E-ISSN:2456-3110

Research Article

Role of Pradhmana

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 2 February
Publisherwww.maharshicharaka.in

Role of Pradhmana (Churna) Nasya and Shirolepa in Ardhavabhedaka w.s.r to Migraine - A Clinical Pilot Study

Namdeo N1*, Dash B2
DOI:10.21760/jaims.9.2.4

1* Nupur Namdeo, Post Graduate Scholar, Department of Panchakarma, Pandit Khushilal Sharma Govt Ayurvedic College and Hospital, Bhopal, Madhya Pradesh, India.

2 Babita Dash, Lecturer, Department of Panchakarma, Pt Khushilal Sharma Govt Autonomous Ayurveda College and Institute, Bhopal, Madhya Pradesh, India.

Ardhavabhedak is one of the Shiroroga which can be correlated with migraine in modern health care system. It is a type of Headache characterized by moderate to severe throbbing pain, generally associated with nausea, photophobia and phonophobia. Its cardinal feature is 'half sided headache' which is also explained by commentator Chakrapani as Ardha Mastaka Vedana. According to International headache society, Migraine constitutes 16% of the primary headache and affects about 10-20% of the general population. As per Acharya Sushruta Ardhavabhedaka occur due to vitiation of Tridosha. While Acharya Charaka had mentioned that vitiated Vata/Vata - Kapha are involved in manifestation of the disease, while Acharya Vagbhatta believed it occurs due to vitiated Vata. Till now there is no effective management present in modern science as they provides the symptomatic treatment. But Ayurveda acts on roots of the disease, it does Samprapti Vighatan and cures the disease. Nasya Karma (Errhine Therapy) is considered as the best therapeutic intervention in Shirogata Roga by Acharya Charaka. In present pilot study, an attempt is made to treat the patient of Ardhavabhedaka with Pradhmana Nasya along with Shirolepa.

Keywords: Ardhavabhedaka, Pradhmana (Churna) Nasya, Shirolepa, Migraine

Corresponding Author How to Cite this Article To Browse
Nupur Namdeo, Post Graduate Scholar, Department of Panchakarma, Pandit Khushilal Sharma Govt Ayurvedic College and Hospital, Bhopal, Madhya Pradesh, India.
Email: 		Namdeo N, Dash B, Role of Pradhmana (Churna) Nasya and Shirolepa in Ardhavabhedaka w.s.r to Migraine - A Clinical Pilot Study. J Ayu Int Med Sci. 2024;9(2):15-21.
Available From
https://jaims.in/jaims/article/view/3117

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-12-15 2023-12-25 2024-01-05 2024-01-15 2024-01-24
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None declared Nil Yes 21.96

© 2024by Namdeo N, Dash Band Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Introduction

According to International headache society, migraine is the most common neurovascular headache and is a common disabling primary headache disorder. In the global burden of disease survey 2010, it was ranked as the third most prevalent disorder and 7th highest specific cause of disability worldwide.[1] The world health organization (WHO) ranks migraine among the world’s most disabling medical illness. It is three times more common in women than men. Migraine being a primary headache, affects one in seven globally.[2] characterized by a unilateral, pulsatile, throbbing sensation, it limits day-to-day activities of daily living. Ranked third most prevalent and seventh highest specific cause of disability worldwide (GBD 2012),[3] migraine is currently the leading cause of Years Lived with Disability/Disease (YLD) among individuals under 50 years with a male, female ratio of 1:3. Vata alone or along with Kapha affects the head and produces severe unilateral pain in the neck, eyebrow, temples, ear, eye, and forehead. Pain is acute, similar to a blow from sharp weapons, pricking, or splitting, and when severe, it impairs the functions of the eye and ear. Pain is paroxysmal, occurring once in ten days, twelve days, or daily.[4]

This phenomenon can be closely read in line with the series of events such as vasodilatation, secondary extravasation, edema, mast cell degranulation, and cortical spreading depression that is triggered by the release of neuropeptides from the trigeminal innervation in migraine.

In Yogratnakara has described the following treatment measures for Shiroroga: Snehana, Upanaha, Svedana, Dhumpana, Lepa, Langhana, Parisheka, Agnikarma, Raktamokshana, and Shirobasti.[5]

In Bhaishajya Ratnavali, general line of treatment for Shirah-Shoola has been described which are Svedana, Nasya, Dhumpana, Virechana, Lepa, Vamana, Langhana, Shirobasti, Raktamokshana, Agnikarma, Upanaha, Purana Ghrita and Shashtika Shali.[6]

Panchakarma can be used in various aspects, i.e., it can be used in curative aspect, palliative aspect and in nourishing aspect.[7,8] Nasal medication is known as Nasya which delivers drugs directly to the brain. Nasya

has its special features because nasal administration needs only little quantity of medicine and it is directly administered into the nose from where it can reach up to the brain and provides greater action.[9] Various modalities of Nasya which can be applied in various disease conditions in various forms viz. Marsha Nasya (high dose medication through nasal route) Pratimarsha, Avipedaka Nasya and Dhuma Nasya. Previously many clinical trials have been conducted showing the role of various Nasya. Still the use of Pradhmana Nasya has limited exposure. So here is an attempt to see the role of Pradhmana Nasya and Shirolepa in the management of Ardhavabhedaka.

Aim and Objective

To evaluate the effect of Pradhmana (Churna) Nasya and Shirolepa in the management of Ardhavabhedaka (migraine).

Materials and Methods

Source of patient

The patients suffering from Ardhavabhedaka (migraine) attending the OPD of Pt. Khushilal Sharma Govt. Ayurvedic Hospital Bhopal were screened and allocated to the study. Overall, 10 patients were included in the study fulfilling the diagnostic, inclusion and exclusion criteria. A detailed history taking and physical examination were carried out in these patients. The clinical data along with the elaborated assessment of the condition were recorded in specially designed case proforma. Among 10 patients, 7 completed the treatment 3 patients did not complete the whole treatment due to unknown cause.

Intervention Period: 14 days

Study Design

The present study is a pilot clinical study conducted in the department of Panchakarma of Pt. Khushilal Sharma Govt. Ayurvedic College and Institute Bhopal.

Inclusion Criteria

  • Patients between 16 to 60 years of age
  • Patients with signs and symptoms of Ardhavabhedaka according to Ayurveda Classics and modern text.

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Nupur Namdeo et al. Role of Pradhmana Nasya and Shirolepa in Ardhavabhedaka
  • Disease chronicity in between 5 years.
  • Patients those fit for Nasya Karma.
  • Patients who have given written consent to participate in the study.

Exclusion Criteria

  • Patients having referred pain in one half of head due to pathology of eye, ear, nose, throat, teeth.
  • Patients having any other chronic system disease like renal failure, TB, heart disease etc.
  • Other neurological disorders.
  • Head Injury, Childhood headache, headache due to Benign/malignant, growth, Lactating and Pregnant women’s.
  • Patients who are not willing to give written consent to participate in the study

Assessment Criteria

Patients were observed for 15 days. Assessment was done before the medical interventions.

Then, Patients were assessed on the 1st,7th day and 15th day. Final assessment was done after completion of the therapy that is on the 15th day. The disease is assessed by graded according to

HIT- 6Tm. test (Headache impact test)

Gradations of Subjective Parameters

SNSeverity of HeadacheScore
1.No Headache0
2.Tolerable headache1
3.Do not disturb the routine work2
4.Disturb the routine work3
5.Intolerable headache4

SNNature of headacheScore
1.Avedana0
2.Manda Vedana1
3.Sambheda Toda2
4.Shastra/Vajrapata Vedana3
5.Chakshurindriya/Shrotrendriya Vinasha4

SNPhotophobiaScore
1.No photophobia0
2.Photophobia only during mild exposure to light1
3.Photophobia only during exposure to light2
4.Continuous photophobia throughout the day3
5.Continuous photophobia throughout the day and night4

SNPhonophobiaScore
1.Nil0
2.Mild (does not interfere with usual activities)1
3.Moderate (inhibits, but does not prevent usual activities)2
4.Sever (some time prevent all activities)3
5.Very sever (unbearable)4

SNVomitingScore
1.Nil0
2.Only if headache does not subside1
3.Vomiting 1-2 times2
4.Vomiting 2-3 times3
5.Forced to take medicine to stop vomiting4

SNVertigoScore
1.Nil0
2.Feeling of giddiness1
3.Patient feels as if everything is revolving2
4.Revolving signs + black outs3
5.Unconscious4

SNFrequency of Headache: According to Acharya VidehaScore
1.Nil0
2.Once in 30 days1
3.Once in 15 days2
4.Once in 5 days3
5.Once in 3 days4

SNDuration of HeadacheScore
1.No headache0
2.1-3 hours1
3.4-12 hours2
4.13-24 hours3
5.Over 24 hours/continuous4

SNNauseaScore
1.Nil0
2.Occasionally1
3.Moderate, but does not disturb the routine work2
4.Severe, disturbing routine work3
5.Severe enough, small amount of liquid regurgitating from mouth4

Criteria for Overall Assessment of Intervention

Percentage of improvementEffect of Therapy
< 25%No improvement
25% - 49%Mild improvement
50% -74%Moderate improvement
75% - 99%Marked improvement
100%Cured

Treatment with duration

Purva Karma - Sthanik Abhyanga with Tila Tailam and Nadi Swedana


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Pradhana Karma -

1. Pradhamana Nasya with Krishna Tila and Vidanga Churna - for seven sittings, with an interval of 1 day between each sitting.[10]
2. Shirolepa with Krishna Tila and Vidanga Churna -14 days

Paschat Karma - Triphala Gandhusa

Ingredients of Lepa and Nasya

Ayurvedic properties and action of composition

1. Vidanga[11] (Embelia ribes), (Chitratandul, Vayavidanga)

It is used in Krimi Roga, Vata Kapha Vikar, Udarasool, Adhyaman, and Vibandha.

Rasa - Katu, Kashaya,

Guna - Laghu, Ruksha, Thikshna

Virya - Ushna Vipaka- Katu

Chemical composition - Embelin, Christembine, Quercitol, Tannin.

Action - Vata Kapha Samak, Krimighan, Vishnasak, Agnimandhyahar.

2. Krishna Tila[12] (Sesamum indicum)

It is Balya, Keshya, Twacha and Varna Hitkari, Vatnasak, Dant Vikar Nashak.

Rasa - Katu, Tikta, Madhur, Kashaya

Guna - Guru Snigdha

Virya - Ushna

Vipaka - Katu

Chemical Composition - Vitamin B complex, Sesamin

Action - Vata Hara, Kapha Pittakrit, Aganiprdiptikar, Grahi, Himasparsi

Method

Administration of Nasya therapy may be classified under the following three headings.

1. Purvakarma (Pre-measures)
2. Pradhanakarma (Nasya therapy)
3. Paschatkarma (Post measures)

After local Snehan and Nadi Swedan at neck, shoulder and arm region. Pradhamana Nasya,

Churna (Powder of drugs) is administered by Nasal passage with the help of Naadi Yantra (6 Angula Naadi, open ended on both sides). The Churna (Fine powder) of required the drug is kept at one end and air is blown from the other end, so that the medicine could enter into the nostrils.[13] After Nasya Triphala Gandusha is advised to combed the remaining morbid Dosha.

After the elimination of Doshas, patient is advised to take warm water and light food and to stay in a room devoid of wind.[13]

Shirolepa- Medicinal paste which is prepared either by boiling method or triturating method and is applied on the vertex, then over right side, back side, left side and again at the center of the head in respective order. The paste is evenly applied all over the scalp. Thickness of paste was 1 Angula.

Result

The values of data were expressed as a percentage of relief and mean-standard error of the mean. The data were analyzed by Student's t-test for comparing before and after treatment obtained scores. The level of significance are expressed as P > 0.05 as insignificant, P < 0.05 and 0.01 as significant, P < 0.001 as highly significant.

SNSymptomsMeanMDSDSE% ReliefT -testP valueResult
BTAT
1.Severity of headache2.710.861.850.690.2668%3.7520.0028Very significant
2.Nature of headache2.290.431.860.530.2081%5.3070.0002Extremely Significant
3.Photophobia2.1411.140.580.2253%3.3600.0057Significant
4Phonophobia2.291.141.150.690.2650%2.5730.0244Significant
5.Vomiting1.140.710.430.490.1837%1.3410.2046Not significant
6.Frequency1.860.711.150.490.1861%3.5770.0038Extremely Significant
7.Duration2.141.1410.580.2246%2.4880.0028Significant
8.Nausea1.570.710.860.490.1854%2.4490.0306Significant

Severity of Headache - The mean score of severity of headache in this study, before treatment was 2.71 and after treatment it was reduced to 0.86 So the mean difference was 1.85, with percentage relief of 68% which was statistically very significant (P=0.0028).


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Nature of Headache - The mean score of natureof headache in this study, before treatment was 2.29 and after treatment it was reduced to 0.43. So the mean difference was 1.86, with percentage relief of 81% which was statistically extremely significant (P=0.0002)

Photophobia - The mean score of photophobia in this study, before treatment was 2.14 and after treatment it was reduced to 1. So the mean difference was 1.14, with percentage relief of 53% which was statistically significant (P=0.0057).

Phonophobia - The mean score of phonophobia in this study, before treatment was 2.29 and after treatment it was reduced to 1.14. So the mean difference was 1.15, with percentage relief of 50% which was statistically significant (P=0.0244).

Vomiting - The mean score of vomiting in this study, before treatment was 1.14 and after treatment it was reduced to 0.71. So, the mean difference was 0.43, with percentage relief of 37% which was not significant (P=0.2046).

Frequency - The mean score of frequency in this study, before treatment was 1.86 and after treatment it was reduced to 0.71 So the mean difference was 1.15, with percentage relief of 61% which was statistically significant (P=0.0038)

Duration - the mean score of duration in this study, before treatment was 2.14 and after treatment it was reduced to 1.14 So the mean difference was 1, with percentage relief of 46% which was statistically significant (P=0.0028).

Nausea - The mean score of nausea in this study, before treatment was 1.57 and after treatment it was reduced to 0.71 So the mean difference was 0.86, with percentage relief of 54% which was statistically significant (P=0.0306).

Overall assessmentNo. of PatientsPercentage
Complete relief0000
Marked improvement114%
Moderate improvement228%
Mildly improved457%
No improvement000

Adverse Effects: There were no any adverse effects or adverse drug reaction was noted during and after the study duration.

Discussion

Ardhavabhedaka is a type of Shiroroga

with the cardinal feature of unilateral headache. This disease can be correlated to Migraine based on the clinical manifestations. In present study Shirah‑Shoola (headache) was taken as chief complain and all patients were found with these symptoms. Along with headache there were associated complaints like nausea, vomiting, vertigo, phonophobia and photophobia. Among this nausea and vomiting indicates vitation of Rasavaha Srotasa. Photophobia and phonophobia is not specified as symptoms in Ardhavabhedaka, but in the progressive stage of disease, loss of vision and hearing impairment (Nayana and Shravana Vinashyet) may be present as complication. Hence, photophobia and phonophobia may be considered as systemic manifestations of the disease. In the present study, the result shows, 68 % relief in headache, 81% relief in nature of headache, 61% relief in frequency of headache, in vomiting, vertigo, phonophobia and photophobia result found was statistically significant. All these patients had to take analgesic medicine before treatment but after treatment none of the patients had to take analgesics for the same.

Probable mode of action of Nasya

In Nasya Purva Karma, Abhyanga and Swedana were done. Doshas aggregate and become Mruduta due to Abhyanga and Vilayana (liquification) due to Swedana. Modern science describes Abhyanga and Swedana as increasing the local blood flow and liquefying mucus, respectively. Vasodilatation causes an increase in blood vessel permeability, which speeds up medication absorption.

In Pradhana Karma, the patient lies head-low and receives the medicine in Churna form through Pradhamana Nadiyantra(powder of drugs) is administered (inhaled) by Nasal passage with the help of Nadi Yantra (Shadangula Nadi both side open ended).[14] so that the medicine may enter into the nostrils. As a result, the medications enter the Shringataka and spreading via Siras to other regions such as Netra and Shirah where they eliminate the morbid Doshas.[15] Transnasal drugs in powder form may stimulate the limbic system and hypothalamus.[16] The action of Nasya explained in Ayurvedic Classic Ashtanga Sangraha as the medicines administered through nostrils can reach up to the brain and it draws out the entire vitiated Doshas.[17] This correlation may be due to the wide spectrum of Nasya as it can be applied to various disorders of head and neck in various forms.


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Vidangadi Pradhmana Nasya helps in treating Ardhavabhedaka by restoring the vitiated states of Vata and Kapha. Nasya's qualities, such as Katu, Laghu, Snigdha, and ush ana Tikshna, have the ability to reduce vitiated Dosha. Krishna Tila has properties of ‘Yogavahi’ & Sukshma which help in cleansing Srotas, thereby improving functions of Srotas, which in turn helps in nourishment and formation of good quality tissues. Due to the Vata and Kapha Doshas being mostly aggravated in Ardhavabhedak, Vidanga and Krishna Tila have the ability to effectively combat the Doshas which are responsible for the disease. This medication may be administered as Shodhana Nasya. Since the issue is head-related, NASA is the closest option for Shodhan Krama. Nasya is an easy-to-use and successful treatment for Ardhavabhedak

This type of Nasya is instilled using medicated Churna (Powder) for Shirovirechana. It is mentioned as Dhmaapana in Charaka Samhitaa and Pradhamana in Sushruta Samhitaa.

Shirolepa - It relaxes mind and body, cure headaches, reduces body heat, prevents greying of hair, improves vision, improves memory and is also useful in Insomnia, depression and other stress related ailments. Drugs used for Thalapothichil (Shirolepa) can be altered according to different disease condition.

Conclusion

A clinical trial with Vidangadi Pradhmana Nasya and Shirolepa as external application has shown encouraging results in them management of Ardhvabhedaka. No complication was observed in the patients at the end of the study. So, this treatment protocol can be a good option for the management of Ardhvabedhaka. In the current study, as the sample is very small and the follow-up period is short, to arrive at a conclusion about the effectiveness and safety of the treatment, a clinical trial with a big sample size and a long follow-up period will be needed.

In the future, the study may prove to be a significant advancement in the treatment of Ardhavbhedaka (Migraine).

References

1. Sacco S, Braschinsky M, Ducros A, Lampl C,

Little P, van den Brink AM, et al.. European headache federation consensus on the definition of resistant and refractory migraine. J Headache Pain. (2020) 21:76. 10.1186/s10194-020-01130-5

2. Gormley P, Anttila V, Winsvold BS, Palta P, Esko T, Pers TH, et al. Meta-analysis of 375,000 individuals identifies 38 susceptibility loci for migraine. Nat Genet. 2016;48:856–66.

3. Vijayan S. Migraine: An expensive headache to the world. Available from http://thelancetstudent.com /2008/03/16/ migraine-an-expensive-headache-to-the-globe/. [last assessed on 2010 Feb 10]

4. Yadavji Trikamji, Dalhana S. Sushruta Samhita, Nibhandhasangraha vyakhya. Vol. Uttarasthana 25/15. Varanasi: Chaukhambha Surbharati Prakashan; 2012.

5. Yogaratnakara with Vidyotini hindi commentary by Vaidya Laksmipati Shastri edited by Brahmasankar Shastri, Chaukhambha Prakashan, Varanasi (Reprint 2013), Uttarardh, Shiroroga Chikitsa

6. Bhaisajya Ratnavali of Kaviraj Govind Das Sen edited by Prof. Siddhi Nandan Mishra, Chaukhamba Surbharati Prakashan.

7. Anna Moreswar Kunte, Krishna Ramachandra Shastri Navre. Ashtanga Hridaya of Vagbhata # Reprint Edition. New Delhi: Prof. V. Kutumba Shastri; 2002. p. 260.

8. Anna Moreswar Kunte, Krishna Ramachandra Shastri Navre. Ashtanga Hridaya of Vagbhata #Reprint Edition. New Delhi: Prof. V. Kutumba Shastri; 2002. p. 285.

9. Anna Moreswar Kunte, Krishna Ramachandra Shastri Navre. Ashtanga Hridaya of Vagbhata# Reprint Edition. New Delhi: Prof. V. Kutumba Shastri; 2002. p. 287.

10. Jadavaji T, Narayana R, editors. Varanasi: Chaukhamba Surbharati Prakashana; 2008. Sushruta. Sushruta Samhita Dalhana Comm. Nibandhasangraha,

11. C.Chunekar;Bhavaprakasa Nighantu of Shri Bhavamisra, Haritikyadivarga/112, Hindi commentary, Edition reprint-1999, Chaukhambha Bharati Academy, Page No-52.


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12. C.Chunekar;Bhavaprakasa Nighantu of Shri Bhavamisra, Dhanyavarga/64-65, Hindi commentary, Edition reprint-1999, Chaukhambha Bharati Academy, Page No-651.

13. K.Sharma,Bhagwan Dash,Agnivesha’s Charaka Samhita, Chowkhamba Sanskrit series office,Varanasi,2019,Siddhi sthana.9/107-110

14. Kashinath shastri and Dr. Gorakhanathchaturvedi, CharakaSamhita of charaka with Vidyostini Hindi Commentary, Sutra sthana, Reprint edition; chapter 5 versus 28-32, Varanasi: Chaukhambhabharati academy, 2013; 118

15. Sharma IS, editor. Varanasi: Chowkhamba Sanskrit Series Office; 2006. Ashtanga Samgrah. Shashilekha comm. Gayadasacharya comm. Nyayachandrika Panjika on Nidanasthana; pp. 40–2.

16. Ramteke RS, Patil PD, Thakar AB. Efficacy of Nasya (nasal medication) in coma: A case study. Anc Sci Life 2016 Apr Jun; 35(4): 232-5. Available from URL https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4995859/

17. Brahmanand Tripathi, Charak Samhita. vol 2, Siddhisthana 9/107; Chaukhamba Surbharati Prakashan Varanasi; reprint 2005; page no. 795


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