Words: Drs Shyam Kumar SAH, Deeraj B C & Ashwini M J
The Migraine Research Foundation considers migraine the third most prevalent illness and the sixth most disabling health illness in the world.
Migraine sufferers have a higher chance of depression, anxiety, sleep disorders, other pain conditions and fatigue. It is also a leading cause of disability throughout the world. It has a multifactorial background, viz., genetic, environmental, metabolic, hormonal and pharmacological patterns.
Such factors often trigger migraines with varying underpinnings between patients. Yet, migraines present a common pattern of occurrence with peak incidence in adolescence and also prevalence in middle age.
A Familial Disorder
About two-thirds of migraine cases run in families. The headaches affect one-half of the head and are throbbing and pulsating in nature, lasting 4-72 hours. Changing hormone levels may also play a role in migraine. The condition affects boys more than girls before puberty and 2-3 times more women than men. Up to one-third of people have an aura — typically a short period of visual disturbance that signals the headache will soon occur. Migraine is a highly prevalent form of headache disorder with considerable impact on the individual and society. It can involve the brain, eye and autonomous nervous system.
Migraines are believed to be triggered by neurovascular factors, starting within the brain and spreading to the blood vessels. The neurotransmitter serotonin (5- hydroxytryptamine) and the hormone oestrogen play a vital role in pain sensitivity of migraine. Low levels of serotonin selectively constrict the cranial blood vessels and also induce the over-activate of peripheral nerve endings which play a key role in triggering migraine headaches. Oestrogen primarily affects women in the reproductive age group.
Consent
Informed consent was taken prior to the case study.
Case Study
A 27-year-old male patient visited the Ear, Nose and Throat [ENT] Out-Patient Department [OPD] — on January 2, 2018 — at Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, with chief complaints of unilateral headache, on and off, once, and sometimes twice a month, since six years. The headache was followed by nausea and sometimes vomiting. The headache was of the alternating type — sometimes in right and sometimes on the left side. The patient’s body weight was 57kg. Occupationally, he was a software engineer. No significant family history and personal history were identified. He consulted many allopathic physicians, but got symptomatic relief only. He was admitted (IP-027476) on the same day for further management. There was no history of diabetes mellitus, or hypertension. His vitals were within normal limits. On general examination, there was no pallor, icterus, clubbing of nails, oedema, or lymphadenopathy. No central nervous system [CNS] abnormalities were noted on thorough examination.
Investigations
Routine haematological and urine investigations as well as a CT scan of brain were carried out. The findings had no pathological significance. The visual acuity of both eyes were 6/6; right eye 6/6, left eye 6/6 and near vision N6 as well as intraocular pressure [IOP] 14mmHg in both eyes were observed before and after treatment.
Treatment Protocol
Day One. The patient was given amapachanna with chitrakadivati; the dose being two tablets and panchakolaphanta 100ml thrice daily [tid], followed by kriyakalpa procedures, sthanika avagundana with dhanyaka and haridra in triphala kashaya over the fronto-maxillary region, once daily. Rasna choorna was applied over the forehead.
Day Two. Sadhyovireachana with nimbamritadi erand taila 60ml, followed by triphala kashaya 100ml, was given on empty stomach at 8:00am. Sips of hot water and jeera jala were also given. The patient had four vegas of virechana on that day. Sthanika avagundana was given at 4:00pm.
Day Three. Mukha abhyanga with asanbilwadi taila was followed by swedana karma. Marsha nasya with Anu taila, 12-12 drops in each nostril was followed by haridra and ghrita dhumapana in the morning on empty stomach. Shirotalam with brahmi churna, bala churna and ashwagandha churna in satapaka taila were applied. Sthanika avagundana was given in the afternoon. The treatment protocols continued for seven days, along with internal medications like tab Cephagraine, 2 tid, madiphala rasayan, 2 tsf, tid, with water and sirasuladi vajra rasa twice daily [2 bid], after food. Rasna choorna for sirolepa was given.
Day Ten. The patient was discharged and advised to continue tab Cephagraine, 2 tid, madiphala rasayan, 2 tsf tid, with water and sirasuladi vajra rasa, 2 bid, after food. Rasna choorna for sirolepa SoS for 20 days, as well as to avoid apathya and triggering factors.
First follow-up. After 20th day, the patient came to ENT OPD with no attacks of migraine. He was advised to continue the same for one month.
Second follow-up. After one month, from the date of first follow-up, there were no attacks of migraine. He was advised to continue tab Cephagraine, 2 tid, and madiphala rasayan, 2 tsf tid, for one month and follow-up next month. The patient did not come for the third follow-up.
Results
Significant changes in signs and symptoms were noticed before treatment and after treatment with the short course treatment duration of seven days. On day one, the patient had severe right-sided headache which reduced on the third day. On day ten, he had no headache and was feeling happy. On first and second follow-up, there were no attacks of migraine [i.e., in-between the course/duration].
Discussion
Ayurveda believes in treating disease from its ‘root,’ also cause, from within. According to the clinical features of the patient, the headache was migraine without aura, i.e., common migraine. This type of migraine is very common and does not have any warning signs. Migraine can be closely related to ardhavbhedaka in Ayurveda, as explained by commentator Chakrapani as ardhamastaka vedna, owing to its cardinal feature — ‘half-sided headache.’
Sodhana and shamana therapies were given to the patient as treatment. Sadhyovirechana with nimbamritadi erand taila detoxifies the body and removes the vitiated pitta doshas from the kosta. Nasya karma with Anu taila was instilled into both nostrils and was expected to strengthen the vital functions of the sense organs by its unique mode of action through shringataka marma. Sthanika avagundana, the special kriyakalpa procedure, helped to open the vatavaha shrotas and lighten the head. The ingredients used for avagundana dhanyaka, haridra and triphala kashaya were supposed to pacify the vitiated vata-kapha doshas. Similarly, rasna choorna sirolepa was having potent vatahara properties. The internal medications also helped to pacify the vitiated doshas and this led to the equilibrium state.
The combination of sodhana and shamana therapies acted synergistically to combat the vitiated tridoshas — the pathology of ardhavbhedaka.
Conclusion
Migraine is an episodic neurovascular disabling disorder, closely related to ardhavbhedaka in Ayurveda. It is characterised by its cardinal feature — half-sided headache. Ayurveda believes in cleansing the body and pacifying the tridoshas from the ‘root’ using unique treatment modalities, such as sodhana and shamana chikitsa. These treatment approaches create a balanced physiology and usher in healing of the body and mind. This also helps to achieve complete treatment as well as control migraine in the patient. Ayurveda opens new doors for treatment of migraine through holistic approaches. It also aids a new treatment option among practitioners when there is no permanent cure for migraine.
