A case of chronic headache treated with Sanguinarum Nitricum-Dr. Meghna Shah (BHMS, FCAH)
A case of chronic headache treated with Sanguinarum Nitricum
Dr. Meghna Shah (BHMS, FCAH)
Edited by- Dr. Alifiya Dedanwala
A 37-year-female consulted Dr. Meghna Shah on 27th November 2018 via skype for chronic cluster headaches; manifesting once every 2 years lasting for a 1-1 ½ months. And this is the year she was expecting another episode. She’d get 3-4 attacks each day, with pain lasting for 1-1 ½ hours each time.
The pain was almost paralyzing her from performing any activity. She’d feel debilitated, as though eyes were pulled out and a hammer striking at the back of her head. It was periodical mainly occurred in months of Nov-Dec- Jan-Feb. The complaint has been there for 19-20 years. At times she has also required oxygen inhalation to relieve from pain. The headache has been right sided since few years, lasting for a couple of days. Two years ago, she also discovered respiratory allergic symptoms after having a dog at home.
(The further conversation is D=Doctor, P=Patient context for better case understanding,
HG = hand gesture.)
D: What bothers you the most?
P: Cluster headache.
D: Explain the pain in as much detail as you can.
P: I feel like throat is closing in on one side, as though choking in on right side. It is so severe that I am not able to move at all. I just get into bed. I cannot open eyes, even little bit of light or little bit of sound, or people talking, gives excruciating pain. The pain goes on increasing. Like head will burst. It is a throbbing pain like hammer is hit from behind. Then gradually reduces after which I slip into very deep sleep. Sometimes sleep can also be a trigger. The triggers are very tricky. It takes the same course every day.
I’ve gone through labor. That one month life becomes completely dysfunctional. You cannot step out.
During that time, I was put on anti epileptic medication and later weaned off. Even my labor pain was bearable. After delivery in January, my cluster headaches started. I couldn’t have any medication since I was feeding. The pain was so intense.
The neurological medicines slow me down like a zombie. I am unable to gather things fast, my movements are slow.
D: Tell more about the pain.
P: It starts from front and goes back. Right side. Throbbing pain, like a pull. Pulling pain (HG). In the front like pulling pain, on back like hammer.
D: Describe pulling pain?
P: Like sockets are being pulled out. Nerves around eye feel great amount of pain. Unable to open eyes. Closes on its own.
D: Describe the pulling?
P: Like bell curve. Peaks up and comes down
D: Describe the pulling in more detail?
P: It feels like its originating from one centre. And then it thrown out HG (hands open outward). Comes from inside out.
D: Describe what you show with your hands when you say thrown out HG?
P: Like something getting thrown out. Coming from somewhere and its spreading with a particular force.
D: Explain this more.
P: Feels like something is moving when pain starts. There is a movement which is outward. It travels from somewhere deep to outside. There is a particular rhythm which is very constant, like a hammer. There is a rhythm to it, its constant, it doesn’t stop.
D: Describe this movement outward.
P: Like its forcing its way out.
D: Describe forcing its way out.
P: Like there is some amount of pressure. Has to be squeezed out.
D: Describe pressure and has to be squeezed out.
P: Like you are pulling something out. Something is pushed out and something is pulled out. It feels it has to be squeezed out. Like something is stuck.
D: Describe something is stuck.
P: Like pushed out from one point to another. And travel is not smooth. As if the space is smaller and you have to squeeze in, HG (both hands close to each other with palms facing each other).
D: Describe this HG.
P: This cannot be moved and something has to go inside. Pressure which is exerted from something. Like pressure is applied for it to go in and it has to come out.
D: What is the experience in that moment?
P: When I have pain there is only pain nothing else. Pain has held you HG (closed fist). Till the pain passes no other thought comes to my mind. Meditating on that excruciating pain. Not wavering at all.
D: Tell more about this experience.
P: It is like wriggling with pain. Even the tiniest movement increases the pain. Even movement to open mouth increases the pain. I am as still as I can. Don’t move one tiny part of my body like opening mouth to talk or opening eyes, tiny movement. My body becomes stiff, just not able to move neck; like I am frozen.
D: Tell more about frozen and still.
P: Trapped. It is trapping HG. Like something is trapped and needs to be pulled out. Like I am trapped in pain.
D: Describe trapped.
P: Like there is not enough space and you are trapped and you need to come out.
D: Now at this point try and close your eyes, sit back; and try and experience this. Trapped, frozen, still. This entire experience try and relive it.
P: (Very spontaneously she slips into a childhood memory) There is this childhood memory. We were playing blind folded (aankh micholi). I slipped and fell into a tank of water and I couldn’t come out. I was choked with water. My grandfather pulled me out.
D: Relieve and tell the experience..with eyes closed..
P: Terror. And I cannot open eyes, I cannot open mouth. Deep dark space. I was not able to come out.
I am just being yamped out.
P: Pulled out. Very sudden. I am too terrified.
D: Go more deeper into this terrified and terror and see what comes up.
P: (pt sitting with eyes closed not resting her head backward on chair) There is pain. Noise. Feeling very paralyzed. Very intense. Going to burst out. Something going to burst.
D: Go more deeper..
P: Like I am going limp. Like I cannot move hands and legs.
D: Describe this experience of death.
P: Nothing there. There is no life! When movement stops and life is slowly going out of you. Black and dark.
D: Describe this black and dark..
P:(again closes her eyes) I feel as if I am pulled into a deep space. HG..going down
D: Describe this deep dark space, this space.
P: There isn’t anybody. Just me and darkness. It feels quite far from. The tank was five feet and I was standing, 3 maybe less feet. Downward movement. Became darker and darker. Downward pull HG. Then the opposite pull of being jerked out HG (pulled out).
D: Describe this HG.
P: Like pulled out. Suddenly travelled from one space to another in instance of time. It disorients you. There is pressure and pulling like not like an orientation.
Like I can’t see. I can’t speak. I can’t hear. Sudden numbness. Going numb
D: What is the experience?
P: There is no response. I was not responding. It was a trapped space.
D: Describe no response..
P: Like I want to but I cannot. Like body is not responding to me. Like mind wants to respond..but body is not responding.
D: Feeling then?
P: Fear and panic..
D: Describe fear and panic.
P: Fear is not knowing. It is bigger than you, a feeling of not in control. Panic is complete helplessness. Panic is almost like body is not listening to mind. Body is not hearing in its own.
D: What would you do to feel better?
P: Being consoled, being held.
D: Describe being held.
P: Feel safe. Feels like now I am ok.
D: Describe safe.
P: There is warmth. There is autonomy. Safe would be gentle.
D: Describe autonomy.
P: Being ok. A sense of wellness. A feeling power within, feeling centered. Autonomy is freedom; being your own individual. Self reliance, confidence..and self sufficient.
D: What is the exact opposite of this?
P: Being coerced; trapped. Don’t have freedom, like jailed.
D: What will be the experience? How would it feel within?
P: Unsafe; fear, and want to get out of it.
D: Why would this happen?
P: I have felt like that for most of my childhood. I wanted to get out. Didn’t have freedom. Very high conflict. Constantly fighting. Father was an alcoholic.
D: Tell more about conflicts and fights?
P: It was about him drinking; not taking responsibility; being irresponsible with money; lying, cheating. Mom would fight, very loud, highly fearful. It took me quite a few years to understand it. I am a therapist now but it was quite traumatizing as a child.
D: Describe this fearful, traumatizing.
P: I was wanting to run away and not be part of this violence. There was a lot of anger at home; it was like an unsafe place. Anything can go wrong; not stable.
D: Tell more..
P: Wanting to get out; it was excruciating pain (tears). Feeling helpless and hopeless. It was like it would never change.
D: Describe this wanting to get out?
P: Lot of hate; like freedom; like I don’t have to deal with it. It felt safer getting out. Unsafe inside.
D: Describe this unsafe inside more.
P: Like they would do something to each other. It can erupt into physical violence. Someone will get hurt badly. Something will break. Completely out of control.
D: Experience within?
P: Sheer terror. I wanted to hide.
D: More about the experience?
P: Like I couldn’t breathe.
D: Just go deeper into this, like I couldn’t breathe?
P: Feeling choked. There isn’t enough air. Heart rate going high.
D: Describe choked.
P: Choking. There is air but I couldn’t take it in. Stifling, constraining. Like I will die if I didnt get out..
D: Tell some dreams.
P: Childhood dreams were only nightmares. I had dreams of being chased; or I am running and not reaching a safe place. Like some danger is following me.
D: What is a safe place?
P: Like I am running to reach there. Safe place for me is where people are not shouting at each other.
There is no violence, like internal safety, not external place.
You can talk without anger. Somebody listens and somebody talks. There is a conversation with no negative energy; no aggressive energy. A feeling close to nature.
D: What is the experience?
P: I am able to breathe. I can talk without fear, where things don’t go out of control. I am managing, I am in control.
D: More dreams.
P: I am very scared of snakes. I grew up there where there were lot of snakes. It is very normal for snakes to be in and around you. But I was excruciatingly scared. I had a dream that there are lot of snakes at home.
D: Describe this dream in detail.
P: I will freak out. Very yucky feeling. Disgusted. Sight of snakes does something to my body.
D: What happens to your body?
P: Like something inside wants to get out HG.
D: Describe this something inside wants to get out.
P: It’s the terror which wants to get out.
D: How does it feel to be in there?
P: Very dissociated. Like my brain and my body are split. I am so scared that only way to contain terror is possibly by this going numb. Like I am in some shut down; go numb. Then you don’t feel anything.
D: Describe the word dissociated.
P: Intense feeling of not wanting to be there but you have to be there. Two forces. Like two things in logger heads with each other HG. Even if see snake in snake park. Two opposite forces; not wanting to be there and having to be there.
P: Very discomforting. Like body in fizz. Like buzzing.
D: Describe the word fizz.
P: Like you intensely become aware of something. Like a rush. In stomach becomes hollow inside. Like its empty and hollow. And I might forget to breathe.
D: More dreams?
P: I am sitting on bare earth. In front there is a carpet. Small one. Small square carpet. It has designs of star shaped. Like invertebrates. Like sea horse, snail, star fish. I am looking at them. And they are coming to life! Becoming actual creatures..
P: I am curious. Engaged, excitement. Wonderment, as to what is happening. Mysterious..
D: How does it feel within?
P: Full of life..
D: What means full of life?
P: Something energizes. It is stimulating..
D: What happens when it energises and stimulating?
P: Smooth flow of breath.
D: Tell more about this.
P: That’s how you feel when you are safe..
In fearful situations go blank..or take over and become highly functional..I take charge.
D: Tell about this?
P: Like crossing a road. If something comes at fast pace I can go blank.
D: Fear while crossing road?
P: Yes. My mother also had the same.
D: Other fears?
P: Snakes, water. When having shower, when water comes on face. Earlier, not now. I would hold breath.
Crossing road, like discomfort. In closed spaces I feel slight claustrophobic; small, tiny spaces.
D: Any interest, hobbies?
P: Love reading, watching movies, learning, cooking, baking, gardening. Interior décor.
D: Like to read?
P: Love to read about human mind, psychology.
P: I enjoy thrillers and romance.
D: And which you don’t like?
P: I dislike fights, action and war movies.
D: Tell one such.
P: Saving Private Ryan, Rajnikanth’s movie Kaala– there is lot of violence, people killing each other. I am sensitive to sound and in action movie there’s lot of sound.
P:I get headache. Even in occasions like weddings there is lot of loud noise and people talking loudly which makes me uncomfortable.
D: How did you feel with the process and consultation?
P: Felt good, like everything came to one thing. and then it seem to connect.
ANALYSIS OF THE CASE:
This case highlights several aspects of the patient but we see the central theme revolves around ‘Pain, fear & Violence’. For us, it is very essential for the center of the patient to match the center of the remedy we choose for her.
We see excruciating pain in her main complaint of headache. She has intense pains, where she has to be put on oxygen, or at times epileptic medicines. Characterized as something bursting, hammering, paralyzing, as though being squeezed from pressure, forced between; and along with a feeling of being trapped, choked, losing oxygen, difficulty in breathing; almost leaving her numb and paralyzed, with no ability to move.
The most interesting turn in her case is when she goes into her experience, she immediately connects with one of the most traumatic experience from her childhood. The incident of falling into a tank in childhood where she experienced a similar situation of being choked in the dark. She felt there were two forces acting upon her. A force drawing her in downward direction and another of being pulled out. While being in there she had the same feeling of being trapped, shocked, numb, not being able to move, completely paralyzed, not knowing what to do. This feeling ran through, in all situations, right since her childhood.
Interestingly, this kind of experience is not just limited to her physical aspect but comes up in her childhood situation in her home. She had always been wanting to get out of her house. The conflicts with father, fights and violence in her house terrified her as a child. She wanted to run away from the situation and hide somewhere but was forced to be there and witness it. Again the same feeling and experience of being choked, not getting enough air to breathe, feeling constrained, excruciating pain with a feeling of trapped and helplessness. She had a strong feeling of taking refuge in a place that was much safer where she could breathe freely with freedom.
We confirm the same experience in her dreams with snakes, or even the sight of them, when it comes to crossing roads, watching violent movies. Her sensitivity esp to violent movies.
Let us understand how to confirm the Sensation of the patient?
- Sensation in the case usually occurs at a level beyond delusions and perceptions
- A sensation is often accompanied with an intense energy pattern, usually a hand gesture
- It is spontaneous, repetitive; and will slowly emerge as a common thread running through the case
- You will see it coming repeatedly in the case while examining different areas.
When we see the same experience coming up in different areas of her life, it becomes her ‘Global Sensation’.
In this case we see two aspects:
- Sensitivity to intense pain, like shock, along with going numb and paralysed
- Feeling trapped, constrained, squeezed, choked, forced into a narrow place; need to come out and breathe
At first it was difficult to put it together, but I started my search as follows. I first checked in the
Reference works software:
The reference works software helps us to channelize our search. It is extremely helpful in such cases where characteristics are at mainly at the level of mind not just in the form of symptoms but where we see a pattern or theme emerging at the Sensation level.
Catalepsy in the same remedy as numbness in the same remedy as shock in the same remedy as violence/terror (148):
I was having some hints towards a nitrate remedy. So I decided to limit this search only to nitrates and carbon remedies:
Here we see four interesting remedies (from carbon and nitrate family) Ammonium carb, Amyl nitrate, Graphites and Sanguinarium nitrate coming in her case.
This kind of put for me all the missing links together. As I could then understand the two aspects, namely the themes of Papavaraceae and nitrates, both coming together in her case.
Themes of Papavaraceae
Themes of Nitrates
-Sensitivity to pain
-Numb, shut down
-Stuck in between
-Push and pull
-Small space, not enough space and need to come out
– To breathe
– Inside out
– Thrown out
– Outward movement
– Forcing its way out
– Pushed put
– Squeezed out
– Pressure – to go in and come out
I checked the repertory as follows:
- head; PAIN, headache; right (547)
- head; PAIN, headache; extending to; back (120)
- head; PAIN, headache; periodical (174)
- head; PAIN, headache; bursting (282)
- head; PAIN, headache; hammering (122)
- head; PAIN, headache; hammering; sides; right (3)
- mind; RECOGNIZE; everything, but cannot move, in catalepsy (2)
- mind; HELPLESSNESS (125)
- mind; HOLDING or being held, desire for (49)
I could see strong indications for Sanguinaria here.
Sanguinarum nitricum from Vermeulen: Crave for fresh air
She received Sanguinarum nitricum 1M 1 dose.
Follow up on skype on 18th December 2018:
P: I took the medicines for two weeks. I could experience a part of my head active. There was no pain but slight discomfort on right side of head that never broke out into a headache. I have contained somehow.
At times redness in eyes, and this nerve would become active. But didn’t result into pain which is very good. This was the first week. The second week the sensation in this part has also become lesser. I’m feeling quite ok. The medication has an effect
D: Mentally and mood wise?
P: Not had allergy break out also. Feeling quite well.
P: Very crowded. Led by someone I know into a cave, underground. I go through a tunnel and suddenly it opens up into something into an open space. It is a very beautiful sight. There’s a house there, something beautiful was hidden that nobody knows about it.
P: Touched by beauty. It was a colonial house. I walk through dirty places in the tunnel suddenly to witness beauty to that kind of grandeur which was quite amazing. Felt very touched. When you go through underground constrained space and suddenly to open up to wide space its very exhilarating. Like suddenly you could breathe!! I don’t like very closed spaces. I felt I need to show this space to my husband and daughter. Going back to bring them. Bringing them going through other place not same place.
My daughter did Bungee jumping. It was terrorizing, very scary, wall, no space. Before I could scream and react she had already jumped. What appeared as well was a hollow space, I almost stopped breathing
I thought she would hit her head.
Follow up on skype on 1st January 2019:
I am doing ok. Having medication till today. Not had headaches. Sometimes I have this pain sensation on right side. But its just sensation. No pain. I am feeling much better even in terms of immunity. I have not had any allergic attacks or allergy triggered. My immunity has improved.
D: Mind state?
P: Much better. Feel centered. Even though nothing has changed externally. Some amount of settling which has happened internally. Even though there is chaos I feel peaceful.
P: Much more calmer. No thoughts racing in head. Going at slow pace. Don’t feel crowded inside. Able to connect with my body better.
P: Long room. Seems to be my therapy practice space which I give on rent. Have made another space within my home. The space was not enough, very long. I saw my husband and told him you can get out from here through the window. I hold my husband’s hand and jump out of the window. Like the games we play and land on window sill. Slightly older, individual houses. Jump and land. I woke up with sense that I jumped and landed ok.
P: Anxiety while moment of jumping. But in the dream felt very natural that we can jump from one floor to another.
Follow up on skype on 22nd January 2019:
P: Doing quite well. Once had slight headache on right side. Maybe had to do with putting oil. It was bearable, not intense. It lasted for two days, not had cluster headache back.
D: What else?
P: My immunity has grown. I am not getting any allergic bouts, like viral cold, cough. Usually if anybody gets even far away, I would catch it immediately. It would be very frequent. Thankfully this time I feel quite different.
D: Mind state?
P: Much much calmer. Earlier when would get stressed about anything would be like screw tightening
And the urge to do something immediately.
P: I do not feel rushed inside. There is stress. Nothing has changed around. Work stress, at home. But some sort of detachment to it. I am observing it. Not creating a reaction on to my body.
Another difference is I don’t feel the need to comfort eat. I used to have this craving for chocolate. Now I don’t feel like eating too much sweets. I am not stuffing myself.
I am a psycho therapist. I would feel completely drained and feel like eating after a session. Now also I feel like eating but not craving for sugar.
P: Want to go to the loo. My therapist place, she shows a place outside. The door is not comfortable. I ask her to show a place inside. Which seems to be very open. I see a couple of colleagues when I come out of loo. Then see me and husband with another person. He is trying to set up a laptop or projector. I and my husband are not able to figure out how to start the program. The 3rd person a Tamil actor, he says this is not how it is to be done. This is how it is supposed to be done. Figured out something and that kind of feeling.
P: Cracked something very challenging. Like an achievement, like something crucial was figured out. Positive feeling; woke up feeling that. Somebody came and helped..
(Then speaks about how her perspective towards her inner self has changed since she came to other song..
And acknowledges that there is no other institute like the other song. And the kind of healing we offer. And have been referring many clients to other song and homeopathy)
Follow up on skype on 26th February 2019:
I am having cough since 3 weeks. Last week it spiked so went to nearby homeopath and took something.
Not had any headache or migraine. Other than that health is fine.
Climate changed from very cold to very hot. The weather is changing quite fast. I’m very busy with work.
Pulled from all sides. Not feeling very centered.
P: Lot of people, I’m in a social space. I’m changing my dress which is socially inappropriate. But in the dream it does not feel like that..
P: Not sure if there was an awkwardness..
P: Exposed, Vulnerable
D: Exposed and vulnerable?
P: Like taking clothes off..HG
P: Shame. Embarrassed. Did something I was not supposed to do..
D: Did anything like this happen?
P: At work something triggered. An ex client came back. She spoke an experience, had handed over her case to someone else. She came back telling how the person was inappropriate. Not holding boundaries. Violation. Hit me badly. She didn’t feel safe
I’m very happy that February is going to end. Usually get the cluster headaches from Nov to Feb..
Rx: Sanguinarum nitricum 1M
Follow up on 27th April 2019:
I am much better. There are no headaches. My allergy is much better. The cough has improved.
The medicines have helped me holistically. The way I feel stress in body is very different. There is no heaviness. Nothing is showing in the head.
Dr. Meghna Shah (BHMS, FCAH)
A young, dynamic, dedicated, intelligent and sincere person, she is gifted with an extremely intuitive mind inclined towards research. She also possesses excellent managerial qualities with tremendous insight into human psychology. She is an ardent follower of Homoeopathy, and having trained under Dr.RajanSankaran for 10 years she is perhaps one of the best practitioners and teachers of Homoeopathy from among the newer generation. Dr.Meghna has worked in the Mumbai homoeopathic hospital after receiving her degree in 2000. Since 2001 she has been a physician in Dr.Sankaran’s clinic. She has organized video and live seminars of Dr.Rajan Sankaran and has been instrumental in starting the web-group ‘Insight-Alliance Homoeopathic’. She has been an active member in organizing ‘Wednesdays with Rajan’, one of the most successful programs in Homoeopathy. She has assisted Dr.Sankaran on the books: Sankaran’s Schema, Structure – Experiences with the Mineral Kingdom, The Other Song, and Survival – the Reptilia—which have all been highly appreciated and translated into many languages. She has spent two years researching the reptiles for this book, including a stay at the Reptile Park in Chennai, where she observed them firsthand and consulted the park’s herpetologists. She is currently working on Survival – the Arachnida, apart from being at the helm of affairs at The Other Song.