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Headache
Headache HAMI
SH
W.
BOYD,
M.B., Ctt.B., M.R.C.P.,
D . C . H . , F.F. ItOM.
Mr. President, Ladies and Gentlemen, I am honoured to have been asked to give the Richard Hughes Lecture for 1971. I feel only too conscious of my inability to match the eloquence and extensive knowledge displayed by your last year's lecturer, m y colleague Dr. Frank Bodman. His was a fascinating historical account of Richard Hughes and his contemporaries and revealed how much Dr. Hughes tried to make his Homceopathy conform to pathological systems and states. We are, of course, all instructed in our medical classes to think in these terms, and the resultant treatment is usually based on such diagnostic labelling. I n Homceopathy, however, our prescribing should wherever possible be related to the patient as a whole in his reaction to disease or environmental stress, although in some instances organ prescribing can be helpful or necessary. I propose in this paper to look at a particular part of the body and try to discuss some homceopathic remedies of value in the treatment of pain in the head. Some of these remedies will of necessity have fairly limited symptoms, others will be of wider general use, prescribed on their broader picture. Before describing these remedies I wish first of all to remind you of the pathology of headache and the possible causes, because in all good medicine we must seek to eradicate the cause. I t is also important that in selecting a remedy we do not allow the search for the drug picture to distract our attention from a surgical or traumatic cause for the pain. Headache can occur from a wide variety of factors and I have set them out briefly as follows:
Extracranial
Cranial
Intracranial
Trauma Myalgia and cervical spondylosis Eye disease Herpes zoster Tic doloureux Cranial arteritis Polymyalgia rhemnatica Migraine Dental abscess Otitis and mastoiditis Sinusitis Disease of skull Traumatic Post-concussional syndrome Haemorrhage--extradural, subdural Inflammatory Meningism and meningitis. Poliomyelitis Abscess. Sinus thrombosis
Richard Hughes Memorial Lecture read to the Faculty of Homceopathy on 25 March 1971
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Vascular Neoplastic
(Hypertensive)
(Psychogenic)
Subarachnoid haemorrhage Primary and secondary tumour Pituitary tumour Primary Essential hypertension Secondary (a) renal (b) vascular (c) endocrine Anxiety, hysteria
As you will see, some of these have distinctive features which distinguish them clinically. I n some circumstances additional investigations will be required, the principal ones being skull X-ray, lumbar puncture, electro-encephalogram, brain scan and occasionally arteriography. I would draw your attention particularly to the Migraine group of which there are a number of variants. An excellent article in the British Medical Journal is worth reading, 1 but I will extract a few symptoms from this to illustrate some of the variants. These are not very common but can cause confusion if they are not in the doctor's mind. A known previous history of classical migraine, a family history or the periodicity of the attacks m a y all help to suggest the possibility of migraine.
Basilar migraine The aura m a y consist of vertigo, dysarthria or ataxia. There m a y be total loss of vision, and bilateral sensory changes m a y be present. Vomiting is a prominent feature, and also occipital throbbing headache.
Hemiplegia Confusion and even coma m a y occur with dysphasia in right-sided paresis.
Cluster headaches Bursts of headache, with long free intervals, usually of stabbing quality and worse at 2-4 a.m., perhaps a Kali carb. case. Watering of the eyes, nasal congestion and local redness of autonomic type is characteristic.
Opthalmoplegic migraine I n these cases the sixth or third cranial nerves are usually involved and vascular leakage m a y be a cause.
Aura without headache The aura m a y be visual or vertigo or tinnitus like a M6ni~re's Syndrome. HOM(EOPATHIC
TREATMENT
OF HEADACHE
As I have mentioned, on first seeing the patient we must exclude gross pathological states requiring investigation or surgical treatment. I f there is a history of injury, even some considerable time before, we must consider using Arnica as a first prescription, before following up with further remedies. I n cases of occipital blows on the head consider Natrum sulph., which will often deal with the persistent headache.
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163
Where the eyes seem to be the main cause of pain, we should consider such remedies as Ruta, Silica and Natrum mur., after making any necessary adjustment to spectacles. These remedies all help in eye strain and weakness of muscle. Sinusitis is, of course, a common source of head pain and one t h a t is often difficult to cure b y orthodox means. We have a wide range of remedies available here:
Aconite, Belladonna, Bryonia, Spigelia, the Kali salts, Pulsatilla. Apart from the conditions mentioned, m a n y patients come with a history of migraine or of headache which has no identifiable cause, and m a y in some cases be psychogenic. I would like now to consider some remedies in more detail with a few illustrative case histories.
Acute headache Belladonna: Throbbing headache, ~ stooping, lying, jar and noise. Flushed d r y face with enlarged pupils and often fever, sometimes accompanied b y delirium. Bryonia: Pain often right-sided, but particularly ~ b y movement of head or eyes and ~ b y pressure, occurring frequently in association with a respiratory infection and cough with aggravation of the pain; also of value in migraine. Glonoine: Bursting headache, sometimes brought on b y exposure to the heat of the sun, with pounding in the head, such as that found in men working with explosives. A lady in our hospital with renal failure and anaemia obtained considerable relief of her headache with this remedy. Gelsemium: This is, of course, the remedy for influenzal headache, dull, aching, occurring in d a m p mild weather and accompanied by the usual aching in the limbs, hot and cold sensations and chills up and down the back. Lack of thirst even when febrile and drowsiness add to this picture. The headache is relieved b y passage of large quantities of pale urine. China sulph.: Aching pain in the occiput extending over the head. Sweaty d a m p head. Better from cold applications, ~ turning the head or eyes and from open air. Patient looks nauseated but wants to eat. Flatulence but cannot break wind (a China symptom). Sanguinaria: A very useful migraine remedy for right temporal or frontal pain, with dizziness and sickness ~ lying down and sleep. The menstrual periods are profuse and the patient feels worse before and after them. I t is a remedy also for paroxysmal cough, ~ b y loud eructations of wind. Rheumatic pains in the right shoulder are also helped (Rhus tox., Ferrum met. also). I often give Sanguinaria to migraine patients to use in the acute phase and it has frequently cut short the attacks or reduced the severity. Spigelia: Shooting pain on the left side of the head extending to the face and arm, ~ motion, stooping. A boy of 10 came complaining of shooting pain around the left eye followed b y sickness and occurring at monthly intervals. He was chilly, highly strung and worried easily. He was friendly but obstinate, rather untidy and easily weepy. More on the local t h a n the general symptoms I prescribed Spigelia 30, expecting t h a t he might require a more general constitutional remedy to follow. However, two months later he had only had two short attacks without sickness and had been able to go to school on each occasion. Spigelia was repeated twice and he was free of all headache for four months between.
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Chronic headache I n patients with chronic headache a cure will often depend on an accurate assessment of the patient's general and mental symptoms rather than purely on the local type of pain, although this m a y help. Kall. bic.: Headaches a t the root of the nose and spreading, of great value in sinus trouble either with the typical sticky white or yellow catarrh or where there is pain, without discharge. The pain is ~ on motion and stooping, open air and eating especially hot things. I n migraine there is dimness of vision first, then a gap and then headache. The patient dislikes the heat, and pains occur in spots; crusting of the nose and bleeding m a y occur. Pains of rheumatism often alternate with the catarrh. A yellowish appearance is characteristic of the remedy. Lachesis: Few of us would like to be without this valuable snake remedy. I t is particularly helpful in menopausal patients and has a characteristic aggravation on first w a k i n g - - t h e patient sleeps into the headache. Pulsating, hammering headache with purplish appearance of the face and puffy eyes: the blueness occurs in Lachesis generally with ecchymoses, congested purplish throat or legs. This remedy is often left-sided and usually ~ b y cold, and the patient is generally ~ by heat and tight constricting garments. The mentals are marked, with jealousy, suspicion and loquacity predominating, although slowness of speech and taciturnity can also occur. _~Irs. L . - - 5 5 years A patient with hypertension (B.P. 240/140--220/120) and menopausal symptoms with flushes, throbbing in the head and occipital headache extending to the left eye, often waking her, or in the morning. She had sensations of choking and was upset by sympathy, in a small room or f r o m company. She liked fish and chocolate and was averse to salt and fat. She was nervous, with fear of the dark and being alone and was generally < b y heat. The remedies which gave her most relief were Lachesis, Natrum tour., and Squid. She would get considerable relief from her headache for some months on one remedy and then require a change to one of the others. Natrum muriaticum: The Natrum headache is also hammering in type and often accompanied b y visual disturbances, zig-zags or even loss of vision while reading, with watering of the eyes. I t is usually worse from midday to evening and is ~ by sun. The patient and her head are sensitive to noise, she feels the cold but is ~ b y much heat and is generally worse at the sea. This latter feature ties up with the strong liking or dislike of salt. Periodicity is a feature of this remedy in regard to m a n y symptoms but equally to headache. These patients often have greasy skins with a tendency to acne and are usually ~ at the menstrual period. The mental symptoms are often difficult to extract because the patients are nervous and reticent b y nature, but they m a y cover this up b y an appeart~nee of seIf assurance. They tend to brood and harbour resentment and the headache m a y occur as a result of emotional breakdown after grief or a disappointed love affair. They dislike s y m p a t h y but at the same time crave attention which they consider due to them.
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165
I t is wise not to give this remedy in the acute phase of headache but rather perhaps its acute partner Bryonia, followed up by Natrura tour. Mrs. I . C . - - 5 7 years
Headaches for four years, occipital, extending to her eyes and preceded by some flashes of light. They were now p r e t t y constant and often woke her at 4 a.m., and had originally started when her husband was ill. She had quite a past history of illness, a partial gastrectomy for duodenal ulcer, both breasts removed for chronic mastitis and a hysterectomy at 49 years of age. Generals: Chilly, > heat. Liking for fish. Sleep--poor. Mind: Weepy, worries, tends to rush, states t h a t she tikes people and mixes well. No marked fears. The headache pulsates ~ touch, vibration, noise and emotional upsets. I n view of the history of onset and the character of the headache she was given N a t r u m tour. 10M over the following two months with improvement, both in the headache and her sleep. The remedy was repeated again when symptoms began to occur. Mrs. M . A . - - 3 2 years
Headaches for seven years, now occurring every week, requiring Femergin injections, Migril or Cafergot. Starts with a tense feeling for two days, then depression and then a dull ache in left temple lasting three to seven days. H e r mother had a history of migraine. Generals: ~ heat. Desires: Most foods, fairly plain. M.P. Regular. Mind: Irritable and weepy during migraine--hates being like this. Likes people and visits elderly people as a part-time nursing job, but is averse to s y m p a t h y and tends to keep her feelings in. Easily startled. She has brown hair, blue eyes and freckles. Nat. mur. 30 given. Headache ~ for two weeks and then one or two bad ones. Nat. tour. 10M given. A month later reported headaches less frequent but still quite severe but none for two weeks so Sac. lac. given. A further month later feeling very well and headache more just before and during periods. Nat. tour. 10M repeated. M i s s E . M c A . - - 2 6 years
Headaches for a year, frontal at first on waking and recently any time. Pain if her nose runs. I t m a y last for hours, is throbbing in character and ~ pressure jar or bright light. Recent history of colds. At the age of 16 she had been knocked off her bicycle and concussed. Recurrent tonsillitis. On examination her nose was congested and she was tender over the frontal sinuses. Generals: ~ heat. Desires: Fruit, reg., salt, cheese, eggs, fish, hot drinks. Mind: Tendency to worry, tidy, easily startled, fear of thunder. States she is a good mixer but is upset b y sympathy. Rather difficult to get symptoms from her.
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Natrum mur. 30 was given and after ten days she was markedly improved. Over the following five years she had bouts of sneezing and catarrh accompanied b y headaches, but the only remedy ever required was Natrum mur. which on each occasion cleared it up. Sepia: The headache of Sepia is often associated with nausea and although occurring in pregnancy, morning sickness is usually better from sleep (unlike 9Lachesis). I t is also > b y violent exertion. You will remember the tired, jaded; irritable housewife with backache, feelings of prolapse and must sit down and yet take her out to a dance in the evening and she comes alive, her headache gone and her sparkle returned. Characteristically these patients are sallow and thin, feel the cold but are faint in hot, stuffy atmosphere and flush easily. The mentals are again helpful---irritable, weepy, usually tidy but now indifferent to their house or their family. Mrs. A . - - 3 7 years Right frontal headache for years, usually < before her periods, or from excitement. from cold especially to her head ~ from heat but not Generals: excessive. Aversion: Fat. Desires: H o t tea. Mind: Tense, irritable, weepy < s y m p a t h y < noise, tidy worries a good deal. Quite likes company but not a lot of talk; upset in anticipation of things. Fear of water. Dislike of tight things. She had quite a bit of strain at home, her husband not being very easy to live with and dominated b y his mother. H e r blood pressure was slightly raised and she had chronic mastitis in the right breast. Within a week of receiving Sepia 30 she was very much better, and a month later her pressure was normal and the breast condition also improved. This was in 1959 and I have seen this patient at intervals over the years with symptoms of rheumatism and sometimes cough. Her headaches vary with stress but she always got considerable benefit from Sepia, with occasional doses of N u x vomica and Lachesis when her menopause came on. Cimicifuga (Actaea racemosa): This remedy is apt to be neglected but it is a most useful one for headache. The pain is often occipital or pressing out or up, as if the top of the head would fly off, and extending to the eyes. There is often rheumatism in the muscle of the neck or neuralgia of the ciliary nerves. I think of it mainly as a female remedy with < at the menstrual period, accompanied b y black gloom. The patient m a y even think she is going insane. Chilliness and tendency to take cold but prefers cool and open air for the local headache. Jerking and twitching of the muscles and changeableness in both physical and mental spheres (like Pulsatilla). Mrs. C . M c P . - - 3 1 years This is an interesting case whom I saw first in May 1970. Eighteen months
I~EADACHE
167
previously she had had a virus infection with faintness, sickness and headache and a lumbar puncture had been done but no definite meningitis found. Since then she had complained of dull headache on the top of the head, with spells of bursting headache, usually later in the day. There is no visual upset but she gets sick and vomits but without relief. The pain is < heat, moving head, jar, > cold applications. There is sometimes vertigo. These attacks usually occur every five to six weeks, but she had had four in three weeks when I saw her. She had a history of dermatitis as a child cleared up b y homceopathie remedies. There was no family history of migraine. She had no family problems and was quite h a p p y in her job as a counting machine operator. She had reddish hair and a pale eolour. Generals: Desires: Mind:
< heat, stuffy places, flushes easily. Savouries, not much salt. Sleep poor due to activity of mind. Worries easily, anticipation upsets, irritable if her headache is bad, not weepy and hates fuss, tidy, fear of thunder and sensitive to noises.
Natrum tour. 30 given with Bryonia for acute attacks, but this did not help and two weeks later the headaches were bad. Cimicifuga 30 was given and three weeks later she reported t h a t she was feeling generally better with only two headaches. A further dose of Cimicifuga was taken in another three weeks and in early August she reported no severe headache all month, no sickness and "the best spell she had had for ages". I n mid-September she said she had been fine till two weeks before when she had a bad week-end with headache and sickness. She took a spare dose of Cimicifuga but had not felt right. She was irritable, drowsy, shouting at people. On further reviewing her picture Sepia 30 was prescribed and in the past few months she has been much improved. Her general health is good, she is mentally better and any headache is much less severe and much less frequent. I think this illustrates t h a t sometimes remedies m a y need changing in chronic conditions even though the general improvement is continuing. I hope the Sepia m a y now prove to be a much more lasting cure. Silica: The headache of this remedy is often occipital, extending over the head to the eyes, especially the right. The head is very sensitive to draughts and he wants it wrapped up tight and w a r m - - t h e old gentleman who always wears a night cap. There is sometimes loss of half the field of vision and numbness of the arm. Bursting headache with sensitivity to noise, and < b y exertion physical and mental. Together with these local symptoms we have the Silica generals and mentals. Chilliness, clammy, sweaty feet and hands, dread of failure, lack of confidence, lack of strength---exhausted by talking and therefore dislikes people, irritable, overconscientious and resentful a n d , of course, the tendency to sepsis. Silica is complementary to Pulsatilla. Mr. 0.--36 years This m a n I have quoted before, but I should like to refer to him briefly. I n 1965 he came with a history of headaches for ten y e a r s - - a c u t e pain over the right eye, boring, ~ bright light, moving, driving, heat. He tended to get cluster attacks every evening for two weeks and then a space. He was a heavy
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smoker. Tenderness was present over his right eyebrow but sinus X - r a y was negative. He was chilly, liked savouries. He tended to worry, was sensitive and emotional, and self-conscious, and hated wounds or accidents. Spigelia 1t~I gave him immediate relief, but the pain troubled him at 2-3 a.m. Silica 1M cleared this completely and it was four years later when he phoned to ask for a repeat of his headache medicine. Again Spigelia followed by Silica cleared it up.
Pulsatilla: I n general Pulsatilla is worse from heat and relieved by motion. The headaches are throbbing, congestive in type, ~ cold applications and slow movement, often associated with the menstrual period and relieved after it (like Lachesis). Girls with headache when about to menstruate. Sickness m a y accompany the headache and this remedy is valuable in periodic attacks, or old-fashioned acidosis resulting from too fat or rich food. The Pulsatilla patient likes sweet food and also pastries which upset, and is not thirsty even during fever. Symptoms of this remedy are often worse in the evening--the headache, the cough, the fever. There is frequently catarrh, usually yellow, and sinus conditions are helped, particularly where the pains are ~ b y heat. Changeableness of symptoms is characteristic--rheumatic pains, headaches, type of stool. The mental symptoms are well known to you--gentle yielding disposition, easily weepy, wants attention and s y m p a t h y but is also touchy, jealous and irritable. Lycopodium: This remedy is one which I frequently use. I t is so applicable to the stresses and strains and rush of modern life. The headaches are often periodic and particularly occur when the patient is empty. He has the faint all-gone sensation one usually associates with Sulphur, and eating helps the JLycopodium headache. I t is ~ b y heat, warmth of the bed and lying down and b y cold, cold air. Right-sided symptoms are common with this remedy. I n spite of the relief from eating, these patients are easily filled up, distended and have much flatus. They love hot drink and sweet food. Aggravation of symptoms at 4 p.m. or 4-8 p.m. is a useful guide. Lycopodium is anxious and worried looking, anticipates trouble and lacks confidence, although he is often intellectual and capable when the time comes. Dread of forgetting, or making mistakes. Averse to company, especially new company and yet a dread of solitude. Fears of crowds, of the dark and of ghosts. Sensitive and emotional--he m a y weep when being thanked. Mrs. C.--45 years I n October 1966 this lady took a giddy turn in the street with double vision. She was admitted to hospital but E E G and lumbar puncture were negative and she was told she probably had migraine. F r o m then until August 1967 when I saw her, she had had frequent "funny turns" with a floating sensation, visual upset and then headache, but no vomiting. These were occurring every few days and she was taking Migril and Panadol. Her mother had a history of migraine. Generals: ~ cold but some hot turns and sweat. Desires: Sweet, savouries, sauce, salt, eggs. Mind: Excitable, nervous, irritable, always worrying with diarrhoea on anticipation. She had a fear of heights, was
HEADACHE
169
easily startled and stated t h a t she was rather emotional, was not a good mixer but liked some sympathy. Lycopodium 30 was given twice in the following three months, with marked improvement in her migraine attacks. I n the last three years Lycopodium and on some occasions Natrum mur. have greatly reduced the incidence of headache and she is much better in herself. N u x vomica: A most valuable remedy for the effects of overindulgence in eating,
drinking or physical exertion. The hangover headache. But also useful with the N u x personality. The pains are often neuralgic in type and some gastric symptoms are common, and vertigo m a y accompany the headache. He is fond of t a s t y foods, spices and fat. N u x is essentially a chilly patient sensitive to draughts and to all external impressions, fight, noise and colours. He is above all irritable and fastidious. Mr. K.R.---39 years
Headaches for a year, starting in the left occiput forehead; three times in the last six months he He had no actual visual disturbance. His glasses small bleeding pile but no other significant past Generals: Desires: Mind:
and gripping the vertex and became dizzy and vomited. were satisfactory. He had a history.
Chilly, ~ warm. Sweating feet and perineum. Savouries, salt, pickles, eggs, some fat. Thirst for water. Worries. Irritable--sometimes holds it in, sometimes flares up. Keyed-up in anticipation, very tidy, fear of heights, easily startled, likes young people.
He was well built, neat in appearance with high colour. N u x Vomica 30 given - - t h e following month he reported some headache to begin with and then improvement, iVux vomica 30 repeated. The next month he reported considerable improvement, no bad headaches and his pile better. I t is only possible to select a few remedies when one is dealing with a particular complaint, but I hope these I have described you will find of value. One is always conscious of the danger of giving too m a n y case histories or too m a n y remedies and I only hope these have not proved tedious. I n conclusion m a y I reiterate the importance in cases of headache of excluding traumatic, neoplastic and mechanical causes before starting medical treatment and even at a later date reviewing the diagnosis if remedies do not seem to be acting. We homceopathic physicians have a wonderful store of remedies which will cure or alleviate headache in m a n y patients if used wisely and correctly. REFERENCE 1 Whitty, C. W. M., British 3ledical Journal (1971) 1, 38-40.
SH
W.
BOYD,
M.B., Ctt.B., M.R.C.P.,
D . C . H . , F.F. ItOM.
Mr. President, Ladies and Gentlemen, I am honoured to have been asked to give the Richard Hughes Lecture for 1971. I feel only too conscious of my inability to match the eloquence and extensive knowledge displayed by your last year's lecturer, m y colleague Dr. Frank Bodman. His was a fascinating historical account of Richard Hughes and his contemporaries and revealed how much Dr. Hughes tried to make his Homceopathy conform to pathological systems and states. We are, of course, all instructed in our medical classes to think in these terms, and the resultant treatment is usually based on such diagnostic labelling. I n Homceopathy, however, our prescribing should wherever possible be related to the patient as a whole in his reaction to disease or environmental stress, although in some instances organ prescribing can be helpful or necessary. I propose in this paper to look at a particular part of the body and try to discuss some homceopathic remedies of value in the treatment of pain in the head. Some of these remedies will of necessity have fairly limited symptoms, others will be of wider general use, prescribed on their broader picture. Before describing these remedies I wish first of all to remind you of the pathology of headache and the possible causes, because in all good medicine we must seek to eradicate the cause. I t is also important that in selecting a remedy we do not allow the search for the drug picture to distract our attention from a surgical or traumatic cause for the pain. Headache can occur from a wide variety of factors and I have set them out briefly as follows:
Extracranial
Cranial
Intracranial
Trauma Myalgia and cervical spondylosis Eye disease Herpes zoster Tic doloureux Cranial arteritis Polymyalgia rhemnatica Migraine Dental abscess Otitis and mastoiditis Sinusitis Disease of skull Traumatic Post-concussional syndrome Haemorrhage--extradural, subdural Inflammatory Meningism and meningitis. Poliomyelitis Abscess. Sinus thrombosis
Richard Hughes Memorial Lecture read to the Faculty of Homceopathy on 25 March 1971
162
THE
BRITISH
]:IOM(EOPATHIC
JOUR:NAL
Vascular Neoplastic
(Hypertensive)
(Psychogenic)
Subarachnoid haemorrhage Primary and secondary tumour Pituitary tumour Primary Essential hypertension Secondary (a) renal (b) vascular (c) endocrine Anxiety, hysteria
As you will see, some of these have distinctive features which distinguish them clinically. I n some circumstances additional investigations will be required, the principal ones being skull X-ray, lumbar puncture, electro-encephalogram, brain scan and occasionally arteriography. I would draw your attention particularly to the Migraine group of which there are a number of variants. An excellent article in the British Medical Journal is worth reading, 1 but I will extract a few symptoms from this to illustrate some of the variants. These are not very common but can cause confusion if they are not in the doctor's mind. A known previous history of classical migraine, a family history or the periodicity of the attacks m a y all help to suggest the possibility of migraine.
Basilar migraine The aura m a y consist of vertigo, dysarthria or ataxia. There m a y be total loss of vision, and bilateral sensory changes m a y be present. Vomiting is a prominent feature, and also occipital throbbing headache.
Hemiplegia Confusion and even coma m a y occur with dysphasia in right-sided paresis.
Cluster headaches Bursts of headache, with long free intervals, usually of stabbing quality and worse at 2-4 a.m., perhaps a Kali carb. case. Watering of the eyes, nasal congestion and local redness of autonomic type is characteristic.
Opthalmoplegic migraine I n these cases the sixth or third cranial nerves are usually involved and vascular leakage m a y be a cause.
Aura without headache The aura m a y be visual or vertigo or tinnitus like a M6ni~re's Syndrome. HOM(EOPATHIC
TREATMENT
OF HEADACHE
As I have mentioned, on first seeing the patient we must exclude gross pathological states requiring investigation or surgical treatment. I f there is a history of injury, even some considerable time before, we must consider using Arnica as a first prescription, before following up with further remedies. I n cases of occipital blows on the head consider Natrum sulph., which will often deal with the persistent headache.
HEADACHE
163
Where the eyes seem to be the main cause of pain, we should consider such remedies as Ruta, Silica and Natrum mur., after making any necessary adjustment to spectacles. These remedies all help in eye strain and weakness of muscle. Sinusitis is, of course, a common source of head pain and one t h a t is often difficult to cure b y orthodox means. We have a wide range of remedies available here:
Aconite, Belladonna, Bryonia, Spigelia, the Kali salts, Pulsatilla. Apart from the conditions mentioned, m a n y patients come with a history of migraine or of headache which has no identifiable cause, and m a y in some cases be psychogenic. I would like now to consider some remedies in more detail with a few illustrative case histories.
Acute headache Belladonna: Throbbing headache, ~ stooping, lying, jar and noise. Flushed d r y face with enlarged pupils and often fever, sometimes accompanied b y delirium. Bryonia: Pain often right-sided, but particularly ~ b y movement of head or eyes and ~ b y pressure, occurring frequently in association with a respiratory infection and cough with aggravation of the pain; also of value in migraine. Glonoine: Bursting headache, sometimes brought on b y exposure to the heat of the sun, with pounding in the head, such as that found in men working with explosives. A lady in our hospital with renal failure and anaemia obtained considerable relief of her headache with this remedy. Gelsemium: This is, of course, the remedy for influenzal headache, dull, aching, occurring in d a m p mild weather and accompanied by the usual aching in the limbs, hot and cold sensations and chills up and down the back. Lack of thirst even when febrile and drowsiness add to this picture. The headache is relieved b y passage of large quantities of pale urine. China sulph.: Aching pain in the occiput extending over the head. Sweaty d a m p head. Better from cold applications, ~ turning the head or eyes and from open air. Patient looks nauseated but wants to eat. Flatulence but cannot break wind (a China symptom). Sanguinaria: A very useful migraine remedy for right temporal or frontal pain, with dizziness and sickness ~ lying down and sleep. The menstrual periods are profuse and the patient feels worse before and after them. I t is a remedy also for paroxysmal cough, ~ b y loud eructations of wind. Rheumatic pains in the right shoulder are also helped (Rhus tox., Ferrum met. also). I often give Sanguinaria to migraine patients to use in the acute phase and it has frequently cut short the attacks or reduced the severity. Spigelia: Shooting pain on the left side of the head extending to the face and arm, ~ motion, stooping. A boy of 10 came complaining of shooting pain around the left eye followed b y sickness and occurring at monthly intervals. He was chilly, highly strung and worried easily. He was friendly but obstinate, rather untidy and easily weepy. More on the local t h a n the general symptoms I prescribed Spigelia 30, expecting t h a t he might require a more general constitutional remedy to follow. However, two months later he had only had two short attacks without sickness and had been able to go to school on each occasion. Spigelia was repeated twice and he was free of all headache for four months between.
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Chronic headache I n patients with chronic headache a cure will often depend on an accurate assessment of the patient's general and mental symptoms rather than purely on the local type of pain, although this m a y help. Kall. bic.: Headaches a t the root of the nose and spreading, of great value in sinus trouble either with the typical sticky white or yellow catarrh or where there is pain, without discharge. The pain is ~ on motion and stooping, open air and eating especially hot things. I n migraine there is dimness of vision first, then a gap and then headache. The patient dislikes the heat, and pains occur in spots; crusting of the nose and bleeding m a y occur. Pains of rheumatism often alternate with the catarrh. A yellowish appearance is characteristic of the remedy. Lachesis: Few of us would like to be without this valuable snake remedy. I t is particularly helpful in menopausal patients and has a characteristic aggravation on first w a k i n g - - t h e patient sleeps into the headache. Pulsating, hammering headache with purplish appearance of the face and puffy eyes: the blueness occurs in Lachesis generally with ecchymoses, congested purplish throat or legs. This remedy is often left-sided and usually ~ b y cold, and the patient is generally ~ by heat and tight constricting garments. The mentals are marked, with jealousy, suspicion and loquacity predominating, although slowness of speech and taciturnity can also occur. _~Irs. L . - - 5 5 years A patient with hypertension (B.P. 240/140--220/120) and menopausal symptoms with flushes, throbbing in the head and occipital headache extending to the left eye, often waking her, or in the morning. She had sensations of choking and was upset by sympathy, in a small room or f r o m company. She liked fish and chocolate and was averse to salt and fat. She was nervous, with fear of the dark and being alone and was generally < b y heat. The remedies which gave her most relief were Lachesis, Natrum tour., and Squid. She would get considerable relief from her headache for some months on one remedy and then require a change to one of the others. Natrum muriaticum: The Natrum headache is also hammering in type and often accompanied b y visual disturbances, zig-zags or even loss of vision while reading, with watering of the eyes. I t is usually worse from midday to evening and is ~ by sun. The patient and her head are sensitive to noise, she feels the cold but is ~ b y much heat and is generally worse at the sea. This latter feature ties up with the strong liking or dislike of salt. Periodicity is a feature of this remedy in regard to m a n y symptoms but equally to headache. These patients often have greasy skins with a tendency to acne and are usually ~ at the menstrual period. The mental symptoms are often difficult to extract because the patients are nervous and reticent b y nature, but they m a y cover this up b y an appeart~nee of seIf assurance. They tend to brood and harbour resentment and the headache m a y occur as a result of emotional breakdown after grief or a disappointed love affair. They dislike s y m p a t h y but at the same time crave attention which they consider due to them.
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I t is wise not to give this remedy in the acute phase of headache but rather perhaps its acute partner Bryonia, followed up by Natrura tour. Mrs. I . C . - - 5 7 years
Headaches for four years, occipital, extending to her eyes and preceded by some flashes of light. They were now p r e t t y constant and often woke her at 4 a.m., and had originally started when her husband was ill. She had quite a past history of illness, a partial gastrectomy for duodenal ulcer, both breasts removed for chronic mastitis and a hysterectomy at 49 years of age. Generals: Chilly, > heat. Liking for fish. Sleep--poor. Mind: Weepy, worries, tends to rush, states t h a t she tikes people and mixes well. No marked fears. The headache pulsates ~ touch, vibration, noise and emotional upsets. I n view of the history of onset and the character of the headache she was given N a t r u m tour. 10M over the following two months with improvement, both in the headache and her sleep. The remedy was repeated again when symptoms began to occur. Mrs. M . A . - - 3 2 years
Headaches for seven years, now occurring every week, requiring Femergin injections, Migril or Cafergot. Starts with a tense feeling for two days, then depression and then a dull ache in left temple lasting three to seven days. H e r mother had a history of migraine. Generals: ~ heat. Desires: Most foods, fairly plain. M.P. Regular. Mind: Irritable and weepy during migraine--hates being like this. Likes people and visits elderly people as a part-time nursing job, but is averse to s y m p a t h y and tends to keep her feelings in. Easily startled. She has brown hair, blue eyes and freckles. Nat. mur. 30 given. Headache ~ for two weeks and then one or two bad ones. Nat. tour. 10M given. A month later reported headaches less frequent but still quite severe but none for two weeks so Sac. lac. given. A further month later feeling very well and headache more just before and during periods. Nat. tour. 10M repeated. M i s s E . M c A . - - 2 6 years
Headaches for a year, frontal at first on waking and recently any time. Pain if her nose runs. I t m a y last for hours, is throbbing in character and ~ pressure jar or bright light. Recent history of colds. At the age of 16 she had been knocked off her bicycle and concussed. Recurrent tonsillitis. On examination her nose was congested and she was tender over the frontal sinuses. Generals: ~ heat. Desires: Fruit, reg., salt, cheese, eggs, fish, hot drinks. Mind: Tendency to worry, tidy, easily startled, fear of thunder. States she is a good mixer but is upset b y sympathy. Rather difficult to get symptoms from her.
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Natrum mur. 30 was given and after ten days she was markedly improved. Over the following five years she had bouts of sneezing and catarrh accompanied b y headaches, but the only remedy ever required was Natrum mur. which on each occasion cleared it up. Sepia: The headache of Sepia is often associated with nausea and although occurring in pregnancy, morning sickness is usually better from sleep (unlike 9Lachesis). I t is also > b y violent exertion. You will remember the tired, jaded; irritable housewife with backache, feelings of prolapse and must sit down and yet take her out to a dance in the evening and she comes alive, her headache gone and her sparkle returned. Characteristically these patients are sallow and thin, feel the cold but are faint in hot, stuffy atmosphere and flush easily. The mentals are again helpful---irritable, weepy, usually tidy but now indifferent to their house or their family. Mrs. A . - - 3 7 years Right frontal headache for years, usually < before her periods, or from excitement. from cold especially to her head ~ from heat but not Generals: excessive. Aversion: Fat. Desires: H o t tea. Mind: Tense, irritable, weepy < s y m p a t h y < noise, tidy worries a good deal. Quite likes company but not a lot of talk; upset in anticipation of things. Fear of water. Dislike of tight things. She had quite a bit of strain at home, her husband not being very easy to live with and dominated b y his mother. H e r blood pressure was slightly raised and she had chronic mastitis in the right breast. Within a week of receiving Sepia 30 she was very much better, and a month later her pressure was normal and the breast condition also improved. This was in 1959 and I have seen this patient at intervals over the years with symptoms of rheumatism and sometimes cough. Her headaches vary with stress but she always got considerable benefit from Sepia, with occasional doses of N u x vomica and Lachesis when her menopause came on. Cimicifuga (Actaea racemosa): This remedy is apt to be neglected but it is a most useful one for headache. The pain is often occipital or pressing out or up, as if the top of the head would fly off, and extending to the eyes. There is often rheumatism in the muscle of the neck or neuralgia of the ciliary nerves. I think of it mainly as a female remedy with < at the menstrual period, accompanied b y black gloom. The patient m a y even think she is going insane. Chilliness and tendency to take cold but prefers cool and open air for the local headache. Jerking and twitching of the muscles and changeableness in both physical and mental spheres (like Pulsatilla). Mrs. C . M c P . - - 3 1 years This is an interesting case whom I saw first in May 1970. Eighteen months
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previously she had had a virus infection with faintness, sickness and headache and a lumbar puncture had been done but no definite meningitis found. Since then she had complained of dull headache on the top of the head, with spells of bursting headache, usually later in the day. There is no visual upset but she gets sick and vomits but without relief. The pain is < heat, moving head, jar, > cold applications. There is sometimes vertigo. These attacks usually occur every five to six weeks, but she had had four in three weeks when I saw her. She had a history of dermatitis as a child cleared up b y homceopathie remedies. There was no family history of migraine. She had no family problems and was quite h a p p y in her job as a counting machine operator. She had reddish hair and a pale eolour. Generals: Desires: Mind:
< heat, stuffy places, flushes easily. Savouries, not much salt. Sleep poor due to activity of mind. Worries easily, anticipation upsets, irritable if her headache is bad, not weepy and hates fuss, tidy, fear of thunder and sensitive to noises.
Natrum tour. 30 given with Bryonia for acute attacks, but this did not help and two weeks later the headaches were bad. Cimicifuga 30 was given and three weeks later she reported t h a t she was feeling generally better with only two headaches. A further dose of Cimicifuga was taken in another three weeks and in early August she reported no severe headache all month, no sickness and "the best spell she had had for ages". I n mid-September she said she had been fine till two weeks before when she had a bad week-end with headache and sickness. She took a spare dose of Cimicifuga but had not felt right. She was irritable, drowsy, shouting at people. On further reviewing her picture Sepia 30 was prescribed and in the past few months she has been much improved. Her general health is good, she is mentally better and any headache is much less severe and much less frequent. I think this illustrates t h a t sometimes remedies m a y need changing in chronic conditions even though the general improvement is continuing. I hope the Sepia m a y now prove to be a much more lasting cure. Silica: The headache of this remedy is often occipital, extending over the head to the eyes, especially the right. The head is very sensitive to draughts and he wants it wrapped up tight and w a r m - - t h e old gentleman who always wears a night cap. There is sometimes loss of half the field of vision and numbness of the arm. Bursting headache with sensitivity to noise, and < b y exertion physical and mental. Together with these local symptoms we have the Silica generals and mentals. Chilliness, clammy, sweaty feet and hands, dread of failure, lack of confidence, lack of strength---exhausted by talking and therefore dislikes people, irritable, overconscientious and resentful a n d , of course, the tendency to sepsis. Silica is complementary to Pulsatilla. Mr. 0.--36 years This m a n I have quoted before, but I should like to refer to him briefly. I n 1965 he came with a history of headaches for ten y e a r s - - a c u t e pain over the right eye, boring, ~ bright light, moving, driving, heat. He tended to get cluster attacks every evening for two weeks and then a space. He was a heavy
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smoker. Tenderness was present over his right eyebrow but sinus X - r a y was negative. He was chilly, liked savouries. He tended to worry, was sensitive and emotional, and self-conscious, and hated wounds or accidents. Spigelia 1t~I gave him immediate relief, but the pain troubled him at 2-3 a.m. Silica 1M cleared this completely and it was four years later when he phoned to ask for a repeat of his headache medicine. Again Spigelia followed by Silica cleared it up.
Pulsatilla: I n general Pulsatilla is worse from heat and relieved by motion. The headaches are throbbing, congestive in type, ~ cold applications and slow movement, often associated with the menstrual period and relieved after it (like Lachesis). Girls with headache when about to menstruate. Sickness m a y accompany the headache and this remedy is valuable in periodic attacks, or old-fashioned acidosis resulting from too fat or rich food. The Pulsatilla patient likes sweet food and also pastries which upset, and is not thirsty even during fever. Symptoms of this remedy are often worse in the evening--the headache, the cough, the fever. There is frequently catarrh, usually yellow, and sinus conditions are helped, particularly where the pains are ~ b y heat. Changeableness of symptoms is characteristic--rheumatic pains, headaches, type of stool. The mental symptoms are well known to you--gentle yielding disposition, easily weepy, wants attention and s y m p a t h y but is also touchy, jealous and irritable. Lycopodium: This remedy is one which I frequently use. I t is so applicable to the stresses and strains and rush of modern life. The headaches are often periodic and particularly occur when the patient is empty. He has the faint all-gone sensation one usually associates with Sulphur, and eating helps the JLycopodium headache. I t is ~ b y heat, warmth of the bed and lying down and b y cold, cold air. Right-sided symptoms are common with this remedy. I n spite of the relief from eating, these patients are easily filled up, distended and have much flatus. They love hot drink and sweet food. Aggravation of symptoms at 4 p.m. or 4-8 p.m. is a useful guide. Lycopodium is anxious and worried looking, anticipates trouble and lacks confidence, although he is often intellectual and capable when the time comes. Dread of forgetting, or making mistakes. Averse to company, especially new company and yet a dread of solitude. Fears of crowds, of the dark and of ghosts. Sensitive and emotional--he m a y weep when being thanked. Mrs. C.--45 years I n October 1966 this lady took a giddy turn in the street with double vision. She was admitted to hospital but E E G and lumbar puncture were negative and she was told she probably had migraine. F r o m then until August 1967 when I saw her, she had had frequent "funny turns" with a floating sensation, visual upset and then headache, but no vomiting. These were occurring every few days and she was taking Migril and Panadol. Her mother had a history of migraine. Generals: ~ cold but some hot turns and sweat. Desires: Sweet, savouries, sauce, salt, eggs. Mind: Excitable, nervous, irritable, always worrying with diarrhoea on anticipation. She had a fear of heights, was
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easily startled and stated t h a t she was rather emotional, was not a good mixer but liked some sympathy. Lycopodium 30 was given twice in the following three months, with marked improvement in her migraine attacks. I n the last three years Lycopodium and on some occasions Natrum mur. have greatly reduced the incidence of headache and she is much better in herself. N u x vomica: A most valuable remedy for the effects of overindulgence in eating,
drinking or physical exertion. The hangover headache. But also useful with the N u x personality. The pains are often neuralgic in type and some gastric symptoms are common, and vertigo m a y accompany the headache. He is fond of t a s t y foods, spices and fat. N u x is essentially a chilly patient sensitive to draughts and to all external impressions, fight, noise and colours. He is above all irritable and fastidious. Mr. K.R.---39 years
Headaches for a year, starting in the left occiput forehead; three times in the last six months he He had no actual visual disturbance. His glasses small bleeding pile but no other significant past Generals: Desires: Mind:
and gripping the vertex and became dizzy and vomited. were satisfactory. He had a history.
Chilly, ~ warm. Sweating feet and perineum. Savouries, salt, pickles, eggs, some fat. Thirst for water. Worries. Irritable--sometimes holds it in, sometimes flares up. Keyed-up in anticipation, very tidy, fear of heights, easily startled, likes young people.
He was well built, neat in appearance with high colour. N u x Vomica 30 given - - t h e following month he reported some headache to begin with and then improvement, iVux vomica 30 repeated. The next month he reported considerable improvement, no bad headaches and his pile better. I t is only possible to select a few remedies when one is dealing with a particular complaint, but I hope these I have described you will find of value. One is always conscious of the danger of giving too m a n y case histories or too m a n y remedies and I only hope these have not proved tedious. I n conclusion m a y I reiterate the importance in cases of headache of excluding traumatic, neoplastic and mechanical causes before starting medical treatment and even at a later date reviewing the diagnosis if remedies do not seem to be acting. We homceopathic physicians have a wonderful store of remedies which will cure or alleviate headache in m a n y patients if used wisely and correctly. REFERENCE 1 Whitty, C. W. M., British 3ledical Journal (1971) 1, 38-40.