NEED FOR STUDY:

Globally, headache disorders affect approximately 40 percentage of the population, or 3.1 billion people in 2021, and are more common in females compared to males. Not only is a headache painful, but it is also disabling. According to Global Health Estimates 2019, headache disorders were found to be third highest cause of disability-adjusted life years (DALYs) worldwide, after stroke and dementia⁽¹⁾ and according to Lancet neurology migraine was the second cause of disability after low back pain and ranked among the top ten causes of YLDs(years of life lived with disability) (age-standardised) in all 195 countries, both in 1990 and in 2016. ⁽²⁾

At present, the commonly used clinical drugs for migraine treatment mainly involve non-steroidal anti-inflammatory drugs (NSAIDs), opioids, and triptans. In addition, NSAIDs may induce gastrointestinal and cardiovascular diseases. Moreover, the frequent use of opioids may lead to medication-overuse headache (MOH), and also have the risk of addiction. Invalid treatment and drug abuse in the acute phase of migraine can worsen the condition from acute to chronic, causing greater burden to patients and society. ⁽³⁾It’s important to explain to the cases at the onset that they’ve been born with a sensitive neurovascular system that overreacts to internal changes or external stimulants, and there’s a veritably good chance that the condition can be brought under control by advice and proper homeopathic drug with proper selection of potency.

In homoeopathy selection of potency is as much integral part of the process of making homoeopathic prescription as the selection of the remedy. In homoeopathy three scales are used decimal scale, centesimal scale and 50 millesimal scale.The discovery of 50 millesimal potency is said to be perfect method of potentization.Although, LM potency has got great advantages like, possibility of frequent repetition, least aggravation and least quantity of material, it doesn’t use widely compared to other potency.Considering all this points I want to study and prove efficacy of LM  potency of homoeopathic medicine in cases of migraine.

REVIEW OF LITERATURE:

The word migraine is French in origin and comes from the Greek hemicrania, as does the Old English term megrim. Literally, hemicrania means "half (the) head." ⁽⁴⁾Migraine is a common disabling primary headache disorder. Many epidemiological studies have documented its high prevalence and socio-economic and personal impacts. ⁽⁵⁾ Migraine is usually an episodic headache associated with certain features such as sensitivity to light, sound, or movement; nausea and vomiting often accompany the headache. A useful description of migraine is a recurring syndrome of headache associated with other symptoms of neurologic dysfunction in varying admixtures. ⁽⁶⁾

A migraine attack has three phases:    Premonitory (prodrome), Headache phase and Postdrome

Each has distinct and sometimes disabling symptoms, which may overlap. About 20-25 percentage of migraine patients have a fourth, aura, phase. Migraine can often be recognized by its activators, referred to as triggers.⁽⁶⁾Migraineurs are particularly sensitive to environmental and sensory stimuli; migraine-prone patients do not habituate easily to sensory stimuli. This sensitivity is amplified in women during the menstrual cycle. Headache can be initiated or amplified by various triggers, including glare, bright lights, sounds, or other types of afferent stimulation; hunger; let-down from stress; physical exertion; stormy weather or barometric pressure changes; hormonal fluctuations during menses; lack of or excess sleep; and alcohol or other chemical stimulation, such as with nitrates. Knowledge of a patient’s susceptibility to specific triggers can be useful in management strategies involving lifestyle adjustments, although it is becoming recognized that some apparent triggers may in fact be part of the initial phase of the attack; i.e., the premonitory phase or prodrome^.(6)

Classification according to ICHD -3: (5)

1.Migraine

1.1 Migraine without aura

1.2 Migraine with aura

1.2.1 Migraine with typical aura

1.2.1.1 Typical aura with headache

1.2.1.2 Typical aura without headache

1.2.2 Migraine with brainstem aura

1.2.3 Hemiplegic migraine

1.2.3.1 Familial hemiplegic migraine (FHM)

1.2.3.1.1 Familial hemiplegic migraine type 1 (FHM1)

1.2.3.1.2 Familial hemiplegic migraine type 2 (FHM2)

1.2.3.1.3 Familial hemiplegic migraine type 3 (FHM3)

1.2.3.1.4 Familial hemiplegic migraine, other loci

1.2.3.2 Sporadic hemiplegic migraine (SHM)

1.2.4 Retinal migraine

1.3 Chronic migraine

1.4 Complications of migraine

1.4.1 Status migrainosus

1.4.2 Persistent aura without infarction

1.4.3 Migrainous infarction

1.4.4 Migraine aura-triggered seizure

1.5 Probable migraine

1.5.1 Probable migraine without aura

1.5.2 Probable migraine with aura

1.6 Episodic syndromes that may be associated with migraine

1.6.1 Recurrent gastrointestinal disturbance

1.6.1.1 Cyclical vomiting syndrome

1.6.1.2 Abdominal migraine

1.6.2 Benign paroxysmal vertigo

        1.6.3 Benign paroxysmal torticollis

Diagnostic criteria for migraine: ⁽⁶⁾

Repeated attacks of headache lasting 4 – 72 hr in patients with a normal physical examination, no other reasonable cause for the headache, and:

·       At least 2 of the following features:

 Unilateral pain

  Throbbing pain

  Aggravation by movement

  Moderate or severe intensity

·       Plus at least 1 of the following features:

  Nausea/ vomiting

 Photophobia and phonophobia

NONPHARMACOLOGIC MANAGEMENT ⁽⁶⁾ Migraine can often be managed to some degree by a variety of nonpharmacologic approaches. When patients can identify reliable triggers, their avoidance can be useful. A regulated lifestyle is helpful, including a healthy diet, regular exercise, regular sleep patterns, avoidance of excess caffeine and alcohol, and avoidance of acute changes in stress levels, being particularly wary of the let down effect.

Homoeopathy aspect: Migraine is type of disease which comes under the bracket of one sided disease (aphorism-172- 184) given by master Hahnemann in organon of medicine.According to aphorism – 275 in Hahnemann’s organon of medicine “The suitableness of a medicine for any given case of disease does not depend on its accurate homoeopathic selection alone, but likewise on the proper size, or rather smallness, of the dose.” ⁽⁷⁾

Different scales of potentisation: ⁽⁸⁾

In homoeopathy three scales are used decimal scale, centesimal scale and 50 millesimal scale.According to Stuart close “Homoeopathic dynamisation is a mathematico mechanical process for reduction according to scale, of crude, inert or poisonous medicinal substances to a state of physical solubility, physiological assimilability, therapeutic activity and harmlessness, for use as homoeopathic healing remedies.

In the preface of the Organon, 5th edition. Hahnemann stated that Homoeopathy was "so near to perfection." But about the 6^th edition he wrote to his publisher that in comparison with the previous ones it was "the most nearly perfect of all." So the 5th edition was near to perfection but not quite perfect, whereas the 6th edition is the most complete of all upto the time of Hahnemann. ⁽⁹⁾Medicinal aggravations which are the common features of the centesimal scale no longer exist in the new method. "Such increase of the original symptoms of chronic disease can appear only at the end of the treatment when the cure is almost or quite finished."(Hahnemann, S: ibid., Apho. 161.) So, the question of"... furious, even dangerous, violence" (Hahnemann, S: ibid., footnote 155 to Apho 270.) of centesimal scale does not arise in 50 millesimal scale. ⁽⁹⁾In comparison with the medicine of centesimal scale, this new method "produces medicines of highest development of power and mildest action." (Hahnemann, S: ibid, footnote 155 to Apho 270.) ⁽⁹⁾But, on the other hand, new dynamization method diminishes this period to "one half, one-quarter and even still less, so that a much more rapid cure might be obtained."(Hahnemann, S: Organon, sixth ed., Apho 246.) ⁽⁹⁾L.M. scale is the finer and latest scale of potency, introduced in the 6^th edition of Organon of Medicine, prepared in the ratio 1:50,000. ⁽⁸⁾