“HOMOEOPATHIC MANAGEMENT OF MIGRAINE IN SCHOOL GOING

CHILDREN BASED ON DISEASE INTENSITY USING CONSTITUITIONAL

REMEDIES”.

A DISSERTATION SUBMITTED IN PARTIAL FULFILLMENT OF THE

REQUIREMENT

FOR THE AWARD OF THE DEGREE OF

DOCTOR OF MEDICINE IN HOMOEOPATHY: M.D. (Hom.)

IN

PRACTICE OF MEDICINE

By
Dr. DIGNA REJI

UNDER THE GUIDANCE OF

Dr. N.V.SUGATHAN M.D. (Hom.)

Prof, Department of Practice of Medicine

SARADA KRISHNA HOMOEOPATHIC MEDICAL COLLEGE,

KULASEKHARAM, TAMIL NADU

SUBMITTED TO

THE TAMILNADU Dr. MGR MEDICAL UNIVERSITY, CHENNAI

2019
 ENDORSEMENT BY THE HEAD OF THE DEPARTMENT AND THE
INSTITUTION

This is to certify that the Dissertation entitled “HOMOEOPATHIC

MANAGEMENT OF MIGRAINE IN SCHOOL GOING CHILDREN BASED ON
DISEASE INTENSITY USING CONSTITUITIONAL REMEDIES " is a bonafide
work carried out by Dr. DIGNA REJI, a student of M.D.(Hom.) in DEPARTMENT
OF PRACTICE OF MEDICINE in the SARADA KRISHNA HOMOEOPATHIC
MEDICAL COLLEGE under the supervision and guidance of
Dr. N.V.SUGATHAN,M.D.(Hom.),Principal and Prof., Dept. of Practice of medicine
in partial fulfilment of the Regulations for the award of the Degree of DOCTOR OF
MEDICINE (HOMOEOPATHY) in PRACTICE OF MEDICINE. This work
confirms to the standards prescribed by THE TAMILNADU DR. M.G.R. MEDICAL
UNIVERSITY, CHENNAI.
This has not been submitted in full or part for the award of any degree or
diploma from any University.

Dr.T.AJAYAN, M.D(Hom.) Dr. N.V.SUGATHAN, M.D(Hom.)

H.O.D Dept. of practice of medicine PRINCIPAL

Place: Kulasekharam
Date:
 CERTIFICATE BY THE GUIDE

This is to certify that the Dissertation entitled “HOMOEOPATHIC

MANAGEMENT OF MIGRAINE IN SCHOOL GOING CHILDREN BASED ON
DISEASE INTENSITY USING CONSTITUITIONAL REMEDIES " is a bonafide
work of Dr. DIGNA REJI. All her work has been carried out under my direct
supervision and guidance. Her approach to the subject has been sincere, scientific and
analytic. This work is recommended for the award of degree of DOCTOR OF
MEDICINE (HOMOEOPATHY) in PRACTICE OF MEDICINE of THE
TAMILNADU DR.M.G.R MEDICAL UNIVERSITY, CHENNAI.

Place: Kulasekharam Dr. N.V.SUGATHAN M.D.(Hom.)

Principal and Professor,
Dept. of Practice of medicine
Date:
 DECLARATION

I, Dr. DIGNA REJI do hereby declare that this Dissertation entitled

“HOMOEOPATHIC MANAGEMENT OF MIGRAINE IN SCHOOL GOING
CHILDREN BASED ON DISEASE INTENSITY USING CONSTITUITIONAL
REMEDIES" is a bonafide work carried out by me under the direct supervision and
guidance of Dr. N.V.SUGATHAN, M.D. (Hom.) Principal and Prof. , Dept. of Practice
of medicine, in partial fulfilment of the Regulations for the award of degree of Doctor of
Medicine (homoeopathy) in PRACTICE OF MEDICINE of The Tamil Nadu Dr.
M.G.R Medical University, Chennai. This has not been submitted in full or part for the
award of any degree or diploma from any University.

Place:kulasekharam Dr. DIGNA REJI

Date:
 ABSTRACT

BACKGROUND

Migraine is one of the common causes of severe, recurring headache; females are more
commonly affects than males. The WHO considered the disability from living with a day of a
migraine attack to be similar to living with a day of quadriplegia. However migraine can be
cured with homoeopathic constitutional treatment. This study was done to evaluate the
efficacy of homoeopathic treatment for migraine with constitutional remedies.

METHODS

A clinical study on thirty cases with Migraine from age group of 12 to 17 years was done at
Sarada Krishna Homoeopathic Medical College Hospital, Rural centres and School Heath
programme. The study cases were selected purposively as per inclusion and exclusion criteria
and diagnosis based on clinical presentation. Improvement criteria were based on the
symptomatic relief according to scoring chart.

RESULTS

The result of this study obtained that 28cases (93.3%) were markedly improved and 2 cases
(6.6%) showed mild improvement. This result was based on statistical analysis of before and
after treatment score.

CONCLUSION

The result of the study shows that homoeopathic constitutional remedies are more
effective in patients with migraine especially in children. Homoeopathy treats the
patient as a whole and it reduces the intensity, prevents the frequent recurrence and thus
improves the Quality of Life.

KEY WORDS: Migraine, Constitutional remedy, School children, Homoeopathy.

 ACKNOWLEDGEMENT
With a devoted heart I thank Almighty God whose grace strengthens me to
complete this work with maximum involvement.

I express my sincere thanks to my guide Dr. N.V.SUGATHAN, M.D. (Hom.),

Principal and Professor of Department of Practice of medicine, Sarada Krishna Homoeopathic
Medical College, Kulasekharam, for the valuable thoughts, guidance and suggestions given
throughout the period of study.

I convey my respectful regards to Dr. C. K. MOHAN B.Sc., M.D. (Hom) Chairman,

Sarada Krishna Homoeopathic Medical College, Kulasekharam for providing the opportunity to
study in this Institution and for providing necessary facilities in the making of this work.

I am thankful to Dr. T.AJAYAN, H.O.D, Department of practice medicine and

Dr.WINSTON VARGHESE, PG co-ordinator, Sarada Krishna Homoeopathic Medical College,
Kulasekharam for their support throughout my study.

I would like to extend my thanks to my teacher Mrs C.V. CHANDRAJA, Research Officer
for their timely support and encouragement. I express my heart full thanks to my respected and
beloved teacher Dr. A. S. SUMAN SANKAR, M.D. (Hom.), Department of Repertory, for his
timely support and sensible advices during my dissertation work. I express my heart full thanks
to my beloved teacher Dr. HARISANKAR .M.D (Hom.) for his timely support and
encouragement. It is my duty to express my sincere thanks to all my kind teachers who lit the
lamp of knowledge in me.

I regard my thanks to librarians and all college staffs for providing the ample support in the
collection of the data and towards the preparation of the work. I am thankful to all the
registration staff and other hospital staff of our hospital, especially the valuable support they had
provided in the completion of this work.

I also extend my thanks to my dear friends Dr.MAHIMA.S, Dr.NITHIN.R.M,

Dr.AMRITHA MOHAN, Dr.RAJESH.R.S, Dr.AYYALAMMAI, Dr. RAKENDU, my
batchmates, seniors, juniors and all my well-wishers for their prayers and immense support.
I acknowledge with deep sense of reverence and gratitude to my parents Dr. K. SATHYA
REJIE, my most lovable mother Dr. VALSA REJIE for their love, care and prayers, my dear
loving brothers Mr. JENKINS REJIE & Mr. COLVIN REJIE. I am grateful to my fiancé Mr.
TITO G DAS for his encouragement, timely support and love. I would have never accomplished
my goal without them. I remain indebted to them for everything I have and whatever I have
achieved. I express my heart full thanks to all patients who had participated in the study.
 TABLE OF CONTENTS

CONTENTS PAGE NO

1. INTRODUCTION 1-3

2. AIMS AND OBJECTIVES 4

3. REVIEW OF LITERATURE 5-26

4. MATERIALS AND METHOD 27-28

5. OBSERVATION AND RESULTS 29-41

6. STATISTICAL ANALYSIS 42-45

7. DISCUSSION 46-48

8. LIMITATION AND 48-49

RECOMMENDATION
9. CONCLUSION 50

10. SUMMARY 51

11. BIBLIOGRAPHY 52-55

12. APPENDICES 56-95

 LIST OF FIGURES

Table No Particulars Pg. No

1. Distribution of case according to age 30

2. Distribution of case according to sex 31

4. Distribution of case according to etiological factor 32

5. Distribution of case according to past history 33

6. Distribution of case according to family history 34

7. Distribution of cases according to medicines prescribed 36

8. Distribution of cases according to potency selected 37

9. Distribution of cases according to mode of administration 38

10. Distribution of cases according to intensity scores of 40

patients before and after treatment

11. Distribution of cases according the improvement status 41

 LIST OF TABLES

Table No Particulars Pg. No

1. Distribution of case according to age 29

2. Distribution of case according to sex 30

3. Distribution of case according to etiological factor 31-32

4. Distribution of case according to past history 33

5. Distribution of case according to family history 34

6. Distribution of cases according to medicines prescribed 35

7. Distribution of cases according to potency selected 36

8. Distribution of cases according to mode of administration 37

9. Distribution of cases according to intensity scores of 38-39

patients before and after treatment

10. Distribution of cases according the improvement status 40

11. Statistical analysis 42-43

 LIST OF ABREVIATIONS USED

SL. NO. ABBREVIATION EXPANSION

1. & And
0
2. F Fahrenheit
3. =,A/F Ailments from

4. BP Blood Pressure

5. % Percentage

6. SL Saccharum Lactis

7. aph, § Aphorism

8. D Dose

9. eg. Example

10. No. Number

11. O/E On Examination

12. OPD Outpatient department

13. IPD In patient department

14. Yrs. Years

15. i.e. That is

16. M Male

17. F Female

18. Marked improvement MI

19. Mild improvement MII

20. BT Blank Tablet

21. HS At bed time

22. < Aggravation

23. > Amelioration

Sl. No. APPENDICES Page. No.

Appendix- I (Glossary)
1. 56

2. Appendix– II (Case Record Format) 57-76

3. Appendix- III (Scoring Chart) 77

78-81
4. Appendix- IV (Consent form)

5. Appendix- V ( Case record of patient) 82-90

6. Appendix - VI (Master Chart) 91-95

LIST OF APPENDICES
1.1 INTRODUCTION

Migraine comes from the Greek word hemikrania, meaning

“half of the head”. The synonyms for Migraine are Hemicranias or

Megrim. Migraine is the most common form of vascular headache,

which can co-exist with psychopathological conditions such as

depression and anxiety. It has been estimated that migraine is the second

most prevalent brain disorder after anxiety. The initial attack of migra ine

can occur at any age. Commonly it begins in childhood, adolescence or

during early adult life with a tendency to decrease in intensity and

frequency as age advances. The clinical type of migraine varies from

patient to patient and even in the same patient from time to time.

Migraine attacks are more often accompanied by one or more of the

disabling symptoms like visual disturbances, nausea, vomiting,

dizziness, extreme sensitivity to sound, light, touch and smell, and

tingling or numbness in the extremities or face.

Migraine is the third most prevalent disease in the world. Migraine

is the sixth most disabling illness in the world. Migraine tends to run in

families. About 90 percent of the migraine sufferers have a family

history of migraine. Most of the sufferers experience attacks once or

twice a month; more than 4 million people have chronic daily migra ine

with at least 15 migraine attack days per month. More than 4 millio n

adults experience chronic daily migraine with at least 15 migraine days

per month. Medication overuse is the most common reason

why episodic migraine turns chronic. Depression, anxiety, and sleep

disturbances are common for those with chronic migraine.

1
 A disabling headache is most probably migraine. Unless one suffers

from the attack of migraine, one cannot understood how severe the pain

of migraine is. The sad thing is that there is considerable disability

associated with this condition in chronic cases which often goes

unrecognised at the clinical settings.

Many homoeopathic medicines had produced symptoms similar to that

of migraine during proving and these medicines will be useful in

reducing the intensity and frequency when administered according to

symptom similarity. Research studies have clearly demonstrated that

Homoeopathy has significant help to offer to patients in terms of reduced

frequency of migrane headaches, reduced intensity of the attacks and

improvement in quality of life after commencing the treatment.

1.2 NEED OF THE STUDY

Migraine is disease which starts from younger age group that is

from the age of 12 due to various etiological factors and get increases in

its frequency and intensity as the age advances.

In Modern Medicine, drugs like Pizotifen, Propranolol,

Topiramate, Timolol, Divalproex sodium are commonly used medicines

for the treatment of Migraine. These medicines have many adverse effects

in our body. Between 17 – 29 % of patients discontinued the medicatio n

because of the adverse effects of the drug such as anxiety, nausea,

vomiting, dryness of mouth, reduced sleep time, drowsiness and

weakness where as in Homoeopathy by taking constitutional medicines

in potentised and the full capacity of the drug is brought out to forcibly

influence the suffering parts of the sick without any adverse effects. In

2
homoeopathic system of medicine treatment is done on the basis of the

principle –“Similia similibus currentur”. Homoeopathic medicines not

only annihilate the disease in its whole extent in the shortest, most

harmless way, but also prevent the complications associated with it.

Through this study we can know the management of migraine in school

children using homoeopathic constitutional treatment by reducing the

intensity, frequency and further progress of the disease as the age

advances.

3
 2. AIMS AND OBJECTIVES

a) To assess the effectiveness of constitutional medicine in pain management and

recurrency of attacks.

b) To know the importance of constitutional remedies indicating symptoms of

migraine.

c) To determine the etiological factors of migraine.

4
 3. REVIEW OF LITERATURE

3.1. DEFINITION:

Migraine is the benign and recurrent headache associated with visual and

gastrointestinal disturbance, neurological dysfunction in varying admixtures with

varied in intensity, frequency and duration; commonly unilateral in onset. It is

associated with conspicuous, sensory, motor and mood disturbances [1, 2] .

3.2. EPIDEMIOLOGY:

Over 20 % of any population world-wide reports with migraine.[1] It is the common

cause of headache, women are most commonly affected than males; it is seen in

approximately 15% of women and 6% of men. [3] Prevalence of migraine without aura

was 2.35% that of migraine with aura was 0.62%. Migraine without aura was equally

distributed among males and females, whereas migraine with aura was preponderant in

the female cohort.

Prevalence of migraine headache in male was constant through the ages, whereas

prevalence of migraine headache in females reached a peak at age 12 and plateau over

the following 2 years. [4]

A rapid growth in incidence amongst girls occurs after puberty which continues

throughout early adult life. By early middle age, about 25% of women experience a

migraine at least once a year, compared with fewer than 10% of men. After menopause,

attacks in women tend to decline dramatically, so that in the over 70s, approximate ly

equal numbers of males and females are sufferers, with prevalence returning to around

5% [5].

5
3.3. AETIOLOGICAL FACTORS:

 Age: The onset may be in childhood, adolescence or early adult life. But rarely

adult life after 35 years of age

 Sex: More common in females than males.

 Hereditary influence: The transmitted factor being an abnormal response of

cranial and other vasculature to certain external or endogenous stimuli [2].

 Precipitating factors

 Foods

 Aged cheese

 Alcohol(particularly red wine and champagne)

 Monosodium glutamate(contained in seasonings and

processed foods)

 Chocolate

 Nuts, oranges, and tomatoes

 Caffeinated beverages

 Nitrates and nitrites(hot dogs, sausages, luncheon meats)

 Avocado

 Smoked or pickled fish or meats

 Onions

 Aspartame(dietary sweetner)

 Yeast or protein extracts(brewer’s yeast, marmite)

6
 Others

 Weather changes

 High altitude (air travel, mountain climbing)

 Medication

 Vasodilators

 Hormones(oral contraceptives, estrogens, clomiphe ne,

danasol)

 Anti-hypertensives (nifedine, captopril, prazosin,

reserpine, minoxidi)

 Histamine-2 blockers(cimetidine, ranitidine)

 Antibiotics(trimethoprim-sulfa, griseofulvin)

 Selective Serotonin Reuptake Inhibitors

 Lifestyle

 Fasting or skipping meals

 Sleep(too little or too much , changes in patterns, e.g.,

jet lag, shift changes)

 Letdown following stress(weekends, vacations, after

exams)

 Caffeine withdrawal[6]

7
3.4. PATHOGENESIS:

The mechanism of migraine remains not completely understood. However, the advent

of new technologies has allowed formulation of current concepts that may explain parts

of the migraine syndrome.

The various theories that explain migraine are

 The Vascular theory

 The Cortical Spreading Depression Theory

 The neurovascular (trigeminal)theory

 The integrated theory

THE VASCULAR THEORY

The vascular theory, which has been popular since the 17 th century, mainta ins

that migraine is a vasospastic disorder, which begins with cerebral vasoconstrictio n.

This vasoconstriction appears to be associated with migraine aura. After the

vasoconstriction phase, intra and extra cranial vessel dilate; activation of the trigemina l

sensory nerves that surround meningeal blood vessels causes pain. Activation of

trigeminal nerve fibres also causes the release of vasoactive neuropeptides, which

further enhance vasodilatation and worse pain. Thus vasodilatation is associated with

the headache phase of migraine.

THE CORTICAL SPREADING DEPRESSION THEORY

The theory of cortical spreading depression has been described in detail by

A.A.P. Leao. Cortical spreading depression is a wave of electrical depolarization that

begins in the occipital cortex, and spreads relatively rapidly (3-5mm/minute) to the

front of the brain. After an initial brief wave of excitation (in migraine with aura), there

8
follows a prolonged period of neuronal depression, which is associated with decreased

neuronal metabolism and regional reduction in cerebral blood flow. The release of

parasympathetic and trigeminal neurotransmitter contributes in part to initial hyper

perfusion of cortex in cortical spreading depression.

A variety of genes coding for metalloproteinases and cycloxygenase2 (COX-2)

are upregulated by cortical depression. Metalloproteinase activation is associated with

leakage of the blood brain barrier. This allows nitric oxide, potassium and adenosine to

reach and sensitize the dural perivascular trigeminal afferents, leading to headache.

THE NEUROVASCULAR (TRIGEMINAL) THEORY

It has been suggested that there is a “migraine generator” in the brainstem that

leads to trigeminal activation.

According to the neurovascular theory, cortical spreading depression or

“triggers” of migraine may activate unmyelinated trigeminal nerve axons, which then

release neuropeptides such as substance P, neurokinin A, and calcitonin-gene related

peptide. These neuropeptides then promote vasodilatation and a sterile inflamma tor y

response around nearby meningeal blood vessels. In addition, these neuropeptides may

sensitize nerve endings, which may result in prolongation of the headache.

THE INTEGRATED THEORY

This theory attempts to combine and consolidate these various theories of

migraine pathogenesis. According to this theory, “triggers” of migraine, such as stress,

noise, certain foods, dilatation of internal or external carotid arteries, or other factors

initially activate certain brainstem centers, such as the locus ceruleus and the dorsal

raphe nucleus. Activating the locus ceruleus causes elevation of epinephrine levels, and

9
the dorsal raphe nucleus causes elevation of serotonin; this results in cerebral

vasoconstriction, leading to localised decrease in cerebral blood flow. The decrease in

cerebral flow is then thought to trigger cortical spreading depression, which in turn

stimules trigeminal nerve fibers, eliciting neurogenic perivascular inflammatio n,

vasodilatation, and headache pain[7].

3.5. CLASSIFICATION OF MIGRAINE

1. MIGRAINE

1.1. Migraine without aura

1.2. Migraine with aura

1.2.1. Typical aura with migraine headache

1.2.2. Typical aura with non- migraine headache

1.2.3. Typical aura without headache

1.2.4. Familial hemiplegic migraine

1.2.5. Sporadic hemiplegic migraine

1.2.6. Basilar-type migraine

1.3. Childhood periodic syndromes that are commonly precursors of migraine

1.3.1. Cyclical vomiting

1.3.2. Abdominal migraine

1.3.3. Benign paroxysmal vertigo of childhood

10
1.4. Retinal migraine

1.5. Complications of migraine

1.5.1. Chronic migraine

1.5.2. Status migrainosus

1.5.3. Persistent aura without infarction

1.5.4. Migrainous infarction

1.5.5. Migraine triggered seizure

1.6. Probable migraine

1.6.1. Probable migraine without aura

1.6.2. Probable migraine with aura

1.6.3. Probable chronic migraine[8].

3.6. CLINICAL MANIFESTATIONS OF MIGRAINE

Age: mostly affects young adults

Sex: common in females

Temperament: obsessional

Family history: positive[9]

11
Migraine should always be thought as a complex neurological disorder with headache

being one of the most common presenting features. Migraine commonly exhibits four

stages during the episode.

 Prodrome

 Aura

 Headache

 Recovery/Postdrome

PRODROME:

Patient feels irritability and depressed, fatigue, yawning, excessive sleepiness, craving

for foods like chocolate, occasional hunger. Patient feels as if gained weight due to

water retention.

These symptoms usually precede the headache phase of migraine attack by several

hours or days and experience teaches the patient or observant family that the migra ine

attack is near.

AURA:

It is comprised of focal neurological phenomenon that precedes or accompany the

attack. They appear gradually over 5 to 20 minutes and usually subside just before the

headache begins.

 VISUAL AURA

Disturbance of vision consisting usually of unformed flashes of

white or rarely multicolored lights, which is known as photopsia or

formation of dazzling zigzag lines, arranged like the battlements of a

castle, hence the term “fortification spectra or Teichopsia”.

12
  SOMATOSENSORY AURA

Lingual or oral paresthesias, a feeling of pain needles

experienced inthe hand and arm as well as in the ipsilateral nose and

mouth area. Paresthesia migrates up the arm and then extends to involve

the lips and tongue.

HEADACHE:

The typical migraine headache is unilateral, throbbing and moderate to severe, can be

aggravated by physical activity. The pain peaks and then subsides, and then usually last

between 4 to72 hours in adults and 1to 48 hours in chidren.

Pain starts above one orbit and spread over entire side of head to the occiput and neck

or begins in back of head and move forward.

Pain is worse in recline position, by shaking head, coughing or straining at stool.

Pain is lessened by sitting or standing, lying down in dark room, vomiting.

ACCOMPANIMENTS

Gastrointestinal- Anorexia, nausea, vomiting, diarrhea

Special senses- Photophobia, phonophobia, osmophobia

Brainstem features- vertigo, ataxia, diplopia, dysarthria.

Autonomic disturbances- Hypertension, hypotension, tachycardia, bradycardia, nasal

congestion

Fluid retention: But rapidly lost by spontaneous dieresis

Mind: psychological upset and confused state

13
POSTDROME

Drained out, exhausted and depressed feeling after headache and may have impaired

concentration, scalp tenderness or mood changes

RECOVERY

Patient experiences a sense of buoyancy and well being. Patients lose several pounds

of water from vomiting and dieresis[10].

3.7. HOMOEOPATHIC CONCEPT:

SAMUEL HAHNEMANN:

To understand the homoeopathic concept of Migraine, The

classification of disease should be known. Hahnemann classified the

disease mainly into three types – Indisposition, Dynamic and surgical

diseases. Dynamic diseases are again classified into acute and chronic

diseases. Headache which lasts for long time comes under chronic

disease with few symptoms, one sided diseases. [11]

RICHARD HUGHES:

He states Migraine is a disease which requires to be closely

individualized. Similimum is administered in frequent doses, during the

paroxysm, in rare ones through the interval, and give it a thorough trial

before you change it. Megrim is a neurosis like epilepsy, having its

periods of incubation and its paroxysms- the latter should be treated with

drugs corresponding to their features Belladonna, Ignatia, Nux vomica,

Digitalis, Cyclamen, Niccolum, Iris and Sangunaria. Sometimes one or

14
 other of these will control the morbid tendency; but more frequently we

have to deal it with by means of deeper acting medicines such as Calcarea,

Sepia, Silicea, Stannum and Zincum which deals with the general disorder

of which the paroxysm are but an expression. By the use of both these

classes of remedies in their respective pace we are best likely to control

the disease now under consideration[12].

CONSTITUTIONAL TREATMENT

Hahnemann in his organon of medicine in aphorism 5

“Useful to the physician in assisting him to cure are the particulars of the most probable

exciting cause of the acute disease as also the most significant points in the whole

history of the chronic disease, to enable him to discover its fundamental cause, which

is generally due to a chronic miasm. In these investigations, the ascertainable physical

constitution of the patient(especially when the disease is chronic), his moral and

intellectual character, his occupation, mode of living and habits, his social and domestic

relations, his age, sexual function, &c., are to be taken in consideration. [11]

Dr. M.L Dhawale says that understanding a human being and what ails him will ever

remain the most difficult task confronting the physician. We have learnt that the remedy

will be known to us through the individual features of the case as against the group

features that enable us to diagnose the clinical condition. Our chief concern during case

receiving, therefore, will be to bring out this individuality which is made known to us

through the chief complaint, concomitants, and the type of individual afflicted. [13]

Constitution can be defined as the “the genotypic inheritance of an individual, the

physical make up of his body, including its functional ability, metabolic activity,

reaction to stimuli and resistance to infection.” During the process of remedy selection,

15
a Homoeopath tries to individualise the patient based on his physical built, his morality,

social behaviour, his desires and aversions in common, etc. Every person inherits some

characters or tendencies from his parents and some tendencies he acquires from his

surroundings that constantly influence him. So constitution is the aggregate of the

external and internal characters of an individual. In Homoeopathy, the nature of the

patient is judged by his temperament, heredity, predisposition, miasms and

constitutional diathesis and the present condition of body mind. The method of

constitutional treatment is unique to Homoeopathy. It is believed that the constitutio na l

medicine can correct the inherent and acquired defects in the personality. Well selected

deep acting Homoeopathic remedy is equal to the constitutional remedy. [14]

3.8 MIASMATIC CONSIDERATION OF MIGRAINE [15,16,17]

Psoric Migraine Sycotic Migraine Syphilitic Migraine

Mostly occipital or

Headache mostly frontal, temporal. Occasionally in

Frontal vertex and
temporal, of the vertex or the base of the brain, the
occasionally parietal.
may be of the whole head. internal head and the

meninges.

Sharp, severe, paroxysmal Stitching, tearing, boring,

headaches are often digging, maddening,

psoric, as are long sharp, cutting sensations.

Dull, aching, heaviness
standing headaches such Headaches often persist
and reeling
as migraines, especially and may occur constantly

when of a functional to one side at the base of

character. the brain.

16
Headache with bilious

attacks, nausea, vomiting,

coming once or twice a

month.

Headache from hunger

and headache, which

Rest, humidity, morning
increases and decreases Night time, evening to
to night time, midnight,
with the sun. Aggravation morning, rest, lying
lying down and cold
occurs in the morning, down, the warmth of bed,
aggravates; whilst
from motion, cold, hot or warm weather,
motion, violent exercise,
anxiety and the sun. natural discharges and
warmth and abnormal
Amelioration is from rest, exertion, all aggravates.
discharges ameliorates.
quiet, sleep, warmth and

natural eliminations.

3.9. REPORTORIAL REPRESENTATION

 BOERICKE’S REPERTORY

HEAD- Migraine(megrim, nervous)-anac, arg n, bell, calc ac, can ind,

17
 dm, coco, coff, eye, epiph, gels, guar, ign, iris, kali c, lac deft,lach,

meli, menisp, nuxvom, onos, puts, sang, scutel, sep. [18]

 CONCISE REPERTORY- PHATHAK

MIGRAINE- chio, gels, ipec, kali bi, lac defl, natmur, natsul, onos,

psor. lob, sang, spig, sil, ther.[19]

 KNERR REPERTORY

Inner head- hemicranias (megrim, migraine)- Cham, sil, apis, arg nit,

am, ars, asar, bar c, bry,calc, caps, clem, chin, cocc, cornus,

gels,indigo, kali bi, kreos, lach, lac defl, syph, vert alb.

Inner head-hemicranias(megrim,migraine)-rheumatic, with

children- CALC.[20]

 BOGER’S REPERTORY

Head internal – Migraine – COLO. PULS. NUXVOM, SANG, SEP [21]

 KENT’S REPERTORY

No direct rubric

Head- Pain chronic

Head- Pain fasting from

Head – Pain vomiting with

Head – Pain vomiting amel.

Vision - flickering – Headache before. [22]

 MURPHY’S REPERTORY

Headaches – Migraine – acon., AGAR., anac., ANT-C.,apis,arg.,

arn.,ars., ASAF., asar.,aur., bell., BRY., cact.,calad., calc., calc-

p.,caust., cedr., cham., chel., CHIN.,cic., cimic., cina, cocc., COFF.,

coloc., eup-per., GELS., glon., graph., IGN., IP., IRIS, kali-bi.,

18
 kali-p., LAC-C.,lach., lyc., NAT-M., nat-s., NUX-V., op., PHOS.,

PULS., SANG.,scut., sep., SIL.,spig., stram., sulph., tab.,tarent.,

ther., THUJ., valer., ZINC.[23]

3.10. CONSTITUTIONAL REMEDIES USED IN THIS STUDY

ARSENICUM ALBUM

Headache relieved by cold, other symptoms are aggravated by cold. Periodical

burning pain, with cold skin. Hemicrania(migraine), with an icy feeling on the

scalp and great weakness. Head sensitive, in open air. Head is in constant motion.

Burning in eyes, with acrid lacrymation. Edema around the eyes. Intense

photophobia; better external warmth. Cannot bear the sight or smell of food.

Excessive exhaustion from least exertion.

BELLADONNA

Vertigo, with falling to the left side or backwards. Sensitive to least contact.

Vertigo

when stooping or rising after stooping on every change of position. Severe

throbbing and heat. palpitation reverbate in the headwith labored breathing. Pain;

fullness, especially in the forehead, occiput and temples. Rush of blood to head

and face. Headache from suppressed catarrhal flow. Sudden outcries. Pain worse

light, noise,jar, lying down and in the afternoon; better by pressure and in a semi-

erect position. Boring of head in the pillow; drawn backwards and rolls from side

to side. Headache worse on the right side and on lying down; ill effects,cold etc.,

from having a hair cut.

19
CALCAREA CARBONICUM

Sensation of weight on top of the head. Headache, with cold hands and feet.

Vertigo on ascending and on turning the head. Headache from over lifting, from

mental exertion, with nausea. Head feels hot and heavy with pale face. Icy

coldness in, and on the head, especially right side. Head enlarged; much

perspiration, wets the pillow. Itching of the scalp. Scratches the head on waking.

Sensitive to light(photophobia).

CALCAREA PHOSPHORICA

Headache, worse near the region of sutures, from change of weather, in school

children around pubertal age. Headache of school girls. Cranial bones soft and

thin. Headache with abdominal flatulence(sick headache). Head hot, with

smarting in the roots of hair.

LYCOPODIUM CLAVATUM

Shakes head without any apparent cause. Twists face and mouth. Pressing

headache on the vertex; worse from 4 to 8 p.m. and from lying down or stooping,

if not eating regularly. Throbbing headache after every paroxysm of cough.

Headaches over the eyes in severe colds; better uncovering. Vertigo in the

morning on rising. Pain in the temples, as if they were screwed together. Tearing

pain in the occiput; better, fresh air.

20
NATRUM MURIATICUM

Throbs. Blinding headache. Aches as if thousand little hammers were knocking

on the brain, in the morning on awakening, after menstruation, from sunrise to

sunset. Feels too large; cold. Headache; beginning with blindness; with zig- zag

dazzling like lightning in eyes, ushering in a throbbing headache; from eye strain.

Anemic headache of school girls; nervous, discouraged, broken down. Chronic

head ache, semi-lateral, congestive, from sunshine to sunset, with pale face,

nausea, vomiting; periodical eyestrain; menstrual, before attack, numbness and

tingling in lips, tongue and nose, relieved by sleep.

NUX VOMICA

Headache in the occiput or over the eyes, with vertigo; brain feels as if turning in

a circle. Over sensitiveness. Vertigo with momentary loss of consciousness.

Intoxicated feeling; worse morning, mental exertion, tobacco, alcohol, coffee,

open air. Pressing pain in the vertex, as if nail was driven in. Vertigo in the

morning and after dinner. Frontal headache, with desire to press the head against

something. Congestive headache, associated with haemorrhoids. Headache in the

sunshine (sunstroke). Feels distended and sore within, after a debauch.

PULSATILLA PRATENSIS

Wandering stitches around the head; pain extends to the face and teeth; vertigo;

better in open air. Frontal and supra- orbital pain. Neuralgia pain, commenc ing

in the right temporal region (migraine), with scalding lachrymation from the

affected side. Headache from overwork. Pressure on vertex.

21
SANGUINARIA CANADENSIS

Worse right side, sun headache. Periodical sick headache. Pain begins in the

occiput, spreads upwards and settles over the eyes, especially right (migraine).

Pain begins in morning, increases during the day, lasts until evening; head feels

as if it would burst, or as if eye would be pressed out; relieved by sleep. Veins in

the temples are distended. Pain better lying down and sleep. Headaches return at

climacteric; every seventh day. Pain in a small spot over the upper left parietal

bone. Burning in eyes. Pain in the back of head “like a flash of lightening”.

SEPIA OFFICIANALIS

Vertigo, with sensation of something rolling round in head. Prodromal symptoms

of apoplexy. Stinging pain from within outward and upward mostly left, or in

forehead, with nausea, vomiting; worse indoors and when lying on painful side.

Jerking of head backwards and forwards. Coldness of vertex. Headache in terrible

shocks at menstrual nisus, with scanty flow. < motion, stooping, mental labor, >

external pressure, continued hard motion.

SILICEA TERRA

Aches from fasting. Vertigo from looking up; better, wrapping up warmly; when

lying on left side. Profuse sweat on head, offensive, and extends to the neck. Pain

begins in the occiput and spreads all over the head and settles over the eyes.

Chronic sick headache, since some severe disease of youth; ascending from nape

of neck to the vertex, as if coming from the spine and locating in one eye

especially the right ; <draft of air or uncovering the head; > pressure and

wrapping up warmly; > profuse urination.

22
Swelling in the glabella. Aversion to light, especially daylight; it produces

dazzling, sharp pain through eyes; eyes tender to touch; worse when closed.

Vision confused; letters run together on reading.

SPIGELIA

Pain beneath frontal eminence and temples, extending to eyes. Semi-latera l,

involving left eye; pain violent, throbbing; worse making false step. Nervous

headache; beginning in morning at base of brain, spreading over the head and

locating in eye, orbit at temple of left side; pain pulsating violent, throbbing.

Headache; at sunrise, asits heightat noon, declines till sunset. Pain as if a band

around head. Vertigo, hearing exalted. Eyes feels too large; pressive pain on

turning them. Pupils dilated; rheumatic ophthalmia. Severe pain in and around

eyes, extending deep into socket. Ciliary neuralgia, a true neuritis.

STAPHYSAGRIA

Stupefying headache; passes off with yawning. Brain feels squeezed. Sensation

of a ball of lead in forehead. Itching eruption above and behind ears. Heat in

eyeballs, dims spectacles.Bursting pain in eye-balls of syphilitic iritis.

SULPHUR

Constant heat on top of head. Heaviness and fullness, pressure in temples.

Beating headache; worse, stooping, and with vertigo. Sick headache , every week

or every two weeks, prostrating, weakening; with hot vertex and cold feet. Halo

around lamp-light. Heat and burning in eyes. Blackmotes before eyeschronic

opthalmia, with much burning and itching. Oversensitive to odors[18,24].

23
3. 11. PREVIOUS STUDY BASED ON MIGRAINE IN CHILDREN:

 A cross-sectional study was performed on 930 school children (aged 12–14

years) through cluster sampling method. International Headache Society criteria

were used for diagnosis. Descriptive statistics and logistic regression were used

for data analysis. The prevalence of migraine headache was 12.3% and tension-

type headache was 4.2%. The factor associated with migraine in multivar ia te

analysis were age and sleep disturbances. [25]

 Studies from Scandinavia reveal increasing prevalence in age groups from 8

years of age and upward. At present, 66% to 71% of 12- to 15-year-olds have

at least one headache every three months, and 33% to 40% have at least one per

week. [26]

 Another study conducted on Monreale, assessed the prevalence of migra ine

headaches in an epidemiological survey of an 11 to 14-year-old student

population. Migraine headaches were classified on the basis of questionna ires

and neurological examination using the operational diagnostic criteria of the

International Headache Society. Prevalence of migraine without aura was

2.35%; that of migraine with aura was 0.62%. Migraine without aura was

equally distributed among males and females, whereas migraine with aura was

preponderant in the female cohort. [27]

 Homeopathic treatment of migraine in children: results of a prospective,

multicenter, observational study were conducted. The study was conducted in

12 countries worldwide. Fifty-nine (59) physicians trained in the prescriptio n

of homeopathic medicines and 168 children, aged 5–15 years, and with definite

or probable migraine diagnosed using International Headache Society 2004

24
 criteria were the subjects in this study. As a result of the study they found that

the frequency, severity, and duration of migraine attacks decreased significa ntly

during the 3-month follow-up period (all p<0.001). Preventive treatment during

this time consisted of homeopathic medicines in 98% of cases (mean=2.6

medicines/patient). Children spent significantly less time off school during

follow-up than before inclusion (2.0 versus 5.5 days, respectively; p<0.001).

The most common preventive medicines used were Ignatiaamara(25%; mainly

9C), Lycopodium clavatum (22%), Natrum muriaticum (21%), Gelsemium

(20%), and Pulsatilla (12%; mainly 15C). Homeopathy alone was used for the

treatment of migraine attacks in 38% of cases. The most commonly used

medicines were Belladonna (32%; mainly 9C), Ignatiaamara (11%; mainly

15C), Iris versicolor (10%; mainly 9C), Kaliumphosphoricum (10%; mainly

9C), and Gelsemium (9%; mainly 15C and 30C).The results of this study

decrease in the frequency, severity, and duration of migraine attacks was

observed and, consequently, reduced absenteeism from school[28].

 Homeopathic Treatment of Patients with Migraine: A Prospective

Observational Study with a 2-Year Follow-Up Period: A prospective

multicenter observational study. Consecutive patients beginning homeopathic

treatment in primary care practices were evaluated over 2 years using

standardized questionnaires. The data recorded included diagnoses

(International Classification of Diseases, Ninth Revision) and current

complaints, including their severity (numeric rating scale = 0–10), health-

related quality of life (QoL, 36-item Short-Form Health Survey), medical

history, consultations, homeopathic and conventional treatments, as well as

other health service use. Two hundred and twelve (212) adults (89.2% women),

25
mean age 39.4 ± 10.7 years were treated by 67 physicians. Patients had suffered

from migraine for a period of 15.2 ± 10.9 years. Most patients (90.0%) were

conventionally pretreated. The physician workload included taking the initia l

patient history (120 ± 45 minutes), case analysis (40 ± 47 minutes), and follow-

ups (7.3 ± 7.0, totaling 165.6 ± 118.8 minutes). Patients received 6.2 ± 4.6

homeopathic prescriptions. Migraine severity showed marked improve me nt

with a large effect size (Cohen's d = 1.48 after 3 months and 2.28 after 24

months. QoL improved accordingly (Mental Component Score and Physical

Component Score after 24 months: 0.42 and 0.45). The use of conventio na l

treatment and health services decreased markedly. In this observational study,

patients seeking homeopathic treatment for migraine showed relevant

improvements that persisted for the observed 24 month period. Due to the

design of this study, however, it does not answer the question as to whether the

effects are treatment specific or not [29].

26
 4. MATERIALS &METHODS

4.1. SOURCE OF DATA

30 selected cases of the patients with migraine visiting the OPD, IPD and Rural

Centers and from school health programme of Sarada Krishna Homoeopathic Medical

College. Age groups of 12-17 years were taken for the study.

4.2. METHOD OF COLLECTION OF DATA

 Sample Size – Minimum 30 cases.

 Sampling Technique – Purposive Sampling.

 Cases have been recorded in standardized pre structured case format.

 The cases were recorded according to holistic concept by interview technique

and observation.

4.3. INCLUSION CRITERIA:

 Age groups between 12-17 years.

 Both sexes.

 Diagnostic criteria will be included after symptomatological screening.

4.4. EXCLUSION CRITERIA:

 Age groups below 12 years & above 17 years.

 Migraine in patients with other systemic diseases.

27
4.4. METHODOLOGY:

 Purposive selection of 30 cases of school children with Migraine is carried

out in Sarada Krishna Homoeopathic medical college and hospital OPD, IPD,

RHC and School Health Programme.

 The case history was taken with holistic concept (etiological factors, mental

generals, physical generals, concomitants, characteristics particulars).

 Diagnosis was done according to clinical presentation, clinical history and

physical examination of patient.

 The cases will be analyzed and evaluated and a constitutional remedy will be

prescribed after referring the Materia Medica.

 Repetition and change of potency and remedy were done as and when needed

according to Homoeopathic principles based on Organon of medicine.

 Assessment of reduction in intensity and frequency of attacks will be done using

a scoring chart prepared from International Headache Society once in a week

or two weeks and the changes will be recorded.

28
 5.1 OBSERVATIONS AND RESULT

A sample of 30 cases of Migraine from the patients who attended

the Out Patient Department, Rural centres and from the school health

programme of Sarada Krishna Homoeopathic Medical College and

Hospital was taken for this study. This section contains observation and

result of tables and charts for the cases and also statistical analysis was

done in these cases.

5.1.1 DISTRIBUTION OF CASES ACCORDING TO AGE

Table No – 1
SL. NO AGE NO OF CASES PERCENTAGE

1. 12 7 23.33%

2. 13 4 13.33%

3. 14 1 3.33%

4. 15 4 13.33%

5. 16 5 16.68%

6. 17 9 30%

29
 Figure No. 1

DISTRIBUTION OF CASES ACCORDING TO AGE

10
9
9
8
7
7
NO OF CASES

6
5
5
4 4
4
3
2
1
1
0
12 13 14 5 16 17
AGE GROUP

In sample of 30 cases, maximum 9 patients (30%) were in the age of 17,7patients

(23.33%) were in the age of 12, 5 (16.68%) patients were in the age of 16,4patients

(13.33%) were in age group of 13 and 15, and 1patient (3.33%) was in the age of 14.

5.1.2 DISTRIBUTION OF CASES ACCORDING TO SEX

Table No – 2
SL.NO SEX NO OF PERCENTAGE
CASES
1. MALE 8 26.67%

2. FEMALE 22 73.33%

30
 Figure No. 2

DISTRIBUTION OF CASES ACCORDING TO SEX

MALE
FEMALE

22

Among 30 cases 22 (73.33%) were females and 8(26.67%) were

males. According to this study Migraine is more prevalent in females.

5.1.3 DISTRIBUTION OF CASES ACCORDING TO AETIOLOGICAL

FACTOR
Table No – 3

Sl.No Etiology No of Percentage

cases
1. Sun 17 56.67%
exposure
2. Mental 10 33.33%
exertion
3. Physical 9 30%
exertion
4. Noise 9 30%

31
 5. Morning 5 16.67%
6. Skipping 4 13.33%
meals
7. Evening 4 13.33%
8. Before 4 13.33%
mensus
9. Travelling 3 10%
10. Loss of sleep 3 10%
11. Cold 3 10%
exposure
12. Strong odors 1 3.33%
13. Perspiration 1 3.33%

Figure No. 3

DISTRIBUTION OF CASES ACCORDING TO

AETIOLOGICAL FACTOR
Perspiration 1
1
ETIOLOGICAL FACTOR

Cold exposure 3
3
Travelling 3
4
Evening 4
4
Morning 5
9
Physical exertion 9
10
Sun exposure 17
0 2 4 6 8 10 12 14 16 18
NO OF CASES

Out of 30 cases 17 (56.67%) case the main etiological factor is sun exposure, 10

(33.33%) cases mental exertion, 9 (30%) cases physical exertion and noise, 5

(16.67%) cases morning, 4 (13.33%) cases skipping meals, evening and before

32
mensus, 3 (10%) cases travelling, loss of sleep and cold exposure, 1 (3.33%)

case from strong odors and perspiration.

5.1.4 DISTRIBUTION OF CASES ACCORDING TO PAST HISTORY

Table No – 4

Sl No Past History No of Percentage

cases
1. Measles 10 33%
2. Chickenpox 8 26%
3. Typhoid 6 20%
4. Jaundice 3 10%
5. Dengue 2 6%
6. Pneumonia 1 3%
7. Primary 1 3%
Tuberculosis
8. No illness 7 23%

Figure No. 4

DISTRIBUTION OF CASES ACCORDING TO PAST

HISTORY
12 10
10
NO OF CASES

8
8 7
6
6
4 3
2
2 1 1
0

PAST ILLNESS

33
Out of 30 cases 10 (33%) have past history of measles, 8 (26%) had

chickenpox, 6 (20%) had typhoid, 3 (10%) had jaundice, 2 (6%) had dengue, 1

(3%) had pneumonia and primary tuberculosis and 7 (23%) had no illness.

5.1.5 DISTRIBUTION OF CASES ACCORDING TO FAMILY HISTORY

Table No – 5

Sl. Family History No of Percentage

No cases
1. Diabetes 5 16%
2. Hypertension 4 13%
3. Asthma 3 10%
4. Migraine 2 6%
5. Cancer 2 6%
6. Rheumatic 1 3%
complaints
7. MI 1 3%
8. No illness 11 36%

Figure No. 5

DISTRIBUTION OF CASES ACCORDING TO FAMILY

HISTORY

No illness 11
MI 1
FAMILY HISTORY

Rheumatic complaints 1
Cancer 2
Migraine 2
Asthma 3
Hypertension 4
Diabetes 5

0 2 4 6 8 10 12
NO OF CASES

34
The study in respect to family history out of 30 cases, 11 (36%) patients does

not have any family history, 5 (16%) had a family history of Diabetes Mellitus,

4 (13%) had a family history of Hypertension, 3 (10%), 2 (6%) had a family

history of Migraine and Cancer and 1 (3%) had family history of Rheumatic

complaints and MI.

5.1.6 DISTRIBUTION OF CASES ACCORDING TO MEDICINE

Table No – 6

Sl. Medicine No of Percentage

No cases
1. Lycopodium 7 23%
Clavatum
2. Calcarea 6 20%
Carbonicum
3. Silicea Terra 3 10%
4. Natrum 2 6%
Muriaticum
5. Sulphur 2 6%
6. Calcarea 2 6%
Phosphoricum
7. Nux vomica 2 6%
8. Pulsatilla 1 3%
Nigricans
9. Arsenicum Album 1 3%
10. Belladonna 1 3%
11. Staphysagria 1 3%
12. Spigelia 1 3%
13. Sanguinaria 1 3%
Canadensis

35
 Figure No. 6

DISTRIBUTION OF CASES ACCORDING TO MEDICINE

Lycopodium Clavatum
Calcarea Carbonicum
1 Silicea Terra
1 1 1 1
1 7 Natrum Muriaticum
Sulphur
2
Calcarea Phosphoricum
2
6 Nux vomica
2
Pulsatilla Nigricans
2 3
Arsenicum Album
Belladonna
Staphysagria
Spigelia
Sanguinaria Canadensis

For all the 30 cases Constitutional medicine was prescribed. Lycopodium

Clavatum was given for 7 cases (23%), Calcarea Carbonicum for 6 cases (20%),

Silicea Terra for 3 (10%), Natrum Muriaticum and Sulphur for 2 cases (6%),

Pulsatilla Nigricans, Arsenicum Album, Belladonna, Staphysagria, Spigelia and

Sanguinaria Canadensis for each case.

5.1.7 DISTRIBUTION OF CASES ACCORDING TO POTENCY

Table No – 7

Sl. No Potency No of Percentage

cases
1. 200 12 40%
2. 30 7 23.33%
3. 0/3 5 16.67%
4. 1M 4 13.33%
5. 0/1 2 6.67%

36
 Figure No. 7

DISTRIBUTION OF CASES ACCODING TO

POTENCY

4
200
12 30
0/3
5 1M
0/1

In all 30 cases potency was selected based on Homoeopathic principles. Out of

30cases, 12 cases (40%) 200 was given, 7 cases (23.33%) 30 was given, 5

cases (16.67%) 0/3 was given, 4 cases (133.33%) 1M was given and for 2 cases

(6.67%) 0/1 was given.

5.1.8 DISTRIBUTION OF CASES ACCORDING TO MODE OF

ADMINISTRATION OF MEDICINES

Table No – 8

Sl. Mode of No of Percentage

No administration cases
1. Water dose 18 60%
2. Dry dose 12 40%

37
 Figure No. 8

DISTRIBUTION OF CASES ACCORDING TO MODE

OF ADMINISTRATION

12

Water dose
18
Dry dose

Out of 30 cases, for 18 cases (60%) medicine was administered in water dose

and for 12 cases (40%) medicine was administered in dry dose.

5.1.9 DISTRIBUTION OF CASES ACCORDING TO DISEASE

INTENSITY SCORES OF PATIENTS BEFORE AND AFTER
TREATMENT.

Table No – 9
Sl. No Before Intensity After Intensity
score score
1. 19 4
2. 21 8
3. 19 3
4. 20 4

38
5. 18 4
6. 22 6
7. 21 4
8. 20 5
9. 18 1
10. 19 2
11. 21 3
12. 20 7
13. 17 1
14. 22 7
15. 21 4
16. 17 4
17. 19 5
18. 20 6
19. 20 9
20. 21 7
21. 18 6
22. 21 5
23. 19 1
24. 19 4
25. 20 5
26. 21 10
27. 18 3
28. 21 4
29. 22 5
30. 17 1

39
 Figure No. 9

DISTRIBUTION OF CASES ACCORDING TO DISEASE

INTENSITY SCORE
25
22 22 22
21 21 21 21 21 21 21 21
20 20 20 20 20 20
19 19 19 19 19 19
20 18 18 18 18
17 17 17

15

10
9
10 8
7 7 7
6 6 6 5
5 5 5 5
4 4 4 4 4 4
5 4 3 3 3 4
2
1 1 1 1
0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

Before Intensity score After Intensity score

From the above chart, it is inferred that Homoeopathic Constitutional treatment

showed significant reduction in the intensity scoring in all migraine cases.

5.1.10 DISTRIBUTION OF CASES ACCORDING TO THE

IMPROVEMENT STATUS

Table No – 10

Sl.No Intensity Improvement No Percentage

score status of
Range case
s
1. 0-8 Marked 28 93.3%
improvement
2. 9-16 Mild 2 6.6%
improvement

40
 3. 17-24 No 0 0%
improvement
Figure No. 10

DISTRIBUTION OF CASES ACCORDING TO

IMPROVEMENT STATUS
28
30
NO OF CASES

25
20
15
10
5 2
0
0
Marked No of cases
improvement Mild improvement
0-8 No improvement
9-16
17-24

IMPROVEMENT STATUS

In my study, out of 30 cases of migraine, 28 cases (93.3%) showed marked

improvement, 2 cases (6.6%) showed mild improvement.

41
 5.1 STATISTICAL ANALYSIS

SL.NO X Y d=X-Y d-d̅ (d-d̅)2

1
19 4 15 -0.1 0.01
2
21 8 13 -2.1 4.41
3
19 3 16 0.9 0.81
4
20 4 16 0.9 0.81
5
18 4 14 -1.1 1.21
6
22 6 16 0.9 0.81
7
21 4 17 1.9 3.61
8
20 5 15 -0.1 0.01
9
18 1 17 1.9 3.61
10
19 2 17 1.9 3.61
11
21 3 18 2.9 8.41
12
20 7 13 -2.1 4.41
13
17 1 16 0.9 0.81
14
22 7 15 -0.1 0.01
15
21 4 17 1.9 3.61
16
17 4 13 -2.1 4.41
17
19 5 14 -1.1 1.21
18
20 6 14 -1.1 1.21
19
20 9 11 -4.1 16.81
20
21 7 14 -1.1 1.21
21
18 6 12 -3.1 9.61

42
 22
21 5 16 0.9 0.81
23
19 1 18 2.9 8.41
24
19 4 15 -0.1 0.01
25
20 5 15 -0.1 0.01
26
21 10 11 -4.1 16.81
27
18 3 15 -0.1 0.01
28
21 4 17 1.9 3.61
29
22 5 17 1.9 3.61
30
17 1 16 0.9 0.81

Total 453 104.7

X= Score before treatment D= Mean difference

Y= Score after treatment

A. Question to be answered:

Whether constitutional treatment is useful in the management of Migraine in school

going children?

B. Null Hypothesis:

There is no difference between the scores taken before and after Homoeopathic

treatment.

43
C. Standard error of the mean differences:

The mean of the differences, d̅ = Σ d∕n

[Where Σ d = 453, n = 30]

= 453∕30

= 15.1

The estimate of population standard deviation is given by,

SD = √Σ (d-d̅)2 ∕(n-1)

[Where Σ (d-d̅)2 = 104.7, n = 30]

= √6.14455∕29

= 1.90

Standard error (S.E) = SD ∕ √n

= 1.90∕ √30

= 0.347

D. The test statistics is Paired t:

d̅
Critical ratio = 𝑡 = 𝑆𝐷⁄
√𝑛

= 15.1∕0.347

= 43.52

44
 t-Test: Paired Two Sample for Means

Variable 1 Variable 2
Mean 19.7 4.6
Variance 2.286206897 5.282758621
Observations 30 30
Pearson Correlation 0.569541986
Hypothesized Mean Difference 0
Df 29
t Stat 43.52745075
P(T<=t) one-tail 2.84467E-28
t Critical one-tail 1.699127027
P(T<=t) two-tail 5.68933E-28
t Critical two-tail 2.045229642

E. Comparison with tabled value:

The critical ratio t follows a distribution with n-1 degrees of freedom. The tabled value

at 5 % significance level is 2.045 and 1% level is 2.756 for 29 degrees of freedom.

Since the calculated value 43.52 is greater than the tabled value at 5% and 1%

significance level. Thus the null hypothesis is rejected.

F. Inference:

This study shows significant reduction in the disease intensity scores after the

Homoeopathic treatment. Therefore, this study shows that Homoeopathic

Constitutional treatment was more effective.

45
 6. DISCUSSION

The subjects of the study were selected from those patients with Migraine were

attending the Outpatient, Inpatient department and rural health centers of Sarada

Krishna Homoeopathic Medical College as per the inclusion criteria.

A total of 30 cases were recorded in pre structured case record format. The cases

were diagnosed based on clinical presentation using the diagnostic criteria of

International Headache Society for migraine. Then the cases were analyzed and the

totality was erected. Medicines were selected after repertorization (wherever necessary)

and with reference to Materia medica. Cases were reviewed at regular interval, follow -

up criteria were fixed and cases followed for minimum of 6 months. The acute episodes

treated with indicated medicines according to acute totality and chronic constitutio na l

medicine was given after the acute episode, for further treatment. For clinica l

assessment before and after treatment, symptom assessment scores were used. Pre-

treatment score and after treatment score was calculated, then‘t’ was applied to test the

significance.

In sample of 30 cases of migraine, maximum 9 patients (30%) were in the age

of 17years, 7patients (23.33%) were in the age of 12 years. Previous study reveals 66%

to 71% of 12- 15 year old have at least one headache every three months.

Among 30 cases of migraine 22 (73.33%) were females and 8(26.67%)

were males. Evidence suggests it is seen in approximately 15% of women and

6% of men. Migraine is more prevalent in females. Prevalence of migra ine

without aura was 2.35%; that of migraine with aura was 0.62%. Migraine without

aura was equally distributed among males and females, whereas migraine with

aura was preponderant in the female cohort.

46
 Among the 30 cases of migraine 17 (56.67%) case the main etiologic a l

factor is sun exposure, 10 (33.33%) cases mental exertion, 9 (30%) cases physical

exertion and noise, 5 (16.67%) cases morning, 4 (13.33%) cases skipping meals,

evening and before mensus, 3 (10%) cases travelling, loss of sleep and cold

exposure, 1 (3.33%) case from strong odors and perspiration.

Among the 30 cases taken for the study 10 (33%) have past history of

measles, 8 (26%) had chickenpox, 6 (20%) had typhoid, 3 (10%) had jaundice, 2

(6%) had dengue, 1 (3%) had pneumonia and primary tuberculosis and 7 (23%)

had no illness.

The study in respect to family history out of 30 cases, 11 (36%) patients

does not have any family history, 5 (16%) had a family history of Diabetes

Mellitus, 4 (13%) had a family history of Hypertension, 3 (10%), 2 (6%) had a

family history of Migraine and Cancer and 1 (3%) had family history of

Rheumatic complaints and MI.

For all the 30 cases Constitutional medicine was prescribed. Lycopodium

Clavatum was given for 7 cases (23%), Calcarea Carbonicum for 6 cases (20%), Silicea

Terra for 3 (10%), Natrum Muriaticum and Sulphur for 2 cases (6%), Pulsatilla

Nigricans, Arsenicum Album, Belladonna, Staphysagria, Spigelia and Sanguinar ia

Canadensis for each case. Previous study reveals Homeopathy alone was used for the

treatment of migraine attacks in 38% of cases. The most commonly used medicines

were Belladonna (32%; mainly 9C), Ignatiaamara (11%; mainly 15C), Iris

versicolor (10%; mainly 9C), Kaliumphosphoricum (10%; mainly 9C),

and Gelsemium (9%; mainly 15C and 30C).The results of this study decrease in the

frequency, severity, and duration of migraine attacks was observed and, consequently,

reduced absenteeism from school.

47
 In all 30 cases potency was selected based on Homoeopathic princip les.

Out of 30cases, 12 cases (40%) 200 was given, 7 cases (23.33%) 30 was given,

5 cases (16.67%) 0/3 was given, 4 cases (133.33%) 1M was given and for 2 cases

(6.67%) 0/1 was given.

Out of 30 cases, for 18 cases (60%) medicine was administered in water

dose and for 12 cases (40%) medicine was administered in dry dose.

In my study, it is inferred that homoeopathic constitutional treatment

showed marked reduction in the intensity scoring in all cases of migraine.

In my study, out of 30 cases of migraine, 28cases (93.3%) showed marked

improvement, 2 cases (6.6%) showed mild improvement.

6.1 LIMITATIONS

1. Number of samples used in this study is very small. Therefore generalization

of the result and inference of the study need to be done cautiously.

2. Some good cases couldn’t be considered in this study because of discontinued

treatment in between the study period.

3. Selection of cases was difficult since many of the cases were irregular for

reporting.

4. This was a time bound study. The cases were followed up only for a period of

3-6 months.

5. There was no control group since the sample size was small.

6. Some follow- ups were taken by various physicians at various times; hence,

proper recording of the symptoms with intensity was difficult.

7. In some cases, necessary information was lacking and the study was based on

the available data.

48
 8. There were no standard studies to compare or take guidance from a study of

this nature in homoeopathy. Therefore some human errors are expected.

6.2. RECOMMENDATIONS

1. Bigger sample size with extended time of research would provide better

results.

2. It will be always scientific if control (placebo) group would have been kept

simultaneously to verify the effectiveness of treatment.

Universal standardized scale can be used, so that evaluation of outcome of the study

would become precise

49
 7. CONCLUSION

The sample for the study consisting of thirty patients with Migraine from

Inpatient, Outpatient, School Health Programme and Rural health centres of Sarada

Krishna Homoeopathic Medical College and Hospital and following conclusion were

obtained after statistical analysis.

This study shows various clinical presentation like headache one any one side

of the head with nausea and vomiting in most of the patient. In my study the most

common age group of Migraine were found in 17 years and 12 years. The prevalence

of Migraine was found in females. Sun exposure and mental exertion were considered

as most common aetiological factors. Lycopodium clavatum were found to be most

indicated medicine and Calcarea Carbonica was the second most indicated medicine in

constitutional treatment of Migraine.

In my study, maximum number of cases was indicated with 200 potency and

most of them were received medicine in water dose. There is marked reduction in the

after treatment scores on comparing with before treatment scores.

The effectiveness of homoeopathic constitutional treatment for Migraine in

school going children was thus proved in this study by showing marked improveme nt

like reduction in intensity, frequency and recurrence of attacks.

50
 8. SUMMARY

Purposive selection of 30 cases of patients with Migraine was taken for

the study from the OPD, IPD, Rural Centers and from school Health programme

of Sarada Krishna Homoeopathic Medical College. The case history was taken

which includes etiological factors, mental generals, physical genera ls,

concomitants, characteristics particulars. Diagnosis was done according to

clinical presentation, clinical history and physical examination of patient. Then

the case were analysed and the totality were erected. Then Constitutio na l

medicine was prescribed according to the symptom similarity.

Symptom intensity score was analysed before and after the treatment.

This study shows the different presentation of migraine and helps us to

understand the migraine in detailed way.

The age incidence in the study showed more people in the age 17.

Lycopodium Clavatum is found to be more useful in most of the cases.

Majority of the cases showed good improvement after the treatment

which was statistically tested. The calculated value 43.52 is greater than the

tabled t value at hypothesis was considered. 5% and 1% level, the null hypothesis

is rejected and alternate.

The result of the study is that homoeopathic Constitutional medicine was very effective

in the treatment of patients with Migraine in different potencies. Homoeopathy treats

the patient as a whole and it reduces the intensity, prevents the frequent recurrence and

thus the quality of life is improved.

51
 9. BIBLIOGRAPHY

1. Kumar Praveen, Clark Micheal. Neurological disease. Kumar And Clarke

Clinical Medicine. Elsevier publishers. 7 th edition; p: 1136 – 1137.

2. GolwallaAspi F, GolwallaSharukh A. Neurology. Golwalla’s Medicine. 23 rd

edition: 2011; p: 438 – 439.

3. GolwallaAspi F, GolwallaSharukh A. Neurology. Golwalla’s Medicine. 23 rd

edition: 2011; p: 438 – 439.

4. Hauser Stephen. L. Clinical manifestation of neurologic disease. Harrison’s

Neurology in Clinical Medicine. 3 rd edition. McGraw Hill Education Medical

Publishers.5th edition; 2013; p: 53 – 62.

5. Migraine [Internet]. En.wikipedia.org. 2019 [cited 18 February 2019].

Available from: https://en.wikipedia.org/wiki/Migraine.

6. Jay.A.VanGerpen, MD, Stephen Hickey, MD and David.J.Capobianco, MD

Migraine: Diagnosis prevention and treatment; www.dcms online.

Org/jax-medicine/2000, journals/…./migraine.html.

7. Michael. T. Pulley, MD, Nader Antonios, MD and Walter F. Ray, MD;

Migraine Headache: Origins, consequences, diagnosis, and treatment;

medicine/2005 journals/…./migraine.

8. Cephalalgia- An International Journal of Headache; Volume 24; Supplement;

2004; www.ihs-headache.org/upload/ct-clas/ihc-11.

9. Das P C, Das P K. Nervous system. Text book of medicine. 5th edition: 2009;

p: 439 – 441.

10. Homoeo Times; Volume 3; April 2006; Migraine clinical features: P: 6-9.

52
11. Hahnemann Samuel. Organon of medicine. 5 th & 6th edition. New Delhi: B. Jain

Publishers (P) Ltd.; 2015; p.54-55, 101.

12. Hughes Richard. The Principle and Practice of Homoeopathy. Diseases of

nervous system. New Delhi: B. Jain publishers (P) Ltd.; p. 405-406.

13. Dhawale ML. Remedy-Selection in Homoeopathic Practice. Principles and

Practice of Homoeopathy Part I. Edition 2000; p:223-225.

14. BabuNagendra G. Knowledge of Disease. Comprehensive Study of Organon of

Medicine;B. Jain Puublishers (P) Ltd. Edition 2014; p: 104-106,109.

15. Banerjea Kumar Subrata. Miasmatic prescribing. Second extended edition.

New Delhi: B. Jain Publisher (P) Ltd.; 2010. p. 187,188.

16. Patel P. Ramanlal. Chronic miasms in homoeopathy and their cure with

classification of their rubrics/symproms in Dr. Kent’s repertory. Indian edition

1996. Kottayam: Hahnemann homoeopathic pharmacy, Hahnemann House

college road; 1996: p. 97-217.

17. Paul Swapan. Migraine- A medical emergency. The Homoeopathic Heritage.

Dec 2009: 34(12): p. 11-17.

18. Boericke William. Homoeopathic MateriaMedica and Repertory. Head. 54th

edition. New Delhi: B. Jain Publishers (P) Ltd., 2013; p.73, 100-102, 129, 136,

363, 408, 503, 518, 522, 530, 535, 546,702.

19. Phatak R. S. A concise repertory of homoeopathic medicines. Migraine.

Revised and Enlarged Edition. New Delhi: B. Jain Publishers (P) Ltd., 2000; p.

275.

20. Knerr B. Calvin. Repertory of Hering’s Guiding Symptoms of our

MateriaMedica. Head. New Delhi: B. Jain Publishers (P) Ltd., 2016; p. 217,&

219.

53
21. Boger C. M. Boeninghausen’s Characteristic MateriaMedica and Repertory.

Head Internal. Reprint edition. New Delhi: B. Jain Publishers (P) Ltd., 1998; p.

86.

22. Kent TJ. Repertory of the Homoeopathic MateriaMedica. Head. 9 th edition.

New Delhi: B. Jain Publishers (P) Ltd., 2015; p.137,140, 150, 278.

23. Murphy Robin. Homoeopathic Medical repertory. Headaches. Third revised

edition. New Delhi: B. Jain Publishers (P) Ltd., 2013; p. 1117.

24. Allen H.C; Allen’s Keynotes Rearranged and Classified with Leading

Remedies of the MateriaMedica and Bowel Nosodes;; 10 th Edition. New Delhi:

B Jain publishers(P) Ltd., 2015; p.43, 56, 75, 213, 269, 279, 283, 285, 297.

25. Raieli V, Raimondo D, Cammalleri R, Camarda R. Migraine Headaches in

Adolescents: A Student Population-Based Study in Monreale. Cephalalgia.

1995;15: p.5–12.

26. Fallahzadeh H, Alihaydari M. Prevalence of migraine and tension- type

headache among school children in Yazd, Iran. Journal of pediatric

neurosciences. 2011 Jul-Dec;6(2): p.106-109.

27. Straube A, Heinen F, Ebinger F, Kries R. Headache in School Children.

DeutschesAerzteblatt Online. 2013;110(48): p.811–818.

28. Danno K, Colas A, Masson LJ, France M. Homoeopathic treatment of migra ine

in children: results of a prospective, multicenter, observational study. The

journal of alternative and complementary medicine. 2013 Feb; 13(2): 119-123.

///doi.org/10.1089/acm.2011.0821.

54
29. Claudia M. Witt, Rainer Ludtke, and Stefen N. Willich. Homoeopathic

Treatment of Patients with Migraine: A Prospective Observational Study with

a 2-Year Follow-Up Period. The Journal of Alternative and Complementar y

Medicine. April2010 .pg.347-355 http://doi.org/10.1089/acm.2009.0376.

55
 APPENDIX I

GLOSSARY

1 APHORISM It is a terse saying, expressing a general truth,

principle or exact observation, and spoken or
written in a laconic and memorable form.
Aphorism literally means a “distinction” or
“definition”

2 POTENCY The power is derived by the grades of medicinal

power as developed by the process of
dynamization. Potency means dilution of energy.

3 CONSTITUTION It is the genotypic inheritance of an individual,

the physical make up of his body, including its
functional ability, metabolic activity, reaction to
stimuli and resistance to infection.

4 CONSTITUTIONAL Method of therapeutics unique to Homoeopathy.

TREATMENT Constitutional medicine is capable of correcting
the inherent and acquired defects in the
personality.

5 DOSE Refers to the force of impact of the remedy. The

homoeopathic dose means ‘that particular
preparation of the remedy employed’, in
particular the amount and or form of that
preparation.
6 AGGRAVATION A situation in which the patient feels worse from
or symptoms are increased by a remedy.
Homoeopathic aggravation symbolized by <.
7 AMELIORATION An improvement of the patient or decrease in
symptoms. Homoeopathic amelioration
symbolized by >.

56
 APPENDIX II
‘Case Records Are Our Valuable Asset’

SARADA KRISHNA CONFIDENTIAL

HOMOEOPATHIC MEDICAL COLLEGE HOSPITAL

KULASEKHARAM, KANNIYAKUMARI DIST, TAMIL NADU- 629 161

CHRONIC CASE RECORD

Date: ………….. Unit…………….. Regn. No…………….

1. PERSONAL DATA
Name of Patient:………………………………………………………………………

Age :…….. yrs Sex : M/F/T Religion :…………… Nationality :……………

Name of Father / Spouse / Guardian / son / Daughter ………………………………

Marital status : Single / Married . Widow (er) / Divorcee / Live-relation

Occupation :……………………………....... Income per capita :…………………

Family size (members living together): ………………………………………………

Diet : Veg. / Non veg. / Mixed

Address: ……………………………………………………………………………...

………………………………………………………………………………………..

Phone (Office) ……………………..… Residence …………………………………

Mobile …………………………… e-mail ………………………………………...

Referred to by:……………………………………………………………………….

FINAL DIAGNOSIS :

Homoeopathic
Disease

RESULT: Cured Relieved Referred Otherwise Expired

Attending Physician …………………………………………………….....................

57
 2. Initial presentation of illness

PATIENT’S PHYSICIAN’S
NARRATION INTERROGATION PHYSICIAN’S
(In the very expression (Details regarding OBSERVATON
used by him / her) symptoms narrated)

58
3. Presenting Complaint (s)
(patient’s narration of ailments chronologically with duration and intensity)

Location
(tissues, organs, systems Sensation Modalities Concomitants,
extension & duration & (>,<) if any
direction & frequency) Pathology &
A/F (=)
A. Chief Complaints(s)

B. Associated
complaints(s)
(In chronological order
with duration)

59
 3. H/o Presenting Illness :
(origin, duration and progression of each symptom in chronological order
along with its mode of onset, probable cause (s), details of treatment and their
outcome)

4. H/o Previous Illness

Illness, trauma, fright, burns(s), drug

No. Age/Year allergy(ies), operation(s), exposure(s), Treatment Outcome
inoculation, vaccination(s), serum, adopted
steroids, hormone therapy, antibiotics,
analgesics, etc

60
 5. H/o FAMILY ILLNESS

6. PERSONAL HISTORY:

A. LIFE SITUATION

Place of birth :
Religion :
Education : Occupation :
Socio-economic status :
Nutritional status :
Marital status :
Family status :

B. HABTS & HOBBIES:

Food :
Addictions :
Sleep :
Artistic :
Games / Sports :

C. DOMESTIC RELATIONS:

With family members :

With other relatives :
With neighbours / friends / colleagues :

D. SEXUAL RELATIONS:

Pre-marital:
Marital:
Extra Marital:

61
7. LIFE SPACE INVESTIGATIONS (as perceived by the ‘Interrogator/
Physician)
(birth and early development (milestone), behaviour during childhood,
education, adolescence & psychosexual history, occupational history, mental
history, children, geriatrics history & travel history)

62
 8. GYNAECOLOGICAL HISTORY

A. Menses

B. Previous History

C. Climacteric

D. Abnormal Vaginal Discharges

E. H/o gynaecological surgeries : Yes/No

(If yes state the reason)

63
 9. OBSTETRICAL HISTORY

A. Previous Pregnancies including abortion:

B. Contraceptive method(s) adopted:

C. Present Pregnancy:

D. Physical Examination – Gynaecological / Obstetrical

64
10. GENERAL SYMPTOMS

A. Physicals

i. Functional

Appetite:

Thirst:

Sleep:

ii. Eliminations

Stool:

Urine:

Sweat:

iii. Reactions to

iv. Constitutional

65
B. Mental General

i. Will & emotions including motivation

ii. Understanding and intellect

iii. Memory

11. PHYSICAL EXAMINATION

A. General Examination

 Conscious/unconscious

 General appearance

 General built

 Ht : cm Wt : Kg BMI :

 Anaemia

 Jaundice

 Cyanosis

 Oedema

 Skin

 Nails

 Gait

 Lymphadenopathy

 Blood pressure Pulse

 Temp Resp. rate

 Others

66
B. Systemic Examination

i. Respiratory system

ii. Cardiovascular system

iii. Gastro Intestinal system

iv. Urogenital system

v. Skin and Glands

67
 vi. Musculo-skeletal system

vii. Central Nervous system

viii. Endocrine

ix. Eye & ENT

x. Others

68
C. REGIONALS

69
12. LABORATORY INVESTIGATIONS & FINDING AND SURGICAL
INVESTIGATIONS
(urine, stool, blood, sputum, imaging, ECG, and other investigations)

13. DIAGNOSIS
A. Provisional Diagnosis

B. Differential Diagnosis

C. Final Diagnosis (Disease)

70
14. DATA PROCESSING

A. Analysis of case

Basic / Common / Pathognomonic Determinative / Uncommon / Non-

Symptoms pathognomonic Symptoms

B. Evaluation of Symptoms

71
C. Miasmatic Analysis

PSORA SYCOTIC SYPHILIS

Miasmatic Diagnosis :

D. Totality of Symptoms

E. Homoeopathic Diagnosis (Hahnemannian Classification)

72
15. SELECTION OF MEDICINE

A. Non Repertorial Approach

B. Repertorial Approach

73
16. SELECTION OF POTENCY AND DOSE

17. PRESCRIPTION

18. GENERAL MANAGEMENT INCLUDING AUXILLARU

MEASURES

A. General/Surgical/Accessory

B. Restrictions (diet, regimen etc)

Disease Medicinal

74
 19. PROGRESS & FOLLOW UP

Date Symptom(s) changes Inference Prescription

75
76
 APPENDIX- III

ASSESSMENT CRITERIA FOR MIGRAINE.

SYMPTOMS Absent Mild Moderate Severe

1 Head pain 0 1 2 3
2 Nausea 0 1 2 3
3 Vomiting 0 1 2 3
4 Visual symptoms 0 1 2 3
5 Phonophobia 0 1 2 3
6 Associated complaints 0 1 2 3
7 Aggravation after exertion 0 1 2 3

8 Aura symptoms 0 1 2 3
TOTAL 24

Marked improvement: 0 – 8

Mild improvement : 9 - 16

No improvement : 17 - 24

77
 APPENDIX -IV

FORM – 4: CONSENT FORM (A)

INFORMATION FOR PARTICIPANTS OF THE STUDY

Title of my study is “HOMOEOPATHIC MANAGEMENT OF MIGRAINE

IN SCHOOL GOING CHILDREN BASED ON DISEASE INTENSITY USING
CONSTITUITIONAL REMEDIES”. The purpose of my study is (1) To assess the
effectiveness of constitutional medicine in pain management and recurrence of
attacks.(2)To know the importance of constitutional remedies indicating symptoms of
migraine.(3)To determine the etiological factors of migraine. Duration of my study is
from July 2017 – January 2019.

The procedures include selection of 30 cases of female patients with

Hypothyroidism are selected from OPD, IPD and from peripheral centers of Sarada
Krishna Homoeopathic Medical College. The case will be analysed and evaluated. It is
repertorised and a well constitutional remedy will be prescribed after referring the
Materia Medica. The repetition of doses will be done based on the Homoeopathic
principles. Assessment will be done once in a week or two weeks and changes will be
recorded. In 3 to 6months study, patients will be assessed on one year observation.

The benefits to the subject or others, reasonably expected from research are (1)
The participants are enquired based on IHS diagnostic criteria for migraine to find out
whether the child is having Migraine. (2) If the participant is diagnosed as Migraine,
awareness should be given to the child as well as the parent to reduce the frequency
and intensity of the attack through homoeopathically (3) Thus study is a benefit not
only to the participant but also to the society as a whole. The records are mainta ined
highly confidential. Only the investigator has the access to the subject’s medical
records. Participant’s identity will never be disclosed at any time, during or after the
study period or during publication of the research. Securely store data documents in
locked locations and Encrypt identifiable computerized data. All information revealed
by patient will be kept as strictly confidential. Free treatment for research related injury
is guaranteed. Compensation of the participants not only disability or death resulting
from such injury but also for unforeseeable risks is provided, in case situation arises.

78
Contact for trial related queries, rights of subjects and in the event of any injury.

INVESTIGATOR

Dr. Digna Reji, P.G. Scholar,

Department of Practice of Medicine,

Sarada Krishna Homoeopathic Medical College,

Kulasekharam, Mobile no: 9487180279.

GUIDE

Dr. Sugathan. N.V

Professor,

Department of Practice of Medicine,

Sarada Krishna Homoeopathic Medical College,

Kulasekharam, Mobile no: 9443558786.

There will not be any anticipated prorated payment to the

subject for participating in the trial. The responsibilities of the participants in the trial
are they must disclose all about the complaints. Participants must strictly stick on to the
scheduled Diet, Regimen and Medicine.

The participation is voluntary, that the subject can

withdraw from the study at any time and that refusal to participate will not involve any
penalty or loss of benefits to which the subject is otherwise entitled.

79
 FORM– 4 A

CONSENT FORM (B)

Informed Consent form to participate in a clinical trial

Study Title: HOMOEOPATHIC MANAGEMENT OF MIGRAINE IN SCHOOL

GOING CHILDREN BASED ON DISEASE INTENSITY USING
CONSTITUITIONAL REMEDIES

Study Number: Subject’s Initials________________ Subject’s Name

_______________ Date of birth/Age: _______________

Please initial

Box (Subject)

i. I confirm that I have read and understood the information sheet dated
July 2017 for the above study and have had the opportunity to ask question.
[]
ii. I understood that my participation in the study is voluntary and that I am
free to withdraw at any time without giving any reason. Without my medical
[]
care or legal rights being affected.
iii. I understand that the sponsor of the clinical trial, others working on the
sponsor’s []
behalf the Ethics Committee and the regulatory authorities will not need my
permission to look at my health records both in respect of the current study
and further research that may be conducted in relation to it, even if I withdraw
from the trial. I agree to this access. However, I understand that my identity
will not be revealed in any information released to third parties or published.
iv. I agree not to restrict the use of any data or result that arise from this study

[]

provided such a use only for scientific purpose(s)

v. I agree to take part in the above study.

80
Signature (or Thumb impression of the subject/legally acceptable)

Representative: ____________________

Date _________/_________/__________

Signatory’s Name: __________________

Signature of the Investigator: _____________

Study Investigator’s Name: Dr. Digna Reji.

Signature of the Witness_____________ Date: ________/________/_______

Signature of the Witness_____________ Date: ________/________/_______

81
 APPENDIX- V
CASE

Name of the patient: Baby. XX Age: 12 years

Sex: Female Religion: Christian
Occupation: Student (8th std)
Address:Thadikkarakonam
Date of case taking: 21-04-2018 OP. NO: 9472/18

Presenting complaint
Location Sensation Modalities (< ,>) & Accompaniments
A/F (=)
HeadFrontal region Stitching type of pain A/F travelling after Perspiration
(left side)Since 1 year Sensitive to light < physical exertion Nausea
< mental tension Vomiting (occasionally)
< morning
< noise
< sleep

History of presenting complaints

Patient’s complaint started as pain on head since 1 year as gradual onset and the pain
was stitching in nature which occurs after travelling, physical exertion and mental
tension and better by sleep. There was perspiration and nausea along with headache.
She didn’t took any other treatment.

History of previous illness with treatment adopted

No history of any previous illness

History of family illness

Maternal grandmother had history of Asthma.

82
Personal history
Place of birth: Thadikkarakonam
Religion: Christian
Education: 8th standard
Economic Status : Middle class
Marital status : Single
Family status : Nuclear
Occupation : Student (8th std)

Habits and hobbies

Food : Non-veg
Addictions : Nil
Sleep : Good

Domestic relations
With family members : Good
With other relatives : Good
With neighbours/ Friends/ Colleagues : Good

Sexual relation
Premarital : Nil
Marital : Nil
Extra marital : Nil

Life space investigation

The patient was born in a moderate family. Her father is a daily wage and mother is
housewife. She had an elder brother. Now she is studying in 8 th standard. She is
average in her studies and very much attached to the family. She is worried about the
complaint.

Psychic features
Appearance
 Calm

83
  Introvert
 Co-operative
Reaction to
 Desire- company
 Consolation - >
Other features
 weeps easily
 Quarrelling with her brother
 Good perception and thinking
 Good memory

Physical features
Appearance
 Stature: Moderate
 Complexion: Fair
 Gait: Steady
 Clean/Unclean:Clean
Generals
 Appetite : Decreased
 Thirst :Normal
 Sleep : Good
 Stool : Regular
 Urine : Normal
 Sweat : Increased during headache
Reaction to:
 Desire: Cold season
 Desire: Fanning
 Aversion: Covering
 Aversion: spicy food
 Desire: sweets
 Desire: Cold foods

84
Physical examination
General:
Jaundice : Not icteric
Anaemia : No pallor
Oedema : Nil
Cyanosis : Nil
Clubbing : Nil
Lymphadenopathy : Nil
Discolouration : Nil
Skin eruption : Nil
Height : 156cm
Weight : 59kg
BMI : 23kg/m2
Pulse : 80 beats/min
Respiratory rate : 18/min
Temperature : 98.60 F
Systemic examination
Respiratory system: Normal vesicular breath sound heard all over the lung field.
Cardiovascular system: S1 S2 heard no murmur.

Regionals
Dandruff present on scalp
Hair falling present
Dimness of vision
Moist and clean tongue

Menstrual history
LMP : 12-4-2018
FMP : 11 years
Cycle : 28 days
Duration : 5 days
Quantity : 3 pads/day
Consistency and clots: No clots
Colour and odour : Bright red in colour
85
 Stains and acridity : No stains and acridity
Provisional diagnosis
?MIGRAINE
Differential diagnosis
TENSION HEADACHE
Analysis of the case
Common symptom Uncommon symptom
Head Head
Frontal region Frontal region
A/F travelling after Stitching type of pain
< physical exertion <morning
< mental tension Associated with Perspiration
<noise Desire- sweets
> sleep Desire: cold foods
Associated with Nausea Easily get angry
Vomiting (occasionally)
Sensitive to light

Evaluation of symptoms
 Stitching type of pain on Frontal region
 Pain on left side
 Sensitive to light
 Angers easily
 Aversion- spicy food
 Desire- sweets
 Desire- cold foods
 headache
A/F travelling after
< Physical exertion
< Mental tension
< Morning
< Noise
> Sleep

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  Headache associated with Nausea, perspiration and vomiting (occasionally)

Miasmatic expression
Psora Sycosis Syphilis
Headache Desire- cold foods Stitching type of pain on
Frontal region frontal region.
<morning
<noise
>sleep
Associated with nausea
and perspiration
Vomiting
Desire- sweets
Angers easily

Prominent miasm: Psora

Totality of symptoms
 Stitching type of pain on Frontal region
 Pain on left side
 Aversion- spicy food
 Desire- sweets
 Desire- cold foods
 headache
A/F travelling after
< Physical exertion
< Mental tension
< Morning
> Sleep
 Headache associated with Nausea and perspiration

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Repertorial totality

Repertorial result
Lycopodium Clavatum : 9/5
Calcarea Carbonicum : 8/4
Argentum Nitricum : 7/4
Arsenicum Album : 7/4
Silicea Terra : 7/4
Natrum muriaticum : 6/4

Management and treatment

Plan of treatment
Medicinal management
General management
Advise for avoid over exertion of mind and body
Advise to take food in proper time

Medicinal Management
Rx
CALCAREA CARBONICUM 0/3/2 doses
(1dose in 10ml aqua ½ x BD)

Basis of selection
Medicine: CALCAREA CARBONICUM
1. Stitching type of pain on forehead
2. Pain on left side

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 3. Pain associated with nausea
4. Desire: sweets
Potency: 0/3
Dose: Two doses

ASSESSMENT CRITERIA FOR MIGRAINE

SL NO Symptoms Absent Mild Moderate Severe
1 Head Pain 0 1 2 3
2 Nausea 0 1 2 3
3 Vomiting 0 1 2 3
4 Visual symptoms 0 1 2 3
5 Phonophobia 0 1 2 3
6 Associated complaints 0 1 2 3
7 Aggravation after exertion 0 1 2 3
8 Aura symptoms 0 1 2 3
Total 24

FIRST VISIT
1 2 3 4 5 6 7 8
3 3 3 3 3 2 3 2

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DATE FOLLOW UP MEDICINE PRESCRIBED
28/4/2018 Headache feels slightly better Rx
than before. CALCAREA
Nausea slightly better. CARBONICUM0/3/2doses
Vomiting better than before (1 dose in10 ml aqua ½ x BD)
Generals: good B. pills 5ml (3xTds)
1 2 3 4 5 6 7 8
2 1 1 2 2 1 2 0 For 2 weeks

12/5/2018 Headache feels better Rx

Nausea and vomiting feels CALCAREA
better CARBONICUM0/3/2doses
Generally patient feels better (1 dose in 10 ml aqua 1/2 x BD)
Generals- Good B. pills 5ml (3xTds)

1 2 3 4 5 6 7 8 For 2 weeks
1 1 0 1 1 0 1 1

2/6/2018 Headache feels better Rx

All complaints feels better than CALCAREA
before CARBONICUM0/3/2doses
Generals- Good (1 dose in 10 ml aqua 1/2x BD)
1 2 3 4 5 6 7 8
1 0 0 1 1 0 2 0 B. pills 5ml (3xTds)

90
 APPENDIX VI
MASTER CHART

Sl. OP. Age Sex Occupation Etiological Past Family Medicine Potency Mode of Disease Improvement
no NO factors history history administration intensity status
score

BT AT
1 144/ 17 F Student after mental Measles, Diabete sulphur 30 Dry dose 19 4 Marked
18 years exertion, Typhoid s improvement
sun
exposure
2 6230 17 F student sun Chicken Nil Lycopodiu 0/3 Water dose 21 8 Marked
/15 years exposure, pox m improvement
noise, after
exertion
3 2705 17 F student Before Jaundice Nil Lycopodiu 200 Water dose 19 3 Marked
/17 years menses, sun m improvement
exposure,
morning
4 5417 16 F student Physical Dengue Hyperte Pulsatilla 1M Dry dose 20 4 Marked
/13 years exertion, nsion improvement
noise

91
5 1060 14 M student Mental Chicken Migrain Natrum 1M Dry dose 18 4 Marked
7/13 years tension, sun pox, e mur improvement
exposure, Measles
skipping
meals
6 5416 16 F student Travelling,n Typhoid, Nil Sulphur 200 Dry dose 22 6 Marked
/13 years oise, sun Primary improvement
exposure TB
7 784/ 16 F student Over Pneumon Nil Calcarea 0/3 Water dose 21 4 Marked
16 years exertion,bef ia, carb improvement
ore Measles
mensus,read
ing
8 4212 15 F Student Mental Typhoid, Nil Calcarea 0/1 Water dose 20 5 Marked
/15 years tension, sun Chicken carb improvement
exposure pox
9 273/ 13 F Student Reading, Nil Diabete Nuxvomic 200 Water dose 18 3 Marked
17 years noise, after s a improvement
fear
10 531/ 17 F Student Mental Measles cancer Calcarea 30 Water dose 19 2 Marked
18 years tension, sun carb improvement
exposure
11 1246 17 F Student Skipping Nil MI Calcarea 0/1 Dry dose 21 10 Marked
2/16 years meals, carb improvement
travelling

92
12 3113 17 F Student Cold Chicken Nil Arsenicum 30 Water dose 20 7 Marked
/17 years exposure, pox album improvement
loss of
sleep,
morning
13 5825 12 M Student Noise, sun Measles Hyperte Calcarea 200 Dry dose 17 5 Marked
/18 years exposure nsion phos improvement

14 6993 15 F Student Sun Nil Nil Belladonn 200 Water dose 22 7 Marked
/18 years exposure, a improvement
skipping
meals
15 7705 13 M Student Mental Nil Diabete Lycopodiu 200 Water dose 21 4 Marked
/18 years exertion, s m improvement
reading,
smell of
perfumes
16 5875 12 F Student After anger, Typhoid, Rheum Calcarea 200 Dry dose 17 4 Marked
/17 years sun Measles atic phos improvement
exposure, complai
over nts
exertion
17 9555 16 M Student Mental Chicken Diabete Silicea 30 Water dose 19 5 Marked
/14 years exertion, pox s improvement
over
perspiring

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18 3591 13 F Student Reading, Measles Cancer Silicea 0/3 Water dose 20 6 Marked
/16 years sun improvement
exposure,
noise
19 1062 16 F Student Noise, cold Measles Nil Natrum 0/3 Dry dose 20 9 Mild
4/16 years exposure, mur improvement
loss of sleep
20 7212 12 F Student After fear, Nil Asthma Silicea 30 Water dose 21 7 Marked
/17 years cold improvement
exposure,
morning
21 8379 15 M Student Mental Chicken Migrain Staphysag 1M Dry dose 18 6 Marked
/8 years exertion, pox e ria improvement
sun
exposure
22 6574 12 M Student sun Jaundice, Diabete Nux 1M Dry dose 21 5 Marked
/15 years exposure, Measles s vomica improvement
over
reading
23 1262 12 F Student Noise, sun Nil Nil Lycopodiu 200 Water dose 19 4 Marked
4/16 years exposure, m improvement
morning
24 527/ 13 F Student Skipping Chicken Nil Lycopodiu 30 Water dose 19 4 Marked
18 years meals, pox m improvement
evening

94
25 2676 17 F Student Before Typhoid hyperte Lycopodiu 200 Water dose 20 5 Marked
/18 years menses, sun nsion m improvement
exposure,
morning
26 9520 17 M Student Travelling,n Chicken asthma Spigelia 200 Dry dose 21 10 Mild
/18 years oise, sun pox improvement
exposure,
physical
exertion
27 7795 17 F Student Before Dengue, migrain Lycopodiu 200 Water dose 18 3 Marked
/18 years menses, Measles e m improvement
noise,
evening
28 9471 15 M Student Reading, Jaundice Nil Calcarea 200 Water dose 21 4 Marked
/18 years loss of carb improvement
sleep,
evening
29 9472 12 F student Morning, Nil Asthma Calcarea 0/3 Dry dose 22 5 Marked
/18 years physical carb improvement
exertion
30 9028 12 F student Sun Typhoid Hyperte Sanguinari 30 Water dose 17 3 Marked
/17 years exposure, nsion a improvement
evening

95