Assessing the Action of Homoeopathic remedies in the management of Common Migraine Using the Headache Impact Test-6(HIT-6) tool
Mumtung T. Tamuk BHMS1
Shama M. Rao*, MD (Hom) 2
Prashant P. Tamboli, MD (Hom)3
Harshla C. Sarvagod MD (Hom)4
Devangini R. Broker MD (Hom)5
1 Post Graduate Student, Department of Practice of Medicine, Dr. M. L. Dhawale Memorial Homoeopathic Institute, Palghar
2Professor & Head, Department of Practice of Medicine, Dr M. L. Dhawale Memorial Homoeopathic Institute, Palghar
3Associate Professor, Dept of Repertory & Head, Research Department, Dr. M. L. Dhawale Memorial Homoeopathic Institute, Palghar
4Assistant Professor, Dept of Practice of Medicine, Dr. M. L. Dhawale Memorial Memorial Homoeopathic Institute, Palghar
5Assistant Professor, Dept of Repertory & Senior Research Fellow, Research Department, Dr. M. L. Dhawale Memorial Homoeopathic Institute, Palghar
*Address of correspondence: Dr. Shama Rao
Email:rao.shama@rediffmail.com
How to cite this article:
Tamuk MT, Rao SM, Tamboli PP, Sarvagod HC, Broker DR. Assessing the Action of Homoeopathic remedies in the management of Common Migraine Using the Headache Impact Test-6(HIT-6) tool. Journal of Integrated Standardized Homoeopathy (JISH) 2019; 02(03)
Received on: 16th August, 2019
Accepted for Publication:6th December 2019
ABSTRACT
Introduction: Migraine is a neurological condition that can cause multiple symptoms; severe excruciating headache is the main symptom that results in physical, psychological, social disabilities. The Headache Impact Test-6 (HIT-6) scale is useful in measuring the grade of disabilities ranging from mild to nearly total disability. Complete information on migraine-related disabilities facilitates appropriate treatment decisions.
Aim & Objectives: To explore the action of Homoeopathic medicines in improving the symptom expressions and disability using HIT-6
Materials &Methods: Thirty cases of migraine were randomly selected from the OPD setting in an uncontrolled experimental study. Out of 30 cases, 4 (13%) were male and 26 (87%) female. The mean age of patients suffering from common migraine was 37 ±8.23 years. The individualised Homoeopathic medicine, selected on the basis of the totality, was administered. Response was assessed through the HIT-6 tool administered before and after 3 months of the treatment.
Result: The HIT-6 score before treatment was 69.0 ± 17.32 (median = 76) and that after treatment was 58.5 ± 16.35 (median = 60).The Wilcoxon signed rank test was applied; the change in median score was found to be statistically significant (z = -2.885, p = 0.004).
Conclusion: An indicated Homoeopathic medicine relieves the symptomatic expressions of common migraine and reduces the disability index, thus improving functioning.
Keywords: Common migraine, disability, Headache Impact Test-6 (HIT-6), Indicated Homoeopathic remedies, Homeopathic Management
INTRODUCTION
Migraine is a benign and recurring syndrome of headache associated with other symptoms of neurologic dysfunction in varying admixtures. Per the simplified diagnostic criteria of migraine, it is a moderate to severely intenseunilateral throbbing type of pain, aggravated by motion accompanied with at least one of the features of nausea / vomiting, photophobia, phonophobia (1). In India, headache is a common neurological complaint, with a prevalence of 14.12% (1, 2). According to an analysis by the World Health Organization (1), migraine is the 3rd most prevalent illness in the world. Studies show that women are 1.3 times more likely to suffer from common migraine than men. Moreover, the study claims that rural women have a higher preponderance to migraine than urban women (3). The World Health Organization ranks common migraine among the top 20 conditions for compromising a Healthy life due to disability (4). Most patients (73.3%) with migraine also experience moderate to severe levels of functional disability (5). Studies performed by the “Global Burden of Headache – a documentation of headache prevalence and disability worldwide” reported migraine being the highest ranked for causing disability among Neurological disorders (6, 7, 8); 7th cause of disability (8). Common migraine associated with physical, psychological, and social disabilities is a major cause of absenteeism from work, avoidance of social and personal activities, and increased medical expenditure.
In the Homeopathic management of common migraine, it is important to assess the intensity of symptoms and its impact on the patient’s daily functioning. Knowing the accurate disabilities along with the intensity of Headache also facilitates the choice of the remedial forces i.e. Constitutional, Acute, Phasic, or Intercurrent along with the appropriate posology. The Headache Impact Test-6 or HIT-6 is a tool that measures the burden of headache and impact of headache on daily functioning. It assesses Social Functioning, Role Functioning, Vitality, Cognitive Functioning and Psychological distress. It measures one’s ability to function on the job, at school, at home, and in social situations along with the intensity of the pain. HIT-6 scores below 49 indicate that there is no disability due to headache. The score of 50 – 55 indicates mild disability, 56 – 59 substantial and ≥ 60 severe disability. The validity and reliability ranges from 0.67 to 0.79 (9).
An observational study by Claudia et. al on common migraine concluded that Homoeopathic treatment improves the quality of life and intensity – severity of migraine with large effect size(10). A systematic review on Homoeopathy in the management of migraine also concluded that Homoeopathy improves migraine, but insignificantly when compared with placebo or analgesics. The systemic review was performed using only four research studies (11). Another systemic review focusing on six articles could not reach a conclusion due to flaws in research design and insufficient evidence (12). Considering these limitations, the present study focuses on evidence-based observations using the validated HIT-6 scale to understand the role of Homoeopathy in providing relief and improving functioning.
AIM & OBJECTIVE
Using the HIT-6 Score, to explore the action of Homoeopathic Remedies on Disability and Intensity of Pain.
RESEARCH METHODOLOGY:
RESEARCH TYPE & DESIGN: A prospective, single blind, non–controlled experimental study was conducted in the OPD setting of the Dr. M. L. Dhawale Memorial Homoeopathic Institute, Palghar, during 2017 – 2018.
SAMPLE SIZE: 30
SAMPLING TECHNIQUE: Simple Random Sampling
CRITERIA FOR INCLUSION AND EXCLUSION
Inclusion criteria:
- Diagnosed cases of common migraine based on clinical presentation
- All age groups
- Patients of both sexes
Exclusion criteria:
- Known cases with associated structural pathology e.g. arteriovenous malformations, slow-growing tumours like gliomas, meningiomas etc. Mimicking common migraine
- Pregnant women, women on hormonal preparations
Withdrawal Criteria:
- The patients whose HIT-6 score increased by 10 points compared to the baseline
Intervention: After receiving ethical clearance, 30 patients, eligible as per the enrolment criteria, were enrolled using a lottery method with simple random sampling. Individualized Homoeopathic medicines were prescribed after taking a detailed history. Chronic, Acute, and Intercurrent remedies were used as per the guidelines given inThe Organon of medicine. The prescription was finalized with the senior consultants so that the bias in remedy selection could be minimized. HIT-6 was applied before the commencement of treatment and after three months of treatment
OBSERVATION:
The analysis included30 patients with common migraine. The statistical analyses were performed with IBM SPSS (Statistical Package for the Social Sciences) version 24.0. All the tests were two–sided with alpha 0.05.
Table 1. Tabular representation of the descriptive statistics of common migraine
| Parameters | Average (SD) | Confidence limit (Mean ± SE) |
| Sex | Male = 4 (13%) & Female = 26 (87%) | |
| Age | 37 (8.23) | 35.5-38.5 |
| HIT–6 Scorebefore | 69.0 (17.32) | 65.84-72.16 |
| HIT–6 Scoreafter | 58.5 (16.35) | 56.02-61.98 |
Table 2. Tabular representation of the HIT–6 descriptive scores before and after the treatment
| Mean | SD | Percentiles | Sig. | |||
| 25th | 50th | 75th | ||||
| BEFORE SCORE | 69.0 | 17.32 | 69 | 76 | 78 | Z = -2.885
P = 0.004* |
| AFTER SCORE | 58.5 | 16.35 | 39 | 60 | 78 | |
*Wilcoxon – signed rank test applied, significant if p ≤ 0.05 at 95% of CI
Graph 1: Box Plot representing the change in the HIT–6 score after the Homoeopathic Intervention
Table 3: Tabular representation of symptoms accompanying headache
| Sl. No | Symptom list | Better | Cured | SQ | Not present | Not mentioned | Total |
| 1 | Nausea | 4 | 9 | 6 | 7 | 4 | 30 |
| 2 | Vomiting | 1 | 5 | 3 | 17 | 4 | 30 |
| 3 | Noise < | – | 8 | 3 | 5 | 14 | 30 |
| 4 | Light < | – | 5 | 3 | 13 | 9 | 30 |
Table 4: Tabular representation of coverage of individualized remedies in the management of common migraine
| Type | Remedy Name | Frequency (%) |
| Constitutional Remedies | Natrium Muriaticum | 6 (23%) |
| Natrium Carbonicum | 5 (19%) | |
| KaliumCarbonicum | 4 (15%) | |
| CalcareaCarbonicum | 4 (15%) | |
| Natrium Phosphoricum | 1 (4%) | |
| KaliumSilicicum | 1 (4%) | |
| KaliumPhosphoricum | 1 (4%) | |
| Phosphorus | 1 (4%) | |
| Pulsatilla Pratensis | 1 (4%) | |
| Sepia Officinalis | 1 (4%) | |
| Cocculus Indicus | 1 (4%) | |
| Silicea | 1 (4%) | |
| Acute Remedies | Belladonna | 4 (80%) |
| Spigelia | 1 (20%) | |
| Intercurrent Remedies | Thuja Occidentalis | 3 (11%) |
DISCUSSION:
The study showed a higher prevalence of women compared to men, which confirms the findings of the prevalence studies by Kulkarni et al (3). The mean age of the patient suffering from common migraine is 35.5 to 38.5 years which also goes hand-in-hand with the recent literature.
The HIT-6 score showed improvement in the score from 69.0 to 58.5 (9): severe impact to substantial impact. Thus, after the Homoeopathic intervention, the HIT-6 score changed, resulting in a reduced disease burden. The intervention helped improve the social functioning, role functioning, vitality, cognitive functioning, and psychological functioning, thus reducing the impact of migraine on the individual. It also reduced the intensity of pain. Along with the improvement in functioning and head pain, there was an improvement in associated expressions like nausea, vomiting, noise <, and light < (Table 3). The individualized Homoeopathic medicine is a holistic approach and hence the results showed improvement at the level of general well-being i.e. functioning and the particular level of head pain. Since the HIT-6 scale focuses on both, it helped in assessing the remedy response. Thus HIT-6 allowed us to not only treat the head pain intensity but also the individual as a whole; this is the key concept of management in Homoeopathy.
CONCLUSION:
- Individualised Homoeopathic medicines have shown action in improving the symptomatic expressions of common migraine
- Individualized Homoeopathic medicines also reduced the disease burden by improving the functioning at the social, psychological, and cognitive levels.
- HIT-6 helped as an evidence-based tool for assessing the remedy response.
RECOMMENDATIONS:
A study with a control group is required to replicate the conclusions of this study.
ACKNOWLEDGEMENTS
Dr. Bipin Jain M.D. (Hom), Principal, Dr. M.L. Dhawale Memorial Homoeopathic Institute, Palghar and Dr Y. Dinesh Rao M.D. (Hom), Former Professor, Department of Medicine, Dr. M.L. Dhawale Memorial Homoeopathic Institute for their immense support, constant motivation and guidance.
Conflict of Interest: None
REFERENCES:
- NVC W. Mac Bryde’s SISNS and SYMPTOMS. 6th RS B, editor. London, Mexico city, New York, St. Louis, Saa Paulo, Sydney: J B LIPPINCOTT COMPANY; 1983
- Ray BK, Paul N, Hazra A, Das S, Ghosal MK, Misra AK, et al.Burden and risk factors of migraine: A community-based study from Eastern India. Neurol India 2017;65:1280-8.
Available from:http://www.neurologyindia.com/text.asp?2017/65/6/1280/217979
- Kulkarni GB, Rao GN, Gururaj G, Stovner L, Steiner TJ. Headache Disorders and Public ill – health in India: prevalence estimates in Karnataka State. J Headache Pain 2015;16:67.
- World Health Organization (2001) the World Health Report 2001. WHO, Geneva.
- Renjith V, Pai MS, Castelino F, Pai A, George A. Clinical Profile and Functional Disability of patients with Migraine. J Neurosci Rural Pract 2016;7:250-256.
- Leonardi M, Steiner TJ, Scher AT, Lipton RB. The global burden of migraine: Measuring disability in headache disorders with WHO’s classification of functioning, disability and health (ICF). J Headache Pain 2005;6:429-440. [PMC free article][PubMed]
- Stovner LJ, Hagen K, Jensen R, Katsarava Z, Lipton R, Scher A, et al. The global burden of headache: A documentation of headache prevalence and disability worldwide. Cephalalgia 2007;27:193-210. [PubMed].
- Steiner TJ, Stovner LJ, Birbeck GL. Migraine: The seventh disabler. J Headache Pain 2013;14:1. [PMC free article][PubMed]
- Juyal R, Verma R, Garg R, Shukla R, Agarwal R, Singh M.Reliability and validity of Hindi translation of the migraine disability assessment and headache impact test-6 questionnaires.Ann Indian Acad Neurol 2010;13:276-283.
- Witt CM, Lüdtke R, Willich SN.Homeopathic treatment of patients with migraine: a prospective observational study with a 2-year follow-up period.J Altern Complement Med2010;16:347-355. Ahead of printhttp://doi.org/10.1089/acm.2009.0376.
- Ernst E.Homeopathic prophylaxis of headaches and migraine? A systematic review.J Pain Symptom Manage 1999;18:353-357.
- Owen JM, Green BN.Homeopathic treatment of headaches: a systematic review of the literature.J Chiropr Med 2004;3:45-52.
