ࡱ> _ T=bjbj,E,E 8N/N/*5)***8b*t"$5ɗցNMt^`zߗ0hTNNb v T]D6 : @RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA ANNEXURE-II APPLICATION FOR REGISTRATION OF SUBJECT FOR DISSERTATION 1. NAME OF THE CANDIDATE & ADDRESS Dr NAKADI POONAM PRABHAKAR DEPARTMENT OF PAEDIATRICS, FATHER MULLER HOMOEOPATHIC MEDICAL COLLEGE AND HOSPITAL, UNIVERSITY ROAD,DERLAKATTE, MANGALORE-575018. KARNATAKA PERMANENT ADDRESS D/O Mr. PRABHAKAR T. NAKADI RAMNAGAR HOUSING COMPLEX, GHAVANE VASTI, VAASTU UDYOG, DNYANESHWARI BLDG,A1/3, BHOSARI.PUNE-411039. MAHARASHTRA 2. NAME OF THE INSTITUTION FATHER MULLER HOMOEOPATHIC MEDICAL COLLEGE AND HOSPITAL, DERALAKATTE, MANGALORE-575018 KARNATAKA. 3. COURSE OF THE STUDY & SUBJECT M .D.(HOM) HOMOEOPATHIC PAEDIATRICS 4. DATE OF ADMISSION TO THE COURSE 24-05-2010 5. TITLE OF THE TOPIC: SCOPE OF HOMOEOPATHY IN CASES OF HEADACHE IN PAEDIATRIC AGE GROUP.  6. BRIEF RESUME OF THE INTENDED WORK 7. 8.  6.1 NEED FOR STUDY: Headache is one of the most common complaints of children. Around 20% of outpatient visits to primary care physicians are due to headaches. Studies have supported that around 80% of pediatric population within the age group of 6-15 yrs. of age have suffered from headache .Studies of prevalence of any type of headache have shown up to 50% of 7yrs old and 80% of 15yrs old have suffered from headache at least once.1 The high incidence of headache in pediatric population has a significant impact on the lives of children, resulting in school abstinence, decreased extracurricular activities and poor academic achievement. In order to manage childhood headaches efficiently, physicians must understand the common headache patterns, also the signs and symptoms that may indicate simple to serious intracranial diseases etc. Early effective intervention may prevent progression and lifelong consequences, including the development of co-morbidities. The cause of most of the headaches can be best elicited by full and accurate history taking and by routine general examination of the patient. History will bring out all the probable factors that < or >, any accompanying symptoms like vomiting and visual disturbances, any symptoms between the attacks etc. Though trivial headache at times may be a symptom of grave significance .thus it is very essential to know the pattern of headache. Also in this study, the scope of homoeopathic treatment in cases of headache in pasediatric age group will be assessed. 6.2 REVIEW OF THE LITERATURE: Headache: It is one of the most frequent neurological symptom but it is seldom associated with significant neurological disease unless accompanied by other symptoms or neurological signs. PATHOPHYSIOLOGY : Distention, traction, or dilatation of intracranial or extra cranial arteries. Traction or displacement of large intracranial veins or their dural envelop. Compression, traction or inflammation of cranial or spinal nerves. Spasm, inflammation or trauma to cranial or cervical muscles. Meningeal irritation and raised intracranial pressure. Other possible mechanisms such as activation of brain stem structures.2 CLASSIFICATION: Classification according to the international headache society: Headache is broadly classified into 3 types. Primary: headache and its associated features are diseases in itself. It is further classified as: Migraine: it is a syndrome of episodic, recurrent headaches more often unilateral which is associated with nausea, vomiting, photophobia or phonophobia.2 Diagnostic criteria consists of atleast two of : -unilateral pain -throbbing pain - < movement - moderate or severe intensity. Or atleast one of: -nausea/ vomiting -photophobia/ phonophobia Migraine is of following types: a .Migraine without aura b .Migraine with aura c. Ophthalmoplegic migraine d .Retinal migraine e .Childhood periodic syndromes that can be precursors or associated with migraine.2 Tension type headache: It is a type of headache that occurs more commonly in patients subjected to stress, anxiety and depression. Various precipitating factors may cause TTH in susceptible individuals like -stress -sleep deprivation -uncomfortable or bad posture -irregular meal timings -eye strain -caffeine withdrawal.3 Cluster headache: It is also called as Raeders syndrome, histamine cephalgia and sphenopalatine neuralgia.It is distinctive and treatable vascular headache syndrome.3 Diagnostic criteria includes one or more of: -conjunctival injection -lacrimation -nasal congestion -rhinorrhea -miosis -eyelid edema -frequent headache3 Miscellaneous headaches: It includes -idiopathic stabbing headache -external compression headache -benign cough headache -benign exertional headache -sinus headache2 Secondary headache: Headaches that are caused exogenously.It can be related to: -intracranial pathology -vascular pathology -infective pathology -neoplastic pathology -traumatic -psychiatric3 Neuralgias: It includes cranial neuralgias and other causes of facial pain like: -occipital neuralgia -trigeminal neuralgia -glossopharyngeal neuralgia -neck tongue syndrome3 ETIOLOGICAL FACTORS:4 1.Stress and muscular tension 2.Diet and food sensitivities 3.Jaw problems 4.Hormonal influences 5.Eye problems 6.Eear, nose and throat problems 7.Medications and rebound headache 8.Allergic causes 9.Physical exertion WARNING SIGNS WITH HEADACHE: -sudden onset -fever -marked change in character and type of pain -neck stiffness -pain associated with neurological disturbance -pain associated with local tenderness INVESTIGATIONS: -Most of the times a thorough history taking and physical examination is all that is required. -laboratory, radiologic or EEG findings may help in excluding other causes of headache. -head trauma and headache due to intracranial hemorrhage can be revealed by a consumptive coagulopathy, thrombocytopenia and prolonged prothrombin time. -in cases of intracranial abscess, lumbar puncture may reveal elevated opening pressure, leukocytosis, elevated protein and low glucose level. -in subarachnoid hemorrhage, lumbar puncture will show RBCs.2 Imaging studies: -Sinus headache- h/o persistent URTI, symptoms lasting more than 10 days and radiographs depicting fluid levels in the sinuses. -Intracranial masses are often diagnosed by CT and MRI. -EEG- is useful to assess the status of an underlying seizure disorder associated with headache.5 DIFFERENTIAL DIAGNOSIS:4 -encephalitis -meningitis -epidural and subdural infections -toxicity PROPHYLAXIS:5 Taking good care of the child can decrease the frequency and severity of their headaches. -drinking plenty of water -caffeine avoided -sports drink may help by keeping sugar and sodium levels normal. -regular and sufficient sleep. -avoid overexertion -eat balanced meals at regular intervals -following prescribed plan of treatment HOMOEOPATHIC APPROACH TOWARDS HEADACHE: Homoeopathy recognizes the individuality of each case. It does not treat the disease but treats the patient. It provides a constitutional treatment based on totality of physical and mental reaction. In cases of headache the symptoms should be qualified with regards to its onset. Frequency, duration, modalities, concomitant and accompanying symptoms if any .The concept of susceptible constitution takes into consideration the hereditary influences and predispositions that play an important role in the genesis of illness. Homoeopathic therapeutics, therefore have unlimited possibilities of influencing favorably the mental process and mitigating the adverse effects of the hereditary predispositions to illness, thereby leading to a better adaptation of the patient to his environment. This is the general management which plays a major role in treatment of headaches. When the patient comes with an acute exacerbation, it is always best to start an acute remedy which is then followed by the constitutional .In many cases well selected similimum fails to act or in the middle of the treatment, progress comes to a standstill. There comes the concept of a miasmatic totality. This can be solved by an appropriate intercurrent remedy to clear the miasmatic block. 6 Few common remedies frequently used for the treatment of headaches are: Acon, Arg nit,Ars, Bell, Bry, Ced, Ign, Iris, Glon, Lac d, Nat mur,Nux vom, Sang, Spig, Calc phos, Sil, Sul, Lyc.7,8,9 6.3 OBJECTIVES OF STUDY: 1. To evaluate the various factors that precipitate headaches in children. 2. To study different types of headaches. 3. To study various homoeopathic approaches in cases of headache in paediatric age group. MATERIALS AND METHODS: 7.1 SOURCE OF DATA: The subjects will be selected from OPD, IPD and peripheral centers of Fr. Muller Homoeopathic Medical College Hospital, Mangalore. 7.2 METHOD OF COLLECTION OF DATA: A sample of minimum of 30 cases will be selected by purposive sampling method as per the inclusion criteria and will be followed for a minimum period of 4-6 months duration. Every case will be analyzed with reference from materia medica, repertory and therapeutics whenever required. The potency selection and repetition of the doses will be done according to the demand of the case, with consideration of susceptibility, sensitivity, suppression (if any), the level of similarity, functional changes, structural changes, vitality and underlying miasm. INCLUSION CRITERIA: 1. The sample on both sexes aged from 5-18 year 2. Diagnostic criteria is mainly on clinical presentation and local examination EXCLUSION CRITERIA: 1. Cases above 18 years of both sex 2. Mentally retarded children 3. Children with genetic disorders RESEARCH HYPOTHESIS: Homoeopathic drugs are effective in the treatment of cases of headache in paediatric age group. NULL HYPOTHESIS: There is no significant improvement among cases of headache in paediatric age group after homoeopathic treatment. PLAN FOR DATA ANALYSIS: The data collected will be analyzed by paired t-test. With respect to the second objective proportions or ratio will be used to measure the prevalence of Headache in paediatric age group. 7.3 Does the study require any investigations to be conducted on patients, or other humans (or animals)? If so please describe briefly. The study may require radiographic investigation or complete blood investigation. 7.4 Has ethical clearance been obtained from your institution in case of 7.3? Yes, enclosed. LIST OF REFERENCES: Epidemiology of headache in children and adolescents .Address :URL: http://www.springerlink.com/content/m765jkrljv7660j5/ Accessed on:02 November 2010 Fauci, Braunwald, kasper, hauser, longo, jameson et al,Harrisons Principles of internal medicine.16th ed. New Delhi: Mc Graw Hill;2008.p95-106.vol-1 Goldman Lee, Ausiello Dennis, Cecil medicine.23rd ed. New Delhi: Elsevier, a division of Reed Elsevier India (P)Ltd;2008.p2639-46.vol-1 Behrman, Kliegman, Jenson, Nelson Text book of paediatrics.16th ed. Noida, Thomson press (I)Ltd;2000.p1832-5.vol-1 Lewis D .W. Headache in children and adolescentsAdress: URL: http://www.sld.w/galerias/pdf/sitios/pediatria/headaches_in_children_and_adolescents.pdf Accessed on:04 November 2010 Hahnemann Samuel, Organon of medicine.6th ed. New Delhi, B Jain publishers (P)Ltd;2003.p166. Fisher C.F, A handbook on the diseases of children and their treatment. New Delhi, B Jain publishers (P)Ltd;1995:p315-22 Lilienthal Samuel, homoeopathic therapeutics.3rd ed.New Delhi, B.Jain publishers (P)Ltd;1996:p508-46 Boericke W. Pocket manual of homoeopathic materia medica with Indian medicine and repertory. New Delhi: Indian Books & Periodicals Publishers; 2006. p. 702-5. 9. SIGNATURE OF THE CANDIDATE  10. REMARKS OF THE GUIDE  11.  NAME & DESIGNATION OF (IN BLOCK LETTERS)  11.1 GUIDE Dr JYOSHNA S. 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