BRIEF RESUME OF INTENDED WORK:

NEED FOR STUDY:

Ø  Headache is common neurological disorder has both a high incidence and prevalence and the burden of this disease impacts not only the child but also the family including school performance, social life, mental health and quality of life. ⁽¹⁾

Ø  Causation is a stimulus which has ability to change the inertia of a living substance. “Cause’ is anything that precedes the ‘effect.’ The disease is an effect, which may result from recent or remote cause.  ⁽²⁾

Ø  According to Hahnemann, there are two types of cause of disease: ⁽²⁾

1. Exciting or precipitating cause (Recent).

2. Fundamental or miasmatic cause (Remote).

Ø  Exciting causes are those which excites the Acute condition in disease.  ⁽³⁾

Ø  The acute disease thus caused are only a temporary explosion of psora which usually remains latent or in dormant condition.  ⁽³⁾

Ø  Exciting causes can trigger latent disease tendencies within the body, prompting them into activity. ⁽³⁾

Ø  In Sec. 73 Hahnemann describes four types of exciting causes:  ⁽²⁾

1.    Physical exciting causes

2.    Mechanical exciting cause

3.    Nervous exciting cause

4.    Hygienic exciting causes

Ø  This thesis aims to explore which types of exciting causes can trigger acute onset headaches in school-going children.

Ø  SIGNIFICANCE OF EXCITING CAUSE  ⁽²⁾

1.    Nature of the exciting cause helps the physician to select a remedy.  ⁽²⁾

Example: calcarea iodata child loves cold air, cold wind on the face which               aggravates them or cause headache. (Headache while riding against a cold wind)-This is example of Physical exciting cause which trigger headache. ⁽⁴⁾

2.    The proper identification of the exciting cause helps to avoid those noxious influences and future sufferings.  ⁽²⁾

3.    In mere indisposition, removal of the exciting cause alone is sufficient to restore healthy^{.  (2)}

4.    Nature of exciting cause helps the physician to manage diet, regimen, environment, sanitation and Hydration. ⁽²⁾

5.    Exciting cause is the most probable precipitating cause and the antecedent of an acute disease that assists in forming the portrait of disease.  ⁽⁵⁾

6.    The importance of exciting cause is to understand the totality in acute diseases. When treating an acute case, it is important to know the ’exciting cause’ - that cause which made the person susceptible to an illness, the ’cause’ which ’excited’ the susceptibility^{.  (5)}

Ø  "The physician is likewise a preserver of health if he knows the things that derange health and cause disease, and how to remove them from persons 

in health."  ^{(6)  (7)}

Ø  While attending to an acute case, the physician should limit his inquiry to the recent deviation from health. Since acute diseases require immediate medical intervention, one should not waste time in collecting details of constitutional state and should confine himself to the presentation of the disease. Undoubtedly, the physician should not miss the picture of disease and its effect on the whole person. ⁽⁸⁾

Ø  In treatment of the acute diseases the physician has to considered first the exciting causes of the diseases, the factors which causes the disease and let the patient come to the physician are the exciting cause for that particular disease.  ⁽⁹⁾

Ø  It will help the physician to bring about the cure if he can determine the most probable exciting causes of the disease.  ⁽⁹⁾

Ø  However, there is limited research specifically investigating the exciting causes of acute onset headaches in children from a homeopathic standpoint.

Ø  Therefore, this study aims to bridge this gap in knowledge by Exploring the exciting causes of acute headaches in school-going children which helps the homeopath to understand the unique circumstances surrounding the patient’s illness and evaluating the efficacy of individualized homeopathic treatment in providing relief.

REVIEW OF LITERATURE:

  INTRODUCTION

Ø  Headache is a common complaint in children and adolescents. ⁽¹⁰⁾

Ø  Headache referred as pain over forehead, orbit, temples, or scalp and does not include isolated facial and neck pain.  ⁽¹¹⁾

Ø  It occurs due to stimulation of pain-sensitive intracranial or extracranial structures^{.  (11)}

^Ø   Pain sensitive intracranial structures are vascular sinuses, large arteries and dura mater at the base of the brain, and extracranial structures are skin, subcutaneous tissue, cranial nerves, arteries, muscles, periosteum, sinuses and teeth.  ^{(11)  (12)}

Ø  The trigeminal and upper cervical nerves mediate the pain sensations.  ^{(11)  (12)}

Fig.1 pain sensitive Area  ⁽¹¹⁾

Ø  Headaches can be a primary problem or occur as a symptom of another disorder (a secondary headache). Recognizing this difference is essential for choosing the appropriate evaluation and treatment to ensure successful management of the headache.  ⁽¹⁰⁾

Ø  Common types of pediatric headaches include tension headaches, migraines, and cluster headaches, each with its own distinct characteristics and triggers.  ⁽¹⁰⁾

Ø  Primary headache can progress to very frequent or even daily headaches with chronic migraine and chronic tension-type headaches.  ⁽¹⁰⁾

Ø  These more frequent headaches can have an enormous impact on the life of the child and adolescent, as reflected in school absences and decreased school performance, social withdrawal, and changes in family interactions.  ⁽¹⁰⁾

PREVALENCE:

Ø  Up to 75% of children experience significant headaches by the time they reach 15 years of age.  ⁽¹⁰⁾

Ø  Recurrent headaches, although less common, are still highly frequent among children^. (10)

Ø  Headaches are slightly more common in young boys than girls (Age<7years) but around the time of puberty, this ratio begins to change. In adolescence, 27% of girls and 20% of boys describe frequent or severe headaches. ⁽¹³⁾

^Ø   Frequent nonmigraine headaches were present in 2.5% of 7-year-olds and 15.7% of 15-year-olds. Infrequent headaches were seen in 35% of 7-year-olds and 54% of 15-year-olds. ⁽¹⁴⁾

Ø  Migraine affects a significant portion of children, occurring in up to 10.6% of those aged between 5 and 15 years, and up to 28% of older adolescents.  ⁽¹⁰⁾

Ø  Tension-type headaches (TTHs) may be very common in children and adolescents, with a prevalence in some studies as high as 48%, with those having a combination of migraine and TTH being around 20%.  ⁽¹⁰⁾

 TRIGGERING FACTORS FOR PEADIATRIC HEADACHE: ^{(10)  (11) (15)  (16)}

Ø  Stress: Emotional stress from school, family issues, or other sources can trigger headaches in children.

Ø  Emotional Factors: Anxiety, depression, or other emotional issues can sometimes trigger or exacerbate headaches in children.

Ø  Irregular Sleep Patterns: Lack of sleep or changes in sleep routine can trigger headaches.

Ø  Dehydration: Not drinking enough fluids throughout the day can lead to headaches, especially in active children.

Ø  Dietary Factors: Certain foods and drinks like chocolate, cheese, processed meats, caffeine, and artificial sweeteners can trigger headaches in some children.

Ø  Skipping Meals: Missing meals or going too long without eating can lead to low blood sugar levels, triggering headaches.

Ø  Sensory Stimuli: Bright lights, loud noises, strong odors, and intense visual stimuli (like video games or flashing lights) can trigger headaches in sensitive children.

Ø  Physical Strain: excessive screen time, and carrying heavy backpacks can strain the muscles in the head and neck, leading to tension headaches.

Ø  Weather Changes: Changes in temperature, humidity, or barometric pressure can trigger headaches in susceptible children.

Ø  Medical Conditions: Underlying medical conditions such as vision problems, or hormonal imbalances can trigger headaches in children.

TYPES OF HEADACHES

Ø  Headaches may be acute, recurrent or chronic and primary or secondary to an intracranial or systemic cause.  ⁽¹²⁾

PRIMARY HEADACHE 

 EVALUATION OF HEADACHE IN CHILDREN

 History  ^(1) (13)

Ø  Diagnosing Paediatric headaches is challenging due to limitations in children’s ability to describe their symptoms.

Ø  A systematic and organized approach is essential for an accurate diagnosis.

Ø  Key components of diagnosis involve gathering a comprehensive history, primarily from the child and then from the parents to get complete picture of the patient and his or her symptoms.

Ø  Evaluation should encompass general, neurological, and psychological assessments, along with selective laboratory testing and neuroimaging in selected patients.

Ø  The headache history is particularly vital, with specific questions highlighted below:

Ø  It is important also to obtain a detailed medical history because headaches may be associated with systemic illnesses and medications.

 HOMOEOPATHY & HEADACHE:

 ADDRESSING ROLE OF EXCITING CAUSES IN ACUTE ONSET            

 OF HEADACHE

Ø  In aphorism 5 of Organon of medicine Dr. Hahnemann mention that for the physician, the understanding of the exciting causes, is useful in curing patients suffering from acute diseases.  ⁽³⁾

Ø  In aphorism 73 of Organon of medicine Dr. Hahnemann mention Acute diseases; He defined Acute disease as diseases which begin suddenly, progress faster, run a definite course and finally end either with recovery or death^{.  (19)}

Ø  Exciting causes bring about the acute disease and acute exacerbation of chronic disease. The exciting or precipitating causes are often referred to as ‘Ailments from’.  ⁽²⁾

Ø  An exciting cause is the factor that triggers a person decline from health to sickness^{.  (9)}

Ø  Identifying the exciting cause is the most important step in treating acute diseases. During the case taking process, if a patient says “since then” or “since that incidence I am not feeling well”, the physician has to consider that cause as the exciting cause that brought about this acute disease.  ⁽¹⁹⁾

Ø  Exciting cause cannot trouble the patient, unless the person is affected with the fundamental cause. So as a conclusion, the acute diseases are nothing but the temporary explosion of the fundamental cause “psora” because of the exciting cause.  ⁽¹⁹⁾

Ø  There is no miasmatic origin of exciting causes, rather there are some factors which are inimical to vital dynamic and activate the latent psora to produce the disagreeable condition. ⁽²⁾

Ø  TYPES OF EXCITING CAUSE  ⁽¹⁹⁾

1.    Physical exciting causes:

·       Physical and environmental conditions come under this heading. Like exposure to excess heat or cold, thunderstorm, intake of excess or lack of food, etc.

2.    Mechanical exciting cause:

·       Damages caused by physical trauma comes under this heading. Example: injuries, accidents, burn and insect bites, etc.

3.    Nervous exciting cause:

·       Psychological reasons like fear, shock, jealousy, grief and over joy, etc fall under this category.

4.    Hygienic exciting causes:

·       Food poisoning, pollution and lack of personal and social hygiene come in this group.

Ø  WHY EXCITING CAUSES ARE IMPORTANT IN HOMOEOPATHIC CASE TAKING  ⁽¹⁹⁾

1.    Selecting a remedy:

·      In acute diseases the exciting cause indicates the remedy to the patient’s condition.

·      Example: Headache of children after examination at school: here the examination at school is the exciting cause which trigger headache. This is the symptom of Picricum Acidum.  ⁽⁴⁾

2.    In the prevention of diseases:

·      By identifying the exciting cause that causes the disease in the patient, physician can advise the patient to protect himself from exposure to such exciting cause in the future.

3.    If acute disease:

·      If acute disease is not of a severe character, just by avoiding the exciting causes alone one can relieve the patient.

Ø  MECHANISM OF EXCITING CAUSE  ⁽²⁾

·      Excites the latent psora.

·      Produces sufficient susceptibility.

·      Weakens dynamic vital force losing its resistance power.

·      Produces acute disease.

Ø  In the investigation of a case, the exciting or the precipitating cause is most important, especially if the case is acute in nature. Similarly, in long lasting or chronic illnesses, the fundamental cause is most vital. Both these factors form the core of the sickness from which the disease picture evolves and differentiates. The total picture thus comprises of the starting point and the way the disease picture has unfolded itself. The disease is a response to the adverse environmental stimuli. Hahnemann wants that in order to cure, the physician should be acquainted with both—the cause and the effect.  ⁽²⁰⁾

Ø  The totality of perceptible symptoms manifested by altered sensations and functions at a given time, constitutes the disease for treatment purpose.  ⁽²¹⁾

Ø  THE ACUTE TOTALITY  ⁽²⁰⁾

·      Exciting or precipitating cause(s)- (Mental, physical, chemical, biological, etc.)

·      Recent changes in mental and physical states

       Characteristic mental generals, physical generals

       Characteristic particulars

Ø  So, Hahnemann contends that if the totality of symptoms (material cause) and the entire collection of efficient causes (exciting and maintaining causes) are removed completely and permanently there should not or could not remain anything else besides health or that the morbid alteration in the interior of the organism could remain as it was.  ⁽²¹⁾

 OBJECTIVE OF THE STUDY:

Ø  Explore the various exciting causes which leads the acute onset of headache in children.

MATERIAL AND METHODS:

SOURCES OF DATA:

Ø  PROJECT SITE:

•        Institutional Out Patient Department.

•        Camps arranged by the institute. 

MATERIALS:

•       Case records from institute.

•       Books: various books related to Paediatrics, organon of medicine and philosophy, homoeopathic materia medica.

METHOD OF COLLECTION OF DATA:

Ø  Study Design: Observational study

Ø  Study Type: Prospective study

Ø  Study Population: Children suffering from acute onset of headache recorded in C. D. Pachchigar college of Homoeopathic medicine and hospital, surat.

Ø  Sample Size: 60 Cases

Ø  Sample Techniques: Simple Random Sampling

Ø  Selection Criteria:

Ø  Inclusion criteria:

•       School going children.

•       Children of both genders.

•       Cases of Primary Headache.    

•       Cases with no advanced and irreversible pathological changes.

Ø  Exclusion criteria: 

•       Cases of secondary Headache.

• Cases with co-existing severe systemic illness (Encephalopathy, Meningitis etc.).

DOES THE STUDY REQUIRING ANY INVESTIGATION TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS?

No

HAS   ETHICAL CLEARENCE BEEN OBTAINED FROM YOUR INSTITUTE?

Yes

BIBLIOGRAPHY: