Clinical Cases

A Case of Headache

headache

Dr. Amit Singh Pal presents a case of chronic headache solved after an acute illness provided a clue.

Mrs. SP, aged 48 came to see me, being referred by one of her relatives. She belongs to the Jain community.

 

Presenting complaints:

headache1HEADACHE since her last delivery. It started with sensitiveness to noise.
Increased since 3-4 yrs. She is handling her husband’s business since 1998. Since no relatives supported her, she had to take care of every problem herself. Her husband was very sick since 1998. Much sleeplessness is associated with it.

< Draft of air+++, getting head wet. Noises++, Sun++.

She has become reserved after her husband’s death.

Loquacious++. Sensitive to death of parents and husband. (but to what extent I was not able to determine. She was being very reserved when it came to her husband or other family matters and just told me only outlines. I am not even aware as to how long the husband was sick and how or when he died !)

Weeping.++

Headache is mostly on forehead, feels cold on the top of head < tying a band around it. Lachrymation with headache < noise >sleep after, noise.

Earlier used to vomit which used to amel+++, but now since 2-3 yrs, even vomiting does not amel.

(I got a little background information from the relative who had referred her to me. According to him, she belonged to a very very rich family and also got married into a moderately rich family. Husband was loving and caring and she too is a nice person as far as he knows. However, her mother-in-law was not so nice and thus after the death of her husband, the In-laws did not support them at all. Her parents were already dead by then and thus she had no one to turn to. So to support her child, she continued with her husband’s work, which was to run a grocery shop. Thus she has to stand all day, from 10am to 11pm. Eventually she developed leg pains also. )

(She was not explicit in discussing her husband’s death or her family matters. Thus I had to use other sources to get some information on her background )

  1. PAIN in bones of lower extremities: No modalities or associated symptoms. From what I could make out, the pains were severe, were present all the time and there were also pains in muscles and tendons of the thighs.
  2. Earlier she never used to wear sweaters etc., but since 2-3 yrs, needs much covering. Cramps in toes, from walking bare foot++.

 

Past History:

Absolutely nothing. She says she has been healthy all her life, until her headaches began.

 

Family History:

  1.     Mother: Sudden death? Healthy all her life.
  2.     Father: Bradycardia-death.
  3.     MGM: DM.
  4.     PGM: Coma-death, in old age.
  5.     M. Uncle: DM, Cancer.
  6.     M. Aunt: DM.
  7.     Siblings:
    1.   Bro: Normal.
    2.   Bro: H/o accidents.
    3.   Self.
    4.   Bro: Died in an accident.

Personal History:

  1.     Appetite: Moderate. No specific desire for hot or cold food.
  2.     Thirst: Enjoys drinking. Good and Normal. No problems with cold drinks.
  3.     Desires: Spicy+++. Chips++. Salt+. Curd=headache++. Fat food++.
  4.     Aversion: Sweets+++. Milk++. Sour++ ( 7-8 yrs. back there was desire for sour). She remembers now that there is also pain in her eyes. She is compelled to close them with aversion to light during headache.
  5.     Micturition: Frequency++; no odor. She says that she gets a kind of anxiety before going out of the house, thus she passes urine once or twice before going out of the house.
  6.     Bowels: normal.
  7.     Sleep: less; due to work. Sleeps on right side++. Covers up to neck; but not in summers. Heat of palms and soles with congestion. Sometimes feels very chilly, sometimes very hot.
  8.     Dreams: Nothing specific. Sometimes of business of the day.
  9.     Perspiration: reduced++. Profuse in childhood. Profuse++, all over, only got it last year, otherwise very much reduced. Weakness after perspiration. No odor or staining.

 

Menstrual History:

Menarche: 16yrs. Normal.

Menopause: 41yrs. Quite problematic, clots, menorrhagia.

Cycle: 4/34days. Regular. They were very much delayed after delivery.

Leucorrhoea, white, constant, all the time, continuous and causes  weakness++.

Complaints Before menses: leg pains.

No complaints during or after menses.

 

Thermals:

  • Fan: Cannot tolerate it at all+++, since childhood.
  • A/c:  Headache. Generally agg.
  • Season: all seasons seem same.
  • Closed room >.
  • Covers amel++.
  • Travelling: Headache <draft of air. Nausea < smell of smoke, alcohol.
  • Windows at home are always closed as drafts agg.
  • Bathing: always with hot water+++, >leg pains.
  • Normal at Hill-stations  and Sea-shore.

 

Physical:

Obese+++, Wt: 90kg. Fair, long nails, clean tongue with mild impression of teeth on sides. Skin looks dull to me.

 

Life-space:

  • Never replies back in an argument, rather introspection++ is there.
  • Religious – normal. No superstitious activity in life nor is she superstitious.
  • Has to think many times before deciding, consults her child+++, fear of making mistakes. Anxiety even for small matters.
  • Sensitive – emotionally. No specific fears. She follows in life what parents taught her in childhood (she seemed very adamant when she said this, otherwise throughout the interview she behaved quite normally, mildly weeping when talking about her husband). Never goes out alone as it’s against what parents taught her. Anxiety about family members.
  • Memory good, no problems with it.
  • Good in studies, needs to read only once to remember it for lifetime.

 

She has been quite a closed person with some anxieties. Inspite of asking many details, I could only get so much information.

 

Analysis:

To decide upon a remedy, I always chart out the prominent characteristics of a person first, which thus helps me to select a group of remedies, and at the same time, rule out other groups of remedies.

In this case, I found the person to be a CLOSED TYPE. She is definitely quite refined, behaved well and disciplined. However, what was confusing again and again was her anxiety for various matters, matters which in my view meant nothing. She has certain sensitivities, e.g. noise, draft of air, getting head wet etc. She says that she is sensitive to the death of her parents and husband, but she did not discuss it any further. She is definitely very CHILLY. Socially I find her to be reserved.  Along with the anxieties, she has muscular pains, but not burning pains, and also sleeplessness. I imagine that a person who is tired from working all day is supposed to get to sleep easily but that does not seem to happen here. This surprised me and gave me a feeling that sleep is definitely a matter of concern here; it’s a disease symptom, not a mere inability to fall asleep. She was so concerned with her daughter’s health and asked me frequently to take care of her daughter’s health. She has a decided aversion to sweets and there have been some change in overall symptomatology in the last 3yrs. This is surprising as despite her anxiety and other problems, she does not visit doctors often. Her daughter informed me that even though she has so many problems, she just keeps working and tries to solve the problem by taking some rest.

Looking at all of this I considered the following rubrics. I decided on Silica.

amitpal-jan14-image002

I treated her with a single doses of Silicea, for 3 months wherein her headaches were reduced by 30-40%, but her weakness, leg pains+++ and leucorrhoea along with sleeplessness were the same. Only her headache reduced.

By this time I was planning to change my remedy, as I could not see significant improvement here. Luck favored me as she got an acute attack of sore throat at this time and this is what actually guided me to her constitutional remedy, which I missed the first time. Her symptoms in the acute attack were as follows:

 

Acute coryza, sore throat, hoarseness. Pain above the eye-brows etc. since 2days. No other modality. (I prescribed Silicea 1M, 1dose, but no effect, SQ). She came back the second day with white expectoration, cough <night, midnight after. Leg pains++++. Had vomiting after apples. Now she tells me that whenever she takes apples, she gets vomiting and headache. There is a kind of general agg. from it.

amitpal-jan14-image003

As there was no burning or amel. from warm drinks, I ruled out Ars. I already knew that this person is a closed type of individual, and in the past, loss of appetite with coryza has served me well for prescribing Phos.  Since there was no loss of appetite or burning pains, I ruled this one out too. Now, it was between Sepia and Kali-c,

Relying more on the after midnight agg., I now prescribed a dose of Kali-c 30 and there was dramatic amel, though I had to give another packet of Kali-c 30 to completely remove the acute attack. Surprisingly, along with these symptoms, her other complaints, especially the leg pains, which were troubling her much, drastically improved.  Later on I followed up with single doses of Kali-c which rapidly cleared up the case (her chronic complaints) within 2 months.  She was put on placebo for another month just to check if there was any relapse. That did not happen and she continues to do well as told to me by her daughter, who is still under my treatment.

The understanding of Kali-c and why it was the constitutional remedy for this case, came to me only after the case was cured and I had read religiously every line from the “Essence of Materia-medica” by George Vithoulkas. I sincerely suggest readers to go through that at least once.

 

Some features of Kali-c that I learnt from this case are:

  • Ailments starting after delivery.
  • Weakness from perspiration and from leucorrhoea. This combination seems peculiar to me.
  • Sensitivity to draft of air and noise as well as getting head wet.
  • After midnight agg. of complaints.
  • Agg. from apples and extreme aversion to sweets. This again seems peculiar to me.
  • Highly reserved and closed individuals, esp. in regard to family. This lady talked freely about her work, how she walks daily and how she works etc., but not much about her family.
  • Anxiety about trifles. (I couldn’t find this in repertory under Kali-c ).

 

I will be happy to have your comments on this case, as well as any comments to add to my understanding of Kali-c.

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About the author

Amit Singh Pal

Amit Singh Pal

Dr. Amit Singh Pal, M.D. (HOM) was born in Uttar pradesh, educated at various universities, and traveled all over India practicing in various places from Delhi to Tamil nadu. Presently he is settled in Belgaum, where he is providing his services at RMO, Bharatesh Homoeopathic Hospital and Research Centre, Belgaum. A teacher of Homoeopathy, he has lectured at various colleges in the country. Dr. Singh Pal has wide experience in the practice of Classical homoeopathy, lately practicing solely on the guidelines of Vithoulkas, after having trained under Dr. Sunil Parse from Nagpur. His varied experiences have helped him treat some incurable cases and now he has gathered his experiences in the form of his upcoming book : ‘Art of Case-Interview’.

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