Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Filter by Categories
Book Review
Case Report
Case Series
Editorial
JISH Reviewers List
Obituary
Original Article
Pilot Research Projects/Observational Studies
Policy Paper on Homoeopathic Education
Policy Paper on Homoeopathic Education/Research/Clinical Training
Review Article
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Filter by Categories
Book Review
Case Report
Case Series
Editorial
JISH Reviewers List
Obituary
Original Article
Pilot Research Projects/Observational Studies
Policy Paper on Homoeopathic Education
Policy Paper on Homoeopathic Education/Research/Clinical Training
Review Article
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Filter by Categories
Book Review
Case Report
Case Series
Editorial
JISH Reviewers List
Obituary
Original Article
Pilot Research Projects/Observational Studies
Policy Paper on Homoeopathic Education
Policy Paper on Homoeopathic Education/Research/Clinical Training
Review Article
View/Download PDF

Translate this page into:

Case Report
5 (
3
); 78-83
doi:
10.25259/JISH_3_2022

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

Life Care Homoeopathy, Kalyan West, Maharashtra, India
Corresponding author: Dr. Manoj Kishor Patil, Life Care Homoeopathy, Tarangan CHS, Wayle nagar, Khadakpada, Kalyan West, Maharashtra, India. drmanojicr@gmail.com
Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Patil MK. Migraine headache treated using homoeopathy with the help of psychodynamic study: A case report. J Intgr Stand Homoeopathy 2022;5:78-83.

Abstract

This case report demonstrates the role of psychodynamics in the genesis of migraine and illustrates the method of creating a portrait of the disease when treating with homoeopathy. The Kentian repertorial approach used based on the totality of symptoms indicated Natrum mur as the similimum, which not only resolved the patient’s migraine but also improved the altered mental state and prevented a possible worsening of the condition.

Keywords

Psychodynamics
Aggression
Homoeopathy
Migraine
Natrum mur

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.

Chief complaint

Location Sensation Modalities Concomitant
Head Occiput to vertex to the forehead. left Side. Pain ++ A/F: Vexation Irritability ++
Aching ++ Evening 6pm
++
++<Motion
++<Sun
For 2 years. O: Gradual I: Moderate – Severe Eructation ++<Anger after
F: 4–5 episodes/ month D: 3–4 h. Nausea ++

Associated complaints

Location Sensation Modalities Concomitant
Mind Since 2–3 months Onset: Gradual. I: Moderate Aloofness and Sadness No impairment in physiological functions or daily life functioning; sleep unrefreshing A/F: Anger vexation ++

Patient as a person

  • Appearance: Fair and average build

  • Perspiration: Scalp ++

  • Hunger: <++ cannot tolerate, restless and has to eat.

  • Cr: Sweets Food: Warm

  • Menstrual history: Regular and clots ++ reddish black.

  • Before the menses: Occasional leucorrhoea thin white.

  • During Menses: Irritability 2 sadness 2 since menarche

  • Bus travelling <++ nausea vomiting

  • Sun < headache

  • Dreams: Unremembered

  • Thermals: C2H. Chilly. Covering: Up to neck and uncovers soles

Life space

The patient is a 33-year-old woman; she appeared anxious and spoke about her complaints in detail. She belongs to the Brahmin community and was born and brought up in Mumbai with father, mother and younger brother. She described her childhood as quite turbulent; the family was quite orthodox and she had numerous conflicts with her parents, especially her mother who was irritable and asocial. Her father was a bank manager, a very social person and the district head of a unit of a Hindu socio-cultural organisation with a nationalistic and to some, a revivalist point of view. He was very dignified, principled and disciplined. Many people would visit their home due to organisation work; the mother never liked it. Hence, there were frequent quarrels between parents. The patient was very disturbed by their behaviour and the family atmosphere. She repeatedly claimed, that she was unable to recollect her reactions to childhood but definitely went through many traumatic events. Her mother used to beat her till she was 14. She used to weep after arguments with either parent. Her Father was against Western culture and never allowed her to don Western attire such as jeans and t-shirts, but she never followed her father’s orders. She used to wear the disapproved attire repeatedly and purposefully to express her protest. She was against certain cultural orthodox norms and used to argue with her father. In school and college, she was a fun-loving person and not very serious about her career and studies. She had a cordial relationship with the younger brother who was mild but a little frivolous and being a boy did not have any restrictions. Hence, he remained unaffected by family conflict and the environment. She was friendly with everybody and loved to have fun in college. During her marriage preparations, her mother quarrelled with her about bangles worth Rs. 60, which she purchased against her mother’s wishes. While this incident disappointed her very much, she had not shared this with anyone earlier; she was weeping while narrating this 6-year-old incident.

She agreed to an arranged marriage in 2006 with a graduate who was the only son of his parents. At present, she lives with her mother-in-law (MIL), father-in-law (FIL), husband and her 4-year-old son. She described her husband as very cooperative. MIL and FIL were reserved and self-centred, which prevented her from understanding their expectations. She too did not make effort to understand them. MIL expected that she should ask their opinion about cooking and household things, which was not possible every time. She too did not feel like communicating and would get angry but was unable to express it. She expected care and concern, which she felt she was not getting. For the past 2 years, she has been getting progressively more disturbed due to MIL’s behaviour.

In July 2012, her in-laws were watching TV at a loud volume; this irritated her and her suppressed anger erupted when she asked them to lower the volume. She also shouted at her husband and broke bottles. Since then, she started remaining aloof, and experienced low mood, sadness and migraine set in; however, this did not alter her daily functioning.

Her husband deals in branded electronic equipment; the patient helps him in his business. After marriage, she had planned to appear for an MBA entrance examination but avoided it due to poor confidence. The husband indicated that she expected care and concern from in-laws, but as they have always been reserved and undemonstrative by nature, she perceived that they did not like her. He also acknowledged that there was a communication block from both sides that accounted for her condition.

Physical Examination: All systems were normal.

Medical history: Jaundice at the age of 20 years

Family history: Mother: Diabetes mellitus

Diagnostic assessment

Clinical presentation

Chronic unilateral and episodic headache.

Intensity: Moderate-to-severe

Headache duration: 3–4 h

Recurrence: 4–5 episodes/month

Headache is associated with nausea and eructation.

Sex: Female

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.

Figure 1:: Psychodynamic and psychosomatic correlations.

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.

Figure 2:: Approach for repertorisation: Kent repertorial syndrome.
Figure 3:: Potential differential field.

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.

Acknowledgment

I would like to thank all the faculty members of Dr. M. L. Dhawale Memorial Homoeopathic Institute, Palghar, who always provide positive motivation.

Declaration of patient consent

Patient’s consent not required as patients identity is not disclosed or compromised.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

  1. , , , , , , et al. Diagnosis and management of migraine in ten steps. Nat Rev Neurol. 2021;17:501-14.
    [CrossRef] [PubMed] [Google Scholar]
  2. . Migraine: A psychosomatic disorder. Headache. 1977;17:125-8.
    [CrossRef] [PubMed] [Google Scholar]
  3. . Contribution to the psychogenesis of migraine 1937. Psychoanal Rev. 2013;100:95-102.
    [CrossRef] [PubMed] [Google Scholar]
  4. . . Pittsburgh, PA: Duquesne University; Available from: https://www.dsc.duq.edu/cgi/viewcontent.cgi?article=1531&context=etd [Last accessed on 2020 May 01]
    [Google Scholar]
  5. . Notes on the Psychosomatic Element of Migraine. . Available from: http://www.natcouncilofpsychotherapists.org.uk/Newsletter/Ed016/P005.htm [Last accessed on 2020 May 01]
    [Google Scholar]
  6. . Behavioral management of migraine headache triggers: Learning to cope with triggers. Curr Pain Headache Rep. 2010;14:221-7.
    [CrossRef] [PubMed] [Google Scholar]
  7. , , . Stress in migraine: Personality-dependent vulnerability, life events, and gender are of significance. Ups J Med Sci. 2011;116:187-99.
    [CrossRef] [PubMed] [Google Scholar]
  8. , , , , , . Adherence to oral migraine-preventive medications among patients with chronic migraine. Cephalalgia. 2015;35:478-88.
    [CrossRef] [PubMed] [Google Scholar]
  9. , . Current practice and future directions in the prevention and acute management of migraine. Lancet Neurol. 2010;9:285-98.
    [CrossRef] [Google Scholar]
  10. . Area D: Repertorial concept and technique: The bridge that gulfs the gap between the natural disease and the drug disease In: , ed. ICR Symposium Volume on Hahnemannian Totality (3rd ed). Mumbai: Dr. M. L Dhawale Memorial Trust; . p. :D2.
    [Google Scholar]
  11. . Prisma, the Arcana of Materia Medica Illuminated France: Salus Infirmorum; . p. :222-62.
    [Google Scholar]
  12. . Portraits of Homoeopathic Medicines: Psychophysical Analyses of Selected Constitutional Types Missouri: Quality Medical; .
    [Google Scholar]
  13. National Headache Foundation Survey shows Majority of People with Migraine are Unable to Control Disease and Dissatisfied with Current Preventive Treatment Options. National Headache Foundation. Available from: https://www.headaches.org/2021/05/11/national-headache-foundation-survey-shows-majority-of-people-with-migraine-are-unable-to-control-disease-and-dissatisfied-with-current-preventive--treatment-options [Last accessed on 2022 Apr 21]
    [Google Scholar]
Show Sections