Headache

Tension type headache

Tension headache is the most common type of primary headache. The pain can radiate from the neck, back, eyes, or other muscle groups in the body. A tension-type headache is the most commonly seen headache.

Symptoms

The pain is usually mild to moderate. These headaches originate in the occipital or frontal region bilaterally and spread over the entire head. It is often described as a constant pressure, as if the head were being squeezed in a vise. The pain is frequently bilateral which means it is present on both sides of the head at once.

Potential triggers for chronic tension-type headache include sleep disturbances, stress,

eyestrain etc.

Frequency and duration

Tension-type headaches can be episodic or chronic.

Episodic tension-type headaches are defined as tension-type headaches occurring fewer than 15 days a month, whereas

Chronic tension headaches occur 15 days or more a month for at least 6 months.

Tension-type headaches can last from minutes to days, months or even years, though a typical tension headache lasts 4–6 hours.

Cause

Stress: usually occurs in the afternoon after long stressful work hours or after an exam

Sleep deprivation Uncomfortable stressful position and/or bad posture Irregular meal time (hunger) Eyestrain Caffeine withdrawal Dehydration

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Migraine

A migraine headache is throbbing, moderate to serve pain, usually on one side of the head, that is worsened by physical activity, light, sounds or smells and that is associated with nausea and vomiting.

Migraine is an episodic primary headache disorder. Symptoms typically last 4 to 72 h and

may be severe.

Symptoms

Throbbing type of pain is typically felt on one side of the head. The pain may be

moderate but is often severe and incapacitating. Physical activity, light, sounds or smells

may make the headache worse. The headache is often accompanied by nausea, sometimes

with vomiting.

The migraine attack often involves more than a headache. It may include a prodrome, an

aura and a postdrome. The prodrome is a change in mood or behavior, which can precede

the rest of the migraine by 24 hours. People may become depressed, elated, irritable or

restless.

Nausea or loss of appetite may also occur. Above 20% of people experience an aura. The

aura involves temporary reversible disturbances in vision, sensation, balance, movement

or speech. Commonly, people see jagged, shimmering or flashing lights or develop a

blind spot with flickering edges. Less commonly, people experience tingling sensations,

loss of balance, weakness in an arm or leg or difficulty talking. The aura occurs within

the hour before the migraine and ends as the migraine begins.

About 25% of people experience a post drome which involves changes in mood and

behavior after the migraine. Migraine attacks may occur frequently for a long period of

time but then may disappear for many weeks, months or even years.

Migraines are diagnosed on the basis of symptoms. No procedure can confirm the

diagnosis. If headaches are developed recently or if the pattern of symptoms has changed,

CT or MRI of the head is perform is to exclude other disorders.

Sinusitis

Sinusitis is inflammation of the paranasal sinuses, most commonly caused by an allergy or infection.

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Causes

Acute sinusitis

Acute sinusitis may be caused by a variety of bacteria and often develops after something blocks the openings to the sinuses. Such blockage commonly results from a viral infection of the upper airways, such as the common cold.

During a cold, the swollen mucous membranes of the nasal cavity tend to block the openings of the sinuses. Air in the sinuses is absorbed into the blood stream, and the pressure inside the sinuses decreases causing pain and drawing fluid into the sinsuses. This fluid is a breeding ground for bacteria. White blood cells and more fluid enter the sinuses to fight the bacteria; this influx increases the pressure and causes more pain.

Allergies also cause mucous membrane swelling, which blocks the opening to the sinuses. Additionally, people with a deviated septum are more prone to obstructed sinuses.

Chronic Sinusitis

Sinusitis is defined as chronic if it has been ongoing for more than 8 to 12 weeks. It may follow an allergy or a viral infection or exposure to an environmental pollutant.

Often the person has a family history; a genetic predisposition appears to be a factor. If the person has a bacterial or fungal infection, the inflammation is much worse. Occasionally, chronic sinusitis of the maxillary sinus results when an upper tooth abscess spreads into the sinus.

Symptoms

Acute sinusitis usually results in pain, tenderness and swelling over the affected sinus. Maxillary sinusitis produces pain over the cheeks just below the eyes, toothache and headache.

Frontal sinusitis produces headache over the forehead.

Ethmoid sinusitis produces pain behind and between the eyes and headache, often described as splitting, over the forehead.

The pain produced by sphenoid sinusitis does not occur in well defined areas and may be felt in the front or back of the head.

In acute sinusitis, yellow or green pus may be discharged from the nose. Fever and chills also can occur, but their presence may suggest that the infection has spread beyond the

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sinuses. Any change in vision or swelling around the eye is a very serious condition that can quickly – within minutes to hours – result in blindness.

The symptoms of chronic sinusitis are usually much more subtle and pain occurs less often. The most common symptoms of chronic sinusitis are nasal obstruction, nasal congestion and post nasal drip.

People with sinusitis may have colored discharge and a decreased sense of smell. A person also may feel generally ill (malaise).

Investigations

Diagnosis of acute sinusitis can be made by noting symptoms and doing a physical examination of nose and face. A CT or MRI of the head is performed to rule out other disorders.

Laboratory tests to assess possible causes of chronic sinusitis include

Blood tests to rule out conditions associated with sinusitis, like an immune deficiency disorder

Tests on the material inside the sinuses to look for bacterial or fungal infection Biopsy (taking a small sample) of the membranes (linings) of the nose or sinuses

to find out the health of the cells lining the cavities

AYURVEDIC VIEW

Importance of Shiras (Head) :

Ayurveda has given prime importance to Shiras, considering it as one of

the three principal vital organs of the body where the Prana resides.

Charaka has considered Shirah as the (Uttamanga). Shirah has been

compared with the Sun. Charaka explains that

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All the sense organs and the channels carrying the sensory and vital im pulses from the Shirah are like the rays from the Sun. (Cha. Si 9/4)

Vagbhata has compared human being with a tree, with roots at the top

and branches at the bottom and

Shaunakya and Kumarshira Bharadwaja emphasized that head of the

foetus develops first, because it is the site of all important Indriyas.

Vagbhatta has described ten “Jivita Dham” which are Shira (head),

Rasana bandhana (ligament of tongue), Kantha (throat), Asra (blood), Hridaya

(heart), Nabhi (umbilicus), Basti (urinary bladder), Shukra (semen), Ojas

(essence of Dhatu) and Guda (rectum and anus). (A. H. Sha. 3/13).

He also considered that Shirah (head) is the root of the body and

consciousness resides in head. Thus Shirah is the supreme amongst all the

organs. Further more, there are 107 Marmas (vital parts) in the human body and

the Pradhana Marma is Shirah. It is a Sadyopranahara Marma.

Shiroroga :

The term Shirahshula is limited only to the pain developed in the head.

Though Khalitya, Palitya etc. occur in the head region they are not included in the

Shiroroga.. Charaka has mentioned Shiro-ruk as a separate disease among

eighty types of Vata-Vyadhis.

Charaka Samhita :

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Defined head as a site where all sense organs alongwith the Prana resides.

Charaka has mentioned 5 types of Shiro roga. Vataja Shiroroga, Pittaja

Shiroroga, Kaphaja Shiroroga, Krimija Shiroroga and Sannipatika Shiroroga.

(Cha. Su. 17/6; Cha. Su. 19.14);

Sushruta Samhita :

Sushruta has mentioned 11 types of Shiroroga (Su. Ut. 25/3-4) and their

management are also described –

They are as follows :

1. Vatika Shiroroga 7. Krimikrita Shiroroga

2. Paittika Shiroroga 8. Suryavarta

3. Kaphaja Shiroroga 9. Anantavata

4. Sannipatika Shiroroga 10. Ardhavabhedaka

5. Raktaja Shiroroga 11. Shankhaka

6. Kshayaja Shiroroga

Ashtanga Sarngraha :

Vagbhatta has described 10 types of shiro roga (A. S. Ut. 27/20). He has

also mentioned nine types of diseases of Shirahkapala. (A. S. Ut. 27/21).

He used the word Shirastapa for Shiroroga. The ten types are –

1. Vatajashirobhitapa

2. Ardhavabhedaka

3. Pittajashirobhitapa

4. Kaphajashirobhitapa

5. Raktajashirobhitapa

6. Sarvajashirobhitapa

7. Krimijashirobhitapa

8. Shirahkampa

9. Shankhaka

10. Suryavarta

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Other Nine types are :

1. Upashirshaka

2. Shirahpitika

3. Shiroarbuda

4. Shiro Vidradhi

5. Arunshika

6. Darunaka

7. Indralupta

8. Khalitya

9. Palitya

ETYMOLOGY OF CERTAIN WORDS REGARDING SHIROROGA

Shirashula : “Shrayeteh Swanga, Shirah Kichcha” i.e. all the organs of the body

are dependant for their functions on the Shirah.

According to Vedickosha ‘Anusyanta Sarvani Indriyani yat tat; i. e. where all

Indriyas are located in the head, which is also known as Aditya. (Vedic Kosha

Vol.II) Uttamanga, Shirah, Shirasa, Murdha, Mastaka.

Shula has been derived from the root ‘Shul’ with ‘Ach’ Pratyaya, which means

“Shulati means pain. (Sidhanta Kaumudi).

Shula means ‘Shula Nyayam Sanghoshe Cha’ i.e. pain, disease or noise.

Ayurveda defines Shula in various context as follows –

1. Sharp piercing pain like piercing of nail or Shanku (Su. Ut. 42/81)

2. As described by ancient scholars, a sudden pain as if Trishulas (Trident) has

made its way in the body is known as Shula (Y. R. Uttarkhanda).

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Some other nearby meanings are Ruja, Vedana, Arti, Toda, Bheda, Shula,

Vyadha, Sphota, Sampidana, Chhedya, Arninibha and Sambhakshana.

Common causes of shiro roga –

Vegavarodha

Diva svapna, Ratri jagarana

Madya

Uchhai bhaashana

Atimaithunya

Asatmyagandha

Shiro abhigatha

Excessive intake of guru, amla aahara, ati shitambu sevana

Manastapa etc

Generally in Ayurvedic classics the word Shula denotes abdominal pain, but

usually the name of a specific organ is added to pain, specifying pain associated

with that particular part of body as Hridashula, Udarshula, Shirahshula etc.

All above mentioned causes are mainly responsible for

Dhatukshaya – particularly for Rasa Dhatu resulting in Vata Prakopa. In Cha. Su.

28 it is clearly mentioned that Chinta, Shoka etc. are causative factor for

Rasavaha Srotodushti ultimately resulting in Vata Prakopa and hence

responsible for Vatika Shirahshula.

Rupa of Vatika Shirahshula (Symptoms):

Shankha nistoda

Ghata Sambheda

Bhrumadya tapanam

Lalata tapanam

Shrotranishkasanavat pida

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Akshiniskasanavat pida

Shirostambha etc.

Chikitsa -

General management of Shiroroga

Commonly in all types of headache the following preventive measures should be

taken –

2. Samshodhana Chikitsa –

Shirovirechana – Nasyakarma has been advised as the important method of

treatment in Urdhvajatrugata Rogas.

Chikitsakrama (Line of Treatment)

Nidana parivarjana

Sodhana, Shamana

Vamana, Virechana, Shirovirechana, Basti, Abhyantara (External

remedies)

Snehanasya Pradhamana, Shirobasti

Lepa, Abhyanga, Svedana

Specific Management of Shiroroga :

In Bhaishajya Ratnavali, General line of treatment for Shirahshula has been

described which is Svedana, Nasya, Dhumapana, Virechana, Lepa, Vamana,

Langhana, Shirobasti, Raktamokshana, Agnikarma, Upanaha, Purana Ghrita &

Charaka Samhita :

According to Charaka, Snehana, Svedana should be done with Vatahara

Dravyas. Similarly those dietitics should be followed. Fomentation (Upanaha)

with Vatahara dravyas should be tied on the head. He further says that Upanaha

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made of Agaru, Jivaniya Gana, meat and fish, Jasmine should be tied around the

head.

He has given some specific Tailas for application on the head e.g. Rasnadi Taila,

Baladi Taila. In the Ghrita are said to be effective for Vatika Shirorogas according

to Charaka (C. Chi. 26/158-174).

Ashtanga Sangraha :

Vagbhata has advised intake of ghrita or taila with milk in Vatika shiro

rogas.

Shiroveshtana with Utkarika alongwith Aanupamamsa, Yava, Taila,

Masha, Kulattha, Kushta, Daru Haridra, Ativisha, Saindhava should be done.

Afterwards Dashamoola ksheera kashayam can be used for Parisheka.

Bhavaprakash :

Bhavaprakasha and Yogaratnakara has quoted importance of shirobasti in

the management of shiro rogas, especially in Vatika shirashula. (Bha. Pr.

Madhyamakhanda 4./27). Kumari Taila, Shadbindu Taila are mentioned for

Shirahshula. (B.P)

Nasya with Shvasakutara Ras is told by Yogaratnakara.

In Ayurvedic view,

Vāta Śirasūlam can be correlated with Tension headachePitta Śirasūlam can be correlated with Migraine headacheKapha Śirasūlam can be correlated with Sinus headache

Treatment for Vātaja headache

Kaşāyam

Kalyāņaka kaşāyam – 60 ml twice daily before food. Vidāryādi kaşāyam – 60 ml twice daily before food.

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Dashamoola kashayam – 6o ml twice daily before food Mashamudgadi kashayam – 60 ml twice daily before food Varuņādi kşīra kaşāyam – 60 ml at bed time Pathya shadangam ksheera kashayam – 60 ml in the evening

Ekamoolika

Mandukaparni – 60 ml bd before food Shankhapushpi – 60 ml bd before food Guduchi – 60 ml bd before food Yashtimadhu – 60 ml twice daily before food

Gulika

Mānasamitram tablet – 2 tablets twice daily after food Laghu vasanta malini ras – 250 – 500 mg twice daily after food Shiroshula vajra ras – 250 mg twice daily after food

Snehapanam

Varanadi ghritam – 10 ml twice daily after food with hot water

Abhyangam

Rasnadi tailam Kakolyadi tailam Bala tailam

Svedanam

Nadi svedam with drugs possessing vata hara properties such as eranda, chincha, sinduvaraka etc.

Nasyam

Kşīrabala tailam – 2 drops in each nostril Kalyanaka ghritham – 2 drops in each nostril Brhat panchamoola ksheera paka Varanadi ghrta – 2 drops in each nostril

Ghrtam

Triphala ghrtam – 10 gms twice daily after food with hot water

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Jeevantyadi ghrtam – 10 gms twice daily after food with hot water Kalyanaka ghrtam – 10 gms twice daily after food with hot water

Lepam

Rasnadi choornam (mixed with hot water) Karpooradi choornam (mixed with hot water) Madhukadi choornam (mixed with hot water)

Śiro picu

Asana vilvādi tailam Balāgudūcyādi tailam Ksheerabala tailam Yashtimadhu Kayatrimeni Dhanwantaram tailam Baladhatryadi Triphaladi

The same oils are used for Shirodhara and Shiro vasthi.

Śiro dhāra

Śiro vasti

Pathyapathyam

The food stuffs prepared with ghee and wheat, mudga, masha, milk etc. can be added in dietics.

Avoiding cold wind, very hot atmosphere, fasting, cold and dry food, awakening at night, mental tension, tedious journey etc should be avoided by patients suffering from Vatika shirashoola.

Treatment for Pittaja headache

Pitta Vata Vriddhi in Kapha sthanam To pacify vitiated Vata and Pitta and to balance Kapha

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Kaşāyam

Vidāryādi kaşāyam – 60 ml twice daily before food Kalyāņaka kaşāyam – 60 ml twice daily before food Pathyā śadańga kaşāyam – 60 ml twice daily before food Drakshadi kashayam – 60 ml twice daily before food Parpataka ksheera kashayam – 60 ml in the evening Dhanyaka ksheera kashayam – 60 ml in the evening Kiratatikta paneeyam – 200 ml per day

Siddha medicines

Pitta jvara kudineer – 500 ml per day Nilavembu kudineer – 500 ml per day Vappampattai kudineer – 500 ml per day Seendhil Paal Kashayam – 60 ml in the evening

Madhulai mannapagu – 5 – 10 ml with water Nannari manapagu – 5 – 10 ml with water

Gulika

Sudarśana vati – 2 tablets twice daily after food Pathyashadangam – 2 tablets twice daily after food Amrutadi gulikai – 2 tablets twice daily after food

Rasaushadhis

Swarna makshika bhasma – 250 mg bd with honey Pravala bhasmam – 250 mg bd with butter Raupya makshika bhasmam – 250 mg bd with honey Chandrakala ras – 250 mg bd with honey Muktashukti bhasmam – 250 mg bd with butter

Eka mūlika

Elam (cardamom) with milk

Lepam

Kachooradi choornam (mixed with hot water) Chandanadi lepam (mixed with hot milk) (Chakradatta)

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Mrunaladi – amalakadi lepam (mixed with ghee) Kakolyadi ghrtam Himasagara tailam

Nasyam

Kşīrabala tailam – 2 drops in each nostril Jeevaniya ghrtam – 2 drops in each nostril

Śiro picu

Asana maňjişţādi Kşīrabala tailam Balāgudūcyādi tailam Yashtimadhu Murivenna

The same oils are used for Shirodhara and Shirovasthi

Śiro dhāra

Śiro vasti

Takradhara

Treatment for kaphaja headache

Kaşāyam

Varuņādi kaşāyam – 60 ml twice daily before food Daśamūla kaţuthrayam – 60 ml twice daily before food Pathya Śadańgam – 60 ml twice daily before food Guggulu tiktakam – 60 ml twice daily before food Surasadi – 60 ml twice daily before food

Gulika

Tŗikaţu tablet – 2 tablets twice daily after food

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Sudarśanam tablet – 2 tablets twice daily after food Talisadi vatakam – 2 tablets twice daily before food Gomutra harithaki – 2 tablets twice daily before food Suryavartham – 2 tablets twice daily after food Vyoshadi vatakam – 2 tablets twice daily after food

Snehapanam

Guggulu tiktaka ghrtam – 10 ml twice daily after food Indukantha ghrtam – 10 ml twice daily after food

Nasyam

Śadbindu tailam – 2 drops in each nostril Śuņţi tailam – 2 drops in each nostril Sarshapa tailam – 2 drops in each nostril Vidanga tailam – 2 drops in each nostril Katphala choornam Amrtadi tailam – 2 drops in each nostril

Gandoosham

Aragwadhadhi kvatham Varunadi kvatham Arimedadi tailam Tila tailam

Dhuma varti

Rasnadi dhuma varti Erandadi dhooma varti Dhoomavarti prepared of gandha dravyas as chandan, aguru, guggulu etc.

exempting or excluding kushta and tagara can be used for this.

Swedana karma is to be done quiet frequently.

Vamana karma should be done after these if there is evidence of incomplete excretion of dosha even after all the treatment.

Vamana with ghee prepared of katu rasa dravyas should be done.

Virechanam

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Aragwadha mahatiktaka ghrtam – 2 teaspoons with hot water at bed time

Lepam

Rasnadi choornam (mixed with hot water) Neerkovai mathirai (scrub in hot water in the form of paste & apply over

forehead) (Siddha Medicines) Krishnadi lepam Devadarvadi lepam (Chakradatta) Lepam with drugs such as sarala, kushta, sharangashta, devakushta, rohisha

added with kshara and saindhava

Śiro picu

Asana elādi tailam Nirgundi tailam

The same oils are used for shirodhara and shirovasthi

Śiro dhāra

Śiro vasti

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