Management of Chronic Migraine (Ardhavabhedaka) through Ayurvedic...

[Full title: Management of Chronic Migraine (Ardhavabhedaka) through Ayurvedic herbo-mineral drugs : A Case Study]

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CASE REPORT October 2022 Journal of Ayurveda and Integrated Medical Sciences | October 2022 | Vol. 7 | Issue 9 170 Management of Chronic Migraine (Ardhavabhedaka) through Ayurvedic herbo-mineral drugs : A Case Study Mohammad Aamir 1 , Laljee Prasad 2 , Amber 3 , Sujeet Kumar 4 1,3 2 nd Year Post Graduate Scholar, Department of Kayachikitsa, Govt Ayurved College, Patna, Bihar, India. 2 1 st Year Post Graduate Scholar, Department of Kayachikitsa, Govt Ayurved College, Patna, Bihar, India. 4 Assistant Professor, Department of Kayachikitsa, Govt Ayurved College, Patna, Bihar, India. I NTRODUCTION Migraine is neurological disorder in which there is a severe headache generally throbbing or pulsating in nature on one side of head. It is generally associated with nausea, vomiting and photophobia. Due to increasing stress and unaccounted workload, mental health got spoiled & disturbed the many aspects of life. Even young children are becoming victims of this disease like migraine. Acharya Charak mentions; Address for correspondence: Dr. Mohammad Aamir 2 nd Year Post Graduate Scholar, Department of Kayachikitsa, Govt. Ayurved College, Patna, Bihar, India. E-mail: mohammadaamir 486@gmail.com Submission Date: 15/08/2022 Accepted Date: 21/09/2022 Access this article online Quick Response Code Website: www.jaims.in Published by Maharshi Charaka Ayurveda Organization, Vijayapur, Karnataka (Regd) under the license CC-by-NC-SA “ Sarwamanyet Parityejaha Shareeramanupalyet | Tadbhave Hi Bhvanam Sarwabhava Sheererina.” [1] So one should pay attention to their health otherwise all things are useless. Nowadays stress has become an integral part of our daily schedule. When psychological stress gets involved, the migraine attack often occurs after the period of stress, so that some patients tend to have attacks at week-ends or at the beginning of a holiday. The headache is associated with vasodilatation of extracranial vessels, but may be due to disturbed neuronal activity in the hypothalamus [2] A migraine attack has three phases: premonitory (prodrome), headache phase, and postdrome; each has distinct and sometimes disabling symptoms. Various pharmacological strategies like Antidepressants, Antiseizure drugs, CGRP monoclonal antibodies and BP lowering medications (In hypertensive) currently are the used for the treatment of Migraine, but a recent population study showed that 84% of the patients with migraine persisted with the diagnosis; and around 10% had 1 year complete clinical remission and 3% A B S T R A C T Migraine is a neuro vascular disorder characterized by recurrent attacks of pulsatile headache of varying intensity and is generally accompanied with nausea and vomiting, sensitive to light and sound. It is most common headache that generally afflicts ~15% of women and 6% of men. WHO has ranked migraine as a no. 19 among all the diseases worldwide causing disability. In Ayurveda it is well correlated as Ardhavabhedaka, one of the Shiroroga out of 11 mentioned by Acharya Sushruta based on the similarities in etiology, pathophysiology, symptoms and treatment principles. Ardhavabhedaka is a Tridoshaja Vyadhi . In allopathic Science many pharmacological strategies like, Antidepressants, Antiseizure drugs, and BP lowering medications (In hypertensive) are commonly used for the quick relief from Migraine pain but it adds drowsiness, insomnia and depression too; as a complication. This case study is about a patient having Chronic migraine for 3 years with generalized burning sensation all over the body, insomnia and stress. Ayurvedic Management with inclusion of Panchkarma procedures like shirodhara and nasya along with internal herbomineral medications have helped immense to get rid off the symptoms. Key words: Migraine, Ardhavabhedaka, Shiroshoola, Shirovirechan

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Mohammad Aamir et al. Management of Chronic Migraine (Ardhavabhedaka) ISSN: 2456-3110 CASE REPORT October 2022 Journal of Ayurveda and Integrated Medical Sciences | October 2022 | Vol. 7 | Issue 9 171 developed chronic migraine. Prevalence of this disease is significantly increasing in youngsters due to their various triggering factors like sedentary lifestyle, environmental factors stress, late night awakening. Sedentary life style plays a significant share in precipitation of Migraine. In Ayurvedic text, almost all the Acharayas have referenced Ardhavabhedaka in Shiro-Roga Prakaran. Acharaya Sushruta has mentioned 11 types of Shiro-Roga in Uttar Tantra . Among them, one of them is Ardhavabhedaka in which paroxysmal unilateral headache associated with nausea and pain related with vertigo is seen. As indicated by Acharaya Sushruta , it is a Tridoshaja disease and according to Acharaya Charak , it is Vataja or Vata-Kaphaja . Ardhavabhedaka can be scientifically correlated with Migraine due to its cardinal feature ‘half sided headache’ which is also explained by commentator Chakrapani as ‘ Ardha Mastaka Vedana’ [3] also due to its paroxysmal nature. All the three Doshas are involved in the pathogenesis of the Ardhavabhedaka with the predominance of Vata or Vatakapha . The disease may not be fatal but if not managed properly then it may damage eyesight or hearing. Ayurveda emphasizes various treatment modalities for Ardhavabhedaka which includes both Shodhana , Shamana to be effective in the management of Ardhavabhedaka . C ASE R EPORT A 24 yrs old female patient Rani Kumari visited our Kayachikitsa OPD, with chief complaint of severe throbbing pain in left half of head along with burning sensation all over the body for past 3 yrs, with an approx. frequency of 3 attacks/month. The symptoms used to get worsen during morning hours, neck movements, sneezing and fasting. The pain was followed by nausea and vomiting. She had reduced appetite, disturbed sleep and inadequate bowel evacuation also. She had no history of thyroid, asthma or any mental disorder. All the vitals were within normal limit. General physical examination ▪ Appetite : Normal ▪ Bowel : Not Clear ▪ Blood pressure : 110/80 ▪ Respiratory rate : 18/min ▪ Temperature : 98°F ▪ Pallor - Absent ▪ Icterus - Absent ▪ Lymphadenopathy - Not Palpable Ashtavidha Pariksha ▪ Nadi - Vatakaphaja ▪ Mutra - Samanya ▪ Mala - Sama, Vibandh ▪ Jihwa - coated (whitish) ▪ Shabd - Samanya ▪ Sparsh - Kinchit Ruksha ▪ Drik - Samanya ▪ Aakriti - Madhyam Systemic examination ▪ Cardiovascular system - NAD ▪ Respiratory system - NAD ▪ Gastrointestinal system - Lower abdomen distended ▪ Nervous system - NAD ▪ Motor functions - NAD M ATERIALS AND M ETHODS Sources of data Patient having symptoms of Ardhavabhedaka is selected from the OPD of Kayachikitsa Department, Govt Ayurved College, Patna. Study design: Single case study. Consent was obtained from patient prior to the treatment. Patient was assessed on subjective parameters before treatment and on every follow up. Treatment protocol Firstly patient was advised Shirodhara with Mamsyadi Kwatha for 7 days then Shiroverachan for 7 days with Shadbindu Nasya ; 6 drops in each nostril followed by Anu Tail Nasya for next 21 days

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Mohammad Aamir et al. Management of Chronic Migraine (Ardhavabhedaka) ISSN: 2456-3110 CASE REPORT October 2022 Journal of Ayurveda and Integrated Medical Sciences | October 2022 | Vol. 7 | Issue 9 172 Shaman Aushadi for 30 days SN Name of Drugs Anupana 1. Sutsekhar Rasa - 250 mg Godanti Bhasm - 125 mg Swarnmakshik Bhasma - 250 mg With Mishri 2. Pathyadi Kadha - 20 ml With equal quantity of water 3. Cap Stresscom - 2 cap With milk QHS Criteria for Assessment Subjective criteria 1 Headache (severity) 2 Headache (Duration) 3 Nausea 4 Vomiting 5 Photophobia 6 Episodes of attack 7 Aura 8 Other symptoms like Giddiness, Lack of sleep, Weakness, Fatigue 1. Severity of Headache 0 Absent 1 Pain tolerable 2 Disturbing Routine work 3 Intolerable pain 2. Duration of Headache 0 Nil 1 2-6 hr /day 2 6-12 hr/day 3 ≥12 hr/day 3. Nausea 0 None 1 Loss of appetite without alterations in eating habits 2 Oral intake decreased without significant weight loss, dehydration or malnutrition. 3 Inadequate oral fluid intake, tube feeding, TPN or hospitalization indicated. 4. Vomiting 0 None 1 1 to 2 episodes in 24 hours 2 3-5 episodes in 24 hours 3 ≥ 6 episodes in 24 hours 5. Photophobia 0 No sensitive to light 1 Mild sensitive to light but can tolerate with work 2 Mild Sensitive to light but can’t tolerate with work 3 Can’t tolerate light; needs either darkness or lights completely off 6. Episodes of attack 0 No attacks within 1 month 1 1-3 attacks in 1 month 2 4-6 attacks in 1 month 3 ≥6 attacks in 1 month 7. Aura 0 Nil 1 Lasts for 5-10 minutes 2 Lasts for 10-15 minutes 3 Lasts for >15 minutes 8. Other symptoms like Giddiness Lack of sleep Weakness Fatigu e 0 None 1 Mild 2 Moderate 3 Severe Results Analysis Sign /symptoms BT 1 st day to 14 th day 15 th day to 45 th day AT Headache (severity of pain) 3 Shirodhara with Mamsyadi Kwatha followed by Shirovirechan with Internal Medication for 30 days 0 Headache (Duration of pain) 3 0 Nausea 3 1 Vomiting 2 0

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Mohammad Aamir et al. Management of Chronic Migraine (Ardhavabhedaka) ISSN: 2456-3110 CASE REPORT October 2022 Journal of Ayurveda and Integrated Medical Sciences | October 2022 | Vol. 7 | Issue 9 173 Photophobia 3 Shadbindu Tail Nasya 1 Episodes of attack 2 0 Aura 3 0 Other symptoms like vertigo, lack of sleep, weakness, fatigue 2 0 DISCUSSION Ardhavabhedaka is caused by simultaneous vitiation of all three Doshas . The Shoola under Ardhavabhedaka manifests in two forms viz predominately caused by vitiated Vata or both Vata and Kapha . Due to intake of Vata vitiating Aahar Vihar , vitiated Vata alone or accompanied with Kapha gets lodged in half of the head and produces severe churning pain in half of Manya Bhru, Shankha, Karna, Akshi, Lalata. In Ayurveda the principle of any treatment is based on its Samprapti Vigghatan and the first step in Samprapti Vigghtatan is Nidana Parivarjanam . Scheduled life style and following Pathyaapathya along with Yoga practice improves the morbidity. Probable mode of action of drug Shirodhara Shirodhara is a purifying and rejuvenating therapy designed to eliminate toxins and mental exhaustion as well as relieves stress. It is mainly indicated in insomnia, anxiety, depression etc. It raises the level of serotonin due to the amplification of vibrations by the intracranial sinuses through Shirodhara ; thus activates the frontal lobe, limbic system, brain stem and ANS and it raises the levels of serotonin. Serotonin have Anxiolytic effects, reduces HR, Breathing rate etc [4] Shadbindu Tail Nasya Nasya Dravya ↓ lipid soluble substances has greater affinity for passive absorption ↓ Olfactory receptors cells in nasal mucosa ↓ Olfactory nerve ↓ Olfactory bulb ↓ Olfactory tract ↓ Shringataka Marma ( Nasya Dravya stimulates it) ↓ Impulses are transmitted to the CNS ↓ Scraping of morbid Doshas of head and extracts them out ↓ Normalises Tridosha Swarnmakshik Bhasma is a herbomineral medicine, balances Kapha and Pitta Dosha . Traditionlly it has been used for Pandu , Anidra , Apasmara , Mandagni etc Sutsekhar Rasa is a herbo-mineral formulation which contains Swarnagairika , Shunthi , Nagvelli juice extract ( Piper betel ) which balances Vata and Pitta . It has Kashaya , Madhura Rasa , Snigdha , Visadaguna and Sheeta Veerya and Madhur Vipaka . It nullifies the aggravated Pitta Dosha and also improves the Agni Vyapar . Since the patient has burning sensation all over the body, so it has been selected Swarnamakshik bhasma along with Sutsekhar Rasa is used in Shiroshula [5] Godanti Bhasma is effective due to the antipyretic, anti-inflammatory, analgesic property [6] Pathyadi Kadha contains drugs such as Guduchi , Nimba and Haridra possessing Raktaprasadaka property that may normalise vitiated Rakta Dhatu . Drugs such as Guduchi and Amalki having Dipana property, will normalise Ama . It is reported that most of the drugs of Pathyadi decoction also possess analgesics, anti-inflammatory, a nervine tonic property which might helped to reduce pain [7] Cap Stresscom - Cap stresscom contains Ashwagandha as a main ingredient which enhances the body’s resilience to

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Mohammad Aamir et al. Management of Chronic Migraine (Ardhavabhedaka) ISSN: 2456-3110 CASE REPORT October 2022 Journal of Ayurveda and Integrated Medical Sciences | October 2022 | Vol. 7 | Issue 9 174 stress. Ashwagandha improves the body’s defence against disease by improving the cell mediated Immunity.It also possess potent antioxidant properties hence protects the cellular damage by free radicals [8] Mamsyadi Kwatha an Ayurvedic formulation mentioned in Siddayoga Sangraha of Yadavji Trikamji Acharya is said to possess a very good effect in all psychological disorders. The components of Mamsyadi Kwatha are Jatamamsi , Ashwagandha and Parasika Yavani in 8:4:1 ratio. It is a strong potent psychoneuro pharmacologically active compound and is subjected for antidepressant activity [9] CONCLUSION The present case study signifies the role of Nasya therapy and internal medicine in the treatment of Chronic Migraine. Despite the limitations of this case study, we conclude that the herbo-mineral formulations are simple and effective treatment modality for Migraine without any adverse effects. Since this is a single case study; further study is required for greater sample size for establishment of this treatment protocol. REFERENCES 1 Charak Samhita with elaborated Vidyotini Hindi commentary, by Pt.Kashinath Shastri and Dr Gorakh Nath Chaturvedi, Chaukhamba Bharti Academy, Varanasi, Nidan Sthan, 2018; 6/7 2 Ralston, S. H., Penman, I. D., Strachan, M. W. J., & Hobson, R. (Eds.). (2018). Davidson’s principles and practice of medicine (23 rd ed). Elsevier Health Sciences 3 Charak Samhita by Agnivesa Revised by Charaka and Dridhabala with the Ayurveda Dipika commentary of Chakrapanidatta. edited by Vaidya Jadavji Trikamji Acharya; Chaukhamba Orientalia Varansi. Chapter 7/16 4 Kajariya Divya, Tripathi JS, Tiwari S.K An Appraisal of the mechanism of action of Shirodhara; Annals of Ayurvedic Medicine Vol -2 Issue 3 July-Sept 2013 5 Anonymous, Ayurved Saarsangraha, Shodhan-Maran- Prakaran by Shree Baidynath Ayurved Bhawan Ltd. page no 181 6 Mangal, A., Pali, S., & Makhija, P. (2021, March 27). Efficacy of an Ayurvedic Intervention in the Management of Migraine: A Case Report. International Journal of AYUSH Case Reports, 5(1), 19-23. Retrieved from https://www.ijacare.in/index.php/ijacare/article/view/ 191 7 Brinda Kanakhara and Varsha Chaudhari ; A pilot study on clinical efficacy of Agnikarma and Pathyadi decoction (An Ayurvedic Formulation) in the management of Ardhavabhedaka (migraine) available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC 6287 398/ 8 An overview on Ashwagandha: A Rasayana (Rejuvenator)of Ayurveda, Afr J Tradit complement -1 0 1 2 3 4 0 2 4 6 8 G radi ng s core Days ——— > Comparison of result of Shirodhara in lack of sleep and migraine pain Lack of sleep (insomnia) Migraine pain intensity -0.5 0 0.5 1 1.5 2 2.5 3 3.5 0 1 2 3 4 5 6 G radi ng s core s Weeks ——— > Other symptoms like vertigo, lack of sleep, weakness, fatigue Other symptoms like vertigo ,lack of sleep ,weakness,fatigue 0 0.5 1 1.5 2 2.5 3 3.5 G radi ng s core s Comparison of symptoms before and after treatment BT AT

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Mohammad Aamir et al. Management of Chronic Migraine (Ardhavabhedaka) ISSN: 2456-3110 CASE REPORT October 2022 Journal of Ayurveda and Integrated Medical Sciences | October 2022 | Vol. 7 | Issue 9 175 Altern Med .2011;8 (5 suppl):208-213 published online 2011 July 3 Available from; https://www.ncbi.nlm.nih. gov/pmc/articles/PMC 3252722/ 9 M. Shreevastha, B. Ravishankar, Rambabu Dwivedi; Antidepressant activity of Mamsyadi Kwatha : An Ayurvedic Compound Formulation available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC 3764 868/#!po=71.1538 ******************************* How to cite this article: Mohammad Aamir, Laljee Prasad, Amber, Sujeet Kumar. Management of Chronic Migraine (Ardhavabhedaka) through Ayurvedic herbomineral drugs : A Case Study. J Ayurveda Integr Med Sci 2022;9:170-175. Source of Support: Nil, Conflict of Interest: None declared. Copyright © 2022 The Author(s); Published by Maharshi Charaka Ayurveda Organization, Vijayapur (Regd). This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc-sa/4.0), which permits unrestricted use, distribution, and perform the work and make derivative works based on it only for non-commercial purposes, provided the original work is properly cited

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