Dr Saja P
Abstract
Headache is one of the man’s most common afflictions. It ranks 9th among the causes of visit to physicians and is a major source both of time lost from work and of medical diagnostic procedures. There are various causes for headache. Most important among the causes of headache are the psychosomatic causes. It is the Physicians task to distinguish among the various causes and plan the treatment accordingly. This articles focuses on the Psychosomatic headaches, its General management and Homoeopathic therapeutics.
Keywords
Psychosomatic, Psychogenic headache, Migraine, Tension Headache, Transcendental meditation, Hypnosis, Biofeedback, Homoeopathic Therapeutics.
Introduction
Headaches are the most common neurological symptom and one of the most common medical complaints. Every year about 80 percent of the population has at least one type of headache, and 10 to 20 percent go to physicians with headache as their primary complaint. Headaches are also a major cause of absenteeism from work and avoidance of social and personal activities.
The majority of headaches are not associated with significant organic disease.
Many persons are susceptible to headaches at times of emotional stress. Moreover, in many psychiatric disorders, including anxiety and depressive disorders, headache is frequently a prominent symptom. Patients with headaches are often referred to psychiatrists by primary care physicians and neurologists after extensive biomedical workups, which often include MRI of the head. Most workups for common headache complaints have negative findings, and such results may be frustrating for both the patient and the physician. Psychological stress usually exacerbates headaches, whether their primary underlying cause is physical or psychological.
TYPES: There are different types of headaches that are not associated with organic causes. The major types of psychosomatic headaches are:
PSYCHOGENIC HEADACHE
Psychiatric causes are among the most frequently missed causes of persistent headaches. Chronic anxiety and depressive syndromes often result in muscular contraction (tension) headaches. Headaches may be the result of hypochondriasis or underlying psychotic disorders (schizophrenia, dementia or delirium).
Many patients with underlying organic causes may develop secondary psychiatric symptoms, which require simultaneous management.
MIGRAINE (VASCULAR) HEADACHES
Migraine (vascular) headache is a paroxysmal disorder characterized by recurrent unilateral headaches, with or without related visual and gastrointestinal disturbances (e.g., nausea, vomiting, and photophobia).
Varying intensities of vascular headaches may present in 15 to 30% of individuals in response to emotional stress or conflicts. The personality of these patients is usually obsessive with overly controlled and suppressed anger. Genetically predisposed to such type of headaches, they develop symptoms under severe nonspecific emotional stress. About two-thirds of persons developing migraine may have family history of similar disorders.
Common precipitants includes overwork, lack of adequate sleep, tyramine containing foods such as cheese and chocolate or other phenylethylamine, monosodium glutamate (Chinese restaurant headache syndrome), menses, fever, drugs.
They are also caused by a functional disturbance in the cranial circulation. Migraines can be precipitated by cycling estrogen, which may account for their higher prevalence in women.
TENSION (MUSCLE CONTRACTION) HEADACHES
Emotional stress is often associated with prolonged contraction of head and neck muscles, which over several hours may constrict the blood vessels and result in ischemia. A dull, aching pain, sometimes feeling like a tightening band, often begins suboccipitally and may spread over the head. The scalp may be tender to the touch and. in contrast to a migraine, the headache is usually bilateral and not associated with prodromata, nausea, or vomiting. Tension headaches may be episodic or chronic and need to be differentiated from migraine headaches, especially with and without aura.
Tension headaches are frequently associated with anxiety and depression and occur to some degree in about 80 percent of persons during periods of emotional stress. Tense, Type A personality traits, high-strung competitive personalities are especially susceptible to the disorder.
The onset of tension headache usually occurs on the weekend or in the early evening, when the person wants to relax but the familial and personal pressures are equal to or greater than those at work.
GENERAL MANAGEMENT:
The major goal in the management of psychosomatic disorders is to mobilize the patient to change behaviour in ways that optimize the process of healing. This may require a general change in lifestyle or a more specific behavioural changes.
STRESS MANAGEMENT AND RELAXATION THERAPY
Cognitive-behavioral therapy methods are increasingly used to help individuals better manage their responses to stressful life events. These treatment methods are based on the notion that cognitive appraisals about stressful events and the coping efforts related to these appraisals play a major role in determining stress responding. Cognitive-behavioral therapy approaches to stress management have three major aims: (1) to help individuals become more aware of their own cognitive appraisals of stressful events, (2) to educate individuals about how their appraisals of stressful events can influence negative emotional and behavioral responses and to help them re conceptualize their abilities to alter these appraisals, and (3) to teach individuals how to develop and maintain the use of a variety of effective cognitive and behavioral stress management skills.
STRESS-MANAGEMENT TRAINING
Five skills: self-observation, cognitive restructuring, relaxation training, time management, and problem-solving.
SELF-OBSERVATION
A daily diary format is used, with patients being asked to keep a record of how they responded to challenging or stressful events that occurred each day.
COGNITIVE RESTRUCTURING
Helping participants become aware of, and change, their maladaptive thoughts, beliefs, and expectations.
RELAXATION EXERCISES
Relaxation Techniques such as Progressive muscle relaxation is a technique to relax without using instrumentation as in biofeedback. Patients are taught to relax muscle groups, such as those involved in “tension headaches.” When they encounter and are aware of situations that caused tension in their muscles, the patients are trained to relax. This method is a type of systematic desensitization—a type of behavior therapy.
TRANSCENDENTAL MEDITATION
Herbert Benson in 1975 used concepts developed from transcendental meditation in which a patient maintained a more passive attitude, allowing relaxation to occur on its own. Benson derived his techniques from various Eastern religions and practices such as yoga.
All of these techniques have in common a position of comfort, a peaceful environment, a passive approach, and a pleasant mental image on which to concentrate.
HYPNOSIS
Hypnosis is effective in smoking cessation and dietary change augmentation. It is used in combination with aversive imagery (e.g.. cigarettes taste obnoxious). Some patients exhibit a moderately high relapse rate and may require repeated programs of hypnotic therapy (usually three to four sessions).
BIOFEEDBACK
Neal Miller in 1969 published his pioneering paper “Learning of Visceral and Glandular Responses”. Human beings able to learn to control certain involuntary physiological responses (called biofeedback) such as blood vessel vasoconstriction, cardiac rhythm, and heart rate. These physiological changes seem to play a significant role in the development and treatment or cure of certain psychosomatic disorders. Such studies, in fact, confirmed that conscious learning could control heart rate and systolic pressure in humans. Biofeedback and related techniques have been useful in tension headaches, migraine headaches, and Raynaud’s disease. Although biofeedback techniques initially produced encouraging results in treating essential hypertension, relaxation therapy has produced more significant long-term effects than biofeedback.
TIME MANAGEMENT
Time-management methods are designed to help individuals restore a sense of balance to their lives. The first step in training in time-management skills is designed to enhance awareness of current patterns of time use. To accomplish this goal, individuals might be asked to keep a record of how they spend their time each day, noting the amount of time spent in important categories, such as work, family, exercise or leisure activities. Alternatively, they may be asked to list the important areas in their lives and then asked to provide two time estimates: (1) the amount of time they currently spend engaging in these activities and (2) the amount of time they would like to spend engaging in these activities. Frequently a substantial difference is seen in the time individuals would like to spend on important activities and the amount of time they actually spend on such activities. With awareness of this difference comes increased motivation to make changes.
PROBLEM-SOLVING
The final step is problem-solving in which patients basically try to apply the best solution to the problem situation and then review their progress with the therapist.
REPERTORIAL APPROACH
SYNTHESIS REPERTORY
- MIND – JOY – headache – from joy
- HEAD – PAIN – anger; after
- HEAD – PAIN – suppressed anger, from
- HEAD – PAIN – excitement, after
- HEAD – PAIN – excitement, depressing or sad news after
- HEAD – PAIN- emotional; after
- HEAD – PAIN- grief; from
- HEAD – PAIN- hysterical headache
- HEAD – PAIN – joy, from excessive
- HEAD – PAIN – mental exertion, after
- HEAD – PAIN – relaxing from mental exertion; on
MURPHY’S REPERTORY
- Headaches – ANGER, from
- Headaches – COMPANY, or crowd, while in
- Headache – CRYING, from suppressed
- Headaches – DEPRESSING, or sad news, after
- Headaches – DREAMS, after unpleasant
- Headache – EMOTIONAL, disturbances, from
- Headache – EXCITEMENT – emotional, after
- Headache – FRIGHT, after
- Headache – GRIEF, from
- Headache – HUMILIATION, from
- Headache – JOY, from excessive
- Headache – MIGRAINE, headaches
- Headache – NERVOUS, headaches
- Headache – VASCULAR, headache
HOMOEOPATHIC MATERIA MEDICA AND REPERTORY DR. WILLIAM BOERICKE
- HEAD – HEADACHE – Cause: Emotional disturbances
- HEAD – HEADACHE – Cause: Mental exertion or nervous exertion
- HEAD – HEADACHE – TYPE – Hysterical
- HEAD – HEADACHE – TYPE – Migraine, megrim, nervous
REPERTORY OF THE HOMOEOPATHIC MATERIA MEDICA BY J.T. KENT
- HEAD – PAIN, anger, from
- HEAD – PAIN, attention, from too eager
- HEAD – PAIN, dreams, after unpleasant
- HEAD – PAIN, excitement of the emotions, after
- HEAD – PAIN, depressing or sad news, after
- HEAD – PAIN, fright, after
- HEAD – PAIN, grief, from
- HEAD – PAIN, hysterical headache
- HEAD – PAIN, joy, from excessive
- HEAD – PAIN, mental exertion, from
- HEAD – PAIN, mortification, from
HOMOEOPATHIC MANAGEMENT
1. Natrum muriaticum
Throbs. Blinding headache. Aches as if a thousand little hammers were knocking on the brain, in the morning on awakening, after menstruation, from sunrise to sunset. Feels too large; cold. Anemic headache of school-girls; nervous, discouraged, broken down. Chronic headache, semi-lateral, congestive, from sunrise to sunset, with pale face, nausea, vomiting; periodical; from eyestrain; menstrual. Before attack, numbness and tingling in lips, tongue and nose, relieved by sleep. Frontal sinus inflammation.
2. Arsenicum album
Headache relieved by cold. Periodic burning pain with restlessness. Hemicrania, with icy feeling of scalp and great weakness. Delirium tremens, cursing, raving; vicious.
3. Bryonia alba
Vertigo, nausea, faintness on rising, confusion. Bursting, splitting headache, as if everything would be pressed out; as if hit by a hammer from within; worse from motion, stooping, opening eyes. Headache becomes seated in occiput. Drawing in bones towards zygoma. Headache; worse on motion, even of eyeballs. Frontal headache, frontal sinuses involved.
4. Cocculus indicus
Vertigo, nausea, especially when riding or sitting up. Sense of emptiness in head. Headache in occiput and nape; worse, lying on back of head. Sick headache from carriage riding, cannot lie on back part of head. Pupils contracted. Opening and shutting sensation, especially in occiput. Trembling of head. Pain in eyes as if torn out of head. From night watching.
5. Kalium carbonicum
After sleepless night, headache with vertigo. Pressure tension in forehead and eyes. Anxious. Heat in head.
6. Sanguinaria Canadensis
Worse right side, sun headache. Periodical sick headache; pain begins in occiput, spreads upwards, and settles over eyes, especially right. Veins and temples are distended. Pain better lying down and sleep. Headaches return at climacteric; every seventh day. Pain in small spot over upper left parietal bone. Burning in eyes. Pain in the back of head “like a flash of lightning”.
7. Menyanthes
Pressing in vertex; better, hard pressure with hand. Pressing-together pain. Weight pressing on brain with every step on ascending. Pain from nape over whole brain; better, stooping, sitting; worse, going upstairs. Cracking in jaw and twitching of facial muscles.
8. Belladonna
Vertigo, with falling to left side or backwards. Sensitive to least contact. Much throbbing and heat. Palpitation reverberating in head with labored breathing. Pain; fullness, especially in forehead, also occiput, and temples. Headache from suppressed catarrhal flow. Sudden outcries. Pain worse light, noise, jar, lying down and in afternoon; better by pressure and semi-erect posture. Boring of head into pillow; drawn backward and rolls from side to side. Constant moaning. Hair splits; is dry and comes out. Headache worse on right side and when lying down; ill effects, colds, etc; from having hair cut.
9. Glonoinum
Confusion, with dizziness. Effects of sunstroke; heat on head, as in type-setters and workers under gas and electric light. Head heavy, but cannot lay it on pillow. Cannot bear any heat about head. Better from uncovering head. Throbbing headache. Angio-spastic neuralgia of head and face. Very irritable. Vertigo on assuming upright position. Cerebral congestion. Head feels enormously large, as if skull were too small for brain. Sun headaches; increases and decreases with the sun. Shocks in head, synchronous with pulse. Headache in place of menses. Rush of blood to head in pregnant women. Threatened apoplexy. Meningitis.
10. Gelsemium sempervirens
Desire to be quiet, to be left alone. Dullness, languor, listless. “Discernings are lethargied.” Apathy regarding his illness. Absolute lack of fear. Delirious on falling to sleep. Emotional excitement, fear, etc, lead to bodily ailments. Bad effects from fright, fear, exciting news. Stage fright. Child starts and grasps the nurse, and screams as if afraid of falling.
11. Silicea terra
Aches from fasting. Vertigo from looking up; better, wrapping up warmly; when lying on left side. Profuse sweat of head, offensive, and extends to neck. Pain begins at occiput, and spreads over head and settles over eyes. Swelling in the glabella.
12. Nux vomica
Very irritable: sensitive to all impressions. Ugly, malicious. Cannot bear noises, odors, light, etc. Does not want to be touched. Time passes too slowly. Even the least ailment affects her greatly. Disposed to reproach others. Sullen, fault-finding.
13. Lycopodium clavatum
Shakes head without apparent cause. Twists face and mouth. Pressing headache on vertex; worse from 4 to 8 pm, and from lying down or stooping, if not eating regularly. Throbbing headache after every paroxysm of coughing. Headaches over eyes in severe colds; better, uncovering. Vertigo in morning on rising. Pain in temples, as if they were screwed toward each other. Tearing pain in occiput; better, fresh air. Great falling out of hair. Eczema; moist oozing behind ears. Deep furrows on forehead. Premature baldness and gray hair.
CONCLUSION
Psychosomatic medicine is a specific area of study in Psychiatry. It is informed by two basic assumptions, there is a unity of mind and body; and psychological factors must be taken into account when considering all diseased states. It relies heavily on examining psychological factors in the maintenance of health and the field of holistic medicine with its emphasis on examining and treating the whole patient, not just his or her diseases or disorders. The concept of psychosomatic medicine also influences the field of behavioural medicine, which integrates the behavioural science and the biomedical approach to the prevention, diagnosis and treatment of diseases.
Homoeopathy as a Holistic treatment method has a lot to offer in this area of diseases and disorders and can act wonders.
REFERENCES
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- .William Boericke. Pocket Manual Of Homoeopathic Materia Medica and repertory. 9’th edition. New Delhi:IBPP; April2014.
- Schroyens F, Synthesis: Repertorium Homeopathicum Syntheticum. Edition 9.1,Noida:B Jain publishers;2016 August.
- Hering C. Herings Guiding Symptoms of Our Materia Medica.Noida:3’rd edition.Vol 5,8. B. Jain Publishers; 2003 Jun 30.
Dr Saja P
MD Scholar Psychiatry
Father Muller Homoeopathic Medical College and Hospital, Mangaluru.
drsajap2@gmail.com,
Good one