Migraine Thesis Final

“EFFECT OF HOMOEOPATHIC HOMOEOPATHIC MEDICINES IN THE TREATMENT OF MIGRAINE “ DISSERTATION SUBMITTED TO

Dr. HAHNEMANN HOMOEOPATHY MEDICAL COLLEGE AND RESEARCH CENTRE, RASIPURAM. IN PARTIAL PARTIAL FULFILMENT OF INTERNSHIP INTERNSHIP PROGRAMME PROGRAMME FOR THE AWARD OF THE DEGREE OF

BACHELOR OF HOMOEOPATHIC MEDICINE AND SURGERY

BY STUDENT NAME

S.VIJAYA SHANKAR (CRRI) SESSION: 2008-2009 Under The Guidance of 

Dr.V. R. NAIDU M.D (HOM) HOD DEPARTMENT OF HOMOEOPATHIC MATERIA MEDICA

DR. HAHNEMANN HOMOEOPATHY MEDICAL COLLEGE COLLEGE AND RESEARCH CENTRE RASIPURAM. DR. M.G.R. MEDICAL UNIVERSITY, CHENNAI TAMIL NADU

1

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CERTIFICATE This Th is is to cert certif ify y that that the the diss disser erta tati tion on capt captio ione ned d EFF EFFECT OF HOMO HO MOE EOPATH ATHIC

MEDI MEDICI CINE NES S

IN

THE TH E

TREA TREATM TMEN ENT T

OF

MIGRAINE has been prepared by Mr. S. VIJAYA SHANKAR under the direct supervision and guidance of in partial fulfillment of the regu re gula lati tion onss for for th thee awar award d of th thee degre egreee of “BAC “BACH HELOR OF HOMOE HO MOEOP OPAT ATHI HIC C MEDICI MEDICINE NE AND SURGE SURGERY RY”o ”off Dr.M.G Dr.M.G.R .R.. Medical university,Chennai,Tamil nadu.

I am fully satisfied with the dissertation work submitted.

PRINCIPAL Dr. Hahnemann Homoeopathy Medical College And Research Centre, Rasipuram.

CERTIFICATE

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This Th is is to cert certif ify y that that the the diss disser erta tati tion on capt captio ione ned d EFF EFFECT OF HOMO HO MOE EOPATH ATHIC

MEDI MEDICI CINE NES S

IN

THE TH E

TREA TREATM TMEN ENT T

OF

MIGRAINE has been prepared by Mr. S. VIJAYA SHANKAR under the direct supervision and guidance of Dr. V. R. NAIDU M.D (HOM) in partial fulfillment of the regulations for the award of the degree of  “BACHELOR OF HOMOEOPATHIC MEDICINE AND SURGERY” to be awarded awarded by RAJIV RAJIV GAND GANDHI HI UNIV UNIVER ERSU SUTY TY OF HE HEAL ALTH TH SCIENCES.

I am fully satisfied with the dissertation work submitted.

Dr. V. R. NAIDU M.D (Hom) Department of Homoeopathic Materia Medica

Dr. Hahnemann Homoeopathy Medical College and Research Centre Rasipuram.

DECLARATION

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I here by declare that this dissertation EFFECT OF HOMOEOPATHIC MEDICI MEDICINE NES S IN TH THE E TREA TREATM TMEN ENT T OF MIGRA MIGRAIN INE E has has been been

 prepared by me under the direct guidance of  Dr. V. R. NAIDU M.D (HOM) DR. HAHNEMANN HOMOEOPATHIC MEDICAL COLLEGE AND RESEARCH CENTRE, RASIPURAM. as part of my study for the award of  the

BACH BACHEL ELO OR

OF

HOMO HO MOE EOPAT OPATHI HIC C

MEDI MEDICI CINE NE

AND AND

SURGERY.

Place:Rasipuram Place:Rasipuram Date:

Student Name.

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TO MY TEACHERS & PARENTS

ACKNOWLEDGEMENT I wish to convey my gratitude to my Principal Dr. N. Subramaniyan M.D (Hom), of Dr. Hahanemann Homoeopathy Medical College, Rasipuram, for his encouragement to do this thesis.

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Homoeopathy Medical College College and Research Centre Rasipuram. His keen and personal interest made me to complete our work.

S.VIJAYA SHANKAR 

CONTENTS

SL NO

1. 2. 3. 4. 5. 6. 7.

PARTICULARS

INTRODUCTION AIMS AND OBJECTIVES REVIEW OF LITERATURE MATERIALS AND METHODS OBSERVATION AND RESULTS SUMMARY CONCLUSION

PAGE NO

08 09 10 40 85 95 96

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ANNEXURES I-Case proforma

41

ANNEXURES II-Summary of cases

95

ANNEXURES IV-Master chart

97

Introduction Migraine

Headache is one of the most common and difficult clinical problems in medicine medicine.. In the majorit majority y of patients patients the cause cause is trivial trivial and reversible reversible and a careful clinical history and examination often allows a specific diagnosis there  by avoiding unnecessary unn ecessary investigation. investi gation.

Migraine Migraine is characteri characterized zed by episodic episodic headache, headache, which which is typicall typically y unilatera unilaterall and often often associat associated ed with vomiting vomiting and visual visual disturban disturbance. ce. The single most characteristic characteristic feature is the episodic nature of the headache.

Prevalence of migraine usually starts after puberty and continues until

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AIMS & OBJECTIVES OF STUDY:

01. To study the mode of clinical presentation of  MIGRAINE.

02. To assess the efficacy of homoeopathy in the Treatment of  MIGRAINE.

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REVIEW OF LITERATURE DEFINITION: neurolog logica icall diseas diseases es disea disease, se, of which which the most most “Migraine'' is a neuro common symptom is an intense and disabling episodic headache. Migraine headaches are usually characterized by severe pain on one or both sides of the head and are often accompanied by photophobia (hypersensitivity to light), hyperacusis (hypersensitivity (hypersensitivi ty to sound) and nausea. nausea. The word ''migraine'' is French in origin and comes from the Greek  language language |Greek |Greek ''hemi ''hemi crania'' crania'' (as does the Old Englis English h term ''meg ''megrim rim''''). ). Literally, ''hemicrania'' means "only half the head."

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1. Th Thee first first pha phase se or or prod prodro rome me::

Prodromal symptoms symptoms occur in 40% to 60% of migraineures. This phase consists of altered mood, irritability, depression or euphoria, fatigue, yawning, yawning, excessiv excessivee sleepine sleepiness, ss, craving craving for certain certain food food (e.g., (e.g., chocol chocolate), ate), and other  vegetative symptoms. These symptoms symptoms usually precede the headache phase of  the migr migrain ainee attack attack by several several hours hours or days days and experi experienc encee teache teachess the  patient or observant observa nt family that th at the th e migraine migrain e attack att ack is near. n ear.

2. The second phase or the”Aura”:

The migraine aura is comprised of focal neurological phenomena that  precedes or accompany the attack. attack . They appear gradually graduall y over 5 to 20 minutes and usually subside just before the headache begins. Symptoms of  migraine aura are usually sensory sensory in nature. Visual aura is the most common of the neurological events. There is a

disturbance of vision consisting usually of unformed flashes of white or rarely of multicolored lights (photophobia) or formations of dazzling zigzag lines (arr (arran ange ged d

like like the batt battle leme ment ntss of a cast castle le,, henc hencee the the term term fortification

spectra or teichopsia). Some patients complain of blurred or shimmering or 

cloudy vision, as though they were looking through thick or smoked glass. The somatosensory migrain ainee consi consists sts of digito digitolin lingua guall or  somatosensory aura of migr cheiro-oral cheiro-oral paresthesias, a feeling of pins-and-needles pins-and-needles experienced in the hand

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onset is usually gradual. The pain peaks and then subsides, and usually lasts and 72 hours hours in adul adults ts and and 1 to 48 hour hourss in childr children en.. The  between 4 and

frequency of attacks is extremely variable, from a few in a lifetime to several time timess a week week,, and and the the aver averag agee migr migrai aine ne expe experi rien ence cess from from one one to thre threee headaches a month. The head pain varies greatly in intensity. The pain of  migraine is invariably accompanied by other features. Anorexia is common, and nausea occurs in almost 90 percent of patients, while vomiting occurs in about

one

third

of

patients nts.

Many

patient ientss

experience nce

sensory

hyperexcitability manifested by photophobia, phonophobia, osmophobia and seek seek a dark dark and and quie quiett room room.. Blur Blurre red d visi vision on,, nasa nasall stuf stuffi fine ness ss,, diar diarrh rhea ea,,  polyuria, pallor or sweating may be noted during the headache phase. There may be localized edema of the scalp or face, scalp tenderness, prominence of  a vein vein or arter artery y in the the temp temple le,, or stif stiffn fnes esss and and tend tender erne ness ss of the the neck neck.. Impairment of concentration and mood are common. Lightheadedness, rather  than true vertigo and a feeling of faintness may occur. The extremities tend to  be cold and an d moist.

4. The postdrome phase:

The patient may feel tired, "washed out", irritable, listless and may have impaired concentration, scalp tenderness or mood changes. Some people feel unusually refreshed or euphoric after an attack, whereas others note depression and malaise.

PATHOPHYSIOLOGY:

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Scientis Scientists ts have devi devise sed d

one one theo theory ry of 

migraine

which explains

these

blood

flow

changes and also certain biochemical changes that may be involved in the

headache process. According to this theory, the nervous system responds to a trigger such as stress by causing a spasm of the nerve-rich arteries at the base of the brain brain.. The The spasm spasm const constric ricts ts sever several al arterie arteriess suppl supplyi ying ng blood blood to the

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inflammation and swelling, and substances which increase sensitivity to pain, are also released. The circulation of these chemicals and the dilation of the scalp scalp arteries arteries stimulate stimulate the pain-sensitive receptors. The result, according to this theory: a throbbing pain in the head. More recent neuro imaging techniques seem to show that migraine is  primarily a disorder of the brain (neurological), not of the blood vessels (vascular). (vascular). A spreading depolarization (electrical (electrical change) may may begin 24 hours hours  before the attack, attack , with onset of the headache headach e occurring at about the time of  maximum brain coverage. The effects of migraine migraine may persist persist for some days after the main headache headache has ended. ended. Many Many sufferers sufferers report report a sore feeling feeling in the area where the migraine was, and some report impaired thinking for a few days after the headache has h as passed. In 2005, a research was made and published indicating that in some  people with wit h a patent pa tent foramen ovale oval e (PFO), a hole between the upper uppe r chambers of the heart, migraine might result and that the occurrence of migraines might end if the hole were blocked.

MIGRAINE TRIGGERS:

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Migraine patients have long been advised to try to identify personal headache triggers by looking for associations between their headaches and variou variouss susp suspect ected ed trigge triggerr factor factors. s. Patien Patients ts are urged urged to keep keep a “head “headach achee diary” diary” in which to note what they eat and when they get a headache, headache, to look  for correlations, and to try to avoid headache by avoiding factors they identify as triggers. Typically Typically this advice is accompanied by a list of trigger factors.

1. Food

Some suspected dietary trigger factors appear to genuinely promote or   precipitate  precipitat e migraine episodes, but many other suspected dietary triggers have never been demonstrated to trigger migraines. The review authors found that alcoho alcohol, l, caff caffein einee withdr withdrawa awal, l, and miss missin ing g meals meals are the most most impor important tant dietary dietary migraine migraine precipitants. precipitants. The authors authors say dehydration dehydration deserves deserves more more attention, and that some patients are sensitive to red wine. The authors found little or no demonstrated evidence that notorious suspected triggers chocolate, cheese, or that histamine, tyramine, nitrates, or nitrites normally present in

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Several studies have found some migraines are triggered by changes in weather. weather. It has been noted that 62% of the subjects subjects in the study thought thought that weather was a factor; in fact 51% were actually sensitive to weather changes. While those whose migraines did occur during a change in weather, often the subjects picked a weather change other than the actual weather data recorded. Most likely to trigger a migraine were, in order : 1.

Temperature mixed with humidity. High humidity plus high or 

low temperature was the biggest cause. 2.

Significant changes in weather

3. Chang Changes es in baro barome metri tricc pre pressu ssure re

Another study says, Chinook winds (warm westerly winds occurring in Alber Alberta, ta, Canada) Canada) are a migra migraine ine trigger trigger..

Many Many patien patients ts had incre increase ased d

incidence of migraines immediately before and/or during the Chinook winds. TREATMENT:

Medication that is used is quite different between attacks as compared to during an attack. Duri During ng a migr migrai aine ne atta attack ck non non ster steroi oida dall anti anti-i -inf nfla lamm mmat ator ory y drug drugss (=NSAIDs) and dihydroergotamine or sumatriptan, which stimulate serotonin

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Gabap Gabapent entin, in, whic which h is used used for treatm treatment ent of chron chronic ic pain, pain, has been been found useful as well in the treatment of migraines as shown in several smaller  studies. Gabapentin(brand name: Neurontin) releases GABA in some parts of  the brain and inhibits the NMDA pain receptors. This link describes the use of  it in the Pain of complex complex regional pain syndrome. syndrome. Dr. Stephen Clarke, Clinical Assista istant nt Profess fessor or in the Div. iv. of Neurol urolo ogy of the the Unive niverrsit sity of  BC/Vanc BC/Vancouve ouver/Ca r/Canada, nada, reviewed reviewed the use of gabapenti gabapentin n at a conferen conference ce in Vancouver/BC in November 2004 Other Other medica medicatio tions ns for for headac headache he preven preventio tion n are the antic anticonv onvuls ulsant ant gabapentin; the MAO inhibitor phenelzine and the serotonin stimulating drugs methysergide and cyproheptatine. Unfortunately many of these medications do not work 100% and there is a lack of good randomized studies to prove effe effecti ctiven veness ess.. It is impo importa rtant nt to includ includee in the regime regimen n of anti-m anti-mig igrai raine ne measur measures es non non drug drug regime regimens ns such such as avoida avoidance nce of trigge triggerin ring g factor factorss like like certain foods (chocolate, (chocolate, red wine, certain cheeses and strong smells) or bright lights and noises. Consistent sleeping patterns and meal times need to be establ establish ished. ed. Couns Counseli eling ng when when emotio emotional nal fact factors ors play play a role, role, relaxa relaxatio tion n techniques like yoga, self hypnosis hypnosis and biofeedback methods are all helpful as

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Conve Conventi ntiona onall treatm treatment ent focu focuse sess on three three areas: areas: trigge triggerr avoid avoidanc ance, e, symp sympto toma mati ticc contr control ol,, and and prev prevent entiv ivee drug drugs. s.

Pati Patient entss who who expe experi rien ence ce

migraines often find that the recommended treatments are not 100% effective at preventing migraines. 1. Trigger avoidance:

Patient Patientss can can attemp attemptt to identi identify fy and avoid avoid factor factorss that that promot promotee or   precipitate  precipitat e migraine episodes. Moderation Moderati on in alcohol and caffeine intake, consist consistency ency in sleep sleep habits, habits, and regular regular meals meals may be helpful helpful.. Beyond Beyond an often often pronou pronounce nced d plac placebo ebo effec effect, t, gener general al dietar dietary y restri restricti ction on has not been been demonstrated to be an effective approach to treating migraine.

2. Symptomatic Symptomatic control to abort attacks:

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 paracetamol,  paraceta mol, aspirin and caffeine .They may provide some relief, although they are not effective for most sufferers. Some patients find relief from taking Benadryl or anti-nausea agents. Narcotic Narcotic pain killers killers (for example, example, codeine codeine , morphine morphine or other  opiat opiates es ) prov provide ide variab variable le relief relief,, but their their side side effec effects, ts, the possi possibil bility ity of  causing rebound headaches or analgesic overuse headache, and the risk of  addiction contraindicates their general use. 2. If over-the-counter medications do not work, the next step for  many doctors is to prescribe a barbiturate and caffeine.

Anti-emetics may be needed in cases where vomiting dominates

the symptoms. symptoms. The earlier these drugs drugs are taken in the attack, the better their 

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is advisable. The effectiveness of individual medications varies widely from one patient to the next. The most effective prescription medications include several classes of

medi edicati ations

inclu nclud ding ing

beta eta

block locker ers, s,

anti ntide depr pres essa sant ntss,

and and

anticonvulsants. Alternative approaches: approaches:

Because the conventional approaches approaches to migraine prevention are not 100% effective effective and can have unpleasant side effects, many seek alternative treatments. 1. Physical therapy:

Many physicians physicians believe that exercise for 15-20 minutes per day is helpful for reducing the frequency of migraines.

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Most optometrists avoid prescribing prism because, when incorrectly  prescribed,  prescribe d, it can cause headaches. h eadaches.

3.Herbal and nutritional supplements: supplements:

50 mg mg or 75 75 mg/day mg/day of

butterbur butterbur

(''Pe (''Petasit tasites es hybrid hybridus'' us'')) rhizo rhizome me

extract was shown in a controlled trial to provide 50% or more reduction in the number of migraines. Cannabis was a standard treatment for migraines from the mid-19th

century until it was outlawed in the early 20th century in the USA. It has been reported to help people through an attack by relieving the nausea and dulling the head pain. There is some indication that semi-regular use may reduce the frequency of attacks.

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Some migraine sufferers find relief through acupuncture which is usua usuall lly y used used to help help prev preven entt head headac ache hess from from deve develo lopi ping ng.. Some Someti time mess acupuncture acupuncture is used to relieve the pain of an active migraine headache. TYPES OF MIGRAINE 1.Basilar type migraine:

'''Basilar type migraine (BTM)''' is an uncommon type of migraine with aura that occurs in the brainstem. To meet the criteria for diagnosing diagnosing BTM, BTM, aura aura symp sympto toms ms must must incl includ udee at leas leastt two two of the foll follow owin ing: g:

dipl diplop opia ia ,

simultaneous simultaneous bilateral nasal and temporal visual changes, hypacusia (impaired hearing) hearing),, tinnitus tinnitus , dysarthr dysarthria ia , ataxia ataxia , vertigo vertigo , simultan simultaneous eous bilateral bilateral  paresthesia  paresthe sia s, or Unconsciousness decreased decre ased level of consciousness consciousne ss . Muscle weakness (called "motor weakness") is not part of the aura of 

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The prevention and treatment of acephalalgic migraine is broadly the same same as for class lassic ical al migra igrain ine. e. Howe Howeve ver, r, bec because ause of the the absen bsencce of  "heada "headache che," ," diagno diagnosi siss of acep acephal halalg algic ic migr migrain ainee is apt to be signi signifi fica cantl ntly y delayed delayed and the risk of misdiagno misdiagnosis sis signifi significant cantly ly increased increased might be a form of acephalalgic migraine. Migraine and stroke risk:

Visual Visual snow

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suffering from the same disease from the nosological point and they require individu individualiza alization tion for their treatment. treatment. Disease Disease individu individualiza alization tion is not merely merely disease disease determinati determination on it is more relevant relevant for therapeutic therapeutic purpose. purpose. Disease Disease deter etermi mina nati tio on

is

enoug nough h

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dia diagno gnostic stic

purpo urposse

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individualization individualization is indispensable for treatment trea tment purpose. In sec 118 of organon tells about the individualization of the medicines. It is crystal clear that the

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depend. Nor will I deal here with Migraine. Recent Recent of this affection affection has given it a place among the n euroses, with which which we shall consider it. The three great type typess whic hich come ome unde underr our our pres preseent noti notice ce are are the the NERVO ERVOUS US,, the the CONGESTIVE, and the "SICK" Headache. INDIVIDUALIZATION INDIVIDUALIZATION OF DRUGS:

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It means there are no substitutes substitutes in the selectio selection n of a remedy. Either Either a medicine is indicated in a case or it is not. Symptomatic Symptomatic comparisons comparisons between similar drugs are carried out to find their individually.

Manifestation of symptoms in various miasms

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and wants to be kept in motion, which>. The head symptoms resemble the syphilitic in that they have the night aggravations, and there is the same type of vertigo at the base of the brain.

REPERTORIAL REFERENCES FOR MIGRAINE MIGRAINE Rubrics related to migraine in Kent’s repertory:

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tarent., thuj., urt-u., verat., zinc.

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nicc., Nit-ac.,  Nux-v., phos.,  plat., prun.,  puis., rhus-t., Sang., sel., Sep., Sil.,

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K. CARB.,  K. nit., Kre., Laur.,  Led., Lye., Mag. m.,  Mang., MENY., Merc:,

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Headache associated with vomiting:

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2.

He a d

4.

Lemon ca causes he head ache Pain in in right side of  of  Head Pulsating pain

141

He a d

head pain from lemonade Pain in right side

He a d

Head pain pulsating

146

5.

rest

146

8.

>Pre >Press ssur uree

Head Head

Pain Pain > Pres Pressu sure re

146 146

9.

Associated with dimness of vision

Head

Pain with blindness

137

3.

CHOICE OF REMEDY: BASIS OF PRESCRIPTION: Repertorial totality, Generalities. PLAN OF TREATMENT: Curative. FIRST PRESCRIPTION: •

Pulsatilla 30/ 1d

•

Placebo/ 7dose

•

Placebo/ 7dose

FOLLOW UP 28.07.08 Patient feels better  05.08.08 Patient feels better 

CONCLUSION : The case showed marked improvement CASE – 06  NAME : Mrs. Krishnaveni Krish naveni OP.No: 14754. AGE/SEX : 32yrs/F OCCUPATION : Ho Housewife ADDRESS : Salem. FINAL DIAGNOSIS:

MIGRAINE

PRESENTING COMPLAINTS:  Headache since 3 years on and off.

169

134

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

Headache since 3 years on and off, gradual in onset. Pain in right side of the head. Stitching type of pain, Pain extend from occiput to forehead Hot applications TOTALITY OF SYMPTOMS:  Desire: Sour things  Pain in left side of the head. Stitching type of pain, Pain extend from occiput to forehead Hot applications MIASMATIC CLEAVAGE: S.No 1.

Expression Desire : Sourthings Sourthings

Psora

Sycosis  -

Syphilis -

2.

Stitching pain in head

-



-

3.

< Mental ex exertion



-

-

4.

> Hot ap application



-

-

5.

< Tension



-

-

FUNDAMENTAL MIASM: Trio miasmatic. miasmatic. DOMINANT MIASM: Psora. TYPE OF DISEASE: DISEASE: Dynamic chronic fully symptoms developed develope d miasmatic disease.

REPERTORIAL TOTALITY: S.No 1.

Symptom Desire for sour things

Chapter Stomach

Rubric Desire Sour things

Page 486

2.

Pain in left side of  head Stitching Pain in head

He a d

Pain in left side

169

He a d

Pain stitching

209

3.

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6.

> Hot application

hot application

He a d

CHOICE OF REMEDY: Silicea BASIS OF PRESCRIPTION: Repertorial totality, Generalities. PLAN OF TREATMENT: Curative. FIRST PRESCRIPTION: •

Silicea 30\ 1d

•

SL 30\ 7d

•

Silicea 200/ 1d

FOLLOW UP 28.08.08 Compliant reduced 02.08.08 Improved persist

CONCLUSION: The case showed marked improvement

 NAME AGE/SEX OCCUPATION ADDRESS

CASE – 07 : Mrs. Muthulakshmi Muthulaksh mi : 21yrs/F : B.Sc(student) : koneripatti, 1st ext, Rasipuram Rasipuram

FINAL DIAGNOSIS:

PRESENTING COMPLAINTS:  Headache since 1 year on and off. H/O PRESENTING COMPLAINTS:

OP.No: 12620.

MIGRAINE

146

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forehead Tight bandage Associated with redness and burning in the eyes. PAST HISTORY:   No H/O Major illness in the past. p ast. FAMILY HISTORY:  Her father known diabetic patient. PERSONAL AND SOCIAL HISTORY: Born and brought up: Rasipuram Diet: Non-veg. Marital status:Un married. Habits: No habits of bettel nut chewing and tobacco chewing. Domestic relationship: Maintaining good domestic relationship. GENERALITIES: PHYSICAL GENERALS:  Appetite: Good and Satisfied.  Thirst: Good and Satisfied.  Aversion: Milk.  Desire: Sweets.  Disagrees: Nothing specifies.  Urine: Normal.  Stool: Regular and satisfied.  Sleep & Dreams: Good, refreshed sleep.  Menses: 4/30 days cycle, cycle, regular, bright, red flow, associated associated with lower abdominal pain in first day of menses.

MENTAL GENERALS:

_ 

GENERAL EXAMINATION: Appearance: Normal

Body proportion: 120/80mm of hg

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     

CVS: Normal CVS: Normal S1 & S2 heard hea rd in i n all four cardiac car diac areas. No murmurs heard.  RS: Normal  RS: Normal vesicular vesicul ar breath brea th sound soun d is heard hear d all over lung field. fiel d. No added sounds. GIT: No GIT: No visible swelling, swelli ng, No tenderness, tende rness, No organomegaly. organomegal y. Normal  bowel sounds heard. GUT: No GUT: No inflammatory signs. No visible swelling. CNS: Patient is conscious. Higher functions normal. Sensory and motor  functions normal.  LOCOMOTOR: No  LOCOMOTOR: No inflammatory signs seen. No deformity. Normal gait.

LAB INVESTIGATIONS: INVESTIGATIONS:  Blood: Hb: 09.8g%. TLC: 8900cells/cu mm of   blood. DLC: N- 62%, L- 47%, E- 1%, B- 0%, M- 0%. ESR: ½ hr- 8mm. 1 hr- 12mm.

Urine: Sugar: Nil. Albumin: Nil.

FINAL DIAGNOSIS: MIGRAINE

ANALYSIS OF SYMPTOMS:  Physical Generals:  Desire: Sweets. Aversion:Milk.  Aversion:  Particulars:  Headache since 1 year on and off gradual in onset. Pain in left side of the head, throbbing pain extend from occiput to forehead. Hot application, rest, sleep sleep Associated Associated with vomiting.

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MENTAL GENERALS: GENERAL EXAMINATION: Appearance: Normal  Nutrition:  Nutrition : Good. Anaemia: Not Anaemic Jaundice: Not jaundiced Pedal edal oedem edemaa: No pedal edal oedem edema. a. Koilonychia: Absent. Height: 170cm. VITAL SIGNS:  Pulse: 76/Min.  B.P : 120/78mm Hg. SYSTEMIC EXAMINATION:

Body proportion: 120/78mm of hg. Skin to touch: Normal. Cyanosis: Not cyanosed. Clubbing: No clubbing. Lymphade adenopa nopath thy: y: Abse bsent. nt. Hair & Nails: Normal. Weight: 68 kg.

 R.R: 19/Min. Temp: 98.6F

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 Desire: Spicy things

 Particulars:  Headache since 4 years. On and off, gradual in onset. Pain in right side of the head. Pricking type of pain, pain extent from occiput to forehead. < mental exertion > Hot application, rest, sleep sleep Associated Associated with vomiting.  Discharge Discharge from nose since 3 days, watery in nature, no acridity no nose blocks. EVALUATION OF SYMPTOMS:  Desire: Spicy things  Pain in right side of the head. Pricking type type of pain, pain extent from occiput to forehead. < mental exertion exertion > Hot application, application, rest, sleep Associated with vomiting.  Discharge Discharge from nose since 3 days, watery in nature, no acridity no nose blocks TOTALITY OF SYMPTOMS:  Desire: Spicy things  Pain in right side of the head. Pricking type type of pain, pain extent

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REPERTORIAL TOTALITY: S.No 1.

3.

Symptom Desire for Spicy things Pain in right side of  of  head Pricking Pain in Head

4.

< Mental exertion

He a d

5.

> Pressure

He a d

6.

Associated with vomiting > Re s t

He a d

Pain in head < Mental exertion Pain in head > Pressure Pain with vomiting

He a d

Pain > Rest

2.

7.

Chapter Stomach

Rubric Desire Spicy things

Page 486

He a d

Pain in right side

169

He a d

Pain Pricking

206 135

148

145 156

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 The stud study y includes includes 10 patient patients s of Eczema Eczema betwe between en the age group of 10-50 years.

AGE INCIDENCE: In 10 patients all age groups were divided in to sub groups for the purposes of analytical study..

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Age Incidence In cidence 60 50

No. No. Of Patient atient

Perce ercenta ntage ge

50

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INCIDENCE IN SEX Both sexes were taken for the study. The statistical analysis is done based on the data obtained from these groups of patients

S.NO

SEX

NO OF

PERCENTAGE

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Sex Incidence 70 60 60 50

No. Of Patie Patient nt

Percent Percentage age

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INCIDENCE IN MIASM

NO

DOMINANT MIASM Psora, syphilis,

NO OF

PERCENTA

CASES

GE

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Discussion:

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accounting in 3individuals resulted mild improvement. But

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