48 year old female June, 23rd, 2012
This is a 48 years old woman, married and with one child. She works in a bank and teaches part time. Chief complaint: debilitating congestive headache with pulsation for three consecutive years with severe hot flushes and profuse perspiration.
The congestive headache is mostly frontal, concentrated on the forehead and mostly left side and extending to her nose and vertex. She gets blurry eyes and heaviness of head, dullness all day long, nausea and dizziness sometimes. She often has coryza which causes severe headache. The headache lasts 4-5 consecutive days with no sign of improvement. She takes many different strong pain killers prescribed by her medical doctor. She gets nausea after taking medications. The headache continues through the night but gets worse in the morning around 4:30-5:00 am and on waking up in the morning. The headache gets worse at before menstruation and it gets better during and after the flow and nasal discharge. Headache gets better only at night about the time she goes to bed.
Gastrointestinal: Generally is fine but she always has to watch her diet to be regular (having more water and vegetables) otherwise she is more prone to be constipation.
Craves salt and pungent food. Drinks alcohol three times a week. Appetite is fine and she is slim.
Urogenital: Only frequent when drinking more fluids, generally low thirst. She has been having herpes genitalia for almost 10 years with bi weekly painful eruptions. She is hyper sexual, but the pain caused by eruption makes her avoid sexual activity.
Sleep: Interrupted, waking up during sleep because of constant headache. Not refreshed in the morning due to lack of sleep. Headache accompanied by hot flushes and perspiration; wakes up soaked in her clothes. She sometimes has nightmares.
Energy: Very low, exhausted and not enough energy to go through the day.
Menstruation: Irregular (every two-three months), premenopausal. Her headache gets worse before menstruation but better after the flow. It takes 5-7 days. She has normal bleeding with some clotting.
Temperature: Generally her upper part is hot and aggravated from heat but lower extremities, hands and feet are cold.
Mental States: She says she is very social and passionate, helpful, emotional, soft and gentle with people. She loves animals. “I think I am smart and ambitious, sensitive, angry sometime, intense, feeling guilty to leave my parents alone, strong attachment to my family, not getting enough sleep because of my headache, feeling depressed sometime. I am afraid of high places (looking down from my parents 15th floor balcony), fear of snakes and spiders, feeling nostalgic, homesick, feeling of not belonging, being abandoned, going to church every Sunday (I am afraid of being punished), I love shopping to buy nice things, love travelling around the world.
Physical examinations: Blood pressure 128/ 85. Sinuses and throat were slightly inflamed. There is a consideration that sinusitis can make her headaches worse.
My observation: She is extroverted, loves to talk a lot and open up to her problems. She always looks nice and stylish. She said she spends a lot of money to look good. She loves to wear beautiful cloths and accessories. She seems suspicious about homeopathy but really wants to try it. She is a very polite, friendly and tactful person.
Mind, abandoned, forsaken feelings
Mind, talking, excessive, loquacity, making speeches
Mind, religious affections, (despair, fear)
Mind, phobia, fear, height, snakes
Female, menses, late, two or three months
Female, menopause, general, headache, with hot flushes, with perspiration
Female, eruptions, genitalia
Headaches, frontal eminence
Headaches, forehead, morning, motion on
Headaches, forehead, night, amel
Female, sexual desire, increased
Weakness, sensation, morning, rising, after, waking on
Food, salt, alcohol, general, desire
I always choose the rubrics from mentals, generals and modalities of the chief complaint, then choose two or three closest remedies to the case and do differential diagnosis to find a simillimum.
Natrum muriaticum and Lachesis are closest to the case. I did a differential diagnosis between the two remedies. Differentiation between mental states of Lachesis and Natrum muriaticum:
Lachesis: The mind is full of ideas and she cannot keep them back and exhibits great loquacity. Lachesis is extroverted, extremely passionate, intense and full of emotions and it expresses them with frightening. Intensity, jealousy, loquacity, often egotistical and arrogant, suspicious, paranoia, hyper sexual, anger, aggressiveness, sarcastic, squanders, religious insanity, fear of snakes and nightmares are the most prominent drug symptoms of Lachesis. Lachesis belongs to the animal kingdom and presents the most mental symptoms of this kingdom.
Natrum Mur: Deep grief, sorrow and dwelling on past grief and humiliations are some of the main characteristics. They are highly sensitive towards rejection, insult or criticism. Natrum muriaticum is introverted, hysterical, reserved, full of silent grief, romantic, responsible, proper and serious, easily offended, depressed but cannot cry, hysterical weeping, perfectionist, compulsive, does not like consolation, fears of robbers, claustrophobia.
Comparing the mental states of the two remedies: Natrum mur covers some of her mental such as anger, fright or depressive mood but does not cover the majority of her mental symptoms. Lachesis covers most of her mental symptoms such as being suspicious, spending money, talkative, extroverted.
Differentiation between general symptoms:
Lachesis: general aggravation from heat, during sleep or upon waking, sleeps into the aggravation, before the menstrual period, amelioration as soon as the flow begins, climax, at pre menopause, menopause, flushes of heat, aversion to touch or pressure, craving for pungent food and alcohol are the most general symptoms of Lachesis.
Natrum muriaticum: general aggravation from the sun (heat), sea but sometimes better at the sea, general aggravation in the morning at 10am, general amelioration from perspiration, twitches or tremor, especially of the face and head, neurological disease, vertigo with tendency to fall, worse pregnancy, tea, looking to distance, nausea and herpetic eruption.
Nat-m covers some of her general symptoms such as headache and pathological symptom such as herpetic eruption, but Lachesis covers the majority of her general symptoms such as congestive frontal headache and hot flushes especially at night.
Differentiation between the modalities of two remedies:
Lachesis: congestive headaches, frontal headache, left sided, hormonal headache (gets worse before menstruation, gets better during and after the flow), intense and continuous headache, and left sided headache. Gets worse in the morning on waking, gets better at night before going to sleep.
Natrum muriaticum: migraine headache, headache from grief, like hammering the head, neuralgic headache, worse light, sun, reading, noise and injury. Headache is intermittent and periodic. Headache is worse in the morning from 10 AM to 3 PM. Headache is better in the dark, quiet and with perspiration. Right sided headache.
Lachesis covers the totality of her symptoms including mental, general and modalities of her headache. Based on the totality of her symptoms and the law of similars, Lachesis is the simillimum to the case and it is her constitutional remedy.
I asked her to be patient since her headache is chronic and it needs a longer period of time to be removed. I explained that she might experience some aggravations of her suppressed symptoms due to consumption of painkillers or hormonal medications. I made her completely aware of how to take homeopathic remedies, homeopathic principles, action, duration and curing affects. My consultations with my patients are like a homeopathy and nutrition course. I teach them to change their lifestyle (nutrition, eating habit, exercise, hygiene and positive thinking).
Since she was a sensitive individual and Lachesis is an animal remedy and can cause a lengthy aggravation in sensitive cases, I took a conservative approach and prescribed Lachesis in 200CH.
RX: Lachesis 200CH in the form of pellets, two times a day for three days and once a day for four days, total seven days. I recommended she follow the blood type diet and eat less animal food, more fresh food, vegetables and fruits to change her body PH from acidity to alkaline, drinking lots of pure water, getting plenty of rest since she has been sleep deprived for a long time. I told her to call or email me if she has any questions or concerns and come to see me in two weeks for the first follow up visit.
1st follow up visit July, 7th
How do you feel generally and how is your headache?
She explained: I took the remedy Lachesis for one week, after the first three days the pain was still there but the time of the headache changed to noon instead of morning. Also the pain moved from frontal to back of the head and vertex. On the fourth day the headache was completely gone to the point I could not believe it. She feels less pressure on her sinuses. Hot flushes were barely noticeable and not happening at night. She continued the remedy for seven days. She slept much deeper, no hot flushes and no headache in the morning. “I am so excited about my improvement. Energy is still low and I am lethargic and tired. Digestion, elimination and urination are good. I am generally feeling better. “
She got a great improvement in her headache so I did not repeat Lachesis this time. I gave her some homeopathic tissue salts to remove her deficiencies and gemmotherapy to balance her hormonal system further and calm her nervous system. I asked her to come back for the next follow up visit in one month.
2nd follow up visit August, 5th
She had two episodes of headaches in the past week. The headaches were less intense. Hot flushes returned five days ago, mostly at night but were of very short duration. Sleep is still much better than before. Energy has increased and she is not too tired during the day. Sexual desire has decreased. She is feeling much better generally. She has no craving for salts and pungent food. Digestion and elimination are very good. She followed all my recommendations about nutritional and lifestyle changes. The remedy was exhausted after three weeks. I repeated Lachesis 200 CH for five days, once a day only. I asked her to continue tissue salts, gemmotherapy protocol and my nutritional recommendations as well.
3rd follow up visit September, 2nd
She has become headache free and has had no hot flushes. Her digestion, urination, sleep, energy, appetite are good. She was very happy that she is headache free but herpes genitalia erupted two weeks ago and it was very painful.
She said: I was very skeptical and mistrustful in the beginning but after I have experienced my homeopathic treatment for my headache I am so grateful, very optimistic and believe in homeopathy. I tried so many different modalities such as allopathic medications; also different alternative approach such as herbal medicine but none of them helped and removed my headache in a short period of time as Lachesis did. I am so happy, many thanks to my homeopath and homeopathic medicine. I am dreaming if I can get rid of the herpes genitalia with homeopathy too.
Note: Headaches respond to homeopathic medicines beautifully. This is especially true when headache is the main problem of the patient and the symptoms have patterns and specific modalities. When there is other significant pathology, the headache may not be the first thing to be removed by the vital force. The majority of headaches are resolved by the simillimum in a short period of time
She came for several follow ups for her herpes genitalia and I treated her with my second choice remedy, Natrum muriaticum. The eruption was milder and occurred every couple of months instead of every two weeks. She reported no eruption only pain for a few episodes. She continued the remedy for almost a year. She reported no eruption and pain after one year. Generally she responded to homeopathic remedies very well.
References: Homeopathic Medical Repertory by Robin Murphy, Repertory of the Homeopathic Materia Medica by Kent J.T., Homeopathic Materia Medica and Repertory by W. Boericke, Concordant Materia Medica (Frans Vermeulen), Desktop Guide & Desktop Companion to Physical Pathology by Rogers Morrison