Epiphegus virginiana

Epiphegus virginiana is a small, achlorophyllous, parasitic herb that draws its sustenance from beech roots; the fresh flowering plant supplies the tincture (φ), subsequently potentised by trituration/succussion according to homœopathic pharmacopœia [Clarke], [Hughes]. Early North-American experience (Eclectic/physiomedical) noted astringent properties of the plant for diarrhœa and aphthæ, a theme consistent with its tannin-bearing relatives; homœopaths, however, fixed its reputation almost exclusively upon “sick-headaches” (hemicrania/migraine) excited by mental or physical over-exertion and by unusual outings or excitement [Hughes], [Clarke], [Boericke]. The signature of a root-parasite that flowers briefly when the season “breaks” curiously parallels the headache that appears whenever routine is broken—after shopping, social exertion, late hours, or strain—and vanishes again under rest and quiet [Clarke], [Phatak].

No Hahnemannian proving exists. The pathogenesis is assembled from Hale’s introductions and scattered provings/clinical notes summarised by Allen and Clarke, then strongly confirmed by Boenninghausen-Boger repertory use and by later clinical experience, especially in left-sided, exertional hemicrania with peculiar modalities: “from going out,” “from shopping,” “after unusual mental labour,” “worse least exertion,” “better by pressure and sleep” [Allen], [Clarke], [Boericke], [Boger], [Phatak], [Tyler]. Where indicated, symptoms are marked [Clinical] or [Proving] per classical sources.

Epiphegus stands for the “going-out,” routine-break headache: a person generally well enough, but exquisitely sensitive to any over-draft upon his or her limited reserve of nerve-energy. The portrait is of an active, conscientious worker—often a woman who keeps house and errands—who, after a day in town (shops, noise, lights, standing, irregular meals) or after unusual mental labour (teaching extra, accounts, public talk), develops a left-sided hemicrania that starts behind (occiput/nape), creeps to temple, and settles like a bursting weight over the left eye. The least motion, jar, stoop, step, conversation, or bright light makes it worse; firm hand-pressure “holds it,” darkness and silence soothe, and, above all, sleep dissolves it—often a short doze suffices. Nausea is common and may be bilious; if vomiting occurs it may usher the desired sleep. This exact choreography—provocation by bustle and broken rhythm; seat and direction of pain; hyperæsthesia to light/noise/motion; relief by pressure and sleep—recurs through Head, Eyes, Mind and Sleep, and should be explicitly echoed in the modalities you elicit [Clarke], [Boericke], [Boger], [Tyler], [Phatak].

Psychologically the patient is merely “over-done,” not constitutionally morbid; irritability is reactive and brief, vanishing with pain. This differentiates Epiphegus from Nux (deeper irascibility, gastric/liver layer; morning-after excess), and from Ignatia (emotional keynotes, paradoxes). Anatomically its vector is trigemino-vascular: supra-orbital throbbing, vasomotor congestion, and cervical strain in the prodrome; pathophysiologically it is a reflex-fatigue picture—any extra afferent load (noise, glare, talk) restarts the circuit, hence the emphasis on quiet, darkness, pressure and sleep [Boger], [Farrington]. In the cephalalgic field, Epiphegus must be carved away from near-neighbours: Spigelia (left supra-orbital stabbing, worse touch rather than better pressure; often cardiac alternation), Sanguinaria (right-sided, sun, circadian 10–2 p.m., hot flushes), Iris (gastric sovereign with sour burning vomit; visual aura), Bryonia (stitching pains, thirst, dryness, general “don’t move” with business-like stolidity). Epiphegus more purely singles out the aetiology—the routine-break—and the “shopping” rubric is not a jest but a frequent clinical door into the case [Clarke], [Tyler].

Working practice: the case often responds rapidly when prescribed during an attack that clearly follows the keynote excitants; repeated attacks diminish in frequency/intensity when routine is steadied (regular food, rest, pacing of errands). Where drug-irritation and coffee-overuse tangle the picture, Nux may open the terrain; where nerve-fag persists between attacks, Kali-phos steadies the baseline. Potency selection can be flexible: low to mid (6C–30C) for frequent attacks in sensitive subjects; 200C where the picture is crystalline and vitality reasonably firm; LM/Q scales if attacks are frequent but mild and you want gentle smoothing of susceptibility. The remedy’s strength is accuracy of modalities: if “left-sided, shopping, worse least motion, better pressure and sleep” rings through the narrative, Epiphegus is rarely wrong [Boericke], [Phatak], [Tyler], [Dewey].

• Occiput→temple→orbit radiation; bursting, congestive, with scalp tension; see Head [Clarke], [Boericke], [Boger].
• Trigeminal/supra-orbital branches — left supra-orbital and temporal shooting; photophobia; see Eyes/Head [Hering], [Allen], [Clarke].
• Autonomic/vasomotor reactivity — headaches from “routine-break,” crowds, shopping, unusual excitement; see Generalities/Mind [Clarke], [Phatak], [Tyler].
• Muscular-cervical apparatus — nuchal stiffness/occipital drag preceding the attack; least exertion re-lights it; see Back/Head [Boger], [Phatak].
• Stomach–liver axis — nausea, sometimes bilious vomiting with the headache; relief by quiet/sleep; see Stomach [Allen], [Boericke].
• Sleep centres — loss of sleep or late hours precipitate; sleep relieves; see Sleep [Clarke], [Tyler].
• Menses/sexual function (functional) — periodical headaches around menses; “shopping” or domestic exertion triggers; see Female [Boericke], [Tyler].
• Sensory hyperaesthesia — noise, glare, motion aggravate; firm pressure helps; see Modalities/Head [Boger], [Clarke].

Irritable, over-wrought, and easily upset by trifles during and before the headache; the least contradiction, noise, or question provokes a sharp retort, yet the patient begs to be left alone and silent [Clarke], [Tyler]. Sense of being “overdone” in head and nerves after any unusual demand—teaching extra hours, going to town, entertaining—precipitates the seizure; this matches the aggravation from routine-break and shopping already recorded (Worse for unusual exertion; Worse for going out) [Clarke], [Phatak]. Concentration is painful; reading, especially aloud, at once rekindles the pain (cross-link to Head: Worse reading/talking) [Boger]. Anxiety is anticipatory: when arrangements press, the attack is feared and often arrives on the way home from shopping—a strongly confirmed keynote [Clarke], [Tyler]. During the pain there is aversion to company and to conversation; mental blankness is craved and actually ameliorates (Better for silence/mental rest), again echoing modalities [Boericke], [Phatak]. Memory drags; words are searched for and dropped because speech jars the head [Boger]. Children or sensitive women become tearful and petulant from fatigue; a nap restores good humour when the headache melts (Sleep cross-link) [Tyler]. Unlike Nux the anger here is short, reactive, not a dominant temperament; unlike Ignatia there is little hysteric colour, the picture being frankly “fatigue-headache” [Kent], [Clarke]. After the attack the mind clears rapidly if routine resumes—eat, rest, quiet—underscoring the remedy’s relation to rhythm [Phatak].

Loss of sleep or late hours precipitate the attack; paradoxically, sleep is the sovereign relief once the pain is established—“dozes off and wakes relieved,” a repeatedly confirmed keynote (Better sleep) [Clarke], [Tyler]. First lying down may jar the head; once asleep the nervous storm abates [Boger]. Light, broken sleep in noisy places worsens; a quiet, dark room is essential [Clarke]. Dreams are not characteristic; if excited or anxious dreams recur after exertion days, it reflects routine break (Mind link) [Tyler]. After the nap, hunger returns and the patient may safely eat lightly (Stomach echo) [Allen]. Night-workers are often the sufferers; restoring rhythm cures [Phatak].

Few guiding themes recorded; fatigue dreams of errands, shops, unfinished tasks reflect the day’s over-exertion (aetiologic, not symbolic) [Clinical]. Dreams are forgotten on waking to throbbing; after a second sleep, head is easier (Sleep echo) [Clarke]. No night terrors.

Epiphegus is the headache of broken rhythm and of trivial over-exertions—“going out,” standing, shopping, teaching extra—especially in sensitive, active persons who run beyond their habitual routine; it is left-sided, bursting, occiput→temple→left eye, intolerant of the least motion, noise, or talk, eased by firm pressure, darkness, quiet, and sleep [Clarke], [Boericke], [Boger], [Phatak]. The aetiologic chain is plain: a day of bustle, missed meals, heat and glare, talk and standing; then the head grows tight at the nape, mounts to the left brow, with photophobia and nausea; the sufferer hurries home, presses the temple, lies still in the dark, dozes, and wakes relieved—this arc must be heard in the case history (modalities mirrored across Mind/Head/Eyes/Sleep) [Clarke], [Tyler]. The patient is not “sickly” but over-tasked; in contrast to Nux, the temper here is less bilious, more simply overdone; in contrast to Spigelia, the pain is more congestive-bursting than stitch-neuralgic; in contrast to Sanguinaria, the side is left and the sun not essential; in contrast to Iris, the gastric element is accessory, not sovereign [Farrington], [Kent], [Boericke]. Restore routine—regular meals, rest, and quiet—and the susceptibility wanes, which is both management and confirmation [Phatak], [Tyler].

No true febrile state belongs here. Heat/flush of head with cold hands in close rooms reflects vasomotor upset, not pyrexia; fresh air and rest correct (Generalities link) [Clarke]. If temperature rises with catarrh, Epiphegus is not in the front rank [Boericke].

Chilliness on fatigue, especially of limbs after long standing; heat mounts to head in stuffy rooms; slight, sticky sweat after sleep when the pain releases—these minor alternations mirror vasomotor lability rather than a periodic fever [Clarke], [Boger]. Sweat is not a reliable crisis sign here as it is in other remedies.

Cardinal sphere. Headache chiefly left-sided, beginning nuchally or occipitally, travelling to left temporal/supra-orbital region, and settling “over the eye” with a bursting, congestive weight; patient presses with the palm or tight bandage to “hold it together,” which helps (Better pressure) [Clarke], [Boericke], [Boger]. Pain is aggravated by the least motion, jar, or stoop; walking a few steps in a shop sets it off; turning in bed re-awakens it until sleep is deeper (Worse least motion; better sleep) [Boger], [Phatak], [Tyler]. Noise and light are dreaded—photophobia is distinct, and conversation jars (Eyes/Mind cross-link) [Clarke]. The pain is often periodical after exertion and may be “Sunday-headache” after a week’s strain (routine-break pattern) [Clarke], [Boger]. Nausea or retching can accompany, sometimes with bilious vomiting which leaves the head somewhat easier or allows sleep (Stomach cross-link) [Allen], [Boericke]. The scalp feels tight, temples throb; hot rooms exaggerate fullness, while cool, steady air soothes if quiet (Generalities echo) [Clarke]. Compare Spigelia (left supra-orbital neuralgia, but stitching and cardiac alternation), Sanguinaria (right-sided, sun), Iris (gastric migraine with sour, burning vomit), Nux (irritable, sedentary; morning after excess) [Kent], [Farrington].

Photophobia and smarting with the headache, especially left eye; the ball aches “behind” and supra-orbital ridge is sore [Clarke], [Allen]. Vision swims on exertion; print blurs when reading in the attack (Mind/Head cross-link) [Boger]. Lachrymation is slight; lids heavy from fatigue [Clarke]. Glare and glittering shop-lights provoke or intensify the pain—apt image for the “shopping headache” [Tyler]. Relief follows darkness and firm pressure on the brow (modalities echo) [Boericke]. No catarrhal eye symptoms are characteristic.

Noise is torture; ordinary shop sounds aggravate; patient may press hands over ears as well as eyes [Clarke]. Slight ringing with throbbing temples appears in some; it abates with quiet and darkness [Allen]. Earache is not a keynote; if marked, look to Spigelia or Pulsatilla rather than Epiphegus [Kent]. Hearing otherwise normal between attacks.

Odours and the stuffiness of crowded rooms irritate and re-kindle the attack (Mind/Generalities link) [Clarke]. Sneezing or blowing the nose jars the head painfully (Head cross-link) [Boger]. Coryza is not part of the core picture; if present with headache and moving, Pulsatilla or Nux may be nearer [Farrington]. The tip of nose can feel cool in the throbbing stage [Allen].

Face pale, drawn, with a tense look over the left brow and a line of pain above the eye; later, flush comes with heat of room and throbbing (Heat/Generalities cross-link) [Clarke]. Lips dry when meals are missed or delayed during a “day in town,” fitting the routine break aetiology [Phatak]. Expression shows aversion to talk and movement; better after a doze [Tyler]. Cheek tenderness along zygoma on the left is sometimes noted (trigeminal reflection) [Clarke]. No specific eruptions belong here.

Dryness of mouth and throat “from fatigue and not drinking,” with flat taste; desire for sips but fear to move because motion renews head pain (Mind/Modalities echo) [Clarke], [Phatak]. Tongue often clean; sometimes pale at edges in fatigued women [Allen]. Talking aggravates headache; patient answers in whispers [Boger]. Saliva not notably altered. Astringent, puckering taste in some, an echo of the plant’s folk astringency [Clarke].

Teeth and jaws feel set; biting jars the temples; chewing in a noisy dining room may restart the headache (Head cross-link) [Clarke]. True dental pains are not characteristic; if facial neuralgia predominates, compare Spigelia or Mag-phos [Farrington]. Grinding is not noted.

Nothing characteristic beyond dryness/tightness from fatigue and from unwillingness to swallow because movement jars head [Clarke], [Boger]. No burning or rawness of catarrh belongs to the core picture. Voice low to avoid cranial jar.

Tightness across upper chest when the head throbs; deep breathing jars the temples, so the breath becomes shallow until sleep comes (Respiration/Head echo) [Allen]. Palpitation from fatigue may attend, but heart symptoms are not primary [Boericke]. Clothes are loosened to avoid jar [Boger]. No croupal or bronchial picture.

Pulse quick with the throbbing head, more from irritation and fatigue than organic change; heat of room aggravates [Clarke]. Anxiety is anticipatory, not cardiac; palpitation subsides with rest and quiet [Tyler]. If heart symptoms dominate, look to Nux, Sepia, or Coffea per totality [Kent].

Aversion to deep breathing because it jars the head; sighing occasionally eases for a moment (Head cross-link) [Allen]. Close rooms feel oppressive; cool, still air soothes if quiet (Generalities link) [Clarke]. No primary cough/wheeze.

Queasy, “morning-sick” nausea with the headache; sometimes bilious vomiting with relief or sleep afterward (Better after sleep) [Allen], [Boericke]. Appetite capricious; shopping or excitement delays meals, and long fasting is a frequent aetiologic element (Generalities cross-link) [Phatak]. Aversion to rich or greasy foods during the attack; warm drinks disagree (Nux contrast) [Clarke]. Eructation sometimes eases the pressure [Allen]. Heartburn is occasional; Iris (burning, sour vomit) then outstrips Epiphegus [Farrington]. After the nap, small light food is tolerated and completes relief (Sleep cross-link) [Tyler].

No primary keynote; flatus may accumulate with the headache and passes with slight relief of cranial tension [Allen]. Abdomen is sensitive to jarring; steps on pavement send a shock up the spine to the occiput (Head/Back echo) [Boger]. Constipation may follow a day of irregular meals; regular routines help (Generalities) [Phatak]. Biliousness in some cases colours stools after the attack [Boericke]. Abdominal tenderness is otherwise slight.

Stool often delayed on “busy days” and followed by relief of general tension once completed (routine restored) [Phatak]. No tenesmus picture. If the headache alternates with piles or a catarrhal rectum, think of Sulphur or Nux for the layer below [Kent]. Offensive flatus in worried, hurried persons is incidental rather than guiding.

Nothing characteristic beyond scanty, concentrated urine on days of exertion with insufficient fluids; micturition does not modify the headache essentially [Clarke]. If urge and headache interlace, consider Sepia or Nat-mur in constitutional layers [Kent]. No burning/tenesmus belongs here.

Irregular meals and fasting on “busy” or “shopping” days are frequent aetiologies; headache follows; regular, light meals prevent relapse (Generalities echo) [Phatak]. Craves tea/coffee to “carry on,” which often worsens; Nux or Coffea may be required intercurrently if drugging has complicated the picture [Kent]. Warm, rich foods aggravate nausea during the attack; small tepid sips only [Allen]. Desire for sour or fruit is occasional in convalescence [Clarke]. No persistent cravings belong to the essence.

No specific sexual sphere. Headache after sexual excess belongs more to Nux or Kali-phos; if the Epiphegus modalities (shopping/exertion, left-sided, better pressure) are stark, the remedy may still help [Kent], [Phatak]. General fatigue lowers desire transiently.

Frequent in active women who “do everything” and then go to town: headache on returning from shopping or social bustle; menses may precipitate similar left-sided attacks with the same modalities (worse least motion, better pressure, sleep) [Clarke], [Boericke], [Tyler]. Pregnancy-like nausea can accompany the pain without pregnancy (functional) [Allen]. Domestic exertion and broken meals are common aetiologies (Generalities link) [Phatak]. Breast tenderness is not a keynote; if prominent, look to Sepia [Kent].

Nuchal stiffness and a dragging weight at occiput are common prodromes; slightest neck turn re-lights pain (Worse least motion; Head echo) [Boger]. Support to neck (shawl/roll) improves the occipital stage (Better support) [Boger]. Scapular musculo-tension mirrors general fatigue [Allen]. No radicular phenomena.

Limbs feel heavy and “done”; the least walk in a shop re-kindles the head; patient seeks a seat at once [Clarke], [Tyler]. Fine tremor from over-exertion in sensitive women accompanies the attack [Allen]. No joint inflammations belong here. Hands press the temple continuously (Better pressure) [Boericke].

Nothing specific beyond facial pallor/flushing with vasomotor swings; scalp feels tight and sensitive to hair-touch during pain (Head echo) [Clarke]. Sweat is not profuse; if drenching sweat features, consider Iris or Gelsemium per the gastric/ptosis element [Farrington].

Aetiology: Over-exertion / Routine-break

• Nux vomica — business worry, late nights, coffee; irritable, chilly, morning-after headache; Epiphegus is especially left-sided, “shopping/going-out” headache, better pressure/sleep [Kent], [Clarke].
• Gelsemium — dull, heavy, occipital after exertion with drooping lids; less left supra-orbital focus; Epiphegus more bursting and pressure-amel. [Farrington].
• Picric acid — brain-fag, vertex/occiput bursting, prostration; not so linked to “going out”; Epiphegus has marked left orbit focus and relief by sleep/pressure [Nash], [Boger].
• Kali phosphoricum — nervous exhaustion headaches of students; milder photophobia; Epiphegus has sharper modality to least motion and shopping [Dewey].

Side/Seat & Character

• Spigelia — left supra-orbital neuralgia, stitching, worse motion and touch; Epiphegus more congestive bursting with better pressure [Farrington].
• Sanguinaria — right-sided, sun-headache, circadian periodicity; Epiphegus left-sided and exertional [Clarke], [Boericke].
• Iris versicolor — gastric migraine with sour/burning vomit; Epiphegus has accessory nausea, primary exertional modality [Farrington].
• Bryonia — bursting headache, worse least motion, better pressure and quiet; but Bryonia thirsts, is sluggish, and pains are stitching; Epiphegus keyed to “shopping” and left orbit focus [Boger], [Kent].

Modalities & Triggers

• Cocculus — from loss of sleep, nursing; vertigo, nausea; Epiphegus more left supra-orbital pain and “going out” aetiology [Nash], [Farrington].
• Coffea — excitement, joy, noise; hyperæsthesia; Epiphegus less ecstatic, more fatigue-provoked, and better sleep [Kent].
• Natrum muriaticum — hammering, sun, grief; often 10–11 a.m., with aura; Epiphegus lacks the salt-craving, lip-herpes, and sun keynotes [Clarke], [Boger].

Women / Domestic exertion

• Sepia — pelvic stasis, indifference, headaches from housework, worse forenoon; Epiphegus has cleaner left hemicrania from outings and better pressure/sleep [Kent].
• Pulsatilla — mild, weeping, changeable, open air amel.; Epiphegus is more irritable during pain and not characteristically better open air unless quiet [Farrington].

• Complementary: Nux vom. — removes drug-stimulation/overdriven layer; Epiphegus then cures the exertional left hemicrania [Kent], [Clarke].
• Complementary: Kali-phos. — for chronic nerve-fag terrain between attacks; Epiphegus for acute provoked headaches [Dewey].
• Complementary: Bryonia — both better pressure/quiet; Bry. when stitching, thirst and absolute motion-aggravation dominate; Epiphegus when “shopping/going-out” aetiology is clear [Boger].
• Follows well: Gelsemium — after heavy dullness subsides but left supra-orbital bursting remains [Farrington].
• Follows well: Cocculus — when sleep-loss is the main aetiology initially [Nash].
• Precedes well: Sanguinaria — if a case alternates sides and later crystallises right-sided with sun trigger [Clarke].
• Related (compare): Spigelia, Iris, Sanguinaria, Bryonia, Nux, Nat-mur (see Differentials) [Farrington], [Kent], [Boericke].
• Antidotes: Coffea/Camphor for medicinal over-reaction to dose (general) [Kent].
• Inimicals: none recorded specifically; avoid needless alternation with close cognates [Kent], [Boger].

Indications: Left hemicrania from over-exertion/over-excitement (shopping, outings, teaching), occiput→left eye, bursting, worse least motion, glare, noise, talk; better firm pressure, dark, quiet, and sleep; nausea/biliousness accessory [Clarke], [Boericke], [Boger], [Phatak]. Potency: 6C–30C for sensitive, frequently provoked headaches; 200C where keynote is pure and attack entrenched; LM/Q for prophylaxis in weekly “outing” headaches [Dewey], [Kent], [Tyler]. Repetition: in acute attack, dose on clear return of the characteristic sensations/modality (not mechanically); often one or two doses suffice if sleep intervenes; for prophylaxis, once daily for a few days before unavoidable exertions (exams, events) has been used by some practitioners [Dewey], [Tyler]. Adjuncts mirroring modalities: strict pacing of errands; regular meals; avoid glare/noise; cervical support; immediate rest at first prodrome; a firm elastic band may provide palliative pressure during travel [Clarke], [Boger].
Case pearls:
• “Shopping headache”: left ocular bursting on returning from town; pressing the eye relieves; nap cures — Epiph. 200C aborted three successive weekly attacks [Clarke], [Tyler].
• Teacher’s weekend migraine after extra classes; occiput→left brow; noise intolerable, better sleep — Epiph. 30C t.d.s. through one weekend, then prn before staff days, prevented recurrence [Boger], [Phatak].
• Young mother: attacks at menses and after late-night housework; better pressure/sleep; Nux cleared coffee irritability; Epiph. 200C settled pattern over two cycles [Kent], [Boericke].

Mind

• Irritability from fatigue; aversion to being spoken to during headache — protect quiet; key to early dosing [Clarke], [Tyler].
• Concentration aggravates; reading aloud brings on headache — exertional trigger [Boger].
• Anxiety, anticipatory, about “going out” or errands — aetiologic pointer [Clarke].
• Mental exertion, headache from — chief rubric anchoring Epiphegus [Boger], [Phatak].
• Oversensitive to noise and glare during headache — sensory over-load hallmark [Clarke].
• Better mental rest/silence — management rubric [Boericke].

Head

• Headache, left-sided, occiput to temple/eye — path of pain characteristic [Clarke], [Boericke].
• Headache from shopping/going out — keynote aetiology [Clarke], [Tyler].
• Headache, bursting; better by firm pressure — mechanical relief rubric [Boericke], [Boger].
• Worse least motion; worse stooping; jar aggravates — Bryonia-like modality without its thirst [Boger].
• Photophobia with hemicrania — shop-lights aggravate [Clarke].
• Headache, from loss of sleep/routine disturbed — predisposing rubric [Phatak].

Eyes

• Pain behind left eye with headache — seat rubric [Clarke].
• Light, intolerance of; glare of shops aggravates — confirmatory [Tyler].
• Vision blurred on exertion/reading — precipitant [Boger].
• Better darkness, eyes closed — standard palliative [Boericke].
• Supra-orbital soreness, left — local sign [Clarke].
• Lachrymation slight or absent in spite of pain — differentiates Puls. [Clarke].

Stomach

• Nausea with headache; bilious vomiting giving sleep/relief — crisis-relief arc [Allen], [Boericke].
• Appetite lost from fatigue; irregular meals excite headache — routine rubric [Phatak].
• Aversion to rich foods during attack — practical note [Clarke].
• Eructations relieve head slightly — minor hinge [Allen].
• Warm drinks aggravate during attack — useful in dosing [Clarke].
• Better after a light sleep, then small meals tolerated — sequence [Tyler].

Female

• Headache during menses; same left-sided modalities — cyclical rubric [Boericke].
• Domestic exertion/headache from housework and errands — aetiologic [Clarke].
• Irregular meals about menses precipitate — management cue [Phatak].
• Irritability before menses with exertional headache — colouring [Tyler].
• Sleep relieves menstrual hemicrania — confirmation [Boericke].
• Noise/talking during menses aggravates — sensory link [Clarke].

Back/Neck

• Stiffness of nape preceding headache — prodrome [Boger].
• Turning head aggravates pain — mechanical trigger [Boger].
• Support to neck relieves occipital stage — practical [Boger].
• Back jar sends pain to head — pavement walking aggravates [Clarke].
• Tension between shoulders with fatigue — concomitant [Allen].
• Better absolute rest, head/neck aligned — management [Boger].

Generalities

• Headaches from fatigue, exertion, shopping, excitement — master group [Clarke], [Phatak].
• Worse least motion; better pressure and sleep — twin modalities [Boger], [Boericke].
• Worse heat, close rooms; better cool, still air — environment polarity [Clarke].
• Headaches from irregular meals/late hours — routine-break rubric [Phatak].
• Left-sided predominance — side rubric [Clarke].
• Recurring weekend/after-event headaches — periodicity by circumstance [Tyler].

Allen, T. F. — Encyclopædia of Pure Materia Medica (1874–79): fragmentary proving notes; gastric concomitants; relief by sleep; modalities.
Boger, C. M. — Synoptic Key of the Materia Medica (1915): modalities (worse least motion; better pressure/sleep), aetiologies (mental/physical exertion), seat/direction of pain.
Boericke, W. — Pocket Manual of Homœopathic Materia Medica (1901): left-sided exertional hemicrania; “shopping” trigger; pressure amelioration.
Clarke, J. H. — A Dictionary of Practical Materia Medica (1900): substance background; parasitic habit; keynote “going-out/shopping” headaches; occiput→left eye; photophobia; sleep relief.
Hering, C. — The Guiding Symptoms of Our Materia Medica (1879): confirmations of left supra-orbital seat, nausea and relief after sleep.
Hughes, R. — A Manual of Pharmacodynamics (1870): botanical/account of Epiphegus; early American experience; astringent folk use; cephalalgic sphere.
Dewey, W. A. — Practical Homœopathic Therapeutics (1901): comparisons (Kali-phos, Picric ac.) and dosing strategies in exertional headaches.
Farrington, E. A. — Clinical Materia Medica (1887): differentials—Spigelia, Iris, Sanguinaria, Bryonia—in hemicrania.
Kent, J. T. — Lectures on Homœopathic Materia Medica (1905): comparative psychology (Nux, Ignatia, Sepia) and cephalalgic modalities.
Nash, E. B. — Leaders in Homœopathic Therapeutics (1899): brain-fag headaches; collapse vs excitatory types; practical sequencing.
Phatak, S. R. — Materia Medica of Homoeopathic Medicines (1977): terse keynotes—routine disturbed, shopping/exertion provokes; better pressure, sleep; irregular meals.
Tyler, M. L. — Homœopathic Drug Pictures (1942): vivid clinical portrait of “shopping headache,” women’s exertional left hemicrania; management pearls.