Migraine headache treated using homoeopathy with the help of psychodynamic study: A case report

INTRODUCTION

According to the Global Burden of Disease Study, migraine is the second most prevalent neurological disorder worldwide and is responsible for more disability in terms of functional impairment, including physical and psychological components, than all other neurological disorders combined.^[1] The pathogenesis of migraine is widely believed to involve peripheral and central activation of the trigeminovascular system.^[1] However, migraine has no single cause. Emotional disturbance is the most common trigger mechanism and is the most important cause of frequent and severe attacks.^[2] Certain personality reactions and patterns of behaviour recur in migraine subjects: A tendency to anxiety reactions, sensitivity to stress and difficulty in handling aggressive and hostile drives. Hence, migraine is similar to many other ‘psychosomatic diseases,’ which are conditions without demonstrable pathology but characterised by disorders of homeostasis.^[2] Fromm-Reichmann took up the notion of ambivalence and developed a more orthodox psychoanalytic theory.^[3] She believed that people with migraines have an unresolved ambivalence. They cannot tolerate being aware of their hostility toward consciously beloved persons. Thus, repressed hostility is expressed through migraine. Migraine is conceptualised as a chronic, intense and vengeful attack against people with whom the patient possesses strong emotional ties. Migraine allows the patient an opportunity to express negative emotions such as anger, hostility and impatience.^[4] Appel’s paper on his migraine headaches conceptualises it as an unconscious psychosomatic reaction to repressed feelings toward others. He added in his further studies that migraine often arises from a frustrating interpersonal situation; therefore, migraine occurs in any situation that provokes rage.^[5]

Overall, the ‘migraine personality’ as conceptualised by psychoanalytic thinkers includes aspects such as rigidity, over-reactivity and suppression of resentment.^[6] According to newer research, the importance of personality traits in migraine has been widely debated. High susceptibility to stress is characteristic of patients with migraine, which correlates with individual stress levels. The anxiety traits of neuroticism are often seen, especially in women.^[7] Hence, stress susceptibility, life events and concomitant psychosomatic illnesses should be considered when evaluating individuals with migraine.

Conventional therapies, including pain killers, often yield unsatisfactory outcomes and are poorly tolerated.^[8,9] There is a strong need for alternative approaches in acute and preventive treatment. The aim of homoeopathy is not only to treat migraine but also to address its underlying cause in terms of correcting the individual susceptibility. The core concept of homoeopathy is Similia Similibus Curentur; similarity established at the level of characteristic signs and symptoms as well as at the level of portrait of disease enables the physician to understand the essence of the problem in terms of the image of the patient with drug picture.^[10]

Here, we present a case of migraine treated with the homoeopathic constitutional medicine Natrum mur, which was selected based on the totality of symptoms.

CASE REPORT

Date of case definition: 9 August 2012

A 33-year-old married lady residing near Mumbai presented with the following complaints.

Diagnosis: Migraine without aura

Psychodynamic and psychosomatic correlations [Figure 1]

In this case, the objective of the psychodynamic evaluation is to understand the dynamic interaction between the internal as well external forces responsible for the genesis of personality and its expressions and which are accountable for the maintenance of illness. Nature and nurture played very important roles in her evolution, where her internal self-instinctual wishes were unable to cope with the external environment which was perceived as harsh, controlling and abusive. This produced a trust and autonomy conflict expressed through painful childhood manifestations that were repressed to face reality. The repression provided the strength to sustain her in unfavourable situations by compromising the demands of the id. The repression proved inadequate to deal with her frustration and the delicate relationship with her parents was the characteristic expression of her morbid (fragile) sensitivity. This sensitivity was not allowing her to acknowledge that her demands and expectations such as wearing jeans and a t-shirt were unreasonable in her Brahmin family, where her father was a respected leader of the RSS.

Close

Figure 1:

Psychodynamic and psychosomatic correlations.

Export to PPT

Her rebellion in acting out the defence was a manifestation of the unresolved anal stage conflict. The void of love was expressed through weeping during the case definition due to the past unresolved experience of disappointment about the mother. It played a role in the further evolving mental state post-marriage, where anger vexation, sadness, violence and headache were adapted through defence mechanisms of suppression, displacement and somatisation. The mother-in-law was identified with her mother where she was unable to express her resentment, the resultant hostility being responsible for the frequent attacks of headache, which is a symbolic representation of aggression.

Totality

MIND – AILMENTS FROM – disappointment – old +++

MIND – AILMENTS FROM – anger – suppressed ++

MIND – CONTRADICTION – intolerant of contradiction ++

MIND – IRRITABILITY – headache, during +++

MIND – SADNESS – menses – before ++

MIND – IRRITABILITY – menses – before ++

HEAD – PAIN – anger; after ++

GENERALS – HUNGER – agg. ++

GENERALS – FOOD and DRINKS – sweets – desire ++

GENERALS – RIDING – streetcar; on a – agg. ++

HEAD – PAIN – Occiput – extending to – Forehead ++ HEAD – PAIN – evening ++

HEAD – PAIN – sun – exposure to sun; from ++

EXTREMITIES – UNCOVER, inclination to – Feet

Remedy differentiation

After repertorisation and applying the filter of the potential differential field,^[10] [Figures 2 and 3] Natrum mur, lycopodium, phosphorus, sepia and ignatia were the indicated remedies. Now, we need to review the total impression through synthesis.^[10] The core of this individual is understood in terms of morbid (fragile) sensitivity and irritability. The disappointment about mother and in-laws, and expressions of anger and vexation at the mental and physical level are the core of the case as well as the expression. Natrum mur, sepia and Ignatia come close from the angle of irritability and oversensitivity, but Nat mur covers the peculiar morbid sensitivity and retained disappointment. Ignatia is indicated predominantly when the disappointment is recent and while an individual is deeply offended; they have no disposition to violent anger or revenge.^[11] Sepia is emotional, offended easily but emotionally dead with no love inside; their love is expressed in the form of their role and responsibility as good a daughter, mother and wife.^[11,12] Nat mur withholds the feeling of sadness or anger when they have passionate outbursts of emotion.^[11,12] In this patient, we see the characteristic expressions of repression, resentment, suppression and violence expressed in smashing the bottles with a headache after anger along with the old unresolved disappointment. The core in terms of morbid sensitivity and irritability with physical characteristics such as sun aggravation and inclination to uncovering feet led to Natrum mur as the final remedy.

Close

Figure 2:

Approach for repertorisation: Kent repertorial syndrome.

Export to PPT

Close

Figure 3:

Potential differential field.

Export to PPT

Natrum mur

Emotional pain, the centre of Natrum’s pathology, originates early in childhood when the unconditional love that the child needs is not received. The primary characteristic of Natrum mur is the great vulnerability to getting easily hurt. Natrum mur is emotionally very sensitive; irritable, impatient, becomes angry at trifles and clings to traumatic experiences. The peculiar nature of heightened sensitivity and reactivity makes them rebel against authority.^[12] Natrum’s emotional suppression goes much deeper than an inability to express emotion. It involves a determined forgetting of painful emotions, many of which the average Natrum is no longer aware of psychic causes of disease, ill effects of anger, depression and particularly in chronic diseases. Catherine Coulter mentioned in her commentary about Natrum mur that retention is encountered in the mental sphere, he exhibits the consequences of a poor relationship with one or both parents, which breeds resentment and/or guilt, so the pathology develops by mourning the past; for these individuals, time is not the ‘Great Healer.’^[12]

Selected Remedy: Natrum mur.

Follow-up

Date	Loss of interest	Sadness	Irritability	Sleep	Headache	Nausea	New Symptom	Prescription
18 August 2012	Improved	Improved	Reduced	Improved	Reduced	Absent		Natrum mur 200 1 P
2 September 2012	Improved ++	Improved++	Reduced++	Improved	No episode	Absent		Natrum mur 200 1 P
1 October 2012	Improved +++	Improved++	Reduced+++	Improved	No episode	Absent		Placebo
23 November 2012	Improved +++	Improved+++	Reduced+++	Improved	No episode	Absent		Placebo
10 January 2013	0	0	Occasionally	Good	No episode	Absent		Placebo
3 March 2013	0	0	0	Good	No episode	Absent	Throat pain since 2 days	Hepar sulph 200
5 May 2013	0	0	0	Good	No episode	Absent		Placebo
15 July 2013	0	0	0	Good	No episode	Absent		Placebo
10 September 2013	0	0	0	Good	No episode	Absent	Throat pain since 1 day	Hepar sulph 200
1 February 2014	0	0	0	Good	No episode	Absent		Placebo
3 March 2014	0	0	0	Good	No episode	Absent		Placebo
2 January 2021	Informed on phone. There was no episode of migraine for the past 9 years. Mood symptoms absent.
	There was seasonal infrequent acute coryza and common cold in between. No medicine was required.

DISCUSSION

In this case, problem definition was an indispensable aspect explored through the psychodynamic study by connecting the childhood experience to conscious emotional and behavioural expression to understand the innate emotional forces or processes responsible for maintenance of illness.

A survey found that approximately 50% of people with migraine are extremely dissatisfied with their current ability to control their disease and report a range of emotions as a result, including frustration (39%), exhaustion (29%), stress (19%) and anxiety (15%).^[13] Despite the variety of options currently available to treat and prevent migraines, most people with migraine still are unable to completely control their disease.^[13] The studies have proved the effectiveness of homoeopathy as a mode of treatment. This case addresses the evolution, disposition, psychosocial stresses and coping mechanisms of the individual in view of psychodynamic study to understand the subconscious forces precipitating and maintaining the migraine. This helped us to define the therapeutic problem definition and problem resolution through constitutional medicine with the help of Kent’s approach. In this case, detailed history and observation were available and helped the physician perceive the essence of the problem and helped construct a portrait of the disease. Natrum mur was the most indicated similimum; it not only resolved her migraine completely but also improved the altered mental state and prevented a possible worsening of the condition.

CONCLUSION

This case is an attempt to demonstrate the role of psychodynamics to understand the genesis of a disease as a result of the failure of defensive mechanisms to resolve conflict in terms of the expression of both the wish (wishes) and the defence (defences) against it.

However, this is a single case report and further well-designed studies are required to obtain further data that may prove helpful for clinical practice.