Dr Saurabh Kumar Sobhari
Abstract:
Migraine is a widespread and tiring neurovascular disorder that has been recognized since the ancient past. The world health organization has listed migraine as a significant public health concern and major cause of years of life with disability. Modern medicine has little scope in its treatment apart from temporary symptomatic relief during an acute episode, it cannot provide relief in the long run and cannot decrease the repetition or intensity of the attacks. When I entered in real field of combat I couldn’t conquer migraine satisfactorily and lost many patients. So I started to refine and upgrade my ideas and knowledge through various channels and what I could, representing here so others can be benefitted. Proper case taking to form characteristic presentation of illness and to understand susceptibility is important. This article explains how Susceptibility plays a key role to cure patients.
About 10- 12 % of school-age children suffer from migraine. Half of the migraine suffers have their 1st attack before the age of 12. Before puberty, boys suffers from migraine more often than girls, but after adolescence, when oestrogen influence begins in young girls, the risk of migraine and its severity rises in females.
Effects of these factors varies from person to person. The variation in clinical presentation and effect of triggering factor on a person is attributed to individual’s sensitivity and susceptibility. Different clinical presentations depend on the individuality of the person which is influenced by his susceptibility to react to the stimulus as mentioned by Dr. Hahnemann in his Organon of Medicine.
Patients of migraine present with a varied symptom complex due to individual’s own characteristic susceptibility and all the symptoms may not be addressed to with a single medicine. Symptomatology of Migraine varies in terms of sensations, emotional reactions, physical reactions, aggravating and ameliorating modalities, etc. All these are the expression of susceptibility and sensitivity of the patient. In this process detailed clinical presentation along with the physical and emotional reactions are important to identify to understand the susceptibility and sensitivity of the case. The qualitative aspect of susceptibility can identify through the past history and family history of the patients. It is important to understand the susceptibility in follow ups also for better second prescription.
A migraine usually lasts from four to 72 hours if untreated. The frequency with which headaches occur varies from person to person. Symptoms can be – unilateral or bilateral • pain that feels throbbing or pulsing • sensitivity to light, sounds, and sometimes smells and touch • nausea and vomiting • blurred vision • light headedness, sometimes followed by fainting
Postdrome
The final phase, known as postdrome, occurs after a migraine attack. You may feel drained and washed out, while some people feel elated.
Miasmatic phenomena can be varied according to case but majorly Sycotic Miasm dominance is usually found as both dominant and fundamental Miasm.
After proper case taking, case not only ends with selection of proper medicine, but the assessment of susceptibility for proper selection of posology is essential & crucial part for improvement or cure. So it is important to understand the correlation of susceptibility with posology in management of migraine. Usually 200 potency in frequent repetition was required. In patients with Sycotic, dominant and fundamental Miasm and with moderate susceptibility had required more frequent repetition along with anti Miasmatic prescription.
Case:
Preliminary data:
| Name: Mrs. N D | Age: 28 years | Sex: Female |
| Education: B Com | Occupation: Housewife | Marital status: married since 6 years |
| Religion: Hindu | Address: M, Jaipur |
Chief complaint:
| Location | Sensation and pathology | Modalities(<,>) and ailments from | Accompaniments |
| Head Vascular phenomena
Side: Right Vertex Frontal region Onset: Gradual since 4 years Duration: 8 to continue days Frequency: 2-3/week Pace: moderate |
Pain+3
Bursting type+3 Nausea+2 Vomiting+2 Sleeplessness due to pain Heaviness+3 |
>tab analgesic
>Sleep if good < sun+2 < Tension+3 |
Patient as a person:
| Appearance: Centrally obese | Perspiration: Scanty+1 Over face+1, axilla+1, upper lips+2 | Appetite: Decreased Thirst: Normal | Craving: Cheese+2, chicken+2, spicy+3, warm food+2
Aversion: milk+2, |
| Stool: N Urine: N
Obstetric history: P1A0L1D0 |
Menses: Regular, moderate to profuse quantity, dark red, clotted. Pain in B/L: breast before menses | Sleep: 7-8 hrs Disturbed due to thoughts Dreams: Not any | Thermally: Ambithermal
Sun aggravation+3 |
Family history: Fa- DM, IHD Mo- Hypothyroidism Past history: Not specific
Life space: Childhood was very good. She was youngest of all siblings. Average in studies. Had good IPR with college & school friends yet. Shae said she tries to maintain relations. Would weep easily if someone scolds, feels bad. Completed her BCOM and got married at the age of 22 years in same city. At in laws house she lived with MIL, FIL Elder SIL, BIL and husband. Good IPR with husband initially, but MIL and used to taunt her for her work at slow speed and on wake up timing, she complained to her husband about it, but husband asked her to adjust and ignore them. But used to feel angry, but never expressed it to Husband or other members as it was not allowed. Later she came to know that her Husband has extra marital affair. She felt disappointment on husband’s behaviour. After lots of issues still husband is with her. She started with complaints of headache after this incident. She has one female child and worried about her future. She used to weep and has trembling during anger. She felt she is all alone and no one with her.
Physical examination: T- Afeb P- 80/min RR- 18/min B. P.- 110/80mmofhg
Systemic examination: RS – NAD CVS- NAD CNS- NAD P/A- Soft,
CASE TOTALITY AND SUMMARY:
- A/F: Disappointment 2. A/F suppressed anger. 3. Company aversion 4. Forsaken feeling 5. Trembling with anger 7. Menses clotted 8. Aversion- milk, sweets 9. Craving- cheese, chicken, spicy, warm food 10. Sun Exposure < 11. Breast heaviness menses before 12. Head pain bursting right side.
- Understanding of Susceptibility
- Miasmatic : Fundamental : Sycosis
Dominant : Sycosis as holding Disappointment anger since 4 years, nature of disease is neuro vascular where dilatation of vessels takes place. Gradual onset and persist for hours to days.
- Quantitative – moderate as functional pathology with common symptoms as head heaviness, bursting pain etc. sensitivity Moderate Mind- Irritability, brooding, Nerves sensitivity – High for pain; Dreams- not characteristic
- Final medicine – Nat. Mur. 200 HS / weekly
Intercurrent Remedy – Anti Miasmatic Thuja
Acute remedy – Belladonna
- Case summary::
Initially nat. mur 30 given BD without any response. After 1 week Nat. Mur.30 QDS prescribed but headache was not responding even environment was getting worse. After 2 week I gave Thuja 200 Single dose HS and same nat. mur repetition for a week without response.
Nat mur 200 HS weekly after one month and now Nat. mur 200 HS on alternate days with good response.
I’m thankful to Dr shradha because after reading her dissertation I could able to see my inaccuracy in my case taking art of migraine as I didn’t took LSMC in Prodrome, Aura, attack, and post attack phase, I didn’t consider susceptibility initially and many others.
In this case susceptibility and sensitivity both are moderate There was significant relief after increasing Potency, repetition and counselling for IPR issues with husband. Now She is living with in laws family and started job for self-expenses also went for MBA. She is optimistic for her child future. Natrum mur 200 alternate day dose with Thuja 200 SOS helped in reducing the intensity and frequency of headache by 70%.
So understanding of susceptibility is important for cure as termed in APH. 2 by Dr. Hahnemann.
Bibliography :
- Harrison principles of internal medicine, 18th edition
- Lawrence c. Kolb, m.d., modern clinical psychiatry, chapter 24
- “Correlating susceptibility with posology in the management of migraine” by Dr Shradha
- Principles of practice Homoeopathy chapter 15
- ICR operational manual
Dr. Saurabh Kumar Sobhari
M.D. Medicine (Hom.)
Asst. Prof. Practice of Medicine
Naiminath homoeopathic medical college
Agra
