Role of Dashmool Tail Nasya and a combination of Herbo-Mineral Drugs in the management of Ardhavbhedak W.S.R. to Migraine- A Clinical Study

Migraine has become the most common neuro-muscular disorder these days; its triggering factors are weather, staying hungry for longer durations like fasting, mental stress, alcohol and certain types of food items like Maida items, and packed food. It has been found that women are more prone to migraine especially while suffering through menstruation. Additionally, allergic reactions, exposure to loud noises or particular odours, smoking, or long exposure to screens/televisions could lead to migraine attacks. WHO ranks migraine among the world's most disabled medical illnesses1. Migraine can be closely related to Ardhavbhedak due to the 'half-sided headache' being its cardinal featurewhich is also explained by commentator Chakrapani as Ardhamastakvedna and also its paroxysmal nature2. Ardhavbhedak has been considered as Tridoshajby Acharya Sushrut3, Vata-kaphaj by Charakand Vataj by Acharya Vagbhatt4. In Ayurveda, Nasya Therapy has always proved itself promising in treating Urdhwajatrugata Vikaras. Hence Dashmool Tail Nasya has been selected for the study, as a benefit of Nasya has been quoted by Acharyas ―Nasa Hi Shirso Dwaram" which means the nose is the door to the head i.e. to cure the diseases that recede in the head Nasya is the best option.Dashmool is highly beneficial in treating Vataj-Kaphaj Disorders and also Taila decreasesVata well. Incidence and Prevalence: Recent studies have found that the prevalence of migraine is about 6- 8% in men and 12-15 % in women, in terms of actual numbers 3000 migraine attacks occur every day for each million of the general population approximately.

• To assess the efficacy of Dashmool Tail Nasya in the management of Ardhavbhedak.

• To explore the effect of a combination of herbo-mineral drugs in the subsidation of symptoms of Migraine.

 Patients between the age group 16 – 70 years. i.e. Migraine.

• Ardha Parshwa (Unilateral)

• Bheda, Toda, Shoola (Pulsating, throbbing type of pain)

• Pakshat, Dashahat, Akasmat (Paroxysmal)

• Prakasha Asahishnuta (Photophobia)

• Having recurrent attacks of headache (mostly unilateral, variable in intensity) with or without nausea, vomiting aura and GI tract symptoms

• Patients suffering from sinusitis, hypertension, and fever

• Secondary headache caused by meningitis, tumour, encephalitis, cervical spondylosis, and refractive errors

• Individuals suffering from immuno- compromised disease or on

immunosuppressive drugs. Pregnancy and lactation

The diagnosis was made based on the criteria of Migraine provided by the International Headache Society.

• At least 5 attacks in history.

• Headache attacks lasting 4-72 hours. Headache has at least 2 of the following:

1. Unilateral location. 2. Pulsating quality. 3. Moderate or severe pain intensity. 4. Aggravation by or causing avoidance of routine physical activity (e. g. walking or climbing stairs)

• During headache at least one of the following

1. Nausea and/or vomiting 2. Photophobia and phonophobia

• Not attributed to another disease

Sample size -12 Study duration – 30 days Follow-up- 15 days Study Centre- Ayurveda Speciality Clinic, Indore. Type of Study- Open level randomize clinical trial Source of data- OPD of Ayurveda Speciality Clinic, Indore

Purva karma – Sthanik Snehan Swedan Pradhan karma –Dashmool Tail in each nostril for 7 days with a gap of 7 days

A combination of Shirashooladi Vajra Rasa- 250 mg Laghu Soot Shekhar Rasa- 250 mg Godanti Bhasma - 500 mg With Honey empty stomach twice daily.

The number of female patients (80 %) was higher as compared to male patients (20 %). This might be due to the highest prevalence in females as hormones produced in their body may trigger/intensify Migraine. The incidence of and also they are more prone to stress and overthinking. Incidence was high ingraduates (46.7 %), the majority being from urban areas (66.7%) and had chronicity between 4-12 years (63.3 %). This would be because of a continuous inclination towards stressful life. It was also noticed that a maximum number of patients were of Vata Pitta Prakriti(43.3 %) and Vata Kaphaja Prakriti (40 %). Probably, it has made patients more susceptible todiseases that occur due to the predominance of Vata Dosha.

In the majority of the patients i.e., 90 %, 96.7 % and 76.7 %,Ardhavbhedakis ignited by Aaharaja,VihaarajaandMansika Nidanasrespectively. Aaharaja Nidanasthat wereobservedin patients were Vishamaasana (82.5 %), Adhyasana (76.5 %), Anashana (73.5 %), Rooksh Ahara Sevana (65 %)etc. This shows a faulty lifestyle, which is blindly followed bytoday‗s generation leading to Agnimandya and Tridosha Dushti, which contributes chiefly to the pathogenesis ofthe disease. VihaarajaNidanas include Ratri Jaagrana (30%) and Diwaswapa (42.5 %). Atapa/Dhupa sevana wasobserved as the maximum triggering factor i.e., 86.5 %.Bright lights and other high-intensity visual stimuli cancause headaches in patients with migraine.MansikaNidanas include Chinta (77.5 %), Krodha (72 %)andShok(62.5 %) some of which were found to trigger migraine headaches. This might lead to Dhatu Kshayaandthe vitiation of Vata Dosha.It was observed that there were statistically highlysignificant and few statistically insignificant results foundamong various parameters in the study. 1) Dashmool Tail6 Nasya: Dashmool is a very good ingredient for Shaman of Vataj Rogas and subsidation of pain. With the Principle― Nasa Hi Shirsodwaram‖ it will direct penetrate the Frontal region and open up the blocked channels Probable mode of action of Dashmool Taila NasyaKarma· Katu, Tikta, Kashaya Rasa has Deepana, Pachana, and Shoshana Karma thus providing proper metabolism and ultimately balances Agni Sthiti by carrying out Ama Pachana. Laghu, Ruksha, Tikshna Guna, by its property ofStrotoshodhakacts as Urdhwabhaga Doshahara and helps in expelling morbid Doshas. All the drugs possess Ushna Veerya which does soften and liquefaction of morbid Doshas, which are ultimately expelled out through the Virechana action of the drug. Dashmool Tail Nasya action is mainly by Vata Kaphahara, Shulagna, Shothagna, Amlapittahara, and Rasayana properties. and Triphala, Dashmool makes it the best combination that works on pain due to vitiated Vata and Avarodh. It clears the small channels and corrects the state of Dhatu Kshay. Also helps in the digestion and absorption of micronutrients. 3) Laghu Soot Shekhar Rasa8: It contains Gairik and Shunthi and Bhavana of Betel leaf which makes it a detoxifier, antiemetic, digestive, stimulant, carminative, antacid and anti-inflammatory. Laghu Soot Shekhar Rasa has proved itself a good reliever from headaches, migraine and painful situations. It improves digestive power and relieves heartburn and constipation due to Shunthi as it‘s content. Also helps in subsidation of Associated Symptoms of Migraine like Nausea and Vomiting. 4) Godanti Bhasma: It is a mineral-based Ayurvedic medicine prepared from Gypsum. Rich in calcium and Sulphur content and is advised in headaches, migraines, tension headaches, hypertension and constipation. Hence Godanti Bhasma is used to treat the cause of migraine and provides relief from it‘s symptoms.

It was observed that out of 12 patients 8 were female and 4 were male. The maximum number of patients 7 patients were in the age group 31 to 40 years,3 patients were in 21 to 30 years of age and 2 patients were in the age group 41 -50 years. It was found that exertion, lack of sleep, hunger and stress were the most aggravating reasons for migraine.

Markedly Improved:- 72% of patients got markedly improvement in overall symptoms Moderate Improvement: - 15% of patients got moderate improvement in overall symptoms.

Ardhavbhedakis Vata Kapha Pradhan Shiroroga, the symptoms complex of which very well correlate to that of Migraine. Most of the Nidanas mentioned in our classical texts go in similarly with migraine triggers, which have an active part in diagnosis and in planning the first line of treatment "Nidanparivarjan". The study was a clinical study which consists of 12 patients after treatment in which 72 % of patients got markedly improvement in symptoms. The study has shown highly significant results in the management of Ardhavbhedak.

1. http://www.who.int/mediacentre/factsheets/fs 277/en and Cephalgia, an international journal of headache disorders, black well publishers, Vol 24, supplement second edition; 2004. 2. Agnivesha; Charak Samhita revised by Charak and Drudhbala with Ayurveda Dipika Commentary by Chakrapani Dutta; Edited by Vaidya Yadavji Trikamji Acharya, published by Chaukhamba Prakashan Varanasi; Edition 2011. 3. Sushrut: Sushrut Samhita with Nibandh Sangrah commentary of Acharya Dalhan, edited by Vaidya Yadavji Trikamji Acharya, published by Chaukhamba Prakashan Varanasi; Edition 2011. 4. Ashtang Hriday, by Acharya Vagbhatt Edited by Dr Brahmanand Tripathi, published by Chaukhamba Prakashan Varanasi; Edition 2011, Uttar Tantra Adhyay 23. 5. Ashtang Hriday, by Acharya Vagbhatt Edited by Dr Brahmanand Tripathi, published by Chaukhamba Prakashan Varanasi; Edition 2011 Uttar Tantra Adhyay 23. 6. Bhaishajya Ratnavali, Siddhi Prada Hindi Vyakhya by Prof. Siddhi Nandan Mishr, Chaukhamba Surbharti Prakashan, Varanasi, Edition- 2009, Sirorogadhikar, Pg-1021. 7. Bhaishajya Ratnavali, Siddhi Prada Hindi Vyakhya by Prof. Siddhi Nandan Mishr, Chaukhamba Surbharti Prakashan, Varanasi, Edition- 2009, Sirorogadhikar. 8. Rasa Tantra Sara-Siddh Yog Sangrah- Kharaliya Rasayana 330, Chaukhamba Surbharti Prakashan, Varanasi, Edition- 2009.

Asst. Professor, Dept. of Kriya Sharir, Shubhdeep Ayurved Medical College & Hospital-PG Institute, Indore