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Resolution of post-coronavirus disease headache with individualised homoeopathic medicine: A case report
*Corresponding author: Dr. Sweksha Yadav, Department of Organon of Medicine and Homoeopathic Philosophy, Nehru Homoeopathic Medical College and Hospital, New Delhi, India. drswekshayadav@gmail.com
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Received: ,
Accepted: ,
How to cite this article: Yadav S. Resolution of post-coronavirus disease headache with individualised homoeopathic medicine: A case report. J Integr Stand Homoeopath. doi: 10.25259/JISH_71_2025
Abstract
The coronavirus disease 2019 (COVID-19) pandemic led to a significant burden of persistent post-infectious symptoms, collectively termed long COVID-19 or post-acute COVID-19 syndrome. Headache remains one of the most frequent and disabling neurological symptoms. Post-COVID-19 headaches are often chronic, significantly impairing quality of life and posing therapeutic challenges due to poor response to conventional treatment. This case report describes a 32-year-old woman who developed daily moderate-to-severe headaches following COVID-19 infection for 5 months. Following a thorough evaluation, individualised homoeopathic treatment with Cinchona officinalis 200C, followed by 1M. The patient showed marked improvement, with visual analogue scale (VAS) scores reducing from 8 to 0 and headache impact test scores decreasing from 72 to 36. A modified naranjo criteria score of +9 suggested a strong causal association. No relapse occurred at the 1-year follow-up. This case highlights the potential of individualised homoeopathic remedies in managing post-COVID headaches; this topic warrants further research.
Keywords
Chronic daily headache
Homoeopathy
Long coronavirus disease 2019
Post-acute coronavirus disease 2019 syndrome
Visual analogue pain scale
INTRODUCTION
The coronavirus disease 2019 (COVID-19) pandemic, which lasted from 2020 to 2022, had a profound impact on global health.[1] While acute COVID-19 primarily affected the respiratory system, many patients later experienced persistent or new symptoms such as muscle fatigue, joint pains, myalgia, cognitive impairment and anxiety, collectively referred to as post-COVID-19 syndrome or long COVID-19 syndrome. However, beyond respiratory complications, it triggered a wide array of neurological symptoms, with headaches being among the most frequently reported.[2]
Headaches associated with viral infections, during the infectious or post-infectious phase, are recognised as secondary headaches in the International Classification of Headache Disorders, 3rd edition (ICHD-3).[3] These are typically classified as chronic if they persist for more than 3 months after the acute phase. Chronic daily headache is defined as 15 or more headache attacks per month for at least 3 months; this may be accompanied by chronic fatigue, anxiety, depression and sleep disorders. In long COVID-19, headaches often present similarly to new daily persistent headache (NDPH), which is characterised by daily pain and poor response to common treatments.[2]
Individuals with pre-existing migraine conditions have been found to have experienced increased headache frequency and intensity during the pandemic, likely due to psychosocial stressors.[4,5] Long COVID-19 headaches are particularly prevalent in middle-aged women; they can be of moderate-to-severe intensity, often accompanied by fatigue and cognitive dysfunction. These headaches primarily exhibit tension-type or migraine-like presentations. Those with a history of headache commonly report worsening of their condition.[6,7] Diagnosis of long COVID-19 headaches remains primarily one of exclusion, as they do not have a distinct clinical presentation.
The headache impact test (HIT-6) is a widely used tool to assess headache-related outcomes. The six-item HIT-6 measures the overall impact of headaches on daily activities, including social, cognitive and role functioning, as well as pain severity. Scores range from 36 to 78, with higher scores indicating greater impact. Severity levels are categorised from little to no impact (below 50) to severe impact (60 and above).[8] The visual analogue scale (VAS), on the other hand, is a simple but effective tool to measure pain intensity. Patients mark their pain level on a 10-cm line, ranging from ‘no pain’ (score 0) to ‘worst pain’ (score 10). The VAS provides a visual representation of pain progression over time, enabling objective tracking of symptoms.
Conventional treatment approaches for long COVID-19 headaches focus on recommendations for primary headache disorders, including the use of simple analgesics and nonsteroidal anti-inflammatory drugs. However, recent studies suggest that some patients do not respond to these treatments.[9]
Despite the prevalence of long COVID-19 headaches, few studies have addressed their management through homoeopathy. While some studies on homoeopathic approaches to post-COVID-19 syndrome, none specifically address the management of post-COVID-19 headaches.[10-13] This case report aims to fill this gap by presenting the resolution of a post-COVID-19 headache through individualised homoeopathic treatment, highlighting its potential as an effective therapeutic approach.
CASE REPORT
Patient information
A 32-year-old woman presented to the post-COVID-19 outpatient department of the NHMC Hospital, New Delhi, with the primary complaint of a persistent, moderate to severe headache, which had been present daily for the past 5 months without remission. In addition to the headache, she reported generalised weakness since recovering from COVID-19.
The patient’s headache began suddenly 2 days after her respiratory symptoms from COVID-19 had subsided. She vividly recalled the exact circumstances when the headache started and since then, it had been a daily occurrence. The pain was described as bursting and tightening in nature, predominantly affecting the bitemporal region. It was mostly aggravated by exposure to noise, bright light and routine physical activities such as walking or climbing stairs. The patient experienced slight relief when resting in a dark, quiet environment or when firm pressure was applied to her head. She also reported episodes of nausea, although no vomiting was present. Initially, she experienced partial relief from over-the-counter medications, including ibuprofen and sumatriptan. However, over time, these medications became ineffective, and the headache persisted daily without any relief.
Medical history
The patient was diagnosed with COVID-19 on 11 May 2021, following a positive result from a reverse transcription polymerase chain reaction test. During the acute phase of the infection, she experienced mild symptoms, including low-grade fever, myalgia, nasal congestion, anosmia and diarrhoea. In addition, her oxygen saturation remained stable throughout her illness, consistently between 98% and 100%. She did not experience headaches during the acute phase of the illness. The patient tested negative for COVID-19 on 23 May 2021. She had been in good health before contracting COVID-19, with no history of headaches or any other significant medical conditions.
Family history
The patient’s father had a history of hypertension, and her mother had been diagnosed with bronchial asthma. Her elder sister has experienced recurrent episodes of tonsillitis. There were no reports of hereditary or genetic predispositions relevant to her current complaints.
Physical generals
The patient had a decreased appetite since her COVID-19 illness; however, her thirst remained adequate. She had a strong desire for sweets (+++). Her urine and stool were satisfactory. She experienced occasional disturbances in sleep, primarily due to persistent thoughts related to her illness. She described her thermal reaction as extremely chilly (+++).
Mental generals
The patient noticed a gradual change in her emotional state over the past 2–3 months. She experienced frequent and unpredictable mood swings, often becoming irritable without provocation. She admitted to being rude to her family, getting offended easily and feeling detached from them. Alongside this, she developed a strong dislike for both mental and physical exertion and became indifferent to tasks she once liked.
In addition, the patient had to leave her job, as her physical condition no longer allowed her to cope with the work demands. This deepened her sense of frustration and dissatisfaction with life. She frequently ruminated on how unfair her circumstances had become, often stating that life had not been kind to her. She believed her life had been filled with constant obstacles, which left her feeling extremely unfortunate. She described feeling tired of her health problems and expressed how worn out she was from dealing with them day after day.
Diagnostic findings
A thorough diagnostic evaluation of the headache included a detailed medical history, neurological examination and brain magnetic resonance imaging, which showed no abnormalities. The patient had no history of headache disorders and did not experience headaches during the acute COVID-19 phase. Her oxygen saturation was stable at 98%, ruling out hypoxia and hypercapnia.
On general physical examination, the patient exhibited mild pallor, with no signs of icterus, cyanosis, clubbing, lymphadenopathy, abnormal pigmentation or oedema. Vital signs were within normal limits.
Given the abrupt onset of the headache, which became continuous and unremitting from the 1st day of occurrence, the diagnosis aligned with New Daily Persistent Headache (NDPH). The international classification of diseases-10-CM code for NDPH is G44.52.[14] According to the ICHD-III criteria, NDPH presents as a new primary daily headache that does not remit and lacks a prior history of evolution from migraine or tension-type headaches. Although the clinical features may resemble those of chronic migraine, such as headache occurring for more than 15 days per month and exhibiting a migraine-like phenotype, the patient’s history does not support an evolution from previous headache syndromes, as would be expected in chronic migraine. Therefore, the diagnosis of NDPH was made based on the sudden onset and continuous nature of the headache, with no history of migraine with or without aura.[3]
Intervention
A totality of symptoms, including characteristic mental and physical general symptoms, was constructed to guide the intervention.
Mental generals
Offended over trifles; frequent mood changes
Decreased motivation towards responsibilities and routine duties
Responds with rudeness or irritability
Persistent sense of being unfortunate.
Physical generals
Desire for sweets (+++)
Chilly patient (+++); extremely sensitive to cold.
Particulars
Persistent generalised weakness after COVID-19 illness
Headache aggravated by the slightest movement
Headache aggravated by noise
Headache relieved when lying in a dark room
Headache better on application of hard pressure.
An individualised homoeopathic approach was adopted based on symptom similarity, with no adjunctive therapies utilised. The Kentian method of repertorisation, which follows a general-to-particular repertorial approach, was adopted in this case since the patient presented with well- defined mental and physical generals. Particular symptoms, including the modalities of headache, were then incorporated to complete the totality. Repertorisation was carried out using rapid aid and data analysis research (RADAR) OPUS (version 4.1.6) software, which suggested Cinchona officinalis, Belladonna, Nitricum acidum, Silicea terra and Lachesis mutus as the most indicated remedies [Figure 1].
Belladonna was excluded as its characteristic picture of acute, congestive and throbbing headache with associated heat and restlessness was not present in the case. N. acidum was ruled out due to the absence of its characteristic features, such as hatred, vindictiveness, ulcerative tendencies and offensive discharges. Similarly, S. terra was not considered, as the mental state in this case reflected apathy and irritability rather than oversensitivity, timidity and conscientiousness. The pattern of headache and general modalities, including the lack of offensive perspiration, further diminished its relevance. Finally, L. mutus was excluded due to contradictory modality and absence of confirmatory symptoms such as left- sided predominance, hyperactivity, loquacity and mental jealousy.[15,16]
C. officinalis was selected for this patient based on indifference to duties, rudeness, hypersensitivity to minor remarks, deep sense of misfortune and a feeling of being burdened or overwhelmed. General weariness following COVID-19 infection, desire for sweets, chilly thermal reaction and characteristic modalities of the headache further supported the final selection.[15,16]
Follow-up and outcome
Based on the repertorial analysis and referring to the Materia Medica, C. officinalis 200C was administered in a single dose, to be taken in aqua on an empty stomach, followed by a placebo for 1 week. The 200C potency was selected based on the intensity and duration of the presenting complaint, along with the presence of well-defined generals and absence of structural pathology. Further dosage, strength and duration of treatment were adjusted according to follow-up evaluations. Outcomes, changes in intervention and follow- up assessments, documented during subsequent visits, are mentioned in Table 1.
| Follow-up date | Symptomatology | Prescription | HIT-6 score |
VAS score |
|---|---|---|---|---|
| 09 November 2021 |
As per repertorial totality and final differentiation using Materia Medica |
Cinchona officinalis 200C/1 dose/ empty stomach Along with placebo for 1 week. |
72 | 8 |
| 16 November 2021 |
Mild reduction in the intensity of headache for 2 days, returned to the previous state 3rd day onwards. |
Cinchona officinalis 200C/1 dose/ empty stomach Along with placebo for 1 week |
72 | 8 |
| 25 November 2021 |
Felt mentally calmer, Appetite - Improved, Fatigue - Reduced, Headache - mild reduction in intensity |
Cinchona officinalis 200C/2 doses/ weekly Along with placebo for 2 weeks |
68 | 7 |
| 04 December 2021 |
Mentally - occasional irritability, better than before, Appetite - continuous improvement Fatigue - Further reduction Headache - Intensity and duration reduced. |
Placebo continued for 2 weeks | 60 | 6 |
| 14 December 2021 |
Same as previous time, no further improvement | Cinchona officinalis 200C/OD/5 days Along with placebo for 2 weeks | 60 | 6 |
| 28 December 2021 |
Appetite - Good, Fatigue - Occasional, Headache - Frequency reduced to 3–4 days and duration reduced to <4–5 h/day in the previous week, didn’t require analgesics |
Placebo continued for 2 weeks | 54 | 5 |
| 15 January 2022 |
Condition same as previous visit, no further improvement. | Cinchona officinalis 200C/BD/3 days Along with placebo for 2 weeks | 54 | 5 |
| 29 January 2022 |
Headache - Frequency 3–4 days/week, duration - 3–5 h/day, intensity - tolerable, didn’t require analgesics. | Cinchona officinalis 200C/BD/3 days Along with placebo for 2 weeks | 48 | 4 |
| 10 February 2022 |
Further reduction in duration to 1–3 h/day, intensity - continuous reduction. | Placebo continued for 2 weeks | 44 | 4 |
| 26 February 2022 |
Condition same as previous visit, no further improvement. | Cinchona officinalis 200C/BD/5 days Along with placebo for 2 weeks | 44 | 4 |
| 22 March 2022 |
No further improvement | Cinchona officinalis 200C/BD/1 week Along with placebo for 2 weeks | 44 | 4 |
| 26 April 2022 | No further improvement | Cinchona officinalis 1M/1 dose/1 day Along with placebo for 2 weeks | 44 | 4 |
| 10 May 2022 | Reported within 15 days due to coryza and increased intensity of headache and duration of headache. Still positive of recovery, didn’t appear worried or restless. |
Placebo continued for 2 weeks | 46 | 5 |
| 11 June 2022 | 2 episodes of headache in the previous week (duration – 1–2 h), didn’t require analgesics, coryza resolved on its own. | Placebo continued for 2 weeks. | 38 | 3 |
| 16 July 2022 | Frequency - 1 episode/week Duration - 1–2 h Intensity - tolerable (mild heaviness) |
Placebo continued for 2 weeks | 38 | 2 |
| 20 August 2022 |
1 episode of increased intensity 5 days back, duration - 2–3 h | Cinchona officinalis 1M/1 dose/1 day Along with placebo for 2 weeks | 38 | 3 |
| 17 September 2022 |
Mild heaviness in the 1st week, no episodes in the 2nd week. | Placebo continued for 2 weeks | 36 | 1 |
| 22 October 2022 |
No episodes of headache. | Placebo continued for 2 weeks | 36 | 0 |
| 05 November 2022 |
Reported early due to loose, watery stool throughout the day, extreme weakness, no episode of headache. | Placebo continued for 2 weeks | 36 | 0 |
| 24 December 2022 |
Reported after 1 month. No episode of headache. Appetite - good, sleep - sound and refreshing. |
Placebo continued for 1 month. | 36 | 0 |
| 18 February 2023 |
Got a new job in January. No episodes of headache. | Cinchona officinalis 1M/1 dose/ Placebo continued for 1 month | 36 | 0 |
| 08 April 2023 | Cinchona officinalis 1M/1 dose was not taken. No repetition of headache. | Placebo continued | 36 | 0 |
| 17 June 2023 to 11 November 2023 |
Patient didn’t visit for her complaints after 08 April 2023. She came twice for her mother’s treatment; she reported no relapses of her headache. | - | - | - |
HIT-6: Headache impact test, VAS: Visual analogue scale, OD: Once a day, BD: Twice a day, h: Hours
Outcomes were evaluated using the VAS and HIT-6 scores that were assessed at each follow-up visit. The initial VAS score was 8, indicating severe pain, which decreased to 0 following treatment. Similarly, the baseline HIT-6 score was 72, reflecting a very high level of headache-related disability; this score subsequently reduced to 36 with treatment [Table 1].
To further assess the causal relationship between the homeopathic intervention and the clinical outcomes, the modified naranjo criteria for homoeopathy (MONARCH) Inventory was employed, resulting in a total score of +9 after treatment, indicating a definite causal relationship [Table 2].
| S. No. | Domains | Yes | No | Not sure or N/A |
|---|---|---|---|---|
| 1. | Was there an improvement in the main symptom or condition for which the homoeopathic medicine was prescribed? | +2 | ||
| 2. | Did the clinical improvement occur within a plausible time frame relative to the drug intake? | +1 | ||
| 3. | Was there an initial aggravation of symptoms? (need to define in glossary) | 0 | ||
| 4. | Did the effect encompass more than the main symptom or condition, i.e., were other symptoms ultimately improved or changed? | +1 | ||
| 5. | Did overall wellbeing improve? (suggest using validated scale) | +1 | ||
| 6.A. | Direction of cure: did some symptoms improve in the opposite order of the development of symptoms of the disease? | 0 | ||
| 6.B. | Direction of cure: Did at least two of the following aspects apply to the order of improvement of symptoms From organs of more importance to those of less importance From deeper to more superficial aspects of the individual From the top downwards |
0 | ||
| 7. | Did ‘old symptoms’ (defined as non-seasonal and non-cyclical symptoms that were previously thought to have resolved) reappear temporarily during the course of improvement? | 0 | ||
| 8. | Are there alternate causes (other than the medicine) that with a high probability could have caused the improvement? (consider known course of disease, other forms of treatment and other clinically relevant interventions) | +1 | ||
| 9. | Was the health improvement confirmed by any objective evidence? (e.g., lab test, clinical observation, etc.) | +2 | ||
| 10. | Did repeat dosing, if conducted, create similar clinical improvement? | +1 |
Total score: +9 (maximum score: +13, minimum score: - 6), N/A : Not applicable
DISCUSSION
This case report highlights the effective management of a 32-year-old woman with persistent post-COVID-19 headaches through individualised homoeopathic treatment. Despite initial responses to over-the-counter medications, the headaches became refractory to common analgesics. This aligns with findings that post-viral headaches often do not respond to standard treatments, emphasising the need for alternative therapeutic options.[9]
In this case, an individualised analysis led to the selection of C. officinalis in potencies of 200C and 1M over time, which resulted in significant improvement in the patient’s symptoms. The use of individualised homoeopathy has been previously documented as effective in managing post-viral syndromes.[10-13]
Throughout the 2-year treatment period, the patient showed marked improvement in headache intensity and frequency, with follow-up assessments indicating no relapses over a period of 1 year. In addition, her general condition improved significantly; weakness reduced, energy levels were regained and her appetite returned to normal, contributing to a better quality of life. Mentally, the patient felt calmer, with a marked reduction in irritability and mood swings. In addition, she secured a new job during this period, reflecting an improvement in her overall well-being.
The VAS and HIT-6 scores were utilised to evaluate her progress, revealing marked reductions in disability and pain levels post-treatment. Specifically, the VAS score decreased from 8 to 0, and the HIT-6 score decreased from 72 to 36, indicating a substantial improvement in her headache-related disability. The application of the MONARCH Inventory yielded a score of +9 after treatment, further establishing a strong causal relationship between the homeopathic intervention and observed clinical outcomes.
However, the limitations of this case must be acknowledged. Being a single case report, the findings are not generalisable. In addition, there are no laboratory investigations specific to post-COVID-19 headache, and the diagnosis of NDPH was based on clinical judgment after ruling out all possible causes.
While this case supports the role of individualised homoeopathic treatment for post-COVID-19 headaches, further research with larger sample sizes and extended follow-up periods is necessary to fully understand the long- term impact of such interventions.
CONCLUSION
This case demonstrates the effective management of post- COVID-19 headaches through individualised homoeopathic treatment, leading to marked improvements in VAS and HIT-6 scores, enhanced quality of life and overall well-being. However, adequately controlled trials with rigorous methodology are required to conclusively prove the efficacy of homoeopathy in managing post-viral headaches.
Ethical approval:
Institutional Review Board approval is not required.
Declaration of patient consent:
The author certifies that they have obtained all appropriate patient consent forms. In the form, the patient has given consent for clinical information to be reported in the journal. The patient understand that the patient’s names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Conflicts of interest:
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation:
The author confirms that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
Financial support and sponsorship: Nil.
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