Notes from the Field: January, 2021

 In Clinical Pearls


The following is not an article prepared for a medical journal. Not every statement of fact is cited or referenced. This is a commentary on the medicine, a running set of observations about practice in the field. It’s not meant to be a peer-reviewed presentation; rather, these are notes and thoughts from a practicing naturopathic physician, a primary care doc in general practice. 

Some Cases of Headache 

Case Study 1 

Last week, a 40-year-old woman came to see me complaining of headaches that had been occurring for 20 years. She described her headaches as like a “shrinking on the top of my head,” and they were usually accompanied by severe nausea. She also suffered from heartburn. “I become dizzy, pale, and cold,” she said. All of these symptoms began when she was 19 or 20 years old. She was very sick. She had a bad cold, but did not take good care of herself. She ate mostly junk food. She was driven at the time, continuing to push herself, working hard and eating poorly. This was a particularly difficult and stressful time. The chronic cold became a sinus infection when she was age 23, and it lasted for 7 years. She developed asthma-like breathing issues. All of her joints began to crack and pop.  

Most of these problems improved when she turned age 30 and changed her lifestyle. She addressed the stress by reducing it. She began to eat a Mediterranean-like diet, with fish and eggs but with no milk or other animal products. The sinus infection resolved, but not the headaches. She was still following that diet when she first presented to my office, and otherwise seemed fairly good; but she wanted to address the headache, which she believed was due to a dietary issue. She also reported very sensitive hearing, almost to the point of pain.        

When I went through her patho-biography, a year-by-year recollection of health problems, she noted persistently swollen cervical lymph nodes since around the age of 5, along with frequent throat infections. In her 30s she wanted to get pregnant but was having trouble. She saw several doctors. One recommended the removal of some uterine fibroids, after which she became pregnant.   

On physical exam, her blood pressure was 122/70 mm Hg, and her body temperature was 36.7 °C (98 °F). She had a positive stomach reflex, suggesting a stomach disturbance, and she had mid-left abdominal tenderness. Her fasting blood sugar was a little low, at 75 mg/dL.   

We think of the picture of homeopathic Aconitum as “hot, red, and dry.” Although that is common, Aconitum can also present with a pale face. It also includes excessive “sensibility of hearing” and “…pain in the head with a sensation of compression and drawing together…” (Clark’s Dictionary). Something struck me about this patient, and I thought of Aconitum. I checked my Clark reference to be sure of the symptoms, and gave her a dose of Aconitum 200c. Within a minute, she seemed to have eased in her chair, and described feeling better in her chest – more relaxed and open. I sent her home with instructions for constitutional hydrotherapy, dietary advice, and a vial of Aconitum 1LM, to take each night before bed.   

I called to check on her a few days later. The headaches seemed to be resolving. The Aconitum helped her sleep. So far, so good. 

Case Study 2 

Headache is a very common problem. Some headaches are minor, most are treated with an NSAID analgesic, but some are debilitating and can be difficult to treat.   

In 2016, a 30-year-old woman came to see me who had been suffering from migraines and fatigue for 11 years. She also suffered from severe hypoglycemia, such that if she missed a meal, she would get angry, shaky, and light-headed. She had frequent urination, with little production. Her headaches were characterized by sudden episodes of nausea, dizziness, photophobia, and occipital pain. The headaches would be triggered by coffee, black tea, or red wine, which are typical migraine triggers. She had a previous history of many episodes of strep throat between 10 and 20 years of age, before the headaches began. She also had chronic pelvic pain throughout her 20s, along with severe dysmenorrhea. 

My assessment, in general, was that her terrain was inflamed, expressed specifically as a chronic pelvic disturbance, adrenal fatigue, and recurrent migraines. I began treatment with a dietary recommendation (she demonstrated a fruit intolerance, per Dr Carroll’s dietary evaluation method); a bitter tonic for her stomach; adrenal support (300 mg adrenal cortex each morning); and a dose of Medorrhinum 200c. I also performed a manipulation of her neck, low back, and hips.  

The first week without fruit, she reported insatiable hunger. However, after that week she felt good, even normal for the first time in a long while, she said; she was even able to skip a meal without devastating consequences. The manipulation was immediately helpful. Her headaches were now less frequent and less intense. The urinary frequency had calmed dramatically. Her energy was improved, as was her digestion and her sleep.   

After another month, she reported that she was significantly better in all respects. She was amazed. She felt like “a normal person.”   

Case Study 3 

In July 2016, a 48-year-old woman came to see me complaining of severe and frequent migraines since the age of 24. At first, she had 1 or 2 migraines per year, but the frequency increased to monthly, near her menses, then additionally at random. She came to us taking cetirizine daily, and was also using ibuprofen. She complained of digestive problems; everything she ate would make her bloaty and gassy. Her headaches were triggered by smells (such as the detergent aisle in the grocery store), by loud noises, by hormones, and by stressful situations. She has tried various diets, and recently did an elimination diet that reduced her headaches somewhat; however, they returned while she was on the diet. She said she was very hungry all the time and that she craved salty foods. She had a history of asthma and lung problems, and suffered from winter depression. 

She described her childhood as horrible, with overbearing strict parents. Her father raged. She said that the first peace she felt was when she moved away at age 20, got a job, and lived alone.  

Physical examination demonstrated a significant stomach reflex (Chapman type), low blood sugar and blood pressure, and a generally tender abdomen. 

We began treatment simply with a dietary evaluation of the Carroll type, which revealed a fruit intolerance. We gave her a simple bitter tonic to take with meals, and a set of initial drainage remedies. I recommended constitutional hydrotherapy at home for a few weeks, and gave her a single dose of Staphysagria 200c in the office. During my examination, I gave her a trial dose of Natrum muriaticum 30c, to which she did not respond, and I followed that with a dose of Pulsatilla, which had a significant effect, calming her and easing her headache and abdominal discomfort. I sent her home with Pulsatilla 1LM, to take as needed. 

She called several weeks later to cancel her next appointment. She reported that since our visit, she had improved dramatically and had not had any headaches. Her digestion was much improved. The no-fruit diet was difficult, but it had made a significant difference. She did not feel the need to see me again; the problems she had presented with were gone. 

Case Study 4 

Some cases are simple. But some are difficult. In 2011, a 51-year-old woman came to see me complaining of migraines. She also suffered from depression and tension in her neck and shoulders. Her headaches were worse in the summer, worse from heat, from glare, and from being in a car, but she could not identify a pattern or cycle to them. The migraines began 15 years prior. She was in a rose garden, on a sunny day, and she developed a debilitating headache. She also experienced shortness of breath, and reported that deep breaths were now an effort. She had some ankle swelling. She also had heartburn, especially if she ate late at night or ate spicy foods. Her stomach was better from salty foods and milk. She reported severe menstrual pain with accompanying headache and vomiting.    

Like all of the previous patients, she suffered from both headaches and digestive disturbance. I gave her a diet (we had found a potato intolerance), a bitter tonic, and Natrum mur 1LM daily for a month. I performed a simple cervical manipulation, which brought immediate relief. I saw her again in 6 weeks, and she was improving. Her digestion was better, her abdomen felt “lighter,” and her headaches were better, though she was still having some – not as bad – and she still needed to take ibuprofen. I saw her 1 month later, and she reported that the diet had really helped her. She was feeling better and healthier in general, and her headaches were much improved, though she occasionally had one. 

She returned 2 years later with a return of the headaches. They “wipe me out,” she reported, and they affected her vision. She was still following the initial advice regarding diet, but her work-life had become significantly more stressful. I reviewed the diet with her, and we found a few errors she had been making. I gave her more of the bitter tonic, as well as homeopathic Ferrum phosphoricum.  

She returned 3 months later, reporting that the headaches were much improved. She was more assiduous with the diet, and could tell within 10 minutes if she had made an error. She felt that things were much improved and wanted refills on the medicines I had given her. Her father had recently passed away and she was grieving. As she spoke of it, tears rolled down her cheeks. I gave her a dose of Ignatia 200c. She immediately felt better and became more articulate.   

I saw her a month later, when she came in with a 4-day headache. Her headaches had become more frequent. Her blood pressure had increased to 150/90 mm Hg. I sent her home with tinctures of Rauvolfia and Crataegus, to be taken as 30 drops in water twice daily.   

Two weeks later she reported feeling much better, and had not had a headache since our last visit. She was no longer waking with headaches. Her blood pressure had reduced to 125/84 mm Hg. I had her continue with the Rauvolfia/Crataegus mix.   

I saw her a month later. Her blood pressure was now 118/75 mm Hg, she had experienced only 1 mild headache that month, and she was feeling much more peaceful, though complaining about nasal congestion. This is a common side effect of Rauvolfia, so I had her stop this medicine. 

One month later, she reported missing the “red medicine” (Rauvolfia/Crataegus), but was feeling pretty good. She’d had a few mild headaches due to diet error or not enough sleep. She said she was really quite better, and I agreed. 

I saw her a month later. Her blood pressure was 118/70 mm Hg. She had not had any headaches. She returned 6 months later with a URI, and reported that she had not had any headaches. The diet was critical to this, she believed. I treated her with Bryonia 200c, and gave her a botanical respiratory tonic to take until her lungs were clear.    


I have found that headaches, particularly migraines, are often relieved by a brief, intense neck massage to release very tight muscles. I have also found that the most common pattern of causation includes diet error (generating toxemia), specific triggers in some people, such as red wine, caffeine of caffeine withdrawal, insufficient sleep, or emotional stress. As these are addressed, particularly the diet and toxemia, the headaches diminish. I reported one case, above, in which frequent headaches of 20 years’ duration were gone in less than 1 month with appropriate dietary change. But the usual case is more like this last one: a gradual improvement over time, with adjustments to the medicines as needed. I usually see that migraines will take 3-4 months to resolve using this method, but not always; some patients take longer, and some do not resolve. Appropriate diet, hydrotherapy, homeopathic medicine, botanicals, and a bit of massage or manipulation will usually resolve even severe migraines.  


Jared L. Zeff, ND, VNMI, LAc 

Jared L. Zeff, ND, VNMI, LAc is a licensed doctor of naturopathic medicine and a licensed acupuncturist. In addition to functioning as Medical Director at the Salmon Creek Naturopathic Clinic in Vancouver, WA, Dr Zeff taught on the faculty at National University of Natural Medicine in Portland, OR, where he was also Dean from 1988 to 1993, and holds a professorship in Naturopathic Medicine. Dr Zeff is a graduate of the University of California, NCNM, and the Emperor’s College of Traditional Oriental Medicine. He, along with Pamela Snider, is the author of the AANP’s Definition of Naturopathic Medicine, and the Therapeutic Order concept. 

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