Background – Tension type headache is the most common (69%) type of primary headache. Tension type headache results from various factors like loss of sleep, physical exertion etc. which imposes a huge economic burden on society from lost work time and reduced productivity. Homoeopathy is based on a holistic concept of disease which treats the cause of disease and gives effective relief to patients and thus improves quality of life of patients.
Study design – Prospective, randomised and experimental study before and after without control group. Sample size and study period- 30 cases were studied for a period of one and half years.
Criteria for assessment- 1) episode of headache
2) Intensity of pain
3) Duration of pain
4) Associated complaint
Result– The value of ‘t’ calculated for intensity of pain and episodes of headache in one month is greater than value of ‘t’ table at 5% and 1% level of significance for degree of freedom 29.
Conclusion – The study concluded that homoeopathic medicines are effective in treatment of tension type headaches. Further studies with control groups can provide a greater resource for proving that homoeopathy is effective in treatment of tension type headaches.
Keywords – Homoeopathy, tension type headache, randomized experimental trials without controls
Headache is the most common neurological problem for which patients seek medical attention as it is decreases the quality of life. 
The International Headache Society classified headaches as primary or secondary.  Primary headaches are mainly benign, i.e. clinical examination and investigation are normal.  Tension type headache is most common (69%) type of primary headaches. 
DEFINITION – TTH is a chronic head pain syndrome characterized by bilateral tight, band like discomfort without any accompanying features such as nausea, vomiting, photophobia, phonophobia and aggravate with movements. 
Pain typically builds slowly, fluctuates in severity and may persist for many days (> 15 days/month). 
Pain is usually constant and generalized but often radiates forward from the occipital region. The pain is characteristically less severe in the early part of the day and becomes more troublesome as the day goes on. 
INCIDENCE – The one year incidence for TTH is between 14 and 44 per 1000 persons. It is most common in the reproductive age group. Females are more prone towards it. Ratio between male and females is between 1: 1.2 to 1:3. 
BACKGROUND AND JUSTIFICATION
Tension Type Headache is most common (69%) type of primary headache  affecting almost 14 to 44 per 1000 person in one year globally.  Risk factors for tension type headache include poor self-rated health, loss of sleep, physical exertion, high work load, familial disposition, lack of secondary education etc. Moreover it decreases the person’s quality of life and imposes a huge economic burden on society from lost work time and reduced productivity. 
As tension type headache is most common in females of reproductive age group with ratio of 3:1 (female: male) so I have taken females of reproductive age group i.e from 15 to 45 years of age for my study. Moreover there is limited research on TTH compared to other types of headache.  Homoeopathy is based on a holistic concept of disease, where individualisation of every case is done to treat the internal cause of the disease.
Is homoeopathy effective in reducing the frequency of headache?
Is homoeopathy is effective in reducing the intensity of headache?
Homoeopathy is effective in reducing the frequency of headache.
Homoeopathy is effective in reducing the intensity of headache.
Homoeopathy is not effective in reducing the frequency of headache.
Homoeopathy is not effective in reducing the intensity of headache.
MATERIALS AND METHODS
A. Study settings –
- Study setup –The study was carried out in Bharati Vidyapeeth Homoeopathic Hospital, OPD, IPD and peripheral OPD.
- Study design – Prospective, randomized and experimental study before and after without control of a sample of minimum 30 cases satisfying the case definition and inclusion and exclusion criteria. The study was carried out for a period of one year.
- Sampling procedure –Minimum 30 cases diagnosed with tension type headache selected for the study by simple random technique.
- Case definition – Cases presenting with episodic or chronic headache characterized by bilateral tight, band- like discomfort without any accompanying symptoms which fluctuates in severity and may persist continuously for 30 min to 7 days in females of age group15- 45 years.
- Inclusion criteria –
- All the patients fulfilling the case definition.
- Females of age group 15 to 45 years having tension type headache was included in my study.
- Patients who were willing to participate in research and cooperate for regular follow-ups.
- Exclusion criteria –
- Patients with underlying diseases like head injury, brain tumor etc.
- Cases not fulfilling the case definition.
- Patients having addiction to alcohol, smoking and tobacco chewing.
B. Diagnostic criteria- Diagnosis was done on the basis of ICHD- II diagnostic criteria for tension type headache – 
- At least 10 episodes occurring on less than 1 day/ month on average ( less than 12 days/year) and fulfilling criteria B-D
- Headache lasting from 30 min to 7 days
- Headache has at least 2 of the following characteristics-
- Bilateral headache
- Pressing /tightening (non- pulsating type)
- Mild or moderate intensity
- Not aggravated by routine physical activity such as walking or climbing stairs
- Both of the following
- No nausea or vomiting
- No more than one of photophobia or phonophobia
- Not attributed to another disorder
C. Data collection – It was done according to standardized homoeopathic case proforma and was thoroughly maintained.
D. Selection of remedy – After detailed homoeopathic case taking and physical examination, individualizing totality was formed and the selection of remedy was done according to symptom similarity based on homoeopathic principles.
E. Dose and strength of drug – Potency in centesimal scale was used as per requirements of the patient on the basis of following criteria: 
- HIGH POTENCY –
- Greater the similarity of a remedy to the picture presented by the patient.
- b) Predominant mental in a case.
- Cases no longer responding to lower potency.
- Intercurrent remedy will be prescribed in higher potency
- MEDIUM POTENCY – If any doubt about accuracy of the prescription or about the probability of an aggravation.
- LOW POTENCY – Cases in which mental and physical generals are less.
F. Drug dispensing and administration – This was done in globule, powder and liquid form through oral route.
G. Criteria for follow up – All the patients were followed for 15 days and details of the symptomatic and clinical changes was recorded as follows-
- No. of headache attacks
- Duration of pain
- Intensity of pain
- Associated complaint
- New complaint
H. Criteria for assessment – This was done on the basis of:
- Mental state
- No. of headache attacks
- Duration of pain
- Intensity of pain
- Associated complaint
- Good – symptoms got reduce within 6weeks of treatment.
- Moderate – symptoms got reduce within 6weeks to 6 months of treatment.
- Poor – symptoms got reduced in more than 6 months of treatment.
I. Statistical techniques and data analysis – Observation of all the 30 cases are explained with the help of tables, Pie diagrams and graphs as per the requirement. Statistical analysis has been done by using student’s’ test for finding results and objectives of the study before and after treatment.
OBSERVATIONS AND RESULTS
Observation of all the 30 cases of Tension Type Headache which satisfying the inclusion criteria were studied for a period of one and half years with the help of tables, graphs and pie diagrams. Statistical analysis has been done by using student’s‘t’ test for finding objectives of my study before and after treatment.
- AGE WISE DISTRIBUTION
Bar Diagram No. 1: Age distribution
- RESPONSE TO TREATMENT
Bar diagram No. 2: Response of treatment
- COMPARISON WITH TABLE VALUE
The value of‘t’ table at 5% and 1% level of significance for the degree of freedom 29 is 2.045 and 2.756 respectively . The value of tcal for intensity of pain and frequency of headache in one month is 5.58 and 4.318 respectively. Since the calculated value of ‘ t’ is greater than table value of ‘t’, so null hypothesis is rejected.
- D) INFERENCE
This study provides evidence that there is significant reduction in intensity of pain and frequency of headache before and after treatment with homoeopathic remedies.
My topic was “To study the efficacy of homoeopathic medicine in the treatment of tension type headaches in females”.
Objectives were-1) To reduce the intensity of headache 2) To reduce to episodes of headache
- During the study it was found that 20 cases out of 30 showed marked reduction in intensity of pain (measured by using 11 point pain scale), while 5 cases showed moderate reduction and 5 cases showed no reduction in intensity of pain.
- 23 cases out of 30 cases showed marked reduction in episodes of headache in one month, while 5 cases showed no reduction and 2 cases showed that their episodes of headache increased in one month after taking medicine. In those 2 cases aggravation was not due to the remedy but rather the natural progression of their headache syndrome.
- During the study it was found that Nat Mur was commonly prescribed (5 cases) and Lachesis, Pulsatilla and Nux vomica (3 cases each) were also prescribed.
- On analyzing the 30 cases, it was found that 5 cases were fully cured with constitutional remedy and antimiasmatic, 22 cases got reduction in intensity of pain and episodes of headache but they were not fully cured. 3 patients showed no reduction in intensity as well as in episodes of headache.
- It is observed that females of age group 15 to 35 years of age are commonly affected with tension type headache.
- Lack of control group was the limitation of my study. In future or further studies we can use a control group.