Aryavaidyan Vol. XlV. No.3, Feb.- Apr. 2001, Pages 166 - 171

A CLINICAL STUDY ON THE ROLE OF NASYAKARMA ANDGHRITAPANA IN THE MANAGEMENT OF

ARDDHAVABHEDAKA VIS-A-VIS MIGRANOUS HEADACHESSrikanth, N.*, Chopra, K.K.** and Jaya Prakash Narayan.***

Abstract: A clinical study was conducted on 20 cases presented with classicalfeatures of arddhavabhedaka (migraine) to evaluate the effect of nasyakarma withfresh leaf juice extracted from Acalypha indica Linn. (Haritamanjari, Nadkarni 1976)along with internal medication of panchagavya ghrita (Ayurvedic Formulary of India,Part-I, 1971). Results were highly encouraging. The present study also includes aclinical observation on the role of different contributory factors attributed to thecausation of the condition and clinical conditions considered for the differentialdiagnosis of arddhavabhedaka found in classical texts.

IntroductionArddhavabhedaka - a comparable

clinical condition of migraine. is a commonlyoccurring vascular headache presenting withpain on one half of the head as cardinal fea-ture. It is described as a separate clinical entityin the classics of Charaka and Susruta whileVagbhata included this condition in theclassification of vataja-siroroga. Pain in onehalf of the head may also appear as a symp-tom in various conditions viz. anyatovata(netraroga), vata-paryayam (netraroga) andardditavata (vataroga).

Need for alternative therapies

Treatment of this condition available atpresent includes the use of analgesics and va-sodilators. They have insignificant role inachieving success but have adverse effects. Ow-ing to the above problems of management, it isimperative to explore newer, efficaciousdrugs/procedures to tackle such diseaseentities. The present study was aimed to estab-lish clinically the effect of internal medicationand nasyakarma in the management ofarddhavabhedaka.

* Asst. Research Officer, Central Research Unit (Ay.) CCR.A.S., Ministry of Health & F.W, GoV!. of India,Unit J, Bhubaneswar 75J 009.

** Director, Central Research Unit (Ay.) CCR.A.S., Ministry of Health & F.W, Govt. of India,Unit J. Bhubaneswar 75J 009.

*** Chairman, Scientific Advisory Committee. CCRAS, New Delhi no 058.

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Historical account

Migraine is as old as civilisation. It wasmentioned in an Egyptian papyrus of 1200 BC,and was described by Hippocrates. The bestearly account was given by Aretaeus ofCappadocia in about AD 130. He has describedthe headache (usually only on one side of thehead), nausea, sickness, dislike of daylight anda feeling of giddiness which may accompanythe attack. Half a century later Galen used theGreek word 'hemicrania' (half skull) to describethe one sided headache in this disorder. Thisword was later corrupted to 'megrim' and thento 'migraine'.

Definition of migraine

Vagbhata's statement regarding arddhava-bhedaka runs as follows: Arddhe tumoorddhanahsosarddhavabhedaka. Vedanainhalf of the portion of the head is calledarddhavabhedaka. A paroxysmal disordercharacterised by visual and lor sensory phe-nomena in an aura associated with or followedby unilateral headache and vomiting. While thisdefinition is satisfactory for 'classical'migraine, there are many patients who neverexperience an aura and in whom the headacheis always bilateral. The single most character-istic and constant feature is that migraine is aparoxysmal disorder, i.e. the headaches occurin attacks, separated by intervals of freedom.

SynonymsHemicrania; bilious attack; sick headache.

AetiologyCerebral: Cerebral ischaemia followed by

hyperaemia (spasm of blood vessels followedby dilatation).

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OcularAllergy

: Refractive errors: Proteins, tobacco, chocolate,pollen

Psychological: Mental fatigue, anxietyEndocrine : SerotoninAge & Sex : Middle age / females

ComplicationsExcerebration of this siroroga may cause

vinasa of srotra (loss of auditory function) aswell as ~inasa of akshi (loss of visual function).

Signs and symptomsVisual aura: Scintillating scotoma up to

V2 hr. duration may be followed by visual fieldloss contralateral to headache. May have aurawithout headache.

Prodrome: Hours to days prior to headache.

Psychic symptoms: Irritability, confusion, anxi-ety, depression, euphoria, altertness, clarity.

Headache: Pulse synchronous, may be like pres-sure behind eye-radiating to face, jaw, neckand back. Peak pain I to 2 hr., nausea andvomiting, rarely diarrhoea, sensitivity to exter-nal stimuli - light and sound changes characterof headache over time.Skin pallor: Temporal arteries tender and di-lated. Pain may decrease by occluding tempo-ral artery anterior to ear. Most common age ofonset 10 to 30 years. 30 to 50% prior to age15. Headaches usually decrease after age 40;rarely increases.

Severe pain on both sides of manya. Painwill be felt in lalata, akshi, bhru, sankha,kama, and regions on anyone of the sides.

Nature of pain: Pain in arddhavabhedaka willbe severe as though cutting by a sharp weaponor churning by a churner. Pain (toda, bheda,bhrama) is felt in half of siras.

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Recurrence of the disease: According to Susrutathis set of clinical features recurs once in 10 or15 days.

Differential diagnosisClinical features resembling arddhava

bhedakaare also found in various other disor-ders of eye (netra rogas), vata ragas andalso appears as vegadharanajanya vyadhis(due to suppression of physiological urgesmay be considered for differential diagnosis).

Other syndromes causing arddhavabhedaka-like symptoms which are described inayurvedic classics:1. Anyatovata (netraroga): Pain in manya,akshi and sankha regions. According to Susrutasevere pain is felt at karna, manya, hanu,greeva, netra and bhru regions.

2. Vataparyayam (netraroga): (a) severe painis felt in pakshma, akshi and bhru regions.(b) Drishtinasa is seen as complication.

3. Adhimantha (netraroga): Headache is apredominant symptom especially in vataja

Model score sheet for assessment in migraine

type adhimantha. (a) Siroantarvedana,(b) netravedan'a, (c) karnanada, bhrama andlalata bhru vedana, (d) Sankha / danta, kapola,kapaLasthi ruja are seen in raktaja adhimantha.

4. Vataja abhishyanda (netraroga):a) Nistoda, stambhana, romaharsha,sirobhitapa. (b) Pain is felt at sankha, lalatabhru and akshi.

5. Ardhitavata (vataroga): Pain is felt in halfof the portion of face and head with other as-sociated symptoms.

6. Miscellaneous cau;es: 1) Arddhava-bhedaka as divasvapnajanya dosha, 2) Arddha-vabhedaka in kshavathu vegadharana.

Classification of migraine1) Classical migraine, 2) Common or simple(minor) migraine, 3) Migrainous neuralgia,4) Abdominal migraine in children, 5) Oph-thalmoplegic migraine, 6) Hemiplegic migraine,7) Retinal migraine, 8) Symptomatic migraineand 9) Facial migraine.

Clinical parameters Scores

HeadacheMild reliefModerate reliefMarked reliefComplete reliefVisual aura (Transitory diplopia / scotoma, etc.)AbsentVomiting / nauseaAbsentParesthesiae (of limb, part of the body, lips, face, etc.)AbsentWeakness (of limb, part of the body, etc.)Absent

60402010o

20o10o6o4o

1.

2.

3.

4.

5.

168 ARYAVAIDYAN

Materials and methodsType of study: Single blind.Level of study: OPD.

20 patients presenting with classical fea-tures of migraine were randomly selected forthe study. Patients with notable visual prob-lems and associated with systemic disordersviz. diabetes, hypertension, etc. were excludedfrom the study.

Treatment and dose scheduleNasya karma with fresh diluted juice ex-

tracted from leaves of Acalypha indica Linn.(threedrops in each nostril) was scheduled forseven days repeated at an interval of 15 days. along with internal administration of

panchagavya ghrita 5ml BD before food withhot water for 3 months. All the patients wereadvised to follow pathyapathya schedule(avoidance of aetioiogical factor).

Table 1. Sex-wise distribution of patients

SexNo.ofpatients

Percentage

MaleFemale

911

4555

Table 2. Age-wise distribution of patients

Age in No.ofpatients Percentage

years

20 - 24 3 1525 - 29 4 2030 - 34 7 3535 - 39 5 2540 - 44 1 5

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Classification of resultsI. Complete relief 100% relief has

been noted2. Partial relief(a) Marked relief Relief up to 75%

and above

(b) Moderate relief Relief above 50%and below 75%

Relief more than25% but below 50%

No relief oronly marginalimprovement.

(c) Mild relief

(d) No relief

ObservationsAmong 20 treated cases 55% are females,

(Table 1), 35% belongs to age group of30 - 34 years (Table 2). 70% are officers(Table 3), 60% belongs to vataprakriti group(Table 4). Vegadharana was observed asaetiological factor in 90% patients (Table 5).

Table 3. Occupation-wise distribution of patients

Occupation No.ofpatients

Percentage

Officers

HousewivesWorkers

14

4

2

7020

10

Table 4. Distribution of prakriti

Prakriti No.of Percentagepatients

Vata 12 60Kapha 6 30Pitta 2 10

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Headache was found in all the patients(Table 6). Refractive errors were observed in60% (12 ) cases (Table 7 & 8).

ResultsComplete relief was found in 25% cases,

marked relief in 15% cases, moderate relief in10% cases, mild relief in 30% cases and norelief was observed in 20% cases (Table 9).

Table 5. Distribution of aetiological factors

Discussion and conclusion

Migraine has become a challenging prob-lem to the present day physician. In the presentstudy an attempt has been made to explore somealternative solutions hidden in the classical textsto manage such conditions. Results obtainedafter the study were highly encouraging andfree from adverse effects. In the present

Aetiological factors No.of Percentagepatients

11 553 1517 856 303 155 2518 904 208 404 200 010 50

Rooksha ahara sevana (over indulgence of dry foods)Atiahara sevana (excessive intake of food)Vishamasanam (frequent & irregular intake of food)Pravata sevana (exposure to direct breeze)Avasya sevana (exposure to snow fall)Atimaithuna (excessive sexual indulgence)Vegadharana (supression of physiological urges)Ativyayama (over exercising)Uchiarbhashana (loud speech)Seetamaruta sevana (exposure to cold air)Unwanted repetition of vamana and virechana karmasAtibhaya and krodha

Table 6. Incidence of clinical features

Clinical feature PercentageNo.of patients

HeadacheVisual auraNausea / vomitingParasthesiaWeakness

2018193I

1009095155

Table 7. Incidence of refractive errors

Sl. No. PercentageNo.of patients

I. Refractive error2. No refractive error

128

6040

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Table 8. Role of different contributory factors at a glance.SI. No. Factors No.of patients Percentagel.2.3.4.5.6.7.

FemalesAge 30 - 34 yrsOfficersVataprakritiVegadharanaHeadache & nauseaRefracti ve errors

1171412182012

553570609010060

Table 9. Results

SI. No. Mode of response No.of patients Percentage

1.2.3.4.5.

Complete reliefMarked reliefModerate reliefMild reliefNo relief

scenario nasyakarma with Acalypha indica andinternal medication of panchagavyaghrita rep-resent a true alternative method for a problemthat has eluded a better solution. The probablemode of action may be the decreased synthesisof serotonin and the regulation of cerebral cir-culation ascribed to the causation of the con-dition. Still, only long term studies with morenumber of cases in grater detail will provide afurther insight into the subject.

References

I. Colin, Ogilive, 1987, Chambarlin's signsand symptoms in clinical medicine, ELBS,London.2. Charaka, 1962, Charakasamhita,Choukhamba Sanskrit series, Varanasi.3. Chatterjee, 1998, Handbook of ophthal-mology, C.B.S. publishers, Delhi.4. Finlaycampell, 1980, Migraine, Guide waypublishers, London.5. G.1. Romanes, 1987, Cunningham'smanual of practical anatomy, ELBS, London.

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6. Gupta, L.C., 1983, Medical emergenciesin general practice, Vikash Publishers, NewDelhi.7. Madhavakara, 1928, Madhava nidanam,V. Ramaswamy Sastri and sons, Madras.8. Nadkarni, 1976, Materia Medica,popular prakashan, Bombay.9. Prives, 1998, Human Anatomy, MIRPublishers, Moscow.10. Prabhakaran, 1990, Shalakyatantra, APAyurvedic Literature improvement trust,Hyderabad.11. Rama Rao, K.V.S.S., 1989, Text book ofBio-chemistry, LK&S Publishers,Visakhapatanam.12. Taber, 1990, Tabers cyclopedic Dictio-nary, IP brothers, New Delhi.13. Tortoura and Angnostakos, 1985,Principles of anatomy and Physiology, Harperand Row, Newyork.14. Susruta, 1962, Susrutasamhita,Chowkhamba Sanskrit series, Varanasi.15. Vagbhata, 1976, Ashtangasangraha,Telugu Academy, Hyderabad.

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