RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES



RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

ANNEXURE-II

APPLICATION FOR REGISTRATION OF SUBJECT FOR DISSERTATION

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|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 |

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|2. |NAME OF THE INSTITUTION |FATHER MULLER HOMOEOPATHIC MEDICAL COLLEGE AND HOSPITAL, |

| | |DERALAKATTE, |

| | |MANGALORE-575018 |

| | |KARNATAKA. |

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|3. |COURSE OF THE STUDY & SUBJECT |M .D.(HOM) |

| | |HOMOEOPATHIC PAEDIATRICS |

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|4. |DATE OF ADMISSION TO THE COURSE |24-05-2010 |

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|5. |TITLE OF THE TOPIC: |

| |“SCOPE OF HOMOEOPATHY IN CASES OF HEADACHE IN PAEDIATRIC AGE GROUP”. |

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|6. |BRIEF RESUME OF THE INTENDED WORK |

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| |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. |

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| |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. |

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| |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 |

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| |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 |

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| |-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 |

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| |Cluster headache: It is also called as Raeder’s 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 |

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| |-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 |

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| |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 |

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| |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 |

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| |DIFFERENTIAL DIAGNOSIS:4 |

| |-encephalitis |

| |-meningitis |

| |-epidural and subdural infections |

| |-toxicity |

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| |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 |

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| |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 |

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| |hereditary predispositions to illness, thereby leading to a better adaptation of the |

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| |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 |

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| |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. |

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| |MATERIALS AND METHODS: |

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| |7.1 SOURCE OF DATA: |

| |The subjects will be selected from OPD, IPD and peripheral centers of Fr. Muller Homoeopathic Medical College Hospital, |

| |Mangalore. |

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| |7.2 METHOD OF COLLECTION OF DATA: |

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| |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. |

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| |INCLUSION CRITERIA: |

| |1. The sample on both sexes aged from 5-18 year |

| |2. Diagnostic criteria is mainly on clinical presentation and local |

| |examination |

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| |EXCLUSION CRITERIA: |

| |1. Cases above 18 years of both sex |

| |2. Mentally retarded children |

| |3. Children with genetic disorders |

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| |RESEARCH HYPOTHESIS: |

| |Homoeopathic drugs are effective in the treatment of cases of headache in paediatric age group. |

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| |NULL HYPOTHESIS: |

| |There is no significant improvement among cases of headache in paediatric age group after homoeopathic treatment. |

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| |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. |

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| |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. |

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| |7.4 Has ethical clearance been obtained from your institution in case of 7.3? Yes, enclosed. |

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| |LIST OF REFERENCES: |

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| |Epidemiology of headache in children and adolescents .Address :URL:

| |Accessed on:02 November 2010 |

| |Fauci, Braunwald, kasper, hauser, longo, jameson et al,Harrison’s 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: |

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| |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. |

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|8. | |

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|9. |SIGNATURE OF THE CANDIDATE | |

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|10. |REMARKS OF THE GUIDE | |

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|11. |NAME & DESIGNATION OF | |

| |(IN BLOCK LETTERS) | |

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| |11.1 GUIDE |Dr JYOSHNA S. |

| | |MD (HOM), |

| | |PROFESSOR, DEPT OF PEDIATRICS, |

| | |FATHER MULLER HOMOEOPATHIC MEDICAL COLLEGE & HOSPITAL, DERALAKATTE, |

| | |MANGALORE. |

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| |11.2 SIGNATURE | |

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| |11.3 CO-GUIDE | |

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| |11.4 SIGNATURE | |

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| |11.5 HEAD OF THE DEPARTMENT |Dr JYOSHNA S |

| | |MD (HOM), |

| | |PROFESSOR, DEPT OF PEDIATRICS, |

| | |FATHER MULLER HOMOEOPATHIC MEDICAL COLLEGE & HOSPITAL, DERALAKATTE, |

| | |MANGALORE. |

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| |11.6 SIGNATURE | |

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|12. |12.1 REMARKS OF THE | |

| |CHAIRMAN& PRINCIPAL | |

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| |12.2 SIGNATURE | |

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