Internal Medicine (f): Headache

There are several records of headache in the Chapters on Medicine in the Theravāda and Dharmaguptaka Vinayas. In Āyurveda, head diseases are grouped in the specialty of śālākya or ūrdhvāṅgacikitsā (related to diseases of head and neck). In modern medicine, such diseases can be managed medically (in neurology) or surgically (in neurosurgery), depending on the pathology of the disease.

Since these cases in the Chapters on Medicine were treated non-surgically, they are discussed here in the section on internal medicine.^[1]

Theravāda:—“At that time the Venerable Pilindavaccha had a headache.^[2] … ‘I allow, monks, [the use of] a small quantity of oil on the head.’[The illness] was not becoming better. … ‘I allow, monks, the nose-treatment.’^[3] The nose dripped. … ‘I allow, monks, a nasal instrument.’^[4] At that time the monks belonging to a group of six held various nasal instruments–that made of gold [and] that made of silver. People criticised, voiced their anger, and condemned [them]:^[5] ‘Just as the householders enjoying sense-desires.’^[6] [The Exalted One said:] ‘Monks, various nasal instruments should not be held. Whoever would hold, there is an offence of wrong-doing. I allow, monks, [the nasal instrument] made of bone … made of saṅkhanābhi.’^[7] [The monks] poured [oil] unevenly to the nose. [The Exalted One said:] ‘I allow, monks, [the use of] a double nasal instrument.’^[8] [The illness] was not becoming better. ‘I allow, monks, to inhale smoke.’ So [the monks], having ignited a wick, inhaled [the smoke]. [It] burnt the throat. … ‘I allow, monks, a smoking pipe.’ At that time the monks belonging to a group of six held various smoking pipes … made of saṅkhanābhi. At that time the smoking pipes were not covered [and] living creatures went into [them]. … ‘I allow, monks, a cover.’ At that time the monks carried about the smoking pipes by hand. ‘I allow, monks, a bag for the smoking pipes.” [The smoking pipes] were rubbed together. … ‘I allow, monks, a double bag.’ There was no shoulder-strap. … ‘I allow, monks, the shoulder-strap [and] the thread for tying.’”^[9]

Dharmaguptaka:— “Then the monks were afflicted with headache. The physician instructed [them] to apply oil at the crown. [They] informed the Buddha [about this]. The Buddha said: ‘[I] allow the application [of oil at the crown].’ Those [monks] were fearful and cautious [and] they did not dare to apply scented oil. The Buddha said: ‘[I] allow applying [the scented oil].’”^[10] “At that time there was a monk afflicted with a headache. The physician instructed [him] to have a nasal douche. The Buddha said: ‘[I] allow [this].’ [The monk] did not know what to use for the douche. The Buddha said: ‘To do the douche with ghee, oil, [or] grease.’ [The monk] did not know how to do the douche. The Buddha said: ‘[I] allow using wool, cotton,^[11] [or] feather which is soaked in oil; then [the oil] is dripped into the nose.’ [The fluid] effused around [from the nose]. The Buddha said: ‘[I] allow making a nasal douching tube.’ He (the monk) then used a precious material to make the [douching] tube. The Buddha said: ‘[You] should not use a precious material to make [it]. [You] should use bone, or tooth, or horn, or iron, or copper, or pewter, or lead, or tin,^[12] or reed, or bamboo, or wood.’ He put aside [the douching tube] without washing [it]. The Buddha said: ‘[You] should not put aside [the douching tube] without washing [it].’ Having been washed, [the douching tube] was not dried and insects arose. The Buddha said: ‘[You] should not, after cleaning [the douching tube], [leave it] without drying. [You] should cause [it] to dry [and then] store [it].’”^[13]

The above accounts are in relation to headache and the remedies (and the tools) employed. The three classical Āyurvedic treatises–the Caraka Saṃhitā, Suśruta Saṃhitā, and Aṣṭāṅga Hṛdaya Saṃhitā–have slightly different classifications of head diseases. The Caraka Saṃhitā has five, Suśruta Saṃhitā eleven, and Aṣṭāṅga Hṛdaya Saṃhitā ten. The five types in the Caraka Saṃhitā are: one by each humour, one by the combination of all humours, and one by worms. The Suśruta Saṃhitā and Aṣṭāṅga Hṛdaya Saṃhitā include these five, as well as one by the blood. The remaining types in the Suśruta Saṃhitā and Aṣṭāṅga Hṛdaya Saṃhitā are just variant forms relating to humours.^[14] All these forms of head disease present with varying degrees of headache (Caraka Saṃhitā Sūtrasthāna 17. 15-29; Suśruta Saṃhitā Uttarasthāna 25. 5-18; Aṣṭāṅga Hṛdaya Saṃhitā Uttarasthāna 23. 3-20). Remedies for head diseases in Āyurveda chiefly employ medicated ghee or oil (prepared by cooking ghee/oil with various drugs), which is then administered in different modes: ingestion; application on head as anointment or paste; nasal applications such as nasal drops, douche, or snuffing; inhalation of powder; smoking; enema;massage; and so on. Measures like cauterisation at the head and bloodletting are also utilised. Treatment for worm-causing head disease includes putting blood into the nose to excite and intoxicate the worms and then removing them by instrument or headevacuation (such as snuffing or smoking antihelminthic drugs) (Caraka Saṃhitā Cikitsāsthāna 26. 158-186; Suśruta Saṃhitā Uttarasthāna 26. 3-43; Aṣṭāṅga Hṛdaya Saṃhitā Uttarasthāna 24. 1-19).

Headaches are one of the most common symptoms that many people have experienced. According to modern medicine, most headaches are benign; only a minority (less than one percent) of cases has a serious cause (such as intracranial mass, haemorrhage, infection, etc.). There are many pain receptors at different tissues and structures in the head, and various lesions triggering these receptors can give rise to pain sensation leading to headache (Jarman 2012, 1107). Nowadays, there is an internationally accepted classification of headaches: primary headaches include migraine, cluster headache, tension headache, and so on; secondary headaches are those due to underlying pathology such as head and neck traumas, infections, cranial vascular disorders, and so forth (Ravenport 2008, 336, box. 2). Management of headaches depends on the diagnosis and the identified cause, and there are diverse therapies for various headache disorders. General measures include avoidance of triggering factors and lifestyle modification, analgesics, symptomatic and preventive medications (e.g. triptans, anticonvulsants, antidepressants), physical therapies (e.g. massage, relaxation), and pain management programme (Jarman 2012, 1109-1111; Ravenport 2008, 341-343).

Few records of headaches and their treatments are found in the Chapters on Medicine. The remedies mentioned include anointing oil on the head, nasal treatment, and smoking therapy. Āyurveda has similar cures, which mainly use medicated ghee or oil for oral intake, application on the head or into the nose (in form of drops, smoke, powder, etc.), massage, enema, and so on. Other treatments such as bloodletting, cauterisation, and treating for worms may also be used. But these treatments play no role in modern medicine. Modern medicine has its classification of headaches and multitudinous remedies, though the mechanisms of many headache disorders are not yet known.

Footnotes and references:

[1]:

Few accounts of head disease treated with surgery by Jīvaka are found in the Theravāda Cīvarakkhandhaka, the Dharmaguptaka Cīvaraskandhaka, and the Mūlasarvāstivāda Cīvaravastu. These records are not included in this thesis, for they are beyond the scope of the study. But these cases, together with other ones cured by Jīvaka as found in the Vinaya Piṭakas, are certainly intriguing materials for future research.

[2]:

Sīsābhitāpa literally means “extreme heat in the head.” Pali-English Dictionary (s.v. “sīsa: -ābhitāpa”) renders it as “heat in the head” or “headache.” A Sanskrit-English Dictionary renders a close term, śirobhitāpa, as headache (s.v. “śiro: bhitāpa”).

[3]:

Pali-English Dictionary (s.v. “natthu: -kamma”) renders the term as a medical treatment through the nose. Hence, from the context, it should involve an application of oil through the nose.

[4]:

Pali-English Dictionary renders the term natthukaraṇī as pocket handkerchief, which is incorrect from the context (the materials that it was allowed to be made of). The Sanskrit parallel of this term should be nastakaraṇa, which means an instrument for injecting the nose (A Sanskrit-English Dictionary, s.v. “nasta: -karaṇa). Horner, in her translation of the Theravāda Bhesajjyakkhandhaka (The Book of Discipline IV. 277), rendered it as nose-spoon. This translation seemingly has been adopted by Zysk (1991, 91) and Talim (2009, 38). Mitra (1985, 348) translates it as nasal speculum, which seems possible. By comparing this account with the parallel in the Dharmaguptaka Vinaya, the treatment should be nasal douching and the instrument should be a tube for such treatment.

[5]:

The translation of “manussā ujjhayanti khīyanti vipācenti” is adopted from Anuruddha 2004, 695.

[6]:

The translation of “seyyathāpi gihī kāmabhogino” is adopted from Anuruddha 2004, 961.

[7]:

Saṅkhanābhi (Pāli) or śankhanābhi (Sanskrit) refers to a kind of shell according to Pali-English Dictionary and A Sanskrit-English Dictionary. No English name is known for it.

[8]:

The Samantapāsādikā (V. 1091) has provided an explanation for this: “‘A double nasal instrument’ is one nasal instrument with two tubes [for] equal streams and so forth” (yamakaṃ natthukaraṇin ti samasotādi dvīhi pi nāḷikāhi ekaṃ natthukaraṇiṃ).

[9]:

Theravāda Vinaya Piṭaka I. 204: “tena kho pana samayena āyasmato Pilindavacchassa sīsābhitāpo hoti–la–anujānāmi bhikkhave muddhani telakan ti. na kkhamaniyo hoti–la–anujānāmi, bhikkhave, natthukamman ti. natthu galati–la–anujānāmi bhikkhave natthukaraṇin ti. tena kho pana samayena chabbaggiyā bhikkhū uccāvacā natthukaraṇiyo dhārenti sovaṇṇamayaṃ rūpiyamayaṃ. manussā ujjhāyanti khīyanti vipācenti: seyyathāpi gihī kāmabhogino’ti. na bhikkhave uccāvacā natthukaraṇī dhāretabbā. yo dhāreyya, āpatti dukkaṭassa. anujānāmi bhikkhave aṭṭhimayaṃ–la–saṅkhanābhimayan ti. natthuṃ visamaṃ āsiñcanti. anujānāmi bhikkhave yamakanatthukaraṇin ti. na kkhamaniyo hoti. anujānāmi bhikkhave dhūmaṃ pātun ti. tañ ñeva vaṭṭiṃ ālimpetvā pivanti. kaṇṭhaṃ dahati–la–anujānāmi bhikkhave dhūmanettan ti. tena kho pana samayena chabbaggiyā bhikkhū uccāvacāni dhūmanettāni dhārenti … saṅkhanābhimayan ti. tena kho pana samayena dhūmanettāni apārutāni honti, pāṇakā pavisanti–la–anujānāmi bhikkhave apidhānan ti. tena kho pana samayena bhikkhū dhūmanettāni hatthena pariharanti. anujānāmi bhikkhave dhūmanettathavikan ti. ekato ghaṃsiyanti–la–anujānāmi bhikkhave yamakathavikan ti. aṃsabandhako na hoti–la–anujānāmi bhikkhave aṃsabandhakaṃ bandhanasuttakan ti.”

[10]:

Taishō Tripiṭaka 1428. 874b12-14: “時諸比丘患頭痛，醫教頂上著油，白佛，佛言：「聽著。」彼畏慎不敢用香油著，佛言：「聽著。」”

[11]:

劫貝 (Pāli: kappāsa; Sanskrit: karpāsa) is cotton.

[12]:

The Taishō Tripiṭaka gives it as “若鉛錫” while older editions of Chinese Buddhist canon have it as “若鉛若錫”. Here the latter is adopted.

[13]:

Taishō Tripiṭaka 1428. 877a2-10: “爾時有比丘患頭痛，醫教灌鼻，佛言：「聽。」不知何物灌？佛言：「以酥油脂灌。」不知云何灌？佛言：「聽以羊毛、若劫貝鳥毛漬油中，然後渧著鼻中。」四邊流出，佛言：「聽作灌鼻筒。」彼便持寶作筒，佛言：「不應用寶作。應用骨、若牙、若角、若鐵、若銅、若白鑞、若鉛錫、若葦、若竹、若木。」彼不洗便舉置，佛言：「不

應不洗舉置。」洗已不燥後虫生，佛言：「不應洗已不燥，應令燥舉置。」”

[14]:

The Aṣṭāṅga Hṛdaya Saṃhitā, in the chapter dealing with head diseases, also mentions nine types of scalp disease (Uttarasthāna 23. 21-32).