Retrospective Observational Study of Pediatric Headaches

Luisa Ferla¹, Aishwarya Madhusudhan², Maria C Bosco³, Seema Mahesh^{4, 5}, George Vithoulkas⁶

[Presented at the 5th Congress of Piemonte (Turin Region) Homeopathic group and at the 16th AMIAR Congress (Acupuncture and Non-Conventional Medicines in Neurological Diseases)].

¹Azienda sanitaria locale TO4 di Ciriè, Chivasso e Ivrea,
Department of Ivrea, Chivasso, Italy
Email: luisaferla@virgilio.it

² Government Homeopathic Medical College and Hospital,
Bangalore, India

³ASL TO4 (local sanitary department)
Chivasso, Italy

⁴Taylor’s University School of Medicine
Malaysia

⁵Centre for Classical Homeopathy
Bangalore, India
email: bhatseema@hotmail.com, research@vithoulkas.com

⁶International Academy of Classical Homeopathy
Greece

Keywords
Pediatric headache, migraine, homeopathic treatment

Background

Pediatric headache is a common condition, difficult to diagnose and or manage. The International Classification of Headache Disorders (ICHD) categorizes headaches as primary (migraine, tension-type headaches – focus of our study), secondary (attributing to infections, trauma etc.) and painful cranial neuropathies and other facial pain¹.

Conventional management largely includes prophylactic and abortive strategies, focusing chiefly on reducing the frequency or severity of the condition, with drugs such as NSAID’s and Triptans². Though effective, they often produce varied adverse systemic outcomes^3,4.

Data on long-term prognosis in pediatric headache is lacking and the short-term prognosis with prophylactic management is being considered favorable; It is likely that the long-term prognosis has not been studied in this age group.

Classical homeopathy treats a person in an integrated manner. Homeopathy provides the insight that mechanisms responsible for generating a complex disorder, such as migraine, are not simple and that analgesia is just one of the requirements in these cases. Homeopathy aims at switching the immune mechanism back to what it was before the onset of the condition such that multiple tiers of this disease are addressed simultaneously.

There have been studies conducted previously regarding the effect of homeopathy on headaches, but few were designed and executed well. Studies need to adhere strictly to homeopathic laws, and failure to do so will not yield reliable data⁵. This study examines findings from a clinical practice that has followed the rules strictly and thus has dependable data^6,7.

Aim of Study

The aim of the present study was to retrospectively analyze the therapeutic results of individualized classical homeopathic treatment in young patients with chronic headaches who did not respond to conventional therapy and to magnesium supplement, in the Homeopathy Department of Ivrea Hospital, Italy.

The study:

The study participants were 70 young Italian patients (3-18 years of age) with headaches that did not respond to conventional medicines and magnesium supplements, with most of them resorting to NSAIDS during attacks.

All of the patients were treated with magnesium or magnesium + melatonin prophylaxis for several months with partial or no results and opted for homeopathic therapy. They received homeopathic treatment in the Classical Homeopathy Department of Ivrea Hospital for at least one year.

Patients who resorted to other treatments during the homeopathic therapy or took vaccinations were dropped from the study as they would confound the results. Therefore 2 patients who were vaccinated and one patient who took antibiotics during the study period were dropped.

17 patients (24%) did not adhere to the treatment; the reason could not be ascertained. The final two year follow up assessment was made for 50 patients. This consisted of 35 girls (70%) and 15 boys (30%) with an average age of 11 years.

Of the 50 patients who received homeopathic treatment; 26 suffered from weekly headaches, whose frequency was at least 2 or more episodes/week, 15 had suffered from chronic daily headache from one year or more, 5 from chronic headache from 2 to 5 years, 3 with severe NSAIDs –resistant headache, one suffered migraine with aura.

Diagnosis: Headache diagnosis was made according to the International Classification of Headache Disorders criteria (ICHD-3, 2018)^1,8.

Prescription: Individualized homeopathic medicines were given. No other drugs or therapeutic solutions were prescribed, nor were any dietetic restrictions made.

Classical homeopathic rules were carefully followed in this study^9,10. There were no restrictions regarding the remedy prescribed, so individualization could be accurate. A provision was made for certain phenomena, which are expected during the follow up of homeopathic therapy such as initial aggravation and relapse of old complaints. This was clearly specified in order to not misinterpret these as adverse events. The patients were followed up for a long period in order to appreciate the changes and stability.

The 1^st follow-up was made two months after the prescription, and the following after two, three or six months depending on the frequency of attacks.

All of the patients were followed up for at least one year and some were followed for two or more years. The results in this study were summarized at the end of two years (Table 1).

Parents were asked to keep a calendar of attacks. The evaluation was very simple and was given at every six months; The patient or the guardian was shown a visual analogue scale depicting severity of pain from 1 to 5, 1 being no pain and 5 being very painful. They pointed to the most appropriate emoticon.

Results at the end of homeopathic treatment: (Figure 1)

• 10 cases (20% of patients) had quick and full improvement (80% amelioration or total remission of symptoms) after two months.
• 8 cases (16% of patients) had slight amelioration at 1^st follow-up but had almost complete remission (80% improvement) of symptoms after 6 months.
• 21 cases (42%) had an improvement of 50% to 60% (decrease in intensity and/or frequency of attacks).
• 5 cases (10%) had slight amelioration after the 1^st prescription and further amelioration (70%) after the prescription of a second remedy.
• 1 case (2%) had no amelioration after the first prescription but quick and full improvement after the second remedy (1^st remedy was probably wrong).
• 3 cases (6%) had no improvement after the 1^st remedy (1 case had significant improvement—between 70-80%—after the 2^nd prescription, the others did not).
• 2 cases (4%) had slight but not significant amelioration (20-30%)

Discussion

Homeopathic therapy abides to the timeless laws of nature and achieves cure by strengthening the body’s immune system through meticulous selection of an individualized remedy. Disease conditions, especially in chronic cases, are understood by systematic questioning of the patients, to spot the predisposition of the defense mechanism viz. genetic makeup and the epigenetic stress (e.g., environmental, physical, psychological, drug influence, and infections).

The practical application of aforesaid homeopathic laws and principles are perspicuously demonstrated in these cases. The foremost, every single case required different individualized remedies. Out of 70 cases, only 5 cases required repetition of the same remedy, out of which, one case due to intervention of antibiotics.

This illustrates that following the classical method of homeopathy is mandatory in treating cases successfully, and untimely repetition of remedies may be detrimental. In the headache cases presented here, 15 cases of headaches had an average suffering from one month to 5years or more; out of which 7 cases recovered producing no headaches during their entire follow-up period, requiring neither a repetition nor a change of remedy; while the remaining cases produced not more than 5 episodes of headache, thereby affirming that homeopathic laws and principles are unchanging.

It is as Kent says, “One who thinks homeopathically, never prescribes to remove a symptom. But, guided by the symptoms he prescribes a remedy no matter what follows. Learn to keep the ideal of homeopathy in mind and in order to do that you will have to rid yourselves of a tremendous amount of inheritance. We have inherited the way to think wrong end to.”¹¹

While mere statistics to the conventional medicine, the results become more comprehensive to us when Theory of Levels of Health is applied¹². The cases that are healthier to begin with, present with clear symptoms, and these cases respond quickly, as is apparent with cases that are seen to improve after the first prescription.

However, children with poorer health level required more than one remedy prescribed in the right sequence in order to obtain the same results. There are few cases in this study that displayed ‘no change’, as these children had complicated circumstances, such as added behavioral problems or learning disabilities.

According to the Theory of Levels of Health, the primary pathology, which is the outcome of a much deeper cause in the system, eventually starts responding when these deep-seated situations are addressed (here, behavioral and learning problems). As evidenced in this report, they required about two years of decorous treatment, and eventually the learning disability and behavioral problems began responding positively during the follow-up period.

Conclusions

The results of this retrospective clinical study of 50 children indicate that individualized homeopathic treatment can contribute considerably to the amelioration of chronic headaches in young patients. Furthermore, the co-morbidities associated with these headaches are also alleviated with homeopathic therapy resulting in a better quality of life and fewer school absences.

References

1. The International Classification of Headache Disorders – ICHD-3. Accessed July 1, 2021. https://ichd-3.org/
2. WP W, S A. Management of children and young people with headache. Arch Dis Child Educ Pract Ed. 2017;102(2):58-65. doi:10.1136/ARCHDISCHILD-2016-311803
3. P U, W C, CS C, EL M. Individual non-steroidal anti-inflammatory drugs and risk of acute kidney injury: A systematic review and meta-analysis of observational studies. Eur J Intern Med. 2015;26(4):285-291. doi:10.1016/J.EJIM.2015.03.008
4. C E, TE C, E F, B A, NM W. Non-steroidal anti-inflammatory drugs (NSAIDs) for chronic non-cancer pain in children and adolescents. Cochrane database Syst Rev. 2017;8(8). doi:10.1002/14651858.CD012537.PUB2
5. Vithoulkas G. Homeopathic treatment of chronic headache: A critique. Homeopathy. 2002;91(1). doi:10.1054/homp.2001.0012
6. Danno K, Colas A, Masson JL, Bordet MF. Homeopathic treatment of migraine in children: Results of a prospective, multicenter, observational study. J Altern Complement Med. 2013;19(2):119-123. doi:10.1089/acm.2011.0821
7. Witt CM, Lüdtke R, Willich SN. Homeopathic treatment of chronic headache (ICD-9: 784.0) – A prospective observational study with 2-year follow-up. Forsch Komplementarmed. 2009;16(4):227-235. doi:10.1159/000226770
8. Munoz-Ceron J, Marin-Careaga V, Peña L, Mutis J, Ortiz G. Headache at the emergency room: Etiologies, diagnostic usefulness of the ICHD 3 criteria, red and green flags. PLoS One. 2019;14(1). doi:10.1371/journal.pone.0208728
9. Vithoulkas G and Tiller W. The Science of Homeopathy.; 2009.
10. Hahnemann S DR and BW. Organon of Medicine. Kolkata Modern Homeopathic Publication; 2013.
11. J.T.Kent. Lectures on Homeopathic Materia Medica. B.Jain Publishers (P) LTD; 2002.
12. Vithoulkas G. Levels of Health.; 2017.

Table 1. Details of treatment

Sex	Age	Initial complaints	Pain level at entry (Numerical Rating Scale)	First prescription	Follow-up remedies	Complaint status at 1 year	Pain level at exit (Numerical Rating Scale)	Duration of treatment
M	14	Headache + vertigo	4	Sabadilla		Comparatively better	2	1 month
F	14	Headache	4	Thuja	Natrum muriaticum	Considerable improvement   after initial onset of a single episode	1	12 months
F	2	Headache + severe sleeplessness + frequently wakes up at night screaming	5	Cina		Fu1: both sleep and headache improved                                    Fu2: consistent improvement; antibiotics taken few times                              Fu3: betterment seen physically, emotionally and mentally	3, 2, 1	12 months
F	12	Headache	4	Calcarephosphorica		Recovered	1	2 months
F	12	Headache	4	Natrum muriaticum		Recovered	1	2 months
F	15	Headache + behavioral problems	4	Natrum sulphuricum	Natrum muriaticum	No change	4	2 months
F	17	Headache	4	Silicea		Slight amelioration	3	2 months
M	12	Headache	5	Magnesia muriatica		Better by 55%	3	2 months
F	10	Chronic daily headache	4	Lachesis		Only 5 episodes in 2 months. .	2	2 months
F	9	Headache for 2 years	4	Sepia		Better by 60%	2	2 months
F	10	Headache	4	Pulsatilla		No change	4	2 months
F	11	Chronic daily headache	5	Natrum carbonicum		Slightly better	3	2 months
F	8	Chronic daily headache	4	Phosphorus		Comparatively better	2	2 months
M	6	Intense headache	6	Belladonna		Strong amelioration	2	2 months
M	10	Migraine with aura + trembling in upper limbs	4	Phosphorus		Only 2 episodes regressed. Remedy repeated.	2	2 months
M	10	Intense headache + pain in stomach	5	Hepar sulphuricum		Partially better, headache frequency reduced	3	2 months
M	13	Headache + learning difficulties	5	Baryta carbonica		Good improvement, only 1 episode of headache.	3	2 months
M	10	Headache + allergy	5	Gelsemium		Comparatively better	2	2 months
F	4	Recurring Headache	4	Cocculus		Recovered	1	2 months
F	12	Headache + lumbago	5	Lac caninum		Intensity reduced	3	2 months
M	9	Headache + vomiting	4	Phosphorus		Comparatively better	2	2 months
F	12	Headache + muscular pain + allergies	4	Chamomilla	Natrum muriaticum	Fu1: strong amelioration                  Fu2: no headache, no muscular pains, allergy better.	1, 1	24 months
M	9	Headache	4	Sulphur		FU1: strong amelioration, with few episodes, cured with remedy repetition.                           FU2: slight aggravation.     FU3: good improvement, only 1 episode in 4 months	1	24 months
F	9	Recurring Headache (2 -3/week)	4	Phosphorus		Reduced after 15 days; reappeared after 2 years concerning school issues.	1	24 months
F	11	Chronic daily headache since 5 years	5	Aethusa		Fu1: slightly better              Fu2: 3 episodes, better with repetition of remedy Fu3: no headache in the past 5 months. Consistent improvement.	3, 2, 1	25 months
F	5	Chronic daily headache since1 year	5	Lachesis		2 episodes regressed. Remedy repeated, followed by good improvement.	1	3 months
F	13	Headache	4	Natrum muriaticum		Fu1: frequency reduced                  Fu2: recovered	3, 1	3 months
M	12	School headache	4	Magnesia carbonica		No episodes of headache, is well at school	1	3 months
F	15	Headache + behavioral problems	4	Bryonia		No change	4	3 months
F	7	School headache	4	Calcareaphosphorica		Is very well	2	3 months
M	12	Chronic daily headache, severe	6	Natrum muriaticum		Recovered	1	3 months
F	10	Headache + nausea	4	Lac defloratum		Comparatively better	2	3 months
F	11	Chronic daily headache	5	Lac caninum		Comparatively better	2	3 months
M	11	Chronic daily headache + daily abdominal pain	4	Magnesia muriatica		3 episodes in 3 months	2	3 months
M	10	Chronic daily headache + abdominal pain	5	Phosphorus		Comparatively better	3	3 months
F	14	Chronic daily headache	4	Belladonna		Only 2 episodes	2	3 months
M	7	Chronic daily headache	4	Tuberculinum		Slightly better	3	3 months
F	6	Recurring headache (2 -3/week)	5	Sulphuric acid	Lachesis	Fu1: no change                        Fu2: good improvement	5, 2	4 months
F	13	Headache	4	Graphites		Frequency reduced	2	4 months
F	13	Headache	3	Carcinosinum	Lycopodium	Comparatively better	2	5 months
F	11	Chronic daily headache + learning disability + vomiting	5	Baryta carbonica		Fu1: comparatively better                          Fu2: no headache, psychologically well	2, 1	5 months
M	14	Headache + OCD	4	Stramonium		Fu1: better 50%             Fu2: better 80%	2, 1	5 months
M	9	Daily headache since a month	4	Natrum muriaticum		No headache, generally better	1	5 months
F	11	Weekly headache	4	Natrum muriaticum		Fu1: one-episode                Fu2: recovered	2, 1	5 months
M	12	Headache	5	Baryta carbonica		Fu1: comparatively better                    Fu2: one episode	2, 1	5 months
F	10	Headache	4	Tuberculinum	Phosphorus	Fu1: no headache, is well after one-year                              Fu2: onset of influenza (cured with Phosphorus)	2, 1	6 months
F	14	Chronic daily headache since 5 years	5	Silicea		Fu1: slightly better                                   Fu2: very much better	4, 2	6 months
M	18	Recurring headache (2 -3/week)	4	Calcareaphosphorica		Fu1: one episode in 2 months Fu2: recovered	2, 1	6 months
F	17	Headache	4	Phosphorus	Phosphoric acid	Frequency reduced	3	7 months

Fig 1: Analysis of response to treatment