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CASE REPORT IJATM.2020;2(3):35-40.
Management of Ardhavabhedaka
(Migraine) through Panchakarma
(Five internal
Bio-Cleansing Therapies).
Avvinish Narine,1 Gopesh Mangal1
1Department of Panchakarma, National Institute of Ayurveda, Jaipur, India.
Migraine is a condition marked by recurrent moderate to severe headache with throbbing pain that usually lasts from hours to
days. It typically begins on one side of the head but may spread to both sides and is frequently accompanied by symptoms
such as nausea and vomiting. Some causative factors of migraine may include stress and tiredness.
It is the second most common reason behind cerebral pains and it usually affects around 15-20% of the general population
worldwide. With the widespread use of over the counter medicines nowadays, the pattern of the disease has evolved and the
medicine used, only temporarily subsides the symptoms, while the root cause of the underlying pathology remains untouched.
Ardhavabhedaka can be scientifically correlated with migraine, due to its cardinal features of “half sided headache”.
According to Ayurvedic Samhita
, all the three Dosha (Regulatory functional factors of the body) are involved in the
manifestation of Ardhavabhedaka
, with the predominance of Vata (Do
ṣ
ha
responsible for movement and cognition) or
Vata
-Kapha Dosha (Kapha Do
ṣ
ha
responsible for regulating body fluids and keeping the body constituents cohesive).
Management of these Dosha
(Regulatory functional factors of the body)
can be done through Panchakarma (Five internal
Bio- Cleansing Therapies) like Nasya Karma (Medication through Nasal route), Abhyanga
(Therapeutic Massage)
and
Swedana
(Sudation Therapy).
Recently,
these therapies have been gaining popularity in the holistic treatment of
Ardhavabhedaka
(migraine).
In this study, a 39-year-old male patient was selected, based on the classical symptoms of Ardhavabhedaka
. He was then
administered Shamana Chikitsa (Palliative procedures) with selected medications, while undergoing Nasya Karma
(Medication through Nasal route)
with Shadbindu Taila along with Sarvanga Abhyanga (Therapeutic Massage)
and Swedana
(Sudation Therapy). After completion of the treatment course, considerable improvement was observed in the clinical
symptoms of Ardhavabhedaka
.
_________________________________________________________________________________
Keywords: Abhyanga
; Ardhavabhedaka
; Migraine Disorders; Nasya; Swedana
.
________________________________________________________________________________
Ardhavabhedaka is one of the Urdhavajatrugataroga
(Disorders above the clavicle)
mentioned in Ayurveda
classics that can be clinically correlated with migraine. Its
symptoms include unilateral half sided headache with
associated complaints of vertigo, nausea, photophobia and
phonophobia. The most sensitive criteria for migraine is
IJATM I VOL 2 I ISSUE 3 I DEC 2020
35 Free Full Text Articles are Available at https://ijatm.org/
International Journal of Ayurveda and Traditional Medicine
ABSTRACT
INTRODUCTION
Correspondence: Dr. Avvinish Narine,
Department of Panchakarma, National Institute of
Ayurveda, Jaipur, India. Email:
dr.anarine@icloud.com, Phone: +91-9971216140.
Avvinish Narine, Gopesh Mangal. Management of Ardhavabhedaka
(Migraine) through Panchakarma
(Five internal Bio-Cleansing Therapies).
headache that aggravates with activity, stress and
tiredness. The vascular theory of the brain suggests that
pain appears to be related to the desensitization of
peripheral perivascular nerve terminals and possibly a
consequence of distended meningeal blood vessels
leading to activation and sensitization of the central
trigeminal system.1The prevalence of migraine cases
recorded in India is approximately 16-20% of the
population.2
The World Health Organization (W.H.O.) ranks migraine
as one of the diseases wherein the causative factor is not
exactly known and furthermore states that it is one of the
world’s most disabling medical illnesses. It is three times
more common in women than in men and usually occurs
in the prime stage of life from 2nd decade to 5th decade.3
This usually has a negative influence on professional and
social activities.
Modern medicine states that there is no proper
standardized line of treatment in the management of
migraine and as such, acute conditions of migraine are
usually dealt with by using over-the-counter medications,
while chronic conditions are usually more prevalent and
difficult to treat. The treatment modalities hence adopted
are non-pharmacological and pharmacotherapy. The
non-pharmacological methods include, but are not limited
to; identification of triggers, meditation, relaxation
training and psychotherapy. In the pharmacotherapy
method, medicines like aspirin, paracetamol, ibuprofen
and diclofenac are most commonly used.4
Urdhvajatrugata Roga (disorders above the clavicle) and
their management has a special mention in Ayurvedic
texts, as Shira (head) is considered the prime seat of
knowledge and the controller of the entire body, as such it
is referred to as the Uttamanga (superlative organ).5
Acharya Sushruta has explained 11 types of Shiroroga
6
(diseases of the head), with one of them being
Ardhavabhedaka (migraine), which presents as a
paroxysmal unilateral headache associated with vertigo
and pain of varying intensity.7Nasa
(nose) is considered
as the gateway of the Shira (head), and Nasya Karma
(Medication through nasal route)
is specifically indicated
to clear away the diseases located in the head, since
medication is administered through the nostrils.
Ayurveda provides a unique line of treatment which
includes Panchakarma (Five internal Bio- Cleansing
Therapies), of which only a selected few were applied in
this study i.e Sarvanga Abhyanga (Therapeutic Massage)
and Swedana
(Sudation Therapy), Nasya Karma
(Medication through Nasal route)
and Shamana Chikitsa
(Palliative procedures). In this case study,
Ardhavabhedaka has been correlated with migraine and
the treatment schedules were carefully planned out to
achieve a holistic effect on the patient. This study was
conducted to observe the overall effect of Shaman
Chikitsa
,Nasya Karma and Sarvanga Abhyanga
/Swedana
in the management of Ardhavabhedaka.
A 39-year-old male patient presented to the O.P.D. of
National Institute of Ayurveda (N.I.A.), Jaipur (O.P.D.
Reg. no: 61887012020) with complaints of headache,
vertigo, nausea and very rarely vomiting; for the past 20
years. He had no history of any other illness or accidents
within the specified period, and he was not taking any
other medications. He has reported continuous, unilateral
headache reportedly in the frontal lobe during each
episode, onset is insidious. The nature of the pain is of
throbbing type. His job usually entails working long hours
away from home and it is reportedly a highly stressful
environment. Family history revealed that his mother and
maternal uncle suffered from the same type of complaints.
He usually takes allopathic treatment, but within the last
few years, the effectiveness has decreased, which led him
to visit the O.P.D. of N.I.A.
Intervention
The patient was admitted to the Panchakarma
Department I.P.D., at the National Institute of Ayurveda,
Jaipur. While there, he was administered Sarvanga
Abhyanga
(Therapeutic Massage)
with Dashmoola Taila
and Sarvanga Swedana
(Sudation Therapy) for
approximately 20 minutes, followed
by Nasya Karma
(Medication through nasal route)
with Shadbindu Taila
daily, usually between the hours of 9:00am to 11:00am,
for 14 days (Table 1). Along with Dashamoola Kwatha
40ml BD, combination of; Sitopladi Churna 3g,
Ashwagandha Churna 2g, Shatavari Churna 2g, Shankha
Bhasma 250mg BD, and Panchsakara Churna 6g HS,
orally (Table 2).
36 IJATM I VOL 2 I ISSUE 3 I DEC 2020
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CASE REPORT
Avvinish Narine, Gopesh Mangal. Management of Ardhavabhedaka
(Migraine) through Panchakarma
(Five internal Bio-Cleansing Therapies).
Treatment Schedule
Results:
Upon admission, the patient’s assessment was conducted
using the MIDAS.8Grading scale along with the Migraine
Specific Quality of Life Questionnaire 9to record the
intensity of the migraine episodes and how it affects his
daily activities and quality of life.
It can clearly be observed from the assessment criteria
adopted, that the patient had noticeably significant
improvement in the migraine complaints (From a MIDAS
score of 12 before treatment and 5 after treatment) and
good improvement in the quality of life from a score of 47
before treatment and 30 after treatment (Table 3).
Assessment Criteria:
Doshic involvement in Ardhavabhedaka according to
different Acharya
Different Acharya of Ayurveda have enumerated slightly
varying Doshic (Regulatory functional factors of the
body) involvement in the manifestation of
Ardhavabhedaka
(Migraine), but the precipitating factors
remain very similar. According to Acharya Charaka,
10
there is involvement of Vata and Vata Pradhana Kapha
Dosha
. While Acharya Sushruta
11 mentioned that there is
Tridosha involvement. Acharya Vagbhatta
12 has
mentioned that Ardhavabhedaka is caused by only Vata
Dosha
.Acharya Dalhana states that Ardhavabhedaka
manifests due to Vata and Pitta Dosha involvement. The
common denomination here being Vata Dosha
, which is
mainly responsible for the onset of pain.
Table 1. Schedule of Sarvang Abhyanga and Swedana and Nasya Karma
DAYS→
Procedure↓
1
2
3
4
5
6
7
8
9
10
11
12
13
14
Sarvang Abhyanga
& Sarvang Swedana
√
√
√
√
√
√
√
√
√
√
√
√
√
√
Nasya Karma
Dose: 4-6 Drops
√
√
√
√
√
√
√
√
√
√
√
√
√
√
Table 2. Ayurvedic medicines administered with
dosages
Ayurvedic
Medicines
Dosage and Time
Taken
Dashamoola
Kwatha
40 ml twice daily, before
meals.
1. Sitopaladi
Churna
3g
2. Ashwagandha Churna
2g
3. Shatavari Churna
2g
4. Shankha Bhasma 250
mg
Twice daily with
lukewarm water, before
meals.
(All medicines were
combined and made into
one dose. The specified
dose was given to the
patient daily.)
Panchsakara
Churna
6g
Once a day, before
sleeping, with lukewarm
water.
Table 3.
Assessment Before and After Treatment.
S.No
.
Assessment
Criteria
Before
Treatment
(B.T.)
After
Treatment
(A.T.)
1.
MIDAS Grade
MIDAS
Score 12
(Moderate
Disability)
MIDAS Score
5
(Little to no
disability)
2.
Migraine
Specific
Quality of Life
Questionnaire
47
30
DISCUSSION
IJATM I VOL 2 I ISSUE 3 I DEC 2020
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37
Avvinish Narine, Gopesh Mangal. Management of Ardhavabhedaka
(Migraine) through Panchakarma
(Five internal Bio-Cleansing Therapies).
Probable mode of action of Shadbindu
Taila
:-
Shadbindu Taila is a polyherbo-mineral Ayurvedic
formulation prescribed widely for several conditions,
especially Siroroga
(diseases of head), in this case
Ardhavabhedaka
. Following are the ingredients used for
the preparation.
Sneha Dravya: Murcchita Krishna Tila Taila (processed
oil from black seeds of Sesamum indicum
L.
Drava Dravya
:Bhringa Rasa
(juice obtained from the
plant of Eclipta alba
(L.)
Hassk and Aja Paya
(goat milk)
Kalka Dravya
: A fine paste obtained from the powdered
mixture of Eranda
(Ricinus communis
L.), Tagara
(Valeriana wallichii
DC.
), Shatahva (Anethum sowa
Roxb.
), Jivanti
(Leptadenia reticulata
[Retz.] Wight and
Arn.
), Rasna
(Alpinia galanga
(L.) Swartz
), Bhringa
(Eclipta alba
(L.) Hassk.
), Vidanga
(Embelia ribes
Burm.f.
), Yashti
(Glycyrrhiza glabra
L.)
and Shunthi
(Zingiber officinale
Roscoe.) and Saindhava Lavana
:
Rock salt.
Properties of some of the Dravyas used are as follows:
Tila Taila is Vata Shamak
,Bhringa Rasa is Kapha
Shamak, Eranda is Vata Shamak
,Tagar is Vata
/Kapha
Shamak
,Shatahva is Vata
/Kapha Shamak
,Jivanti is
Tridosahara
,Rasna is Kapha Shamak
,Vidanga is
Vata/Kapha Shamak, Yasthi
is Tridosahara.
Probable mode of action of Shamaka Aushadhi:
Dashamoola Kwatha
and Dashamoola Taila is a
well-known and common polyherbal combination of ten
roots of certain plants used in Ayurveda to treat a variety
of ailments, especially those of Vata Dosha origin.
“Dasha” means ten and “Moola” or “Mula''
means roots.
It is Tridoshahara and some studies suggest it exhibits
aspirin-like antipyretic and anti-inflammatory effects.
Properties of the contents of Dashamoola Kwatha and
Dashamoola Taila are as follows: (1) Bilva (Aegle
marmelos
) which is Vata/ Kapha Shamaka
, (2)
Agnimantha (Premna obtusifolia
) which is Vata
Shamaka
, (3) Patala (Stereospermum suaveolens
DC.) is
Vata/Kapha Shamaka
, (4) Kashmari/Gambhari (Gmelina
arborea
Linn.) is Kapha Shamaka
, (5) Shyonak
(Oroxylum indicum
) , (6) Trikantaka (Tribulus terrestris
Linn.) is Vata Shamaka
, (7) Kantakari (Solanum
xanthocarpum
) is Vata/Kapha Shamaka
, (8) Brihati
(Solanum indicum
Linn) is Vata Shamaka
, (9,10)
Prishniparni and Shaliparni (Uraria picta
Desv. &
Desmodium gangeticum
DC.
) is Tridoshahara
.
Sitopaladi Churna has the property of Vata/Pitta
Shamaka
,Ashwagandha Churna is Vata/Kapha Shamak
and increases Pitta
,Shatavari Churna is Vata/Pitta
Shamaka, Medhya and Vedana Sthapana
,Shanka Bhasma
is Vata/Pitta Shamaka and aids in nausea, Panchsakara
Churna
is Vata/Kapha Shamaka
.
Since the contents of Shadbindu Taila
,Dashamoola
Kwatha, Sitopaladi Churna, Ashwagandha Churna,
Shatavari Churna, Shankha Bhasma
and Panchsakara
Churna are mentioned, it can clearly be seen that most of
the ingredients are directly acting on the causative factors
of Ardhavabhedaka i.e. Vata and Kapha Dosha
. The drug
also must contain the Doshapratyanika properties. So,
Vata
and Kapha Dosha are directly pacified by the
administration of the selected medications, hence by all
virtues narrated above they are effective in the overall
treatment, by reducing the symptoms presented in
Ardhavabhedaka
.
Action of Sarvanga Abhyanga/ Swedana
The main purpose of Abhyanga and Swedana among
other points, is to pacify the aggravated Vata Dosha,
Kapha Dosha and in the treatment of Vata-Kapha Roga
(diseases) in which context it comes under Shamana
Chikitsa
(treatment).
Swedana not only includes the appearance of sweating but
it is administered until the relief of pain, coldness,
stiffness of the body.13 It liquefies the Dosha and Mala
(waste products) and brings it to a part of the body where
it can be eliminated, which causes cleansing of the Srotas
(Channels). It is also indicated for pain in the ear, neck
and head, and mainly diseases caused by Vata Dosha.
14
Abhyanga is done by massaging the body with any Sneha
in the direction of the hair follicles. By performing
Abhyanga
, the body becomes strong and resistance is
built up against stressful situations. Application of oil in
this manner
prevents headaches, greying of the hairs and
induces a sound sleep. It has a very soothing effect on the
nervous system, which is controlled by Vata Dosha
.
Hence, it is very beneficial for those people stuck in
stressful job situations.
Since, Vata and Kapha Dosha Sthana (local sites) are
different, from a holistic point of view, it would be
sensible to target those sites, to bring about the desired
effect. In doing so, the patient would be more relaxed, the
38 IJATM I VOL 2 I ISSUE 3 I DEC 2020
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Avvinish Narine, Gopesh Mangal. Management of Ardhavabhedaka
(Migraine) through Panchakarma
(Five internal Bio-Cleansing Therapies).
Dosha would be pacified and the overall effect would be
beneficial to the patient.
Action of Nasya Karma
It is explained that since Nasa being the doorway to
Shira
, the drug administered through the nostrils reaches
Sringaataka
, a Siramarma
by Nasa Srota and spreads in
the Murdha (~brain), taking routes of Netra (eyes),
Shrotra (ears), Kantha (throat) Sira and Mukha,
gathering
the morbid Dosha in Urdwajatru
and then extracting from
the Uttamanga
. The aqueous part of the active principle
will be easily absorbed through mucous membrane (nasal
mucosa, olfactory mucosa) and fat soluble active principle
can be easily assimilated through the nerve endings
(trigeminal and olfactory). When the Nasya Dravya is
administered through the nasal cavity, the drug gets
absorbed by the passive process across the cell wall
directly through the cell membrane as lipid soluble
medicine has greater passive absorption.
The preoperative procedures (Poorvakarma
) of Nasya
Karma play a major role in the access of the drug into the
body. The lowering of the head, elevation of lower
extremities and fomentation of face seems to have an
impact on blood circulation of the head and face. As the
efferent vasodilator nerves are spread out on the
superficial surface of the face, they receive stimulation by
fomentation and it may cause the increased blood flow to
the brain. Lowering of the head plays a major role in the
spread of medicine to the sinus ostia.
The drugs used in the preparation of all these drugs have
Kapha Vata Nashaka
and Srotoshodhaka
properties.
These drugs used for Nasya Karma help in stimulation of
vasodilator nerves which are spread out on the superficial
surface of Urdhwanga
, this increases the blood circulation
to the brain. With all these factors being considered, it can
thus be said that Nasya Karma brings effective relief to
the patient suffering from migraine.
The present case study signifies the role of Ayurvedic
therapies in the management of Ardhavabhedaka
(migraine). The human body as a whole, works by smaller
systems performing different tasks. Thus, by adopting a
holistic approach to the causative Dosha
, and treating the
whole system, rather than just a part of it, the patient can
have significant relief in symptoms in a relatively short
space of time, provided treatment is done timely and
whole-heartedly. Despite the limitations of this case
study, it can be said that Panchakarma therapies like
Sarvang Abhyanga and Swedana
,Nasya Karma
and
Ayurvedic
Oral Medications
is a simple, holistic, yet
effective treatment modality in Ardhavabhedaka
, without
having any adverse effects to the patient. The treatment
adopted here needs to be administered to a larger number
of the population for better assessment of the results. If
this is done, then the wonderful benefit of Panchakarma
therapies can be ascertained and promoted as a reliable
treatment in the management of Ardhavabhedaka
.
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40 IJATM I VOL 2 I ISSUE 3 I DEC 2020
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Source of Support: Nil
Conflict Of Interest: None Declared
Consent: The consent was signed by the patient and
the original article is attached with the patient’s chart
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