AYURVEDIC MANAGEMENT OF MIGRAINE: A CASE REPORT.

Dr S. D. Pandey 1 And Dr. Swapnil Singhai 2 . 1. Professor & Principal, MahaveerAyurvedic Medical College & Hospital, Meerut, Uttar Pradesh, India. 2. Professor (Kayachikitsa), UttarakhandAyurved University, Main Campus, Haridwar, Uttarakhand, India. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History Received: 08 June 2019 Final Accepted: 10 July 2019 Published: August 2019

Migraine is a benign and recurrent syndrome of headache, nausea, vomiting and other symptoms of neurological dysfunctions in varying admixtures. It is as one of the diseases where cause is exactly not known. Migraine, the second most common reason for cerebral pain, afflicts around 15% of women and 6% of men. With the disease afflicting majority of the people in their prime age i.e. from second decade to fifth decade, it is affecting their professional and social life, hampering their health. The various treatment modules comprises of non-pharmacological treatment such as identification of triggers, meditation, relaxation training, psychotherapy etc. and pharmacotherapy as abortive and preventive therapy. Ardhavabhedaka can be scientifically correlated with Migraine due to its cardinal feature 'half sided headache' and 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 shamana, shodhana. asthapana and anuvasanabasti to be effective in the management ofArdhavabhedaka. This patient was treated with LaghuSootshekhar Rasa, NarikelLavana, GodantiBhasma and PathyadiKwathare found to be efficacious in the whole symptom of Migraine (Ardhavabhedaka).

Introduction:-
Headache in general is one of the commonest complaints of the people seeking professional help. Only few of us are spared the experience of a headache. It is also a major cause of absenteeism from work and of avoidance of social and personal activities. It is a benign symptom, which may be of primary idiopathic type or may be a manifestation of a wide range of organic diseases such as brain tumor, subarachnoid hemorrhage, meningitis or giant cell arteritis. It may be psychosomatic like migraine, tension headache or may be psychogenic in origin e.g. Anxiety, Depression, hypochondrial and delusional headache. Severe headache attacks despite of cause are more likely to be described as throbbing and associated with vomiting and scalp tenderness. Milder headaches tend to be non-descriptive tight band like discomfort often involving the entire head, the profile of tension type headache.
Migraine is recognized bythe W.H.O., as one of the diseases where cause is not exactly known. Migraine, the second most common reason for cerebral pain, afflicts around 15% of women and 6% of men. With the disease afflicting the majority of the people in their prime age i.e. from second decade to fifth decade, it is affecting their professional and social life, hampering their health. A useful definition of migraine is a benign and recurrent syndrome of headache, nausea, vomiting and other sign and symptoms of neurological dysfunctions in various admixtures. Migraine can often be recognized by its activators like stress (psychological as well as physical), Lack of Sleep, Worries, Red wine, Menses, Estrogen etc. and by its deactivators like sleep, relaxation, meditation, pregnancy, exhilaration, sumatriptan medication.
Coming to the management, other systems of medicines have lots and lots of limitations. The authentic text books of modern medicine clearly state that there is no proper standardized treatment for migraine. The acute condition of migraine is being dealt with 'over-the-counter' medicine and minimum percentages of patients of this category are able to consult a physician. But the chronic stage of migraine is more prevalent and difficult to treat. The chronic migrainous headache is the most common problem seen among the patients visiting a hospital with specific complaints of headache. The various treatment modules comprises of non-pharmacological treatment such as identification of triggers, meditation, relaxation training, psychotherapy etc. and pharmacotherapy as abortive and preventive therapy. Aspirin, Paracetamol, Ibuprofen, Diclofenac etc. are non-specific abortive therapy, whereas Ergot, 5-HT receptor agonists are specific abortive therapy.
In Ayurvedic text, almost all the Acharayas have referenced Ardhavabhedaka in Shiro-roga. AcharayaSushruta has mentioned 11 types of Shiro-roga in Uttar Tantra. Among them, one of them is Ardhavabhedaka in which paroxysmal unilateral headache associated with vertigo and pain related with vertigo and agony of changing power is seen. This can be associated with Migraine. As indicated by AcharayaSushruta, it is a tridoshaj disease and according to AcharayaCharaka 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 'ArdhaMastakaVedana' (Ch.Su. 7/16) and 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 shamana, shodhana. asthapana and anuvasanabasti to be effective in the management ofArdhavabhedaka.

Instrumentation:
Severity of Headache 0 = No headache. 1 = Mild headache, patient is aware only if he/she pays attention to it. 2 = Moderate headache, can ignore at times. 3 = Severe headache, can't ignore but he/she can do his/her usual activities. 4 = Excruciating headache, can't do anything.

Case Report:
A 47 year old male patient presented with complaints of headache, nausea, vomiting and vertigo for the past 1 year. No history of illness or accidents in the past five years and not taking any medication for any illness/disorder. He has continuous, unilateral headache in frontal, parietal lobe in left side sometimes right side. The nature of pain was moderate to severe associated with nausea and sometimes vomiting. Blackouts and vertigo were also present. Family history was not contributory. He has to take allopathic medicine for pain.   Severity of headache  3  3  2  2  1  1  1  Frequency of headache  3  3  2  2  1  0  0  Duration of headache  3  3  2  2  1  1  0  Vomiting  2  2  2  1  1  0  0  Nausea  3  3  3  2  2  1  1  Vertigo  3  3  2  2  1  1  1  Aura  3  3  2  2  1  0  0  Associated symptoms  2  1  1  1  1  0  0 Discussion:-

NarikelLavana
contains Narikela (Coconut nucifera) and SaindhavaLavana (Rock salt). It is non-crystalline material having alkaline pH and hygroscopic nature. Its activity on hyperacidity is because of the presence of activated charcoal and alkaline nature. It calmsVata and Pitta dosha.

Godantibhasma
(Gypsum) balances all three doshas, especially Pitta dosha. It is Sheeta in potency, alleviates Pitta dosha, arrest bleeding, ameliorates hyperacidity and has been used as best drug for headache.
PathyadiKwath is a decoction of Haritaki, Amalaki, Vibhitaki, Haridra, Neem and Guduchi has been described for the treatment of various types of headache. Triphala corrects our digestion and assimilation process, it normalizes the gut. Haridra and Neem both acts as an antibiotic and prevent unwanted production of inflammatory chemical mediators. Guduchi acts as an antioxidant and free radical scavengers.

Conclusion:-
The present case study signifies the role of Ayurvedic medicine in the treatment of Migraine. The patient can make significant gains in symptoms in relatively short periods of time. Despite the limitations of this case study, conclude that the herbo-mineral formulations are simple and effective treatment modality for Migraine without any adverse effects.