Headache and homoeopathy treatment

Headache and homoeopathy treatment    

Dr Shwetha Bhat

INTRODUCTION

• Headache is a common symptom often associated with disability but rarely life threatening.
• Most common reason for patient consultation in the general neurology atleast 20% are accounting of all consultations

APPROACH TO THE PATIENTS OF HEADACHE

• First step is to distinguish serious from benign etiologies
• Intensity of headaches rarely has diagnostic value
• Headache location can suggest involvement of local structures.
• Provocation by environmental factors suggests a benign cause.

ETIOPATHOLOGY

• Headache results from stimulation/pressure  of any of the pain sensitive structures of the head (All Tissues Covering Cranium, 5^th,9^th,10^th cranial nerves, The Upper Cervical Nerve, Large Intracranial Venous Sinuses, Large Arteries At Base Of Brain, Dural arteries, Dura matter of the skull base).
• Dilatation or contraction of blood vessel walls stimulates nerve endings causing headache.

CLASSIFICATION

• Acute headache-Sudden in onset,resent origin.
• Chronic headache-occurs gradually and lasts for long period.

 TYPES OF ACUTE HEADACHES

Meningitis and other infectious causes

• Acute, Most commonly seen
• Whole cranial pain
• Severe headache associated with fever, photophobia stiffness of neck

Subarachnoid headache

• Most commonly seen acute headache with meningeal irritation
• Space occupying lesions
• Subacute progressive headache

PRIMARY HEADACHES-

MIGRAINE-Headache that lasts 4 to 72 hrs , throbbing, moderate to severe in intensity , is unilateral becomes worse with exertion and associated with nausea vomiting or photophobia or phonophobia. may be associated with focal disturbances

Pathophysiology of migraine- Related to neurovascular dysfunction ,Dilatation of blood vessels innervated by the trigeminal nerve caused by release of neuropeptides from parasympathetic nerve fibers.

Familial hemiplegic migraine  (FHM): Autosomal dominant

Mutation of 3 associated genes –ATP1A2,CACNA1A, SCINA

BASILAR ARTERY MIGRAINE– A uncommon variantAssociated with blindness or visual disturbances throughout both visual fields. Also called as menstrual migraine, since its commonly seen in females.

• Accompanied by dysarthria, dysequilibrium, tinnitus and periodical and distal paraesthesias, transient loss or impairment of consciousness or confessionals state .

TENSION HEADACHE– Most common type of primary headache disorder

• Pericranial bilateral Headache lasts 30 min to 7 days and is NONPULSATING, BANDLIKE discomfort
• Mild to moderate in severity, builds slowly,
• Not aggravated by exertion and not associated with nausea, vomiting, or sensitivity to light , sound or smell.
• Management– Along with therapeutic approach treatment for co-morbid anxiety or depression is important.

Techniques to induce relaxation are useful include;

• Massage ,Hot baths,Biofeedback –Is a process that enables an individual to     learn how to change      physiological activity for the purposes of improving health and performance.
• Precise instruments measure physiological activity such as brainwaves, heart function, breathing, muscle activity, and skin temperature. .
• These instruments rapidly and accurately ‘feed back’ information to the user.
• The presentation of this information—often about changes in thinking, emotions, and behaviour—supports desired physiological changes. Over time, these changes can endure without continued use of an instrument.

 CLUSTER HEADACHE (SUICIDAL HEADACHE)- Headache lasts for 15 to 180 min (3hrs) , is severe, is unilateral is located periorbitally or retroorbital occurs upto 8 times per day , Attacks may last for 4 to 8 weeks

• associated atleast with  the following
• Tearing pain with recurrent episodes
• Conjunctival congestion, unilateral lachrymation
• unilateral nasal congestion, rhinorrhoea ,Facial sweating
• Ptosis, meiosis and anhidrosis (horner syndrome), Unlike migraine , patient tend to move about during attacks,Core feature is periodicity.

Triggering factors– Alcoholism,Stress, glare,Ingestion of specific food

  TRIGEMINAL NEURALGIA (TIC DOULOUREUX)– Causes unilateral    lancinating facial pains

• Severe and repetitive pains
• Precipitated by touching triggering zones within trigeminal territory or by eating.
• Tendency of relapse over the years.

Management- Pharmacological

• Surgical treatment should be considered when response is in complete in young patients
• Decompression of the vascular loop on the trigeminal roots ( 90% success rate).

CAUSES OF SECONDARY HEADACHE

INTRACRANIAL	EXTRACRANIAL	SYSTEMIC
Arteriovenous malformation Benign intracranial hypertension Brain abcess Encephalitis Intracerebral hematoma Meningitis Subarachnoid hemorrhage Subdural hematoma Stroke vasculitis	Cervical spine disorders Dental disorders Giant cell arteritis Glaucoma Optic neurtitis Sinusitis TMJ disorders	Anemia Caffeine withdrawal Fever Hypercapnia Hypertension Hypoxia Vasoactive chemicals viremia

POST TRAUMATIC HEADACHE

• Nonspecific symptoms may follow closed head injury
• Positional Headache appears within a day following injury, may worsen over weeks and gradually subsides.

Lumbar puncture headache– Typical onset within 48 hrs after lumbar puncture

• Seen in 10-30% patients
• Onset when patient sits or stands,
• Relief by lying flat;Mostly remit <1week.
• Dull throbbing headache is frequently seen in case of lumbar puncture may last for several weeks.
• Headache is commonly due to leakage of cerebrospinal fluid through dural puncture site.

Headache due to intracranial lesions– Headache caused due to displacement of vascular structures and other pain sensitive tissues

• Posterior fossa tumors often cause occipital pain.
• Supratentorial lesions  lead to bifrontal headache
• Headache may get worse on exertion and postural changes.

EVALUATION OF HEADACHE IN GENERAL

• Complete neurological examination
• If examination is abnormal or  serious underlying cause is suspected , an imaging study (CT/MRI) is indicated
• Lumbar puncture is required when meningitis is suspected.
• Psychological state of the patient should also be evaluated because a relationship exists between pain and depression.
• Electronystagmogram suggests either peripheral or central vestibulopathy. (is a diagnostic test to record involuntary movements of eyes caused by nystagmus. Also detects the lesion is in eyes, inner ear, brain. )

HOMOEOPATHIC APPROACH- 

Some of the common remedies in homoeopathy that could be used in our daily practice for these varieties of headache according to their symptom similarity are as follows

• Natrum mur- Throbbing pain, pain as if thousand hammers  were knocking on the brain, in the morning on awakening, after menses, from sunrise to sunset, with pale face, nausea and vomiting , periodical. <during menses.
• Bryonia-Headache with nausea, bursting, splitting type, sensation as if everything would be pressed out, as if hit by a hammer from within, headache settles in occiput <motion even of eye balls.
• Belladona-Throbbing pain with fullness especially in forehead, also occiput and temples. Pain < light, noise, lying on right side, in afternoon >pressure, semierrect.
• Iris versicolor- Frontal headache with nausea. Scalp feels constricted. Right temples affected, begins with a blurring of vision, a/f mental stress,<rest.
• Glonine- A/F sunstroke, heat, artificial lights; Throbbing headache, head feels large as if skull were too small for brain, sun headache, increases and decreases with sun. headache in place of menses >uncovering head.
• Spigellia-Pain beneath frontal eminence and temples extending to eyes, unilateral, involving left eye. Pain is violent, throbbing, pain as if a band around the head.
• Sanguinaria-Sun headache (LIKE A FLASH OF LIGHTNING) periodical, begins in occiput spreads upwards and settles over the eyes, especially right headache every 7^th day (sulph,sabad);  <right side ; > lying down , sleep.

REFERENCES

• Longo .L. Dan, Fauci.S.Anthony,Kasper.L.Dennis et al.Harrisons principles of internal medicine 19^th edition.
• Porter Robert S , Justin L. Kaplan The Merck manual 19^th edition
• Colledge.R.Nicki, Walker.R Brian, Ralston.H. Stuart,Davidson’s principles and practice of medicine 21^st edition.
• A.J.Coles, A.J.Larner, N.J.Solding, R.A.Barker;A-Z of neurological practice-a guide to clinical neurology.
• Papadakis .A. Maxine, McPhee.J.Stephen , Rabow.W.Michael, Current medical diagnosis and treatment 2015,54^th edition, Publisher: McGraw-Hill Education.
• Boericke william  Pocket  manual of homoeopathic material medica with repertory,B Jain Publishers,(P) Ltd, new Delhi
• https://migraine.com/migraine-types/basilar-migraine/
• www.medscape.com/