40%
2
Female
6
60%
10
100%
Total
Discussion: In the analytical study, the maximum incidence are females than males. In that 60% accounting 6 female cases and 40% i.e.4 male cases were noted.
84
Sex Incidence 70 60 60
No. Of Patient
Perc entage
50 s e s a C f O . o N
40 40 30 20 10
6
4
0 Male
SEX
85
Female
INCIDENCE IN MIASM
NO
1.
DOMINANT MIASM Psora, syphilis,
NO OF
PERCENTA
CASES
GE
7
70%
sycosis. (Trio miasm)
2.
Psora,syphilitic
Total
3
30%
10
100%
Discussion: Analytical study of all the 7 cases of individuals expressed combined miasms. Other 3 case is psoro – syphilitic miasm.
86
Miasm Incidence 80
70
70 60 s e s a C f O . o N
No. Of Patient
Perc entage
50 40
30
30 20 10
7 3
0 Trio Miasm
Miasm
87
Psoro - Sy philitic
CONSTITUTIONAL REMEDIES Based on the constitutional approach statistical data is given.
NO
REMEDIES
NO OF CASES
PARCENTAGE
1 .
Pulsatilla
1
10%
.
Sanguinaria
1
10%
3 .
Natrum Mur
03
30%
Selenium
01
10%
Silicea
02
20%
Belladonna
01
10%
2
4 . 5 . 6 . 7 .
Iris
01
88
10%
Discussion: As per the above shown table, frequently used the constitutional remedy was Natrum Mur and Silicea The other drugs are Sanguinaria, Selenium, Belladonna, Iris, Pulsatilla. .
Constitutional Remedy 35 30 s e s a C f O . o N
30 No. Of Patient
25
20
20 15
10
10 5
Percentage
10
1
1
la til Pulsa
ia ar
10 3
10 2
1
10
1
1
a nn
s Ir i
0
Sa
uin ng
M Nat.
ur
a ice
m iu Se
len
Sil
Remedy
89
llado Be
RESULT OF STUDY Statistical analysis of 10 cases ,after treating with constitutional remedies
S.NO
RESULT
NOOF
PERCENTAGE
CASES 1. 2. 3.
Marked improvement Mild Improvement No improvement
06
60%
03
30%
01
10%
Discussion: After the constitutional approach 60% of cases i.e. 6 individuals showed marked improvement. 30% of cases
90
accounting in 3individuals resulted mild improvement. But 10% of cases i.e. 1 individuals shown no improvement.
91
Result Incidence 70 60 s e s a C f O . o N
50 40 30 20 10 0
ed rk
No. Of Patient
60
Perc entage
30 10
6
p Im
em v ro
3
t en ld Mi
Im
p
t en em v ro
Ma
Result
SUMMARY
92
1
t en m ve o pr m -I No
Age incidence As shown in the table, the maximum incidence was between the age group of 41- 50 yrs accounting 30% in 5 cases.. The youngest patient in the study was 17 and the oldest was 46.
Sex incidence In the analytical study, the maximum incidence are females than males. In that 60% accounting 6 female cases and 40% i.e.4 male cases were noted.
Miasmatic background Analytical study of all the 9 cases of individuals expressed Psora,Sycosis,Sypilis (all the miasms). Other one case is
psoro –
sycotic miasm.
Constitutional remedy As per the above shown table, frequently used the constitutional remedy was Natrum Mur and Silicea. The other drugs are Sanguinaria, Selenium, Belladonna, Iris, Pulsatilla. .
Result After the constitutional approach 60% of cases i.e. 6 individuals showed marked improvement. 30% of cases accounting in 3 individuals resulted in mild improvement. But 10% of cases i.e. 1 individuals shown no improvement.
93
CONCLUSION The study of ten cases of migraine revealed that the mass incidence of migraine is in the pubertal and late middle age group and the incidence females are more affected than males. It was observed that it is commonly seen in house-wives, students, weavers, and farmers The commonest exiting cause for migraine were eye strains, heat of sun,mental exertion and oral contraceptives.
The stud y also revealed
that the mias matic back ground of the pati ent most ly
indicate psora . Though other miasms are also in the background.
Other systems have less scope on this migraine. The Homoeopathic system has a better scope when compared to other systems. Since migraine show mostly functional alterations, it requires antipsoric medicines. When more than one remed y is required it is better to start with an antipsoric followed by other antimiasmatic remedies.
94
MASTERCHART: Chief complaint s
S. No
N a me
A ge
Se x
Occupation
1
Mrs.Anjagam
45
F
Farmer
Headache
2
Mrs.Mariyammal
39
F
weaver
Headache
3
Mr.Varadharajan
41
M
Teacher
Headache & Cough
4
Mrs.Parameswari
37
F
Housewife
Headache,
Past history
-
Famil y histor y
-
Typhoid
Constitutiona l remedy
Pulsatilla
Father have DM Similar illness Father have
Marked Improvement
Nat.Mur
Psora, syphilitic
Marked Improvement
Sangunaria
Trio Miasm
Marked Improvement
TrioMiasm
Marked Improvement
Trio Miasm
Mild Improvement
HT
22
M
Student
Headache & Eruptions
-
-
Selenium
6
Mrs.Krishnavani
32
F
Housewife
Headache
Chickun Gunea
Father have DM
Silicea
7
Miss. Muthulakshmi
21
F
Student
Headache
8
Mrs. Dhnalakshmi
43
F
House Wife
Headache
Mr.Ponnusamy
46
M
Farmer
10
Mrs.Srinivasan
42
M
Weaver
Marked Improvement
Trio Miasm
Mr.Thambidurai
9
TrioMiasm
Re s u l t
Nat.Mur
5
Headache & Cold
Mia s m
-
-
Use of oral contraceptive Chickun Gunea
Headache
-
95
-
Belladonna
T rioMiasm
-
Nat.Mur
Psora, syphilitic
-
Iris
TrioMiasm
Silicea
Psora, syphilitic
Marked Improvement Marked Improvement Mild Improvement No Improvement
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THERAPEUTIC POCKET BOOK” 2) BOERICKE,
M.D.
“BOERICKE’S POCKET MANUAL OF HOMOEOPATHIC
MATERIA MEDICA AND REPERTORY” 3) BOGER C.M. “ BOENINGHAUSEN’S CHARACTERISTICS & REPERTORY”, 4) CHOUDRURI M.D, “A STUDY ON MATERIA MEDICA” 5) DORLAND’S “ POCKET MEDICAL DICTIONARY” 6) FREDERICK SCHROYENS, “SYNTHESIS REPERTORIUM HOMOEOPATHICUM
SYNTHETICUM” 7) HAHNEMANN’S ‘THE CHRONIC DISEASES THEIR PECULIAR NATURE AND
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COLOUR ATLAS” 18) PHATAK, “A CONCISE REPERTORY OF HOMOEOPATHIC MEDICINES” 19) ROBERT H.A, “THE PRINCIPLES AND PRACTICE OFMEDICINE” 20) ROBIN MURPHY, “HOMOEOPATHIC MEDICAL REPERTORY” 21) SAMUEL HAHNEMANN’S “ORGANAN OF MEDICINE” SIR STANLEY DAVIDSON JOHN MACLEOD , “THE PRINCIPLES AND PRACTICE OF
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