A Case of Migraine

This is a case of a lady 32 years old with fair skin, dark eyes and hair, who complains of migraine headaches. She has pimples on her face. She was not talking much during case taking and it was difficult to open her up to know the mental symptoms.

Her case as given on January 19, 2008:

“I have migraine headaches since 4 years. It first started after pregnancy. Fifteen years back, during my college days, I used to get headaches, usually after studying continuously or after getting exposed to sun for 2-3 hours. That time, I used to have vomiting following the headaches. But since 4 years, I am getting headaches every week. Last year I consulted a physician who diagnosed it as migraine. I took allopathic treatment for 6 months. Later I stopped it because I started developing the side effects of those medicines. Headache recurred soon after stopping those tablets.”

“Surprisingly, I get migraine headache on every Monday. It usually starts in the morning with heaviness in the head. The pain starts from right forehead and gradually extends to whole of head.  Headaches are violent. My whole head throbs with pain. I can sense the pulsations of blood vessels on both temples. With migraine, I cannot eat anything, neither can I work or talk with anybody. I just want to be quiet at that time. Headaches are continuous throughout the day and I get relief only after vomiting. Sometimes the headache continues the next day also. Sometimes the pain is so violent and unbearable that I pull my hair to get relief. I cannot recognize the sensation of touch on my head during the headache. Also I can’t tolerate noise or light during headache. I prefer to sit alone in a dark room. The sound of people talking around me, the sound of television, even mild light in the room irritates me.”

“I have noticed that whenever I get tense due to work pressure, I get a migraine. I also get migraine after eating spicy chicken. That may be the reason I am getting migraine every Monday. Most of the time I take pain killer tablets to get relief. But that gives only partial relief.  The migraine subsides only after vomiting. I also feel better after sleeping.”

“Constipation is another complaint I usually get since my childhood. I don’t get desire to pass stools every day. Stools are hard and with a lot of straining. My water intake is very little. I don’t feel thirsty at all. Even during hot summer days, I hardly drink one or two glasses of water. I like to eat fish a lot. I don’t like milk at all. Since childhood I have a kind of aversion to milk. I sweat moderately and it leaves no stains. I require at least 8 hours of sleep every day. I feel drowsy throughout the day if I haven’t slept properly on the previous night. I get dreams but I cannot recollect them after getting up in the morning. I cannot tolerate the cold of winters nor direct sun. I start getting vomiting and headache if I get exposed to sun for more than two hours.”

“4 years back, I underwent surgery for anal fissures. Other than that, migraine is the only complaint I have suffered from. My mother is diabetic and my father has cervical spondylitis. Both my brothers are healthy. My menstrual periods are regular. I get menses every after 28-30 days and bleeding lasts for 4 days. I don’t have any complaints regarding menses. I have a 3 years old daughter. She was born with normal delivery.”

“Since childhood I am known as a timid and bashful girl. I never used to talk with strangers. I used to hide my face or runaway in another room whenever we used to have guests. I never mixed with other children in school. I always had just one or two selected friends. Even now, I take lot of time to mix with people. I prefer to be alone and have just one friend close to me. I never like to have many friends or to be among many people, so I hardly attend parties. Everyone says that I talk verylittle. I don’t like to share my thoughts or emotions with anybody. I discuss a few issues only with my husband.”

“I am a very sensitive person since childhood. I am sensitive to being criticized or being scolded. I weep easily. If my boss fires me due to some reason, I weep even in the office. I cannot tolerate loud noise. I startle with sudden loud noise. Certain noises like crackling of paper or loud music irritates me. I like listening to old songs. But music sooths me only when I am in a relaxed mood. If I listen to music when I am worried or sad, then I feel as if it’s adding to my disturbance and I feel sadder. ”

Initial assessment:

This lady has come for relief from chronic migraine headaches. She gets migraine headache after mental exertion and after getting exposed to sun and also after eating spicy food. She cannot tolerate noise or light during headache. Headache is relieved only after vomiting or after sleeping. By nature, she describes herself as a timid, bashful and sensitive, reserved and introverted lady. She does not like to make friends, to communicate with people or to attend parties. She talks very little. She also mentions that she is sensitive to noise, music and to the heat of the sun. Though she likes listening to old music, it depresses her mood further if she is already worried or tense. She is a chilly person (cannot tolerate cold weather), thirstless and has aversion to milk. She cannot tolerate mental exertion and she gets migraine headache whenever under work pressure.

Repertorization using complete repertory:

Mind, talk, talking, talks indisposed to

Mind, reserved

Mind, timidity, bashful

Mind, sensitive, oversensitive, noise to

Mind, sensitive, oversensitive, music to

Generalities, music, agg

Generalities, food and drinks, milk, aversion

These rubrics were referenced also:

Mind, mental exertion, agg

Stomach, thirstlessness

Generalities, sun, from: exposure to: agg or ailments from

Mind, sensitive, oversensitive, noise to, crackling of paper, to

Kent repertory; head, pain, headache in general, sun from exposure to, agg

The remedies seriously considered based on this repertorization were Natrum carb, Pulsatilla, Nux vomica.

Natrum carb :

Reserved, introverted, indisposed to talk, aversion to company, mildness, irritability, sentimental, sensitivity to music and noise, desire for salt and fish, aggravation from sun and one to one attachment are the group symptoms of Natrum remedies. So I was strongly considering the Natrum remedies while taking the case as this lady is also timid, reserved, introverted, gets headache from exposure to sun, has desire for fish and is sensitive to music and to noise. Similar to Natrum, she also gets aggravated from music, though she likes listening to music otherwise. She is emotionally attached only with her husband and has only one friend.

Other than the above mentioned symptoms, Natrum carb covers bashful nature, strong aversion to milk, headache due to mental exertion, aggravation from music and noise and headache from exposure to sun. Similar to this lady, Natrum carb is a chilly remedy, yet with aggravation from sun and is thirst less. Natrum carb also gets aggravated after exertion especially from mental exertion. The Natrum carb patient is unable to think or perform any mental labor without headache. This lady also gives a history of headaches after studying continuously and whenever under work pressure. She describes getting irritated due to noise of crackling of paper, and in the complete repertory, Natrum carb is mentioned under rubric: mind, sensitive, oversensitive, noise to, crackling of paper, to.

Repertorization and these additional confirmations make Natrum carb the strongest choice.

Pulsatilla is another remedy coming up in the repertorization. It is especially indicated in patients of a mild, tearful disposition, having a rather slow, phlegmatic temperament. Natrum also has tearful disposition similar to that of Pulsatilla, but  the difference is, Natrum gets aggravated from consolation, while under Pulsatilla the patient seeks consolation. The lady described in the case does not seek consolation. Pulsatilla covers weeping disposition, timidity, bashfulness, aggravation from mental exertion, aversion to milk, thirstlessness and chilliness. The Pulsatilla patient gets aggravated from warmth of air, room, cloths, from rich fatty food and are relieved in fresh open air. Though this lady gets headache after eating spicy chicken, in contrast to other modalities of Pulsatilla, she feels better by sitting alone in a closed room. Aggravation from music, aggravation from mental exertion and aversion to milk are not marked under Pulsatilla though it covers all these symptoms. In Kent’s repertory, it is absent under the rubric: head, headache in general, sun, heat of. That means it is not a marked symptom of Pulsatiila compared to Natrum carb. Considering the above mentioned comparison, I ruled out Pulsatilla. However, there is still much similarity to the case, and it is my second choice remedy.

Nux vomica is a good match for the symptoms during the acute phase of migraine headache. It covers, sensitivity to noise, to light, to loud music, desire to sit alone in a room, indisposition to talk with anybody and angry when obliged to answer. The typical Nux vomica patient is thin, spare, quick, active, nervous and irritable. Basically they are workaholic, competitive, impatient and ambitious. The basic mental and physical constitution of Nux vomica does not match with this patient. Nux vomica is angry and impatient; cannot stand pain, they cry with pain. Nux vomica is usually thirsty but can be thirstless also. After going through the materia medica, I thought Nux vomica is a good match during the acute phase of headache but it is not a perfect choice to prescribe constitutionally.

Based on my evaluation, Natrum carb was selected. It was given in 200c potency. The lady was generally in good health, her symptom picture was clear and she had no limiting conditions that would have led me to choose a low potency. This is the potency I generally start a case with unless there is a reason to go higher or lower. She took a single dose of Natrum carb 200c on January 19, 2008.

Follow up – February 21, 2008.

She reports: “I got migraine headache only once since I received the homeopathic remedy. Intensity of pain was less by 40%. Other associated complaints like aversion to loud noise, aversion to bright light and no desire to talk were equally less. This time migraine lasted only one day. I had vomiting twice, after which the migraine was relieved. Since severity was much less, I did not receive any painkiller tablet and I could do my routine work. My appetite was little less during migraine, but it is normal otherwise. My bowels were not clear for two days prior to migraine. Otherwise my bowel habits have become regular with the homeopathic remedy. Also my sleep is peaceful. I have no other complaints.”

In response to questioning about what precipitated the migraine headache she said, “It’s difficult to point out one specific reason that triggered migraine. But eating chicken and other spicy food and getting exposed to heat of sun may be the two possible reasons.”

Assessment

My assessment based on this information was that Natrum carb was acting. Getting migraine is just a normal fluctuation. The frequency and intensity of all her complaints was less. The lady used to get migraine every week but with the constitutional remedy, she got it only once in a month. In her words, intensity of pain and of all other associated complaints was less by 40%. She could work with migraine. Her bowel habits become regular. So Natrum carb also acted effectively on the chronic complaint of constipation. Still the sensitivity towards causative factors (spicy food, heat of sun) is the same but bodily reaction to it (migraine) has become mild. Considering all these facts I thought, the case still has a forward momentum and is still progressing. No action was taken. A follow up was scheduled and she was instructed to call in the mean time if migraine returned.

Follow up – March 24, 2008.

She reports: “Though I am eating chicken and other spicy food, going out in sun, I did not get migraine again. In last week, I had acidity after eating spicy food but I did not get migraine. My energy level is good. I feel thirsty and drink 5-6 glasses of water in a day. Bowel habits are regular. Menstrual periods are also normal. About one week back, I had a cold with sore throat for the initial two days. Watery nasal discharge was flowing for 5-6 days. But I neither had fever nor weakness. The cold subsided by itself. Pimples on my face are also getting less.”

In response to questioning she said, “I think, my capacity to work has increased with homeopathic medicine. Since my physical stamina has increased, I don’t feel tired.  Two weeks back, I worked really hard in the office and there was a lot of pressure to complete the work in given time. I used to get migraine in such situations but this time I could work without noticing any mental stress. I enjoyed my work.”

My assessment was that she was continuing to improve. Getting acidity and a cold were minor symptoms due to indisposition and so she recovered without any medication. Her physical as well as mental stamina had increased and she was able to tolerate more stress. She was not getting migraine after eating spice or after getting exposed to sun. This indicates that her tolerance has increased. Her physical general symptoms like thirst, appetite, stools, sleep were normal. She was getting fewer pimples.

Considering this overall improvement on the physical and mental level, I concluded that the action of the remedy was still in progress and it should be left to do its work. No action was taken and follow up was scheduled.

Follow up May 18, 2008.

She reports: “I was perfectly better all these days without having any complaints. Since summer is going on, we went out for a vacation last week. I ate lot of spicy food in those days. Since I am not getting migraine even after eating spicy things, I am able to enjoy eating every kind of food without any anxiety in my mind. Throughout day I used to wander out in the sun, without any complaint. I could enjoy my vacation without having any complaints. But yesterday I had headache. Though severity was less by almost 75%, I had headache for whole day. I was feeling dull and had no desire to work. Later, in the evening I had vomiting and then headache reduced gradually. Till night, my head was heavy but I could sleep properly. Today I don’t have headache. I am still feeling little weak but I am much better than yesterday.”

“Its only yesterday, I had weakness. Otherwise since I have received the remedy, I don’t get weakness. I have good stamina to do physical or mental work. I am able to work without any complaints even in stressful situations. Appetite, thirst, bowel habits, sleep and every other thing is normal.”

My assessment at this point of case was that the reappearance of migraine could have been a normal fluctuation, or may indicate that the remedy will need to be repeated if it becomes a continual problem. Since she had no other complaints and was feeling better on both physical and mental levels, no action was taken. A follow up was scheduled and she was instructed to call in the mean time if migraine returned.

Follow up June 15, 2008.

She reports: “I became perfectly normal by the next day, after the migraine subsided. I have no complaints of headache since then. But I am having itching all over my body. It started two days back. It distracts my mind while working, as I feel urge to scratch frequently. There are no eruptions on my skin, just itching. I am not able to make out any reason behind getting this itching. I never had skin allergy till now and I have not exposed to anything that will cause allergy. Apart from this itching, every other thing is normal.”

“I don’t have any other complaints. I am working regularly with good stamina. My appetite, thirst, bowel habits, sleep and menstrual periods are normal. My constipation and pimples are also better. I am not getting pimples on my face.”

My assessment was that the itching was due to exteriorization of the disease force on the level of skin. Her migraine and other complaints of constipation and pimples improved with improvement of overall health. And now she was getting itching all over her body. With reference of the book, ‘The Science of Homeopathy’ by George Vithoulkas, skin is the most superficial plane of the body. The disease force was moving from higher (more important) plane to lower (less important) plane. In other words, the disease was getting expressed in milder form. So itching is a good sign indicating cure. As per Hearings law, cure was taking place from within outwards. With this analysis, I concluded that the remedy is still acting and the case still has a forward momentum. No action was taken and follow up was scheduled. The patient was assured that she was getting cured and itching will get subsided soon. The patient was instructed not to suppress the itching by applying any ointment or any other medicine. She was also instructed to call if itching gets worse or if she develops any other problem.

Follow up July 19, 2008.

She reports: “I am doing great. I don’t have migraine, constipation. The itching I had last month, reduced completely in 6-7 days. There is no itching since then. Work is going on well. Now I don’t feel mentally stressed at all. My capacity to work has increased. My boss seems to think I had some big change. I am feeling more confident and positive than ever before.”

“My family members including my son say that now I look more happy and energetic. Their satisfaction makes me happier. I used to get migraine 3-4 times in a month. Those days I used to sit alone in my bedroom for hours, without talking with anybody. Many times, due to severe headache, I used to get angry on them. Now I feel guilty about my behavior. They were also fed up of my sickness.”

“I am eating everything including chicken, spicy food but I am not getting migraine, constipation or any other complaints. Also I am able to tolerate heat of sun. Now even if I get exposed to direct sunlight for 4-5 hours, I don’t get headache or any other complaints.”

My assessment was that she has progressed well over the past few months. Her mental and emotional states also improved with homeopathic remedy. She is showing progress in her work and her relationship with her family members has grown healthier. Hearings law of cure is followed following removal of all signs and symptoms, indicating long lasting cure. No action was taken, and she was asked to call if she had problems in the future.

A single dose of Natrum carb triggered the process of healing so well that intensity and frequency of headaches became less. So she never required any acute remedy for migraine headaches.  A single dose of Natrum carb acted well to cure her chronic migraine headaches and other complaints of chronic constipation and  pimples. It also proved effective at moving this lady forward to present time, with more confidence and positivity.