Dr Meera Narendran BHMS,MD(Hom)
Migraine the most common cause of vascular headache affects approximately 15% of Women and 6% of men. Migraine can be defined as a benign and recurring syndromes of headache, nausea, vomiting and or other symptoms of neurlogical dysfunction in varying admixtures.
A classification of many subtypes of migraine as defined by the international headache society as follows
- Migraine without aura
- Migraine with aura
- Opthalmoplegic migraine
- Retinal migraine
- Childhood periodic syndrome that may be precursors to or associated with migraine.
- Migranious disorder not fulfilling above criteria.
Aetiology and pathogenesis
Age : Although migraine can start of any age they usually begin between the age of 10 and 40. In most people migraine recur periodically, but they become significantly less severe or resolve entirely after age 50 or 60.
Sex : Migraines are 3 times more common among women than among men.
There is a genetical predisposition. Migraine tend to run in families, more than half of the people who have migraine have close relatives who have them. The rare sub type of migraine called familial hemiplegic migraine is associated with a genetic defect on chromosome 1 and 19. The role of genes in the more common forms of migraine is under study.
Estrogen the female hormone is said to have a role in migraine. That is the reason why it is more common in females of reproductive age group. In some women migraine is associated with menstrual periods. Oral contraceptives and estrogen replacement therapy often make the migraine worse.
Other precipitating factors
In some cheese, chocolate or red wine etc. will precipitate the attack
- Less of sleep
- Mental stress and strain
The ‘aura’ of classical migraine represents a spreading front of excitation followed by a depression of cortical cells. The cause of this is not understood, but probably represents a paroxysmal alteration in cortical modulation pathways from the brain stem. The headache is cause by vasodilatation of intracranial vessels and may like the headache following epileptic seizures, be a non-specific effect of intracranial metabolic disturbance.
- Usually migraine will presented as a triad of
- Paroxysmal headache
- Focal neurological events (usually visual) patient with all three of these features are said to have classical migraine.
- Those with just paroxysmal headache with or without vomiting, but no classical focal events are said to have common migraine.
Typically a classical migraine attack starts with a non- specific prodrome of malaise and irritability followed by the ‘aura’ of a focal neurological event, a severe throbbing hemicranial headache, photophobia and vomiting. During the headache phase patients prefer to be in a quiet, dark room and go to sleep. The headache may persist for several days. The aura of migraine is most often in the form of fortification spectra’ shimmering silvery zig zag lines which march across the visual fields over 20 minutes sometimes leaving a train of visual field loss. In some patients there is a spreading front of tingling followed by numbness which moves over 20-30 minutes from one part of the body to another or even aphasia when the dominant side is involved.
Migraines are diagnosed on the basis of symptoms.
1. Structural disorders of brain
2. Focal epilepsy
5. Brain tumor
These should be excluded. No procedure can confirm the diagnosis. If the headache has developed recently or if the pattern of symptoms has changed, CT of MRI scan should be performed to exclude other disorders.
Identification and avoidance of precipitants may prevent the attacks. Avoid stress and strains.
In allopathic system of medicine, they are using Beta blockers, calcium channel blockers, anti depressants, anticonvulsants, 5 hydroxy tryptophan agonists, ergotanines and analgesics.
Boreick – Repertory
Anac, Argn., Bell, calc., aceti,cannindica, cimicifuga, coccular, coffera, cycl, Epiphegus, Meli, Menisperms, Nuxvom, Ones, Puls, Sang scutallena, Sepia, Zincum Sulph, zincum Valerianm
Headache – Migraine
Agan, Ant.c, Bry, China, Coffee, gels, Ign, Ipecal, Iris, Nux Vom,Phos, Puls, Sang, Silicea, Phuja, Zincum.
1. Head-Pain, Gastric
Ant-C, Bry, Ipecae, Iris, Nux Vom, Puls, sang, sulph
2. Head-Pain Vomiting
3. vision – blurred – headache before
IRIS (3+), Kalibic, Sep (2+)
4. Vision – Dim headache before : Iris (3+) Gels, Kali bic, lac.d, Nat. mur, psor, sep(2)
5. Vision – Dim-head during – CYCL, IRIS, SULPH (3+)
ana, bell, caust, Nat. mur, petro, phos, psor, sil, stram, zinc (2+)
6. Vision – Dim headache after – Sil(2+)
7. Stomach – nausea-headache during – ANT.C, CAUST, COCC, CON, IP, IRIS, SANG
Headache comes in the morning or at 10 a.m lasting until 3 pm or evening. The headache are periodical. It is preceded by partial blindness (Iris, gels, Kali bic, psorinum, silic etc.) sensation as if there were little hammers beating in the skull similar to psorium. Headache during menses.
Violent hyperemia with throbbing carotids red face, intolerance of least , noise or jar. Hemiopia, retinal blindness, slight paralysis of tongue even transitory hemiplegia.
< Afternoon or evening before or during menses
> in a dark room
Migraine which had existed for years with profuse leucorrhoea has been cured with sepia. It is usually left sided and pain extends backwards. Deep stitching pain seems to be in the membranes of the brain. It is so severe that it extorts cries and frequently ends in vomiting. It is < by motion light, noise or by thunderstorm
> sleep, rest in dark room.
It get worse during menstrual periods.
Right sided headache. Pain comes from the occiput. They increases and decreases with the course of the sun, reaching their height at midday. The paroxysms and with profuse urination (sil, gels, vera alb). They recover at every 9th day. Sanguinaria also has a menstrual headache, which attends a profuse flow in contrast to sepia, where the menses will be scanty.
5. Iris Versicolor
When the attack begins with blurring of sight (gels, Kalibic, Nat.mur, pson, Lac.def) are attended with sour watery vomiting. Pain involve the infra orbital and dental nerves, with stupid stunning head ache. Mostly right sided. It is useful remedy for Sunday headache, which occurs in teachers, scholars, professors etc, in which a relief of the strain of the preceding six days; produces the head ache. In sick headache with continuous nausea, it is one of our most useful remedies, and when the headache are produced by eating sweet things, iris is probably the remedy.
<Towards evening, from cold air, coughing, violent motion
>from moderate motion,open air
Pulsatilla is very similar to sepia. Both are indicated by scanty menses, bursting, throbbing, boring or stitching pain on one side of the head obscuration of sight, white tongue, nausea & vomiting pulsatilla has more vomiting, and thickly furred tongue with clammy with mouth and relief from cold air. The pains are shifting in nature and associated with chilliness in the evening.
7. Nux Vom
Nux vom is more suited to man than in sepia. The attack commences early in the morning and generally increase to a frantic degree. Headache can be caused by tobacco, coffee, alcohol intake, digestive troubles, constipation and hepatic insufficiency. It suits the gouty and haemarohoidal subjects. Headache is usually left sided, and is associated with sour taste or perhaps nausea and violent retching. The dull, wooden, busting of head following a debauch is most characteristic of Nux vom. Headache of high livers, business men.
< stooping & coughing, Moving the eyes & motion is general.
A headache all over the head is also characteristic of Nux. vom.
8) Arsenic alb
Causes a throbbing, stupefying headache over the left eye. The arsenicum headache is temporarily relieved by the application of cold water.
9)Theridion Flickering before eyes, then blurring. The nausea is made worse by closing the eyes and also by noise.
Headache after any unwanted exertion. The pains excite nausea and fainting. The peculiarity is that there will be obscuration of vision after headache. Headache is decreased by urination.
11. Argentum nitricum
It is a deep seated neurotic disease and by some it is supposed to be of epileptic in nature. It comes periodically. There is frequently boring pain in the head, which is worse in the left frontal eminence. The boring is relieved by tight bandaging. It is excited by any a mental emotion or by anything that depreciates the nervous system, as loss of fluids, loss of sleep or mental strain. Sometimes the pain becomes as severe that the patient loses his consciousness. The paroxysms frequently end in vomiting of bile or sour fluid.
Headache commencing with blindness and especially it is also a remedy for headache due to eyestrain (onos). Pain commences in the occiput and comes up over head and settles over eyes. (Cocculus is another remedy for occipital pain). Headache get worse with sun begins at 2 or 3 am and reaches its height at afternoon. It is associated with stiff neck. The patient cannot think effectively or fix his attention. Copious urination relieves the headache and the headache is accompanies with visual troubles such as double vision, squinting and dim sight. Gelsimium headache are relieved by sleep. A characteristic of gels is a sensation a band around the head just above the ears. It also suits “tobacco headache” HA > Urniation ( Silica Ign)
13. Kali bic
The patient is affected with blindness objects become obscured, the headache then begins. It is violent and is associated with aversion to light and noise and the sight returns as the headache grows worse. It can be compared with psorinum. In psorinum blindness, before headache and the sight returns before the pain begins.
14. Oleum animale
Migraine with polyuria the urine being perfectly clear. Eyes heavy and blood shot can hardly lift the eyelids. Speech is thick unwieldy.
Migraine with vertigo and nausea, occipital pain is characteristic. Sick headache from riding in a carriage, boat train or cars. headache at each menstrual period with nausea and inclination to vomit. Headache from loss of sleep.
Juglans cinerea is one of the important remedies for occipital headache with hepatic complaints.
Left sided sun headache. Noise and jarring of bed will aggravate the headache. Stooping and change of weather also make the pain worse.
17. Lac defloratum
Frontal migraine in anemic women with nausea, vomiting and obstinate constipation. Hyperesthesia of sight and hearing. Icy coldness of body even near the stove. Deathly sickness of stomach. Sometimes vomiting < during menses.
18. Lac caninum
Pain over left eye < noise and talking
>rest and cold water
Neuralgic pain in left side of head followed by a film over right eye. Intense darting. pain around left eye.
Intense frontal headache preceded by hot flushed face <forenoon. Periodically recurring every few days > epitaxis &Menstrual flow
Hemicrania from excessive use of wine. Nausea Dimness before eyes like a cloud followed by most violent headache > by vomiting.
Headaches are neurasthenic in type, brought on by strenuous exertion. Such as going on a visit, doing a days shopping etc. Visions get a little blurred. It is worse on rising from supine position and in the open air. There is a decided relief offer a sound sleep pressive pain in the temples traveling inwards.
< from working in open air. Headache is caused by mental and physical exertion and they are preceded by hunger.
In nervous sick headache which is caused by excitement and over exertion with frequent scanty urination. Associated with restless sleep and night terrors. Worse over right eye, aching in eye balls. Explosive headache of school teachers
< Noise, odor, light
> Night, rest
Used in migraine with neurological affections. Tearing pain in supra orbital nerve with beat and throbbing pain in head. Trembling in right upper lid. The symptoms are < by rest, when seated
> by movement & pressure
Migraine is accompanied by sparking before eyes. One sided headache. Vertigo things turn in a circle, better in a room worse open air. Frequent sneezing and itching of ears.
25) Picric acid
Headache from over study or over work occipital pain. Relieved by bandaging tightly worse from slightest mental exertion
It is an excellent remedy for migraine
Migraine due to acidity and sluggishness of liver
28. Carbolic acid
For migraine in children – Tight feeling in head as if compressed by a rubber band headache. better by green tea, while smoking
29. Cannabis Indica
Migraine attack preceded by unusal excitement with loquacity.
Headache with flatulence. Feels as if top of head were opening and shutting and as if calvarium were being lifted.
30. Lobelia in flota
Periodical headache that comes on in the afternoon and continues to increase till midnight every third attach being more violent than the two previous attacks. Gastric headache with nausea, vomiting and prostration.
31. Lithium carb
Headache of females, brough on by sudden ceastation of menses, and it is always better when the patient eat something
32. Prunus spinosa
Right sided migraine shooting pain from right frontal bone through brain to occiput pain in right eye ball as if it would burst.
33. Verbascum thapus
Sensation as if the temples were crushed together. neuralgic pain in the zygoma tempero maxillary joint and ear, particularly of left sided, with lachrymatioh, coryza and sensation as if parts were crushed with tongs. Talking, sneezing and change of temperature aggravate the pain also pressing teeth together. Pain seems to come in flashes, excited by least movement, occurring periodically at some hour in the morning and afternoon each day.
A remedy for migraine associated with restlessness and dreams. Pressure from within outward with stretching and yawning and pain down the back. Sick headache, pain in forehead and temples moving to occiput
1. Harrison`s text book of medicine
2. Davidson`s text book of medicine
3. Text book of medicine by K.V.Krishnadas
4. Merc`s manual
5. Clinical material medica by farrington
6. Clark`s dictionary of material medica
7. Borieck`s material medica
8. Clinical material medica by N.M.Choudhari
9. Text book of material medica by Blackwood