Migraine in an Adolescent with a Pineal Cyst Treated with Classical Individualized Homeopathy: A Case Report Open Access

Migraine is a primary headache disorder affecting 5–40% of the pediatric population [1]. The treatment involves various pharmacologic and non-pharmacologic measures, ranging from stress management, trigger avoidance, and lifestyle modification, to use of analgesics, with no standardized management established so far [2]. Population-based surveys showed that in about 50% of the children, the migraine remained status quo [3, 4]. Females are more likely to be affected by persistent headaches after puberty in the pediatric population. In addition, positive family history of one parent and migrainous headaches during childhood increases the likelihood of higher headache frequency in the long term [1]. About 1.9% of the pediatric population with migraine undergoing intracranial imaging show pineal cyst (PC) lesions [5]. Though vast majorities of PCs are asymptomatic, studies have demonstrated a significant relationship between headaches and PCs; however, its causal relationship remains controversial [6, 7].

Conventional therapy of PC includes conservative management of symptoms and surgical resection based on the size of the cyst [8]. Management of PC or its improvement homeopathically has not been documented so far. We present a case of pediatric migraine with incidental diagnosis of PC, where the headaches improved along with regression in the size of the cyst.

The patient, an 11-year-old female, presented for a homeopathic consultation on February 22, 2018.

The patient had one-sided headaches preceded by an aura, with a transitory loss of vision in the form of central scotoma or contralateral hemianopia. The vision was dim or foggy at times. Later episodes were followed by formication of the left hand and vomiting, without ameliorative effect. About 10 episodes of headache were seen in 6 months, where the patient used analgesics like paracetamol or ibuprofen. Headaches lingered for 2 days after conventional therapy.

The patient had two episodes of head injury, at 1.5 years and 6 years of age, with a concussion during the second incident, where the response time was delayed for 3 h. She had atopic dermatitis during her early childhood, Mycoplasma pneumoniae infection at 3 years of age, recurrent herpetic eruptions on the nasal mucosa at the age of 9 years, and recurrent aphthae since the age of 10 years. She is also allergic to fur and pollen. The patient was regularly attended to, by conventional medicine specialists.

The child’s parent and maternal grandmother had a positive medical history of migraine.

Magnetic resonance imaging at the beginning of consultation revealed a septate PC measuring 9.0 mm (shown in Fig. 1). The MR angiography, hematological tests, thyroid hormone assay, and serology for B. burgdorferi were normal. No specific ECG or ophthalmologic or endocrine pathology was found.

Infections, meningitis, malignant tumor growth, hypertensive encephalopathy, antiphospholipid syndrome, and stroke were not confirmed.

Migraine with aura – ICD: G43.1; congenital cerebral cyst – ICD: Q04.6 [9].

On February 22, 2018, the patient presented with recurrent headaches. On further examination, it was found that the migraine affected the patient’s concentration and performance to an extent that it made day-to-day activities difficult, and she could not attend school during those days. The headache aggravated with exertion and on fasting. She was sensitive to cold weather and had difficulty in falling asleep; she complained of formication in the extremities and perspiration over the back and face. On inquiring about her nature, the mother described the child as being compassionate. She used to cling to the parents when younger and did not like staying alone. The child was excessively worried about the health of her loved ones and would have nightmares often.

Classical homeopathy provides holistic treatment tailored to the patient based on the symptomatology presented. The emotional state where she wanted the company of her mother and would cling on to her, coupled with her sympathetic nature, anxiety, and physical symptoms like her desire for ice cream, pointed toward the homeopathic remedy Phosphorous. Other remedies such as Stramonium and Causticum also show symptoms such as strong clinging to the mother and sympathetic behavior respectively; however, in Stramonium, the clingy nature is seen due to fear with severe aggressive and violent behavior, while in Causticum, neurological affections are seen with sympathetic behavior toward social suffering rather than physical [10] (online suppl. Fig. S1; for all online suppl. material, see https://doi.org/10.1159/000535615). Prescription: February 22, 2018; Phosphorous 200 CH, one dose.

Follow-up of the patient is shown in Table 1. The patient was treated homeopathically for a period of 5 years, with 9 follow-ups during this time. During this period, 2 remedies were prescribed; Phosphorous in different potencies initially, under which she improved consistently. After 9 months of initial prescription, she received a repetition of Phosphorous 200 CH as there was a relapse of migraines from antidoting effect, from suppression of aphthous ulcers with topical application. After this, the homeopathic physician perceived that with certain triggers, the migraine relapsed. This meant that the case was not stabilizing with 200 CH. Therefore, a repeated dosing was opted for, with LM potency. It is a practice to give consecutively higher potencies with the LM scale in homeopathy whenever a need for more stimulation is observed, for example, when the improvement regresses or hits a plateau. Three years and 4 months into the treatment, the repeat magnetic resonance imaging showed normal brain study, remarking the resolution of PC (Fig. 1). However, milder episodes of migraine continued and so did the treatment. It should be noted that around the same time, the patient expressed her old, suppressed herpes simplex eruptions. This is considered a good change in homeopathy. The effort with homeopathy is always to revert the immune status of the organism to how it was before developing the diseases being addressed. During this, it can happen that old conditions that were suppressed with the aid of superficial treatments make an appearance again. This is a welcome change, and the new situation must be assessed anew for homeopathic treatment. If they do not resolve on their own, they will need a remedy, as happened in this case. Natrum muriaticum 200 CH was prescribed when the herpes persisted and became the main issue. The herpes resolved with Natrum mur, and the patient was generally well. The mother of the patient has provided her experience with homeopathic treatment for her daughter’s condition. Though migraine relapsed a few times with external triggers, the PC did not return (Fig. 2), and the episodes were milder when compared to before homeopathic therapy, with improved quality of life (shown in Table 1).

Recurrent headaches affect nearly 1 in 10 children, causing significant impairment in quality of life. Studies show that in unresponsive cases, triptans, opioids and electrical neuromodulation devices are advised by evidence-based medicine; however, acute medication can predispose patients to more frequent headaches termed “medication overuse headache” and cause dependency [11]. A study involving use of classical homeopathic remedies for its treatment showed favorable results; however, it concluded to have low external validity [12]. Another study using homeopathic prescriptions for migraine in children showed positive results in reducing attacks but used preventive treatment using homeopathic remedies as well as combination of homeopathic drugs [13]. The use of homeopathy in the treatment of PCs has not been published till date.

Studies show that cysts smaller than 10 mm remain asymptomatic and may reduce in size with time; however, complete autoregression of PCs has not been documented. Nevertheless, we cannot rule out the remote possibility of autoregression.

The return of older, superficial, and suppressed conditions during the treatment of a deeper newer issue is expected during the course of classical homeopathic treatment and is considered a sure sign of improvement [14]. In this case, after the suppression of atopic dermatitis, the child developed herpetic eruptions and later migraine, which may be secondary to PC. Therefore, the reverse order of the process (disappearance of the PC, followed by relapse of the herpetic eruptions) was expected and appreciated during treatment.

The agreed Modified Naranjo Criteria for Homeopathy (MONARCH) causality score was +8 points (shown in online suppl. Table S1) as there is the rare possibility that the cyst may have disappeared spontaneously, and the initial therapeutic homeopathic aggravation was unclear. The result suggests that homeopathy contributed to clinical improvement. This being a case report, we cannot yet claim the effect to result from the therapy employed, but it gives us enough ground to further investigate.

Individualized homeopathic treatment effectively managed the case of migraine in an adolescent, with complete regression of the PC during the period of treatment. Further scientific investigation is required in this direction to establish effectiveness of classical homeopathy.

Before seeing homeopath Dr Glas, my daughter, L, had migraines every 14 days, usually on Tuesdays, and sometimes every week. All migraine attacks were accompanied by visual disturbances, aura, severe headaches, and tingling in the arm and face. She kept a regular migraine diary and also recorded other symptoms that occurred during the homeopathic treatment (herpes, common headaches, aphthae). Often, the migraine occurred on the 2nd day of her menstruation and after physical exertion (training, matches). The headaches were very severe on the first day, less so on the second day, so she did not need to take painkillers. In September 2022, tingling sensations on the tongue and consequent speech disorders appeared for the first time. L had her last migraine on June 9, 2023. At that time, she was still taking homeopathic remedies. It was one of the worst migraines she has ever had. She has not had migraines since then. My daughter sees a neurologist regularly, with regular diagnostic tests, but she does not choose to treat her with medication.

Overall, we are very satisfied with the results of homeopathic treatment. During the homeopathic treatment, the migraines were weaker and significantly less frequent, sometimes without accompanying symptoms (aura, tingling, visual disturbances). The cyst in the brain also disappeared. As a mother with very similar migraines that have been recurring for more than 25 years, I find it hard to believe that the daughter’s health problems would resolve on their own.

The authors acknowledge the help of the patient in consenting for publication and thank Dr. Rainer Appell for independently reviewing the case and providing the MONARCH scores.

Ethical approval was not required for this study in accordance with local/national guidelines. Written informed consent was obtained from the patient’s guardian for publication of the details of their medical case and any accompanying images.

The authors have no conflicts of interest to declare.

This study does not have any funding.

Katarina Lucija Glas was the primary physician who treated the patient and analyzed the data for the study. Seema Mahesh and Amritha Belagaje analyzed the data, wrote the manuscript, and obtained the references. George Vithoulkas was the guide and guarantor of the work. All the authors have read and approved the final version of the manuscript.

All data available are included in this article and its supplementary material files. Further inquiries can be directed to the corresponding author.