Dr. Ashok Yadav, Dr. Virendra Chauhan, Dr. Bhavneet Kaur*
Headache is most common presenting complaint with which we have to deal with in our day to day clinical practice. There are various types of headache which are broadly classified into primary and secondary headache. A careful assessment is essential to distinguish between different type of headaches so that the case is managed appropriately. Among the primary headaches , tension type headache affects a large population and is found commonly in all age groups and both sexes. Cases of tension type headache are managed well by reassurance and exploring the cause of stress and anxiety and selecting the appropriate homoeopathic medicines on the basis of totality of symptoms. Homoeopathic medicines such as Argentum Nitricum, Pulsatilla Nigricans , Lachesis, Coffea, Ignatia etc. play a great role in management of tension type headache.
Keywords: headache, homoeopathy, homoeopathic medicines, rubrics, tension type headache
Headache is one of the most common presenting complaint of neurological disease for which patient seeks medical attention on global basis. Globally , active headache of any type is present in around 52.0% of population with more prevalence in the age group of 10-19 years. Females are generally more affected for all type of headaches.  The cause of headache ranges from a mild head injury to brain tumor. A careful clinical approach with proper understanding of anatomy , physiology of nervous system is important for diagnosing the exact type of headache and its management. International headache society characterizes headache as primary and secondary. Primary headache includes the benign type of headache in which investigations shows no abnormal findings. Tension type headache, migraine, cluster headache, ,trigeminal autonomic cephalalgia (including cluster headache), Primary stabbing/coughing/exertional/sex-related headache, thunderclap headache, new daily persistent headache syndrome are classified under primary headache. These are responsible for decreasing patient’s quality of life by resulting in considerable disability. Tension type headache is the commonest among the primary headaches.  Secondary headaches are caused by infections or underlying structural , vascular or metabolic abnormality.  Secondary causes of headache includes medication overuse headache (chronic daily headache), intracranial bleeding (subdural haematoma, subarachnoid or intracerebral haemorrhage), raised intracranial pressure (brain tumour, idiopathic intracranial hypertension), infection (meningitis, encephalitis, brain abscess), inflammatory disease (temporal arteritis, other vasculitis, arthritis), referred pain from other structures (orbit, temporomandibular joint, neck )
Tension type headache:
Tension type headache is a neurological disorder which is characterized by predisposition to attacks of mild to moderate headache.  The pain of tension type headache is described as dull ,tight or like a pressure. The patient may have band like sensation round the head or pressure at the vertex. The pain builds gradually and is variable in severity and duration. It may be episodic or chronic.  The pain often progresses throughout the day with no associated symptoms of vomiting or photophobia. Anxiety about the headache may even cause headache 
No obvious cause of tension type headache is discovered. Activation of hyper excitable peripheral afferent neurons from head and neck muscles may be responsible for episodes of infrequent tension-type headache. Muscle tenderness and psychological tension are both associated and aggravates tension-type headache. Genetic factors are involved in increasing susceptibility to tension type headache. Children are mostly affected but high prevalence is seen in the age group of 40-49 years of age in both gender. The female to male ratio is about 5:4 and increases as headaches become more chronic  It occurs more commonly in patients subjected to stress, anxiety and depression.
Diagnostic criteria for tension type headache: 
- At least 10 episodes fulfilling the criteria B-D
- Headache lasting from 30 minutes to 7 days
- Headache has at least two of the following characteristics : Bilateral location Pressing/tightening (non-pulsating) quality Mild or moderate intensity Not aggravated by routine physical activity such as walking or climbing stairs
- Both of the following:
- No nausea or vomiting (anorexia may occur)
- No more than one episode of photophobia or phonophobia
- Not attributable to another disorder
Classification of tension type headache: 
- Infrequent Episodic Tension-Type Headache
If headache occurs on an average of less than one day in a month i.e. less than 12 days per year , it is termed as infrequent episodic tension-type headache.
- Frequent Episodic Tension-Type Headache
If headache occur for more than 1 day and less than 15 days a month i.e. more than 12 and less than 180 days per year , it is termed as frequent episodic tension-type headache.
- Chronic Tension-Type Headache
If headache occur for equal to or more than 15 days a month i.e.180 or more days a year, it is termed as Chronic Tension-Type Headache.
Pericranial tenderness can be detected by manual palpation by small rotating movements and a firm pressure with the second and third finger on the frontal, temporal, masseter, pterygoid , sternocleidomastoid, splenius, and trapezius muscles. A local tenderness score from 0-3 on each muscle can be added to yield a total tenderness score for each patient.
- Migraine : Headache is associated with photophobia, phonophobia, nausea and vomiting. Headache may be hemicranial but it soon becomes generalized. Foods such as chocolate, cheese, citrus fruits, banana and coffee are considered as precipitating factors. 
- Cluster headache: Cluster headache is periodical and featuring runs of identical headaches begins at the same time for weeks at a stretch . Patients may experience one or several attacks within a 24-hour period, and typically are awoken from sleep by symptoms (‘alarm clock headache’). Cluster headache causes severe, unilateral periorbital pain with autonomic features, such as ipsilateral tearing, nasal congestion and conjunctival injection (occasionally with the other features of a Horner’s syndrome). There is excruciating pain of stabbing and boring type. 
- Trigeminal neuralgia: The pain of trigeminal neuralgia is characterised by unilateral lancinating facial pain which most commonly involving the second and/or third divisions of the trigeminal nerve territory. There is repetitive, severe pain which is brief (seconds or less). It may be triggered by touch, a cold wind or eating
- Most important step is to reassure patient that he has been heard and his problem is understood and taken seriously.
- Identification of the cause of stress and anxiety, if there is emotional problem , the patient should be referred for psychiatric evaluation.
- Argentum nitricum:
The patient is apprehensive, nervous, sad , taciturn and hurried. She fears to approach the doctor as she is afraid of being told that she has some incurable disease and as if the doctor is concealing facts and is giving fake assurance. Emotional disturbances, mental exertion and dancing brings the attack of headache. There is excessive congestion of blood to head, which seems enlarged. There is dull and constant headache. Sometimes the pain becomes so severe that patient almost loses her senses.Nervous headache is accompanied by coldness and trembling. Pains better by tight bandage.
- Cimicifuga Racemosa/ Actea Racemosa:
Patients are nervous, plump , delicate and sensitive who always complains of aching here and there. There is great depression with a sense of gloom and dejection, like a black cloud over everything. There is shooting, throbbing type of pain after mental worry, over study or from reflex uterine pains. There is severe headache with sensation as if pressing outwards and as if top would fly off , or running into the eyes and sometimes pain settles in occiput and shoot down the neck. Headache of drunkards and students. Pain in every portion of head but more marked in vertex and occiput which is accompanied by delirium. Headache is felt even in eyes which is aggravated by slightest movement of head or eyeballs. Pain is better in open air.
- Coffea Cruda:
The patient is extremely sensitive and of sanguine temperament. Headache from thinking, talking, after pleasant surprise, contradiction, noise, music and over exertion of mind. Headache as if brain were torn or dashed to pieces. Head feels too small. There is throbbing in temples with burning in eyes. There is sensation as if nail were driven into the brain , worse in open air.
- Gelsemium :
It is suited to nervous, hystrerical, irritable, sensitive and excitable persons. Nervous headache which starts in cervical portion of spinal cord and spreads over whole head. The characteristic headache of gelsemium is dull, tired headache felt at the base of brain. The patient wants to lie still with head raised upon a high pillow. The patient gets relief by pressure, stimulants ,profuse flow of urine and is aggravated by mental labor, smoking , heat of sun, tobacco and lying with head low. There is dull headache with band like sensation and heaviness of eyelids.
- Ignatia :
Patient is sensitive, peevish, excitable, hysterical with sanguine nervous temperament. There is silent grief, mortification, suppressed vexation, fretfulness of temper, timidity and spasmodic laughter from grief. Headache in highly nervous and sensitive temperaments, or in those whose nervous system has given way to anxiety, grief or mental work. One of the chief symptoms is weight at the back of head and a tendency of head to incline backward against the back of a chair, due to congestion of cerebellum. There is congestive headache after anger or grief. Headache is worse from abuse of snuff tobacco smoke, coffee, from close attention. Headache relieved by warmth, rest and stimulants.
It is suited to nervous, excitable , jealous, religious , restless and loquacious persons. headaches with flickering dim vision and pale face. Headache over eyes and in occiput which is worse in morning , on rising. Tearing on the top of head from within outwards. The patient is exhausted by mental fatigue. There is pulsating headache usually in the left temple and over the eyes, with mental confusion. Headache is relieved as soon as discharge is established. Patient dreads to go to sleep, because she wakes with a distressing headache.
- Natrum muriaticum:
Patient is emaciated, anaemic, melancholic, depressed, sad and has weeping tendency. The headaches of natrum mur occur mostly in anaemic , school going girls, during menses, or by eye strain , after long continued study , close sewing, etc. there is throbbing sensation as from little hammers. Headache is worse in morning on waking, from sunrise to sunset, moving the head or eyes, mental exertion and warmth. The patient feels better from sitting still or lying down and after perspiration. There is pain as if nail is driven into the left side of head. Natrum mur produces a headache which is worse from any use of mind. The pain becomes so severe at times that the patient becomes maniacal.
- Pulsatilla nigricans:
The patient is mild , yielding , timid , fearful , gentles , sometimes silent and melancholic. She weeps easily , whether it’s a moment of joy or sorrow and can hardly narrate her complaints without weeping.The patient is discontented and ill humored all day. The headache is chiefly in the forehead, supra orbital region and in the temples, which is aggravated by mental exertion, stooping and evening. Pulsatilla is of great use in headache characterised by violent pain behind , on one side , as if a nail were driven in. Headache as if one had eaten too much , or as if stomach is disordered by being overloaded with fat meat. Pulsatilla suffers from a bad headache which is either uterine or neuralgic in origin. Headache is better after walking in open air.
The patient is very sensitive even to least impression, least word that seems wrong offends her. There is dull headache with inability to perform any mental labor. There is sensation of a round ball in forehead, sitting firmly there even after shaking. Brain feels as if compressed. Brain aches as if torn to pieces, worst from motion, better from rest and warmth .Stupefying headache which passes off with yawning.
- Nux vomica:
The patient is inclined to find fault and scold , morose and stubborn. The patient does a good deal of mental work, has mental strains and leads a sedentary life. There is headache in the occipital or over eyes, with vertigo. There is sensation as if brain is turning in a circle. Frontal headache with desire to press the head against something. Headache in sunrise and in morning after eating. Pressive pains in head , beginning in morning , less by evening , with dim sight , sour vomiting and palpitations. There is bruised sensation of brain, generally on one side, which is better by lying on painful side.
Researches on effectiveness of Homoeopathic medicines in cases of Headache
- Retrospective Observational study of Pediatric headaches :
50 children suffering with chronic headache were included in the study. Individualized homoeopathic medicines were given to the patients. The results were summarized after two years of study
- 10 cases (20% of patients) had quick and full improvement
- 8 cases (16% of patients) had slight amelioration at 1stfollow-up but had almost complete remission (80% improvement) of symptoms after 6 months.
- 21 cases (42%) had an improvement of 50% to 60%
- 5 cases (10%) had slight amelioration after the 1stprescription and further amelioration (70%) after the prescription of a second remedy.
- 1 case (2%) had no amelioration after the first prescription but quick and full improvement after the second remedy
- 3 cases (6%) had no improvement after the 1stremedy (only 1 case had significant improvement—between 70-80%—after the 2nd prescription)
- 2 cases (4%) had slight amelioration (20-30%)
- Observational study of quality of patients with headache , receiving homoeopathic treatment :
53 patients who were suffering with either migraine or tension type headache were enrolled for the study. Individualized homoeopathic medicines were prescribed to the patient and they were asked to fill the SF-36 questionnaire at the beginning of the treatment and after 4-6 months. 73.6% of patients completed the study. More than 60% of the patients showed marked improvement in their symptoms and increase in their quality of life.
Some Rubrics in kent repertory for tension type headache :
- Head , pain , mental exertion , from
- Head , pain , thinking of pain
- Head , pain , pressing , band as if by
Some Rubrics in boericke repertory for tension type headache :
- Head , headache ( cephalgia ), aggravation, exertion , mental or physical
- Head, headache ( cephalgia) , character of pain , pressing
- Head , headache ( cephalgia ), character of pain , aching , dull
Homoeopathy is a science which believes in Individualisation and treating the patient as a whole. The holistic approach in homoeopathy is beneficial in providing the patients a good quality of life and aids in providing relief to the sufferings to the patient. When it comes to managing the cases of tension type headache, homoeopathy treatment has a lot to offer to the patient. As homoeopathic medicines acts on physical as well as mental sphere, the patient gets relief in his headache as well as his stress levels can also get reduced to a great level by appropriate guidance and counselling. Case taking should be done in detail with giving equal importance to mental symptoms and particular symptoms so that if there is any mental cause of headache , it should be well identified and the patient should be managed accordingly.
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Dr. Ashok Yadav, Dr. Virendra Chauhan, Dr. Bhavneet Kaur*
- Professor , H.O.D., Department of Practice Of Medicine, Dr. MPK Homoeopathic medical College, Hospital and Research Centre, Jaipur, Rajasthan
- Associate Professor, Department of Practice Of Medicine, Dr. MPK Homoeopathic medical College, Hospital and Research Centre, Jaipur, Rajasthan
- D. Scholar, Department of Practice Of Medicine, Dr. MPK Homoeopathic medical College, Hospital and Research Centre, Jaipur, Rajasthan Email: email@example.com