Aryavaidyan Vol. XlV. No.3, Feb.- Apr.
2001, Pages 166 - 171
A CLINICAL STUDY ON THE ROLE OF NASYAKARMA AND
GHRITAPANA IN THE MANAGEMENT OF
ARDDHAVABHEDAKA VIS-A-VIS MIGRANOUS HEADACHES
Srikanth, N.*, Chopra, K.K.** and Jaya Prakash Narayan.***
Abstract: A clinical study was conducted on 20 cases presented with classical
features of arddhavabhedaka (migraine) to evaluate the effect of nasyakarma with
fresh 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 a
clinical observation on the role of different contributory factors attributed to the
causation of the condition and clinical conditions considered for the differential
diagnosis of arddhavabhedaka found in classical texts.
Introduction Need for alternative therapies
Arddhavabhedaka - a comparable Treatment of this condition available at
clinical condition of migraine. is a commonly
present includes the use of analgesics and va-
occurring vascular headache presenting with
sodilators. They have insignificant role in
pain on one half of the head as cardinal fea-
achieving success but have adverse effects. Ow-
ture. It is described as a separate clinical entity
ing to the above problems of management, it is
in the classics of Charaka and Susruta while
imperative to explore newer, efficacious
Vagbhata included this condition in the
classification of vataja-siroroga. Pain in one drugs/procedures to tackle such disease
half of the head may also appear as a symp- entities. The present study was aimed to estab-
tom in various conditions viz. anyatovata lish clinically the effect of internal medication
(netraroga), vata-paryayam (netraroga) and and nasyakarma in the management of
ardditavata (vataroga). arddhavabhedaka.
* 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.
166 ARYAVAIDYAN
Historical account Ocular : Refractive errors
Allergy : Proteins, tobacco, chocolate,
Migraine is as old as civilisation. It was pollen
mentioned in an Egyptian papyrus of 1200 BC,
Psychological: Mental fatigue, anxiety
and was described by Hippocrates. The best Endocrine : Serotonin
early account was given by Aretaeus of Age & Sex : Middle age / females
Cappadocia in about AD 130. He has described
Complications
the headache (usually only on one side of the
Excerebration of this siroroga may cause
head), nausea, sickness, dislike of daylight and
vinasa of srotra (loss of auditory function) as
a feeling of giddiness which may accompany
well as ~inasa of akshi (loss of visual function).
the attack. Half a century later Galen used the
Greek word 'hemicrania' (half skull) to describe Signs and symptoms
the one sided headache in this disorder. This Visual aura: Scintillating scotoma up to
word was later corrupted to 'megrim' and then V2 hr. duration may be followed by visual field
to 'migraine'. loss contralateral to headache. May have aura
without headache.
Definition of migraine
Prodrome: Hours to days prior to headache.
Vagbhata's statement regarding arddhava-
Psychic symptoms: Irritability, confusion, anxi-
bhedaka runs as follows: Arddhe tu
ety, depression, euphoria, altertness, clarity.
moorddhanahsosarddhavabhedaka. Vedanain
half of the portion of the head is called Headache: Pulse synchronous, may be like pres-
arddhavabhedaka. A paroxysmal disorder sure behind eye-radiating to face, jaw, neck
characterised by visual and lor sensory phe- and back. Peak pain I to 2 hr., nausea and
nomena in an aura associated with or followed vomiting, rarely diarrhoea, sensitivity to exter-
by unilateral headache and vomiting. While this nal stimuli - light and sound changes character
definition is satisfactory for 'classical' of headache over time.
migraine, there are many patients who never Skin pallor: Temporal arteries tender and di-
experience an aura and in whom the headache lated. Pain may decrease by occluding tempo-
is always bilateral. The single most character- ral artery anterior to ear. Most common age of
istic and constant feature is that migraine is a onset 10 to 30 years. 30 to 50% prior to age
paroxysmal disorder, i.e. the headaches occur 15. Headaches usually decrease after age 40;
in attacks, separated by intervals of freedom. rarely increases.
Severe pain on both sides of manya. Pain
Synonyms will be felt in lalata, akshi, bhru, sankha,
Hemicrania; bilious attack; sick headache. kama, and regions on anyone of the sides.
Aetiology Nature of pain: Pain in arddhavabhedaka will
Cerebral: Cerebral ischaemia followed by be severe as though cutting by a sharp weapon
hyperaemia (spasm of blood vessels followed or churning by a churner. Pain (toda, bheda,
by dilatation). bhrama) is felt in half of siras.
ARYAVAIDYAN 167
Recurrence of the disease: According to Susruta type adhimantha. (a) Siroantarvedana,
this set of clinical features recurs once in 10 or (b) netravedan'a, (c) karnanada, bhrama and
15 days. lalata bhru vedana, (d) Sankha / danta, kapola,
Differential diagnosis kapaLasthi ruja are seen in raktaja adhimantha.
Clinical features resembling arddhava 4. Vataja abhishyanda (netraroga):
bhedakaare also found in various other disor- a) Nistoda, stambhana, romaharsha,
ders of eye (netra rogas), vata ragas and
sirobhitapa. (b) Pain is felt at sankha, lalata
also appears as vegadharanajanya vyadhis
bhru and akshi.
(due to suppression of physiological urges
5. Ardhitavata (vataroga): Pain is felt in half
may be considered for differential diagnosis).
of the portion of face and head with other as-
Other syndromes causing arddhavabhedaka- sociated symptoms.
like symptoms which are described in
ayurvedic classics: 6. Miscellaneous cau;es: 1) Arddhava-
1. Anyatovata (netraroga): Pain in manya, bhedaka as divasvapnajanya dosha, 2) Arddha-
akshi and sankha regions. According to Susruta vabhedaka in kshavathu vegadharana.
severe pain is felt at karna, manya, hanu, Classification of migraine
greeva, netra and bhru regions. 1) Classical migraine, 2) Common or simple
2. Vataparyayam (netraroga): (a) severe pain (minor) migraine, 3) Migrainous neuralgia,
is felt in pakshma, akshi and bhru regions. 4) Abdominal migraine in children, 5) Oph-
(b) Drishtinasa is seen as complication. thalmoplegic migraine, 6) Hemiplegic migraine,
3. Adhimantha (netraroga): Headache is a 7) Retinal migraine, 8) Symptomatic migraine
predominant symptom especially in vataja and 9) Facial migraine.
Model score sheet for assessment in migraine
Clinical parameters Scores
1. Headache 60
Mild relief 40
Moderate relief 20
Marked relief 10
Complete relief o
2. Visual aura (Transitory diplopia / scotoma, etc.) 20
Absent o
3. Vomiting / nausea 10
Absent o
4. Paresthesiae (of limb, part of the body, lips, face, etc.) 6
Absent o
5. Weakness (of limb, part of the body, etc.) 4
Absent o
168 ARYAVAIDYAN
Materials and methods Classification of results
Type of study: Single blind. I. Complete relief 100% relief has
Level of study: OPD. been noted
2. Partial relief
20 patients presenting with classical fea-
(a) Marked relief Relief up to 75%
tures of migraine were randomly selected for
and above
the study. Patients with notable visual prob-
(b) Moderate relief Relief above 50%
lems and associated with systemic disorders
and below 75%
viz. diabetes, hypertension, etc. were excluded
(c) Mild relief Relief more than
from the study.
25% but below 50%
Treatment and dose schedule
(d) No relief No relief or
Nasya karma with fresh diluted juice ex- only marginal
tracted from leaves of Acalypha indica Linn. improvement.
(three drops in each nostril) was scheduled for Observations
seven days repeated at an interval of 15 days Among 20 treated cases 55% are females,
. along with internal administration of (Table 1), 35% belongs to age group of
panchagavya ghrita 5ml BD before food with 30 - 34 years (Table 2). 70% are officers
hot water for 3 months. All the patients were (Table 3), 60% belongs to vataprakriti group
advised to follow pathyapathya schedule (Table 4). Vegadharana was observed as
(avoidance of aetioiogical factor). aetiological factor in 90% patients (Table 5).
Table 1. Sex-wise distribution of patients Table 3. Occupation-wise distribution of patients
No.of No.of
Sex Percentage Occupation Percentage
patients patients
Male 9 45 Officers 14 70
Female 11 55
Housewives 4 20
Table 2. Age-wise distribution of patients Workers 2 10
Age in No.of
Percentage Table 4. Distribution of prakriti
years patients
20 - 24 3 15 Prakriti No.of
Percentage
patients
25 - 29 4 20
30 - 34 7 35 Vata 12 60
35 - 39 5 25 Kapha 6 30
40 - 44 1 5 Pitta 2 10
ARYAVAIDYAN 169
Headache was found in all the patients Discussion and conclusion
(Table 6). Refractive errors were observed in Migraine has become a challenging prob-
60% (12 ) cases (Table 7 & 8). lem to the present day physician. In the present
Results study an attempt has been made to explore some
Complete relief was found in 25% cases, alternative solutions hidden in the classical texts
marked relief in 15% cases, moderate relief in to manage such conditions. Results obtained
10% cases, mild relief in 30% cases and no after the study were highly encouraging and
relief was observed in 20% cases (Table 9). free from adverse effects. In the present
Table 5. Distribution of aetiological factors
Aetiological factors No.of
Percentage
patients
Rooksha ahara sevana (over indulgence of dry foods) 11 55
Atiahara sevana (excessive intake of food) 3 15
Vishamasanam (frequent & irregular intake of food) 17 85
Pravata sevana (exposure to direct breeze) 6 30
Avasya sevana (exposure to snow fall) 3 15
Atimaithuna (excessive sexual indulgence) 5 25
Vegadharana (supression of physiological urges) 18 90
Ativyayama (over exercising) 4 20
Uchiarbhashana (loud speech) 8 40
Seetamaruta sevana (exposure to cold air) 4 20
Unwanted repetition of vamana and virechana karmas 0 0
Atibhaya and krodha 10 50
Table 6. Incidence of clinical features
Clinical feature No.of patients Percentage
Headache 20 100
Visual aura 18 90
Nausea / vomiting 19 95
Parasthesia 3 15
Weakness I 5
Table 7. Incidence of refractive errors
Sl. No. N o.of patients Percentage
I. Refractive error 12 60
2. No refractive error 8 40
170 ARYAVAIDYAN
Table 8. Role of different contributory factors at a glance
.
SI. No. Factors No.of patients Percentage
l. Females 11 55
2. Age 30 - 34 yrs 7 35
3. Officers 14 70
4. Vataprakriti 12 60
5. Vegadharana 18 90
6. Headache & nausea 20 100
7. Refracti ve errors 12 60
Table 9. Results
SI. No. Mode of response No.of patients Percentage
1. Complete relief 5 25
2. Marked relief 3 15
3. Moderate relief 2 10
4. Mild relief 6 30
5. No relief 4 20
scenario nasyakarma with Acalypha indica and 6. Gupta, L.C., 1983, Medical emergencies
internal medication of panchagavyaghrita rep- in general practice, Vikash Publishers, New
resent a true alternative method for a problem Delhi.
that has eluded a better solution. The probable 7. Madhavakara, 1928, Madhava nidanam,
mode of action may be the decreased synthesis V. Ramaswamy Sastri and sons, Madras.
8. Nadkarni, 1976, Materia Medica,
of serotonin and the regulation of cerebral cir-
popular prakashan, Bombay.
culation ascribed to the causation of the con-
9. Prives, 1998, Human Anatomy, MIR
dition. Still, only long term studies with more
Publishers, Moscow.
number of cases in grater detail will provide a
10. Prabhakaran, 1990, Shalakyatantra, AP
further insight into the subject. Ayurvedic Literature improvement trust,
Hyderabad.
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ARYAVAIDYAN 171
