E-ISSN:2456-3110

Case Report

Severe Migraine

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 8 AUGUST
Publisherwww.maharshicharaka.in

The significant relief of Ayurvedic management for Severe Migraine Episodes: A Case Study

Pohiya R1*, Singh D2, Mishra PK3, Sharma I4
DOI:10.21760/jaims.9.8.39

1* Ritu Pohiya, Post Graduate Scholar, PG Department of Kayachikitsa, Post Graduate Institute of Ayurved Jodhpur Dr Sarvepalli Radhakrishnan Rajasthan Ayurved University, Jodhpur, Rajasthan, India.

2 Devjinder Singh, Post Graduate Scholar, PG Department of Rog Nidan Evum Vikruti Vigyan, Pt. Khusilal Sharma (Auto) Ayurvedic College and Hospital, Bhopal, Madhya Pradesh, India.

3 Pramod Kumar Mishra, Professor and HOD, PG Department of Kayachikitsa, Post Graduate Institute of Ayurved, Jodhpur, Dr. Sarvepalli Radhakrishnan Rajasthan Ayurved University, Jodhpur, Rajasthan, India.

4 Indumati Sharma, Associate Professor, PG Department of Kayachikitsa, Madan Mohan Malviya Ayurved Mahavidyalaya, Udaipur, Rajasthan, India.

Migraine is a common and debilitating neurological disorder marked by recurrent, severe headaches that are frequently accompanied by nausea, sensitivity to light, and sensitivity to sound. These migraine attacks can profoundly disrupt daily life and overall well-being. The development of migraines is influenced by a complex interaction of genetic, environmental, and neurovascular factors. Recent studies have enhanced our understanding of migraine mechanisms, highlighting the role of cortical spreading depression and neuropeptides such as calcitonin gene-related peptide (CGRP). Managing migraines effectively often involves a combination of lifestyle changes, medications, and, in some cases, alternative treatments. In Ayurveda, migraine is compared with Ardhavbhedaka (half-headache) which belongs to the Shiroroga. Ardhavbhedaka is primarily associated with imbalances in the Pitta and Vata Doshas due to etiological factors such as eating dry food, eating immediately after a meal, exposure to air from the east, dew, excessive sexual activity, preventing the natural urge of bodily waste, excessive physical labor, develop Ardhavbhedaka.

Keywords: Migraine, Shiroroga, Ardhavbhedaka, Pitta, Vata

Corresponding Author How to Cite this Article To Browse
Ritu Pohiya, Post Graduate Scholar, PG Department of Kayachikitsa, Post Graduate Institute of Ayurved Jodhpur Dr Sarvepalli Radhakrishnan Rajasthan Ayurved University, Jodhpur, Rajasthan, India.
Email: 		Pohiya R, Singh D, Mishra PK, Sharma I, The significant relief of Ayurvedic management for Severe Migraine Episodes: A Case Study. J Ayu Int Med Sci. 2024;9(8):257-261.
Available From
https://jaims.in/jaims/article/view/3744

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-07-14 2024-07-24 2024-08-04 2024-08-14 2024-08-21
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 12.32

© 2024by Pohiya R, Singh D, Mishra PK, Sharma Iand 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

Migraine is a complex and debilitating neurological disorder characterized by recurrent, severe headaches often accompanied by nausea, vomiting, and sensitivity to light and sound. Migraines affect approximately 12% of the global population and pose a significant public health challenge due to their impact on quality of life and productivity.[1] The pathophysiology of migraines involves genetic, environmental, and neurobiological factors, which complicate diagnosis and treatment.[2]

Recent advancements in our understanding of migraine have highlighted the role of cortical spreading depression and the trigemino vascular system in the initiation and progression of migraine attacks.[3] Despite these insights, effective management remains challenging due to the variability in individual response to treatments and the diverse range of migraine subtypes.[4]

This case study aims to explore the intricacies of migraine through a detailed examination of a patient’s experience with chronic migraine. By analyzing the patient’s symptoms, triggers, and response to various treatments, this study seeks to contribute to the growing body of knowledge on effective management strategies and potential areas for future research.[5] In Ayurveda, the management of Ardavvedaka involves a holistic approach integrating dietary modifications, herbal therapies, Panchakarma (detoxification therapies), and lifestyle changes to restore dosha balance and alleviate symptoms. Treatments often include the use of specific Shaman Aushadh such as Guduchi Sattva, Pathyadi Kwath, Ashwagandha (Withania somnifera) etc. which are believed to pacify aggravated Doshas and support mental clarity and relaxation.

Case Report

A 30-year-old female patient came to the Kayachikitsa OPD of Sanjivani Chikitsalaya, DSRRAU Jodhpur with a history of

Demographic data

  • Age: 30 years
  • Sex: female
  • Religion: Sikh
  • Education: Graduate
  • Occupation: Housewife
  • Marital status: Married
  • Socio-economic status: Lower Middle class

Presenting complaints with duration

SNComplaintsDuration
1.Headache (left temporal region), Neck pain and tenderness2-Year
2.Nausea2-Year
3.Vomiting2-Year
4.Photophobia2-Year
5.Phonophobia2-Year
6.Sleep disturbed due to pain2-Year
7.Vertigoon/off
8.Fatigue: A marked sense of exhaustion or lack of energy that can occur during or after a migraine attack.2-Years
9.Irritability: Mood changes, such as becoming easily annoyed or agitated.2-Years

History of present illness

A 30-year-old female patient visited the Kayachikitsa OPD of Sanjivani Chikitsalaya, DSRRAU Jodhpur and presented with chief complaints of headaches involving the left half side (temporal region) for the last 2 years with an interval of 20 days per month. The severity of the headache increased in the last 6 months, with an episodic attack at intervals of 3-4 days.

Associated complaints were irritability, nausea, anger, and pulse, Aggravating factors of headache were stress, hunger, sunlight, noisy surroundings, and crowds whereas relieving factors were only strong analgesics of modern science. The patient was diagnosed with Migraine (Ardhavabhedaka).

Assessment of Pain: (Based on Socrates)

SNAssessmentSymptoms
1.SiteLeft temporal region
2.OnsetChronic
3.CharacterThrobbing pain
4.RadiationNo radiate
5.Associated SymptomsNausea, vomiting,
6.Timing/duration2 years
7.ExacerbationIncreased with exposure to light, and sound
8.SeveritySevere

Family history: No family history related to disease


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    Personal history:
  • Diet: Vegetarian
  • Appetite: Good
  • Bowel: Clear
  • Sleep: Disturbed due to pain
  • Micturition: 4 - times/day
  • 0: times/night
Treatment history: Ergomar, Compazine, Pamelor, fremanezumab, and Naproxen for the Last 2 years.

General Examination

  • Pulse - 78bpm
  • P. - 110/80 mm of Hg
  • - 98.6°F
  • RR - 16/min.
  • Pain - Left Temporal Region
  • Pallor - Absent
  • Icterus - Absent
  • Clubbing - Absent
  • Cyanosis - Absent
  • Oedema - Absent

Systemic examination of the cervical spine

  • Inspection: No Protracted cervical spine
  • Palpation: Tenderness over C3, C4, vertebrae
  • Spurling’s test: Negative (No radicular pain)

Examination of the ear

External Inspection

  • Auricle and Ear Canal: No signs of infection, inflammation, trauma, and any discharge.

Otoscopy

  • Ear Canal: No obstruction
  • Tympanic Membrane: No signs of infection (e.g., redness, bulging), perforation, or fluid behind it (e.g., otitis media).

Hearing Tests

  • Weber Test: No conductive or sensorineural hearing loss.
  • Rinne Test: Negative Rinne test

Balance Tests

  • Romberg Test: Negative Romberg test
  • Dix-Hallpike Maneuver: Negative

Through a detailed assessment of the patient’s medical history and a careful physical examination, a diagnosis was made. Based on this diagnosis, an appropriate treatment regimen was then prescribed to manage the condition.

SNMedicineDoseDurationAnupana
1.Pathyadi Kwath 20 ml with the same quantity of water bd1 monthJaggery, Ghee
2.Ashwagandha Churna
Shirashooladi Vajra Ras
Mahavata Vidhvansan Ras
Kamdudha Ras (Mukta Yukt)
Godanti Bhasma
Guduchi Sattva 		3 gm
250 mg
250 mg
250 mg
500 mg
500 mg		1 monthJaggery, Ghee
  • Subjective Criteria Pain will be assessed using the Numeric Pain Rating Scale before and after the treatment.
  • Disability will be assessed using the MIDAS questionnaire, before the treatment and after the fourth follow-up.

Effect of therapy on symptoms of Migraine

SNSymptomsBTAT
1.Intensity of headache80
2.Nausea80
3.Vomiting70
4.Photophobia91
5.Phonophobia71
6.Sleep disturbed due to pain90
7.Vertigo30
8.Fatigue61
9.Irritability81

Numeric Pain Rating Scale(NPRS)

jaims_3744_01.JPG

MIDAS Grade:3 Score 17 (Moderate Disability)

The Migraine Disability Assessment Test

The MIDAS (Migraine Disability Assessment) questionnaire was put together to help you measure the impact your headaches have on your life.


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The information on this questionnaire is also helpful for your primary care provider to determine the level of pain and disability caused by your headaches and to find the best treatment for you.

Instructions

Please answer the following questions about ALL of the headaches you have had over the last 3 months. Select your answer in the box next to each question. Select zero if you did not have the activity in the last 3 months. Please take the completed form to your healthcare professional.

  • On how many days in the last 3 months did you miss work or school because of your headaches?
  • How many days in the last 3 months was your productivity at work or school reduced by half or more because of your headaches? (Do not include days you counted in question 1 where you missed work or school.)
  • On how many days in the last 3 months did you not do household work (such as housework, home repairs and maintenance, shopping, caring for children and relatives) because of your headaches?
  • How many days in the last 3 months was your productivity in household work reduced by half of more because of your headaches? (Do not include days you counted in question 3 where you did not do household work.)
  • On how many days in the last 3 months did you miss family, social or leisure activities because of your headaches?
  • On how many days in the last 3 months did you have a headache? (If a headache lasted more than 1 day, count each day.)
  • On a scale of 0 - 10, on average how painful were these headaches? (Where 0=no pain at all, and 10= pain as bad as it can be.)

Scoring: After you have filled out this questionnaire, add the total number of days from questions 1-5 (ignore A and B).

Total (Questions 1-5)

Midas GradeDefinitionMidas Score
ILittle or No Disability0-5
IIMild Disability6-10
IIIModerate Disability11-20
IVSevere Disability21+
  • On how many days in the last 3 months did you have a headache? (If a headache lasted more than 1 day, count each day.)
  • On a scale of 0 - 10, on average how painful were these headaches? (where 0 - No pain at all, and 10 pain is as bad as it can be.)

Scoring: After you have filled out this questionnaire, add the total number of days from questions 1-5 (ignore A and B).

Discussion on Shaman Aushad

  • Pathyadi Kwath: Facilitates the optimal functioning of digestive fire (Agni) and enhances metabolic processes.
  • Ashwagandha Churn: Anti-anxiety and Stress Relief and It is known for its calming effects, which help in reducing symptoms of anxiety and stress.

Ashwagandha is considered to balance all three Doshas (Vata, Pitta, and Kapha).

It is particularly useful for balancing Vata and Pitta Doshas.

  • Shirashooladi Vajra Ras: The formulation is believed to balance all three Doshas (Vata, Pitta, and Kapha), though its primary action is often associated with balancing Vata and Shira Shoolaadi Vajra Ras has a heating potency (Ushna) which helps in alleviating cold or damp conditions in the body.
  • Mahavata Vidhvansan Ras: Helps in balancing Vata Dosha, it reduces inflammation, and it can potentially help decrease the frequency and severity of migraine attacks.
  • Kamdudharas (Mukta Yukt): Kamdhudha Ras is a classical Ayurvedic formulation primarily used to balance Pitta dosha. It’s a mineral-herbal compound with a history of use in treating various conditions related to heat and inflammation.
  • Godanti Bhasma: Godanti Bhasma is believed to balance Pitta Dosha and reduce inflammation, which may help alleviate migraine symptoms. It is thought to have cooling and soothing effects.
  • Godanti Bhasma is said to work by neutralizing excess Pitta and reducing inflammation.
  • This can theoretically help with the heat and intensity associated with migraines.

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  • The exact mechanisms of Godanti Bhasma are limited. However, understanding its primary
  • Ingredient, gypsum, suggests potential roles in calcium regulation and its impact on nerve function and inflammation.
  • Guduchi Sattva: Guduchi has potential benefits in reducing inflammation, improving immunity, and managing stress, all of which could impact migraine management.

Guduchi is known for its ability to balance all three Doshas (Vata, Pitta, and Kapha). It is particularly beneficial for balancing Pitta due to its cooling properties.

Conclusion

In the present case, the Ayurvedic diagnosis of (Ardhavabhedaka) is made for ‘Migraine. This case study reveals that Ayurvedic treatments, such as Pathyadi Kwath, Ashwagandha Churna, and Giloy Satva, can effectively alleviate migraines, as demonstrated by the notable improvement in the patient's symptoms. The significant decrease in headache severity, nausea, and light sensitivity, along with the overall enhancement in the patient’s quality of life, highlights the effectiveness of these remedies. These results suggest that Ayurvedic medicine could serve as a valuable alternative for managing migraines, particularly for those who do not achieve satisfactory results from conventional therapies. Additional research is needed to validate these outcomes and refine treatment approaches for wider use.

References

1. Denuelle, M., Lucas, C., & Payoux, P. (2020). Cortical spreading depression and its relationship with migraine. Frontiers in Neurology, 11, 123.
2. Goadsby, P. J., Holland, P. R., & Martins-Oliveira, M. (2017). Migraine pathophysiology: a review. Journal of Neurology, 264(1), 85-98.
3. Lipton, R. B., Bigal, M. E., & Diamond, M. (2018). Migraine prevalence, disability, and health care utilization in the United States: results from the American Migraine Study II. Headache: The Journal of Head and Face Pain, 48(6), 855-865.
4. Meyer, G., & Robson, S. (2021). The global burden of migraine. Current Neurology and Neuroscience Reports, 21(5), 28.

5. Saylor, D., Hsu, J., & Schramm, S. (2022). Case studies in chronic migraine: insights into treatment strategies. Headache Medicine, 13(2), 45-54.


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