Research 189

Migraine and the Scope of Homeopathy

Pranali M. Wandile1

1 Department of Clinical Research, Kearney Regional Medical Center, Address for correspondence Pranali M. Wandile, BHMS, MS, CCRP,
Kearney, Nebraska, United States Department of Clinical Research, Kearney Regional Medical Center,
1919 W 39th Street, Kearney, NE 68845, United States
Homœopathic Links 2017;30(3):189–194. (e-mail: pranali_wandile2006@yahoo.com).

Abstract Migraine is usually a genetic disorder. In the United States, every 10 seconds someone
with a migraine goes to the emergency room. Approximately 1.2 million annual visits to
the emergency room occur due to acute migraine attacks. About 90% of migraine
patients have a family history of this illness. More than 90% of sufferers are unable to
work or function normally during their migraine episode, affecting their quality of life
and medical expenditure. While the majority of patients experience attacks once or
twice a month, more than four million people suffer due to a chronic migraine with at
least 15 migraine days per month. Migraine is often undiagnosed and undertreated and

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remains a poorly understood disease. In spite of the high prevalence of migraine and its
effects on patients, research into migraine is still underfunded. In this article, the
author reviewed facts about migraine, the best possible suggested treatments and the
Keywords scope of homeopathy for its treatment. More research and clinical trials with improved
► homeopathy trial designs are warranted. Publications of large numbers of homeopathic case studies
► migraine worldwide, long-term observational studies of treated migraine patients having no
► double-blind placebo- further migraine recurrences are needed to see the role of homeopathy for the
controlled trials complete cure.

Introduction In the United States, approximately one in four people has

Migraine is the sixth most disabling and the third most
prevalent illness in the world.1,2
It reduces the quality of the patient’s life, reducing his
productivity to a great extent, along with increasing the
medical expenditure of the family.
It is one of the extremely incapacitating and extraordinarily
prevalent neurological conditions, affecting 1 billion people
around the world and 38 million people in the United States.
Migraine is usually a genetic disorder. Approximately 90%
of migraine patients have a family history of this illness. If
one parent has migraine, then there is a 50% chance of
children getting inherited migraine. The chances will be
75% if both parents have migraine.1,2
Because of hormonal influences, approximately three
times more women suffer from migraine than men. In
women, migraine most often begins at puberty. Before
puberty boys are affected more than girls, but during ado-
lescence, the risk and intensity of migraine rise in girls.
migraine, contributing to 12% of the population as migraine
sufferers. Of these 18% are women, 6% are men and 10% are
children. Every 10 seconds one person visits the emergency
room (ER) due to migraine, making an annual 1.2 million
total patients visit ER.
More than 90% of sufferers are unable to work or function
normally during their migraine episode.
Common problems associated with chronic migraine
patients are depression, anxiety, sleep disturbances and
medication habituation/overdose.
Treating migraine symptomatically with pain relievers
rather than treating the cause of the disease could be one
of the reasons migraine becomes a chronic condition.1
Pathophysiology of Migraine
Initiation of a migraine begins either by a cortical spreading
depression or a brain stem generator followed by meningeal
pain mechanisms that commence through trigeminovascular

© 2017 Thieme Medical and Scientific DOI https://doi.org/

Publishers Private Ltd. 10.1055/s-0037-1606343.
ISSN 1019-2050.
190 Migraine and the Scope of Homeopathy Wandile

activation. These mechanisms include the release of neuroin-
flammatory peptides, inflammatory cytokines and calcitonin
gene-related peptides. Cerebral vasodilatation (caused by
calcitonin gene-related peptides) and neurogenic inflamma-
tion sensitise trigeminovascular sensory fibres which in turn
carry pain signals via the trigeminal ganglion to the trigem-
inal nucleus caudalis.3 Activation of these peripheral noci-
ceptors is referred to as peripheral sensitisation whereas
activation of trigeminal nucleus caudalis and rostral brain
structures is referred to as central sensitisation.4
This initial wave activation is followed by a wave of
decreased brain activity and oligemia. The wave of activa-
tion and depression spreads in various areas of the
brain including the cerebellum, cortex or hippocampus.
Cortical spreading depression alters the blood–brain bar-
rier by activating brain matrix metalloproteinases, which
open the blood–brain barrier and may contribute to
migraine pain.5
• Triptans: Naratriptan, zolmitriptan for short-term MAMs
prevention
• Antidepressants: Amitriptyline, venlafaxine
Level C Recommendation Medications
• α-agonists: Clonidine, guanfacine
• AEDs: Carbamazepine
• β-blockers: Nebivolol, pindolol
• Angiotensin converting enzyme inhibitors: Lisinopril
• Angiotensin receptor blockers: candesartan
Complementary Treatment for Adult’s Episodic
Migraine
American Academy of Neurology and the American Head-
ache Society guidelines suggested following NSAIDs and
complementary treatments in preventing episodic
migraine.7
Level A Recommendation

Migraine Types, Causes and Symptoms • Petasites (butterbur)

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Different Types of Migraine Level B Recommendation

• Around 80% of migraines are a common migraine, and • Herbal therapies, vitamins and minerals: Riboflavin, mag-
there is no “aura” associated before a migraine headache. nesium, MIG-99 (feverfew)
• Classic migraines patients experience an aura before their • Histamines: Histamine SC
headaches which are usually much severe than common • NSAIDS: Fenoprofen, ibuprofen, ketoprofen, naproxen,
migraines.6 naproxen sodium

Migraine Headache Treatment Level C Recommendation

There are various treatments for migraine headache includ-
• Herbal therapies, vitamins and minerals: Co-Q10,
ing self-care measures, over-the-counter medications and
oestrogen
prescription medications.
• Antihistamines: Cyproheptadine
Many migraine patients can manage mild-to-moderate
• NSAIDs: Flurbiprofen, mefenamic acid
attacks at home with the following measures:
Pharmacologic Agents for Alleviation of Acute Phase
• Resting in a room with no light, sound or odours
and Prophylaxis7
• Sleeping with pillows comfortably supporting the head or
Abortive medications include the following
neck
• Isolating from a stressful environment • Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Consuming moderate amount of caffeine • Combination products
• Using a cold compress on the area of pain or taking • Antiemetics
paracetamol or other nonsteroidal anti-inflammatory • Selective serotonin receptor (5-HT1) agonists (triptans)
drugs (NSAIDs). • Ergot alkaloids
• Analgesics
Pharmacologic Treatment for Adult’s Episodic
Migraine Prophylactic medications include the following
American Academy of Neurology and the American Head-
• Calcium channel blockers
ache Society provided guidelines for migraine prevention.7
• Selective serotonin reuptake inhibitors
• NSAIDs
Level A Recommendation Medications
• Serotonin antagonists
• Triptans: Frovatriptan for short-term menstrually asso- • Antiepileptic drugs
ciated migraine (MAMs) prevention • Beta-blockers
• Antiepileptic drugs (AEDs): Divalproex sodium, sodium • Tricyclic antidepressants
valproate, topiramate • Botulinum toxin
• β-blockers: Metoprolol, propranolol, timolol
Homeopathy Management
Level B Recommendation Medications
While many homeopathic medicines can be indicated for
• β-blockers: Atenolol, nadolol migraine headache, the best way of treating this disorder is to

Homœopathic Links Vol. 30 No. 3/2017


treat it with constitutional individualised homeopathic
treatment.
Complete, thorough case taking is required as per the
homeopathic philosophy8 (Organon of Medicine).
The patient’s medical history, family medical history,
physical desires and aversions, responses to various stimuli,
mental evaluation—way of thinking, psychosocial behaviour
will be considered for homeopathic medicine selection.
Acute remedies helpful for acute episodes of migraine
headache include Bryonia album, Belladonna, Gelsemium,
Ignatia amara, Pulsatilla, Cedron, Nux vomica, and many
more.
Chronic remedies include: Natrum muriaticum, Iris versi-
color, Kali bichromicum, Lachesis, Sanguinaria canadensis,
Graphitis, Thuja occidentalis, Pulsatilla, Medorrhinum, Sepia,
Silica, Sulfur, Calcarea carbonica, Spigelia anthelmia, Syphili-
num, and many more.
Published Clinical Trials in Homeopathy
The author has reviewed six homeopathic published clinical
trials for migraine.
Out of six, four trials were double-blind placebo-con-
trolled trials, and two were observational trials.
1. Bruno Brigo, and G. Serpelloni. Homeopathic Treatment of
Migraines: A Randomized Double-Blind, Placebo Con-
trolled Study of 60 Cases. Berlin Journal on Research in
Homeopathy 1991; 1(2):98–106.9–11
Patients enrolled: 60, duration of trial: 4 months
The objective of this trial was to evaluate the effectiveness
of classical homeopathic treatment for migraine.
A total of 60 migraine patients were randomised into two
groups: constitutional homeopathy treatment group/or
placebo group over the period of 4 months.
After evaluating the patients as per classical homeopathy,
one or two of the following remedies were prescribed in
30c potency, Belladonna, Ignatia amara, Lachesis, Silica,
Gelsemium, Cyclamen, Natrum muriaticum, Sulfur or
placebo.
Study results showed that patients in the control group
experienced a reduction in migraine frequency from 9.9
attacks per month to 7.9 attacks per month. Those in the
treatment group reduced their monthly attack frequency
from 10 to 1.8–3 per month.
Study results showed that homeopathic treatment
brought a marked reduction in the frequency of migraine
attacks and also has an effect on both severity and
duration of this disease.
The study concluded that individualised homeopathy
proved to be superior to placebo for the treatment of
migraine.
2. Straumsheim P, Borchgrevink C, Mowinckel P, Kierulf H,
Hafslund O. Homeopathic treatment of migraine: a double
blind, placebo-controlled trial of 68 patients. British
Homeopathic Journal 2000;89:4–7.12
Patients enrolled: 68, duration of trial: 4 months
Migraine and the Scope of Homeopathy Wandile 191
The objective of this trial was to evaluate the efficacy of
homeopathy in preventing migraine attacks and accom-
panying symptoms.
A total of 73 patients having common or classical migraine
were randomised into individualised homeopathic treat-
ment groups or identical placebo group. Baseline values
were similar in two groups. Out of 73 patients, 68 patients
completed the trial.
Results showed that both homeopathy and placebo
groups had a reduction in attack frequency, pain intensity
and drug consumption. As there was no statistically
significant difference in effectiveness in both groups
and migraine diaries also showed no difference, homeop-
athy cannot be recommended. However neurologists' trial
evaluation showed that there was a significant statistical
reduction in migraine attack frequency in the homeop-
athy group (p ¼ 0.04), pain intensity, the overall assess-
ment showed significant nonstatistical trends which
favour homeopathy.
The study concluded that more research is warranted with
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improved trial design to support a possible role of ho-
meopathy in migraine prophylaxis.
3. Whitmarsh TE, Coleston-Shields DM, Steiner TJ. Dou-
ble-blind, randomized placebo-controlled study of ho-
meopathic prophylaxis of migraine. Cephalalgia
1997;17:600–604.13
Patients enrolled: 63, duration of trial: 4 months
The objective of this trial was to see if individualised
homeopathic treatment will be more efficient for mi-
graine prophylaxis as compared with placebo.
A total of 63 outpatients meeting International Headache
Society criteria for migraine were enrolled in this 4-
month trial. The first month was baseline and all patients
were on placebo.
As 3 patients dropped out, the remaining 60 patients were
randomised into two treatment groups.
There was a chance of a difference in migraine attack
frequency and severity in two groups. The frequency was
more and severity was less in the placebo group. The
primary outcome measure was migraine attack
frequency.
The study results showed improvement in both groups
but not much improvement in primary outcome measure.
For example, the number of attacks reduced in the treat-
ment group was 19% as compared to 16% in the placebo
group. The reduction was mostly in mild attacks in the
placebo group and moderate/severe attacks in the treat-
ment group. There were few adverse events.
The study concluded that there was no statistically sig-
nificant benefit of homeopathic medicines over the pla-
cebo treatment. This led to the conclusion that we cannot
recommend homeopathy for migraine prophylaxis, but
cannot conclude that it is without effect.
4. Walach H, Hausler W, Lowes T, et al. Classical homeo-
pathic treatment of chronic headaches. Cephalalgia ho-
meopathic treatment of chronic headaches. Cephalalgia
1997;17:119–126.14
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192 Migraine and the Scope of Homeopathy Wandile
The objective of this trial was to determine the efficacy of
traditional homeopathy treatment in chronic headache
patients.
Randomised, placebo-controlled, double-blind clinical
trial.
Patients enrolled: 98, duration of trial: 12 weeks
A total of 98 patients enrolled in the trial, of which 65
were females, 33 males: the median age was 48.5 years.
These patients were suffering from chronic headache
(since 2–54 years, median: 23 years) with at least one
headache per week. According to the International Head-
ache Society criteria 75 patients had migraine, 48 patients
had tension-type headache and 15 had other types of
headache.
Overall, 94% patients were previously treated for head-
ache, 79% reported poor benefit from treatment and
hence they were participating in this trial.
The study includes 6 weeks of baseline observation period
followed by 12 weeks of randomised treatment period/
either homeopathic treatment or placebo treatment
group.
It was seen that out of 98 patients, 37 patients received
placebo and 61 received individualised homeopathic
remedies.
The findings were as follows:
Patients showed a reduction of one headache day per
month and reduction in medication usage for an acute
headache in both groups. The headache frequency of 21
patients was reduced by more than 40%, whereas in 39
patients there was neither improvement nor aggrava-
tions. There was no significant difference in any para-
meter between homeopathy and placebo.
The study concluded that there was no difference in the
effect of individualised homeopathy remedies and
placebo.
5. Danno K, Colas A, Masson JL, Bordet MF. Homeopathic
treatment of migraine in children: a prospective, multi-
center, observational study. Journal of Alternative & Com-
plementary Medicine 2013;19(2):119–123.15
Patients enrolled: 168, duration of trial: 4 months
The objective of this Prospective, multicenter, observa-
tional study was to evaluate the effectiveness of homeo-
pathic medicines for the prevention and treatment of
migraine in children.
Total 168 children having definite or probable migraine
diagnosis using International Headache Society 2004
criteria were enrolled in this trial. These childrens were
aged between 5 and 15 years from 12 countries. A total of
59 trained homeopathic physicians treated these patients
with individualised homeopathic treatment.
Study results showed that migraine attacks reduced sig-
nificantly in frequency, severity and duration during the
3-month follow-up period. Children spent significantly
less time off school during the follow-up (2.0 vs. 5.5 days).
In 98% of cases, homeopathic medicines were prescribed
as preventive treatment. The most common preventive
medications used were Natrum muriaticum (21%), Gelse-
Homœopathic Links Vol. 30 No. 3/2017
mium (20%) and Pulsatilla (12%; mainly 15C), Ignatia
amara (25%; mainly 9C) and Lycopodium clavatum
(22%). Homeopathy alone was used for the treatment of
migraine attacks in 38% of cases and the most commonly
used homeopathic medicines were Belladonna (32%;
mainly 9C), Ignatia amara (11%; mainly 15C), Iris versi-
color (10%; mainly 9C), Kalium phosphoricum (10%;
mainly 9C) and Gelsemium (9%; mainly 15C and 30C).
The study concluded significant decrease in the frequency,
severity, and duration of migraine attacks and reduced
absenteeism from school
6. Witt CM, Lüdtke R, Willich SN. Homeopathic treatment of
patients with migraine: a prospective observational study
with a two-year follow-up period. J Altern Complement
Med 2010;16(4):347–355.16
Patients enrolled: 212, duration of trial/observation per-
iod: 2 years
The objective of this prospective multicenter observa-
tional study was to evaluate treatment details and possible
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effects of an individualized homeopathic treatment in pa-
tients with migraine in usual care.
The study included 212 adults treated by 67 physicians.
Out of which 90% patients had been treated with conven-
tional treatment earlier. During the trial, patients received
6.2  4.6 homeopathic prescriptions.
The study results showed that migraine severity showed
marked improvement with a large effect size (Cohen’s d ¼
1.48 after 3 months and 2.28 after 24 months. Quality of life
improved accordingly (Mental Component Score and Physi-
cal Component Score after 24 months: 0.42 and 0.45).
The study concluded that the patient’s migraine severity
markedly reduced to a significant effect size leading to
improvement in their quality of life. This improvement lasted
for the observed 24 months, and it also showed a marked
reduction in the use of conventional treatment and health
services.
Critical Evaluation of Published Clinical
Trials
Following is the critical assessment of the clinical studies
described earlier.
Critic 1
At the conclusion of this 4-month study period, the treatment
group showed statistically significant reduction in the inten-
sity, duration and frequency of migraine attacks as compared
with the placebo group, but this positive study result was not
repeated in another study of similar size, giving doubtfulness
about the consistency of homeopathic treatment effects. How-
ever, judgement, knowledge and medicinal selection by an
individual homeopath could affect study results.
The International Headache Society (IHS) is the world's
leading membership organization for those with a profes-
sional commitment to helping people affected by headache.
Purpose of IHS is to advance headache science, education,

and management, and promote headache awareness
worldwide.
It is not clear if the enrolled patients met the International
Headache Society criteria for migraine diagnosis.
The sample size and the duration of the study were
limited. (Four-month study period may not be a long enough
treatment span for chronic migraine patients.)
Critic 2
This study was not able to reproduce the effectiveness of
homeopathy treatment as produced by study 1 discussed earlier.
The study further concluded more research is warranted.
It is not clear if IHS (International Headache Society)
criteria for migraine diagnosis were used while enrolling
patients in this trial.
The sample size and the duration of the study were
limited.
Longer study duration, more extended observation period
along with an improved trial design could be a better way to
conduct clinical trials to support the possible role of ho-
meopathy in migraine prophylaxis.
Critic 3
The study included patients with the chance of differences in
migraine attack frequency and severity, and this might have
biased study results.
The sample size and the duration of the study were
restricted.
Critic 4
98 patients were enrolled in this 12 weeks of trial. Out of
which majority of patients were previously treated for head-
ache, which means they were chronic patients. The treat-
ment period of 12 weeks may not be sufficient to bring the
best possible results in chronic cases.
A long-term treatment and long-term observational per-
iod are needed to evaluate the effectiveness of any treatment
for the chronic condition.
Critic 5
Two observational studies described in this article provided
an excellent way of gathering the effectiveness data of
homeopathy clinical trials.
Enrolling patients in the clinical trials who had already
received long-term conventional treatment for chronic mi-
graine is also an effective way to collect beneficial informa-
tion of homeopathy over another line of treatment.
Homeopathic treatment effect could be affected by the
knowledge and judgement of the prescriber. However, these
observational studies conducted in different countries with
different homeopaths still showed the effectiveness of ho-
meopathic remedies and produced same positive results.
Discussion
Randomised, placebo-controlled, double-blind trials may be
the best way to prove the effectiveness of various therapies.
However, if the results of the clinical trials are not repro-
Migraine and the Scope of Homeopathy Wandile 193
ducible in subsequent clinical trials, then it will not have any
clinical significance. Reproducibility is still challenging;
there are reasons behind it. Also, the conduct of clinical
trials will remain an unending process.
Large patient sample size and longer duration of clinical
trials can predict the effectiveness of study drug treatment in
best possible way, especially when the disease is chronic.
Homeopathic ultradilutions are still not understood in
current pharmacological concepts. This may lead to disbelief
about this therapy among some patients. However, until
now, 200 homeopathic clinical trial research articles have
been published which have provided positive conclusion
about the effectiveness of homeopathy.10
Many clinical trials which have provided positive results
earlier failed to produce similar positive results in subse-
quent trials. Homeopathic prescriptions differ as per the
knowledge and judgement of the prescriber. This will affect
the study result. Also, this is the biggest challenge or limita-
tion in homeopathic clinical trials.
Another challenge is the patient’s willingness to partici-
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pate in the trial, as there is always the possibility of receiving
placebo treatment. Every patient would like to get the best
possible treatment—is it correct and fair? Yes, it is! And this
affects in the following way.
Many times patients come to a homeopath after exhausting
all their treatment resources, or after they have tried many
practices of medicine for the treatment of their migraine. It is
challenging to get such population for clinical trials even
though that population could be the best sample size to see
homeopathic treatment effectiveness.
IHS classification guidelines for migraine diagnosis should
be used while selecting sample size for migraine trials. Not
every headache is migraine.
Case studies, observational studies would be the best
approach to see the effectiveness of homeopathic remedies.
Researchers should focus more on practice-based research
studies.
Migraine cases treated with homeopathy need to be
published worldwide with evidences.
Open-label clinical trials should also be conducted. These
methods will give new input into homeopathic research/
treatment approach and will improve the quality of the
homeopathic practice of medicine.
Vita
Pranali Wandile is currently working as Clinical Research
coordinator/Research in a brand new research site in the
United States.
Originally a homeopathic physician from India, I have
practised homeopathy for more than a decade and treated
many complex chronic diseases using the homeopathic
practice of medicine. In the treatment of autoimmune
disorders, where conventional medicine act on a palliative
basis, homeopathy shows its miracle. I firmly believe
more awareness needs to be spread about homeopathy
to let people know the scope of this medicine in almost all
disorders, except in critical emergency conditions.
Homœopathic Links Vol. 30 No. 3/2017
194 Migraine and the Scope of Homeopathy Wandile
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9 Brigo B, Serpelloni G. Homeopathic treatment of migraine: A sixty
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controlled trial of 68 patients [see comment]. Br Homeopath J
2000;89(01):4–7
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randomized placebo-controlled study of homoeopathic prophy-
laxis of migraine. Cephalalgia 1997;17(05):600–604
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treatment of chronic headaches. Cephalalgia 1997;17(02):119-
–126, discussion 101
15 Danno K, Colas A, Masson JL, Bordet MF. Homeopathic treatment of
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tional study. J Altern Complement Med 2013;19(02):119–123
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with migraine: a prospective observational study with a 2-year
follow-up period. J Altern Complement Med 2010;16(04):347–355
Downloaded by: Boston University. Copyrighted material.