Clinical Cases

A Case of Chronic Migraine

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Dr. Pankil Dhruv treats a case of chronic migraine and shares his thoughts during case analysis.

A female, 36 yrs of age came to my clinic with the chief complaint of chronic migraine. On further probing, the following symptoms were noted:

1) Chronic migraine for the last ten months.
Started with Left side headache since last February, then Right side since November, 2013.
Headache earlier left side now towards right side. From eyebrow extends backwards.
<12-5pm. <eating also painful.
<AC , <cold air.
>ice application
<Sun
< emotional tension

Also when acidity increases. No visual aura or any other visual defect before migraine. Gets heaviness of head and starts expressing everything to relieve headache… emotions should vent out.
<half sleep,
< sneezing, coughing, laughing

Last month: daily episodes and cries with pain. Can’t tolerate severe pulling pain.
“These days I have sleepless nights doctor, with pain above eyebrows.”

<chewing – had pain      >pressure

Appetite reduced.   Can fast in morning hrs.
2)  Low Hb: 5%

Looking very pale and gets exhausted after exertion.
Joints pain – ascending agg.
3) Recurrent cough cold, sinusitis – watery discharge eyes and nose.
<headache from strong odours –  Nose blocked <cold.
Maxillary sinus ++
<cold drinks.
Chilly patient

Spasmodic cough earlier in 2000. <Dusting, laughing , talking. Once it starts it continuous for full day!
Earlier was on Sinarest.  On: Lanoler (610) Migraine sibolium

Mental temperament:
People tell me I am mild and reserved, also short tempered, anxiety when time is set, so I have to pack my bags two days in advance and reach station three hours before train arrival. Don’t have patience.
I have shared information about me only with husband, mother and now you. Always had few friends in life. Sometimes get jealous for husband who stays outstation for work. What he must be doing? Wont he get into bad habits ?
I feel people who are close to me shouldn’t get away from me.  I am independent in decision outside but with husband dependent on him.
only single person I am dependent in life.

I feel this mental issue only keeps my brain active and gets mood swings and causes migraine attack.  I feel terribly low and sad these days. I want to talk, to meet, to discuss and clear out, vent out. If someone talks to me on issue or consoles me, I feel better. I only approach every time after fight, whether it be my fault or not.
If I cook something bad, my father-in -law is strict… what will he say? I shouldn’t do anything wrong.  I feel extremely low and always think  the fault in mine.

Do you like music?

Yes, indeed!  Emotions flow in me with songs. I love listening to songs, feel my life is with songs. Romantic and religious songs I like to listen to more. I connect to the rhythm.
Feels alone always as husband is out. I feel lonely, forsaken. Have just my daughter to care for and no one else. These days I get some weird dreams.

Dreams: My mom comes into my dream. Mother had died 4 yrs back, her omentum was filled with water and swellings.

She gets mother in her dream to help her.
I see water waves in dream, am stepping down from stairs and trying to go there but find the waves are moving away, the closer I go, the farther away it goes. Can’t get my feet touched by the waves.

What do you experience?

Like not attached. I need to depend, trust in relation and only few trustworthy people with whom I can share. I am very sympathetic and easily affected by slight change in relationship, or if someone breaks the relation or trust I have in them.

Generals:
Craves: spicy, salty. Before marriage used to have more salt in food.
Aversion : sweets.
Perspiration : gets icy cold on forehead.

Analysis:
This case is a chronic case and had been on allopathic treatment for long.  On probing details of her case, I found many peculiar characteristic symptoms which help to identify who the person is.  In analysis of a case we try to find what is it that is peculiar to the case.  Who is the person who has these complaints?  What are the most central sensitive aspects of her?
Now if try to manually repertorize the important symptoms of the case,
we find following symptoms and remedies.

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Nat mur , ars, cal , phos, bell  are coming prominently.

Now, how do we go about this?  I usually look for three main things while selecting remedy:

1) Central idea of similiarity
2) Sphere of action
3) General and systemic approach

Phos and Nat mur are closer and matching symptomatology.
So, what is more central and sure in the case? Let’s list it,

1) <sun
2) >music
3) migraine headache
4) anemia
5) cough recurrent,
6) tendency to have cold
7) Attachment, trust, relation issue
8) melancholy mood
9) love care from relationship she depends on
10) dream of mother

Peculiar is when she said : dream of water and waves.

What was it? Was it waves or water that was important?

No, it was her mother talking with her. And the second aspect, waves going away…. detachment!

Now which remedy has this idea out of 4 other differential remedies mentioned above?

Rx:  Nat muriaticum

Main idea of Nat mur  (from The Soul of Remedies: Rajan Sankaran ) is that

she will be let down or betrayed or disappointed by the person she trusts and  depends on, or by the one she loves. The relationship she seeks is not one of dependence like Calcarea or Magnesium but of friendship or romance, a relation on a one to one basis. Also check for other peculiar symptoms in repertorization chart above.

But, there are a few symptoms which don’t match the remedy:
chilly patient
consolation amel
conversation amel

These are 3 symptoms of case don’t match nat mur.  Now how do we understand this?  Firstly, try to see if these are eliminating symptoms? No. Only if it’s very central to case then we can have higher value to it, otherwise we can just keep it very low in our totality.  The more peculiar and deviated symptom, the more is its value.

Remedy given:  Natrum Muriaticum 200  on 15 December 2013.

Follow ups:

3/2/14:  First change observed was, intensity is reduced, headache still there but much less painful.
Overall better, weakness better. Exhaustion less after work.
Pain over vertex and not one sided now. “It is shifting I feel, dry cough since 3 days. Use to get recurrent cough and severe.”
Sleep: Okay but if noisy, then sleeping difficult.
App:  now normal.
Slimy sticky cough after coughing too much.
> sitting up. Breathlessness.
<while going to sleep at night.
Have stopped all allopathic medications as suggested by you.
Rx: Sac lac for month

8/3/14:   Headache: Better, did not have headache even during sun exposure while travelling.  Feeling relaxed now!

Now episodes better – only triggered during loss of sleep. <bus riding
Mood sometimes not happy, can’t let go easily.
I again think all negative thoughts when my husband is far away. I am alone.
feel lonely, sad. Listen to music. Cough starts triggering again. Dreams of waves coming and going.
Cough: dry, started again <night while sleeping…only I get this. Cant talk at all.
(Cough – Lying – night – as soon as head touches pillow

caps. Conium DROS.

> sitting up for sometime and having warm water.
Dream:  as if someone had hold of her and she couldn’t move, fear.
Woke up frightened with perspiration.
Rx: Drosera 200 (SOS if required while traveling and in acute)
then, Nat mur 1M for 2 days.  Let me know in one week’s time.

16/3/14:  Phone follow up:
Cough is better.  Headache much better compared to past. Completely stopped allopathic medicines and episodes are much less, bearable.
Dream:  Earlier dream was that I couldn’t touch water, and sea moving farther…
this time I had dream that I could go inside it and water was up to my knee.
Saw later my mother was feeling happy, and I was talking with her. I
felt much relieved.
Rx:  Sac lac

29/4/14:  FU: cough <night, cough minimum. Coryza – nose blocked and fluent coryza.  Headache : once a month now. Energy level good. Appetite : good.
Face and hands don’t look pale now.
Rx:  Sac lac

Nat mur 1M (SOS)

4/6/14:  FU:  Had just one episode in last 2 months of headache. Only one was severe and she took SOS dose. Cough intensity less but gets once a month. Mood is also okay now. No more jealousy or fights with husband.  Feeling better overall. Also Hb levels have improved, last report showed 8.6 %

7/8/14:  Migraines occur no more.  Acidity sometimes- experience  <spicy,> butter milk.  Recurrent cold reduced. No more sinusitis  Dry cough comes sometimes for 3 days then reduces.  Energy level good, occupied with family functions. No dreams now.

Rx: Sac Lac

About the author

Pankil Dhruv

Pankil Dhruv

Dr. Pankil Dhruv (BHMS, CCAH) graduated in 2012 from CMP Homoeopathic Medical College, Mumbai and later did post-graduation studies (CCAH, FCAH) in Advanced Homoeopathy. He runs a busy private practice in the suburbs of Mumbai and provides online consultation to overseas patients. He is associated with the other song - International Academy of Advanced Homoeopathy as an academic team faculty and web media consultant. He has been instrumental in initiating and developing a unique e-learning course known as “Essential Homoeopathy” with Dr. Rajan Sankaran. He has always had a keen interest in Metaphysical sciences and is a degree holder in FengShui from Malaysian masters. He conducts a yearly workshop on the importance of Homoeopathy and Fengshui for maintaining health. www.Homenhealth.in www.thefengshuiacademy.com

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