Migraine

Migraine
(Ardhavabhedaka)
Migraine is a headache disorder characterized by recurrent headaches that are moderate to severe. Typically, the headache that mostly effect one half of the head but in some cases, patients may experience pain bilaterally or on both sides, are pulsating in nature, and last from two to 72 hours. The pain of a migraine is often described as throbbing or pounding and it may be made worse with physical exertion.Associated symptoms may include nausea, vomiting, and sensitivity to light( photophobia), sensitivity to sound, or smell. The pain is generally made worse by physical activity.
Some people experience an aura, a typical short period of visual disturbance which indicates that the headache will soon occur. Occasionally, an aura can occur with little or no headache following it.
Migraines are believed to be run in families or can say that it may be hereditable and it may be due to environmental and genetic factors.
Hormonal changes sometimes may also play a role, as migraines affect slightly more in boys than girls before adolsence and two to three times more in women than men. The risk of episodes of migraine usually decreases during the pregnancy. The exact causes of migraine are not fully known. It is, however, believed to involve the nerves and blood vessels of the brain. Excessive stress sometimes also might be the cause of the disease.
Globally, approximately 15% of people are affected by migraines. It mostly starts at puberty and is worst in middle age. In some women it become less common following menopause but oftenly experienced during or near the menstrual cycles.

In Ayurveda, Ardhavabhedaka (meaning literally the unilateral pain) and Ananta vaata, these two situations resembles, the classical migraine.

Ayurvedic view:
From Ayurveda point of view, headaches are because of a problem in the balance of Tri-dosha viz vata, pitta and kapha doshas. When these doshas especially vata gets vitiated due to the root causes, causes dryness and emaciation of the structures include blood vessels inside the brain. Along with pitta and kapha dosha vata gets lodge indise the brain and the microstructures causes the disease and produces various types of symptoms.

Symptoms: Migraines typically present with self-limited, recurrent severe headache associated with symptoms like:
• Often severe pounding or throbing pain, usually on one side of the head
• Sometimes also pain in neck and back of the skull
• Nausea and/or vomiting
• Sensitivity to light
• Sensitivity to sound
• Eye pain or pain inside the eye orbit

About 15–30% of people with migraines experience migraines with an aura and those who have migraines with aura also frequently have migraines without aura. The severity of the pain, duration of the headache, and frequency of attacks are variable. A migraine lasting longer than 72 hours is termed Status migrainosus. There are four possible phases to a migraine, although not all the phases are necessarily experienced.
• The prodrome, which occurs hours or days before the headache
• The aura, which immediately precedes the headache
• The pain phase, also known as headache phase
• The postdrome, the effects experienced following the end of a migraine attack
Prodrome phase
Prodromal or pre-monitory symptoms occur with migraine, with an onset that can range from two hours to two days before the start of pain or the aura. These may include a wide variety of symptoms including:
• Altered mood
• Irritability
• Depression
• Fatigue
• Craving for certain food(s)
• Stiffness of muscles (especially in the neck)
• Constipation /diarrhea
• Sensitivity to smells or noise.

Aura phase
An aura is a transient focal neurological phenomenon that occurs before or during the headache. Auras appear gradually over a minutes and generally last less than an hour. Symptoms can be:
Visual, sensory or motor in nature and many people experience more than one. Visual effects occur most frequently and are not accompanied by sensory or motor effects.
Sensory aura are the second most common type. Often a feeling of pins-and-needles begins on one side in the hand and arm and spreads to the nose–mouth area on the same side. Numbness usually occurs after the tingling has passed. Other symptoms of the aura phase can include speech or language disturbances, world spinning, and less commonly motor problems.
Motor symptoms indicate that this is a hemiplegic migraine, and weakness often lasts longer than one hour unlike other auras. Auditory hallucinations or delusions have also been experienced.
Pain phase
Classically the headache is unilateral, throbbing, and moderate to severe in intensity. It usually comes on graduallyand is aggravated by physical activity. Sometimes the pain may be bilateral and neck pain is commonly associated with it. Bilateral pain is particularly common in those who have migraines without an aura. Commonly pain may occur primarily in the back or top of the head. The pain usually lasts 4 to 72 hours in adults, however in young children frequently lasts less than 1 hour. The frequency of attacks is variable, from a few in a lifetime to several a week, with the average being about one a month, fortnight or in a week the pain in the migraine has a pattern, that individual can experience it after some particular time or day. Some may experience it after 3 days, some after 5days may be after 10-15 days or after a month also. This periodic type of pattern in pain made the classical nature.
The pain is frequently accompanied by nausea, vomiting, sensitivity to light, sensitivity to sound, sensitivity to smells, fatigue and irritability.
Rarely, an aura occurs without a subsequent headache. This is known as an Silent migraine, however, it is difficult to assess the frequency of such cases because people who do not experience symptoms severe enough to seek treatment may not realize that anything unusual is happening to them and pass it off without reporting any problems.
Postdrome
The migraine postdrome could be defined as group of symptoms occurring once the acute headache has settled. Swelling or stiffness feeling in the area where the migraine pain was experienced, and sometimes feeling of impaired thinking for a few days after the headache has passed. The person may feel tired or “hung over” and have head pain, cognitive difficulties, gastrointestinal symptoms, mood changes, and weakness like symptoms.

Causes : The exact cause of the attacks of migraine headache are not clearly noted, However, they are believed to be related to a mix of environmental and genetic factors. A number of psychological conditions are associated, including depression, anxiety, and many other biological events or triggers but some of the triggers that seen are enlisted below:
• Activities: In most of the individuals the following activities may possibly trigger migraine.

• Stress and time pressure, major hassles, major losses, anger, frustration, depression and conflict.

• Excessive relaxation and positive feelings such as excitement.

• Smells and fumes, tobacco smoke, light glare or dazzle, weather changes and high altitude.

• Onset of puberty in girls, monthly period, birth control pills, pregnancy, delivery, oestrogen therapy and menopause.

• Motion and travel.

• Too much, too little or interrupted sleep.

• Hunger or fasting.

• Excessive activity (especially if you are not in good health).
• Food: The food items that are known to trigger migraine are:

• Beer, wine and ‘hot’ liquor.

• Caffeine in coffee, tea, and cola drinks and some over-the-counter medicines.

• Dairy products such as ice-cream, milk, curd, cheese, butter and milk cream.

• Fermented foods, such as dosa and pickled foods.

• Grapes, lemons, bananas, figs, and raisins.

• Processed meats.

• Chinese food containing monosodium glutamate (MSG).

• Saccharin in diet foods or diet drinks.

• Onions and beans.

• Yeast-containing products, such as fresh breads and doughnuts.

• Nuts and peanuts.
• Drugs: Medicines that might trigger migraine are:

• Blood vessel dilating drugs such as nitroglycerine.

• drugs for high blood pressure such as reserpine, nifedipine; diuretics.

• anti-asthma medications like aminophylline.

• oestrogens including birth control pills.

• painkillers in general—either overuse or withdrawal from them.
• Self-Help Guidelines

• Spread your workload evenly during the day to avoid highs and lows of stress at work or at home.

• Do not sleep excessively, especially during Sunday mornings and holidays.

• Do not get too tired.

• Eat at regular times, and do not skip meals.

• Do not eat or drink anything, you think brings on a headache.

• Limit the amount of tea, coffee and painkillers you use.

• Watch your posture. Try to keep your neck straight.

• Keep your muscles relaxed when you are not physically active. Try not to frown or tighten your jaw.

• Restrict your physical activities in hot weather.

• Avoid bright or flickering lights, loud noises or strong smells if they trigger headaches for you.

• Remember the classic advice; “ati sarvatra varjayeth” or moderation in all things.

From ayurvedic view the cause of migraine is the imbalance of the doshas, that causes the symptoms accordingly. According to ayurveda migraine is divided into two types:
Vataja: in this condition the vata dosha mainly get disturbed leads to vata dominating symptoms.
As specified migraines can additionally begin because of imbalance in vata dosha. The symptoms of vata irregularity are: tension, sadness, dry skin, constipation, and extreame pain.
Vatakaphaja: in this condition along with vata dosha kaphs dosha also gets disturbed, thus causes combined vitiation, leads to exhibit mixed symptoms. This condition is characterized by dull headache, heaviness, fatigue, nausea, white or clear phlegm, vomiting, and excess salivation. Respiratory disorders are frequently connected with these symptoms.
According to Ayurvedic principles, migraine is a tridosha disorder,Out of the three doshas, Vata and kapha dosha are the prominent factors. Vata controls the nervous system and brain activity and it is the imbalance of this Vata that causes the diseases. Vata imbalance arises due to improper metabolism, poor elimination, mental and physical stress, viewing of TV for long periods, reading with insufficient light, sleeplessness, etc. On the other hand Kapha dosha causes heaviness in the head that leads to diminish blood supply.

Migraine due to Vata dosha Migraine due to Kapha dosha
Dryness of skin Fatigue
Constipation Depression
Pain is very acute Headache with a dull throbbing pain

Treatment:
According to ayurveda, the treatment for ardhavabhedaka or migraine is classified into two:
• Sodhana or panchakarma chikitsa
• Shamana or oral medication

Panchakarma chikitsa involves,

Shirolepa – Application of herbal pastes which pacify vata and kapha Dosha like Sandalwood, camphor, Jatamansi, rasna, lasuna paste etc.
Shiro Dhara – pouring of thin stream of liquid over scalp, that includes:.
Taila dhara with oils like ksheerabala taila, chandanadi taila , where Vata involvement is high.
ksheera dhara (cow milk) where, Pitta dosha is involved along with vata.
Takra Dhara (buttermilk) is done when there is obstruction to Vata passage by the kapha dosha is involved.
Kavala graha – filling oil and retaining for certain time in the mouth, with chandanadi taila, mahanarayana taila
Shirovasti – Retaining the medicated oils over the leather cap fitted over the scalp. Any vata-pitta pacifying oils are beneficial for this purpose.

Sneha nasya – Instillation of medicated oils can be carried to the nostrils, shadbindu taila, Anu taila , ksheerabala 101 yield significant benefits in this condition.
Herbs useful in migraine
Yastimadhu – Indian licorice – Glycyrrhiza glabra
Sariva – Hemidesmus indicus
Hareetaki – Chebulic myrobalan-Terminalia chebula
Amalaki – amala – Eemblica officinalis
Bala – Sida cardifolia
Mallika – Jasminum officinarum
Kumari – Aloe vera
Ayurvedic medicines useful in migraine:

• Pathyadi khada
• Shirashooladi vajra rasa
• Brahami vati
• Saraswatarista
• Ashwagandharista

Mayura ghrita
Bhoonimbadi khada
• Kamadugha rasa (mouktika yukta)
• Chandrakala rasa

• Saptamrita rasa

Sudhanidhi rasa

Kumaryasava

Godanti Bhasma

Prevention
Preventive treatments of migraines include medications, nutritional supplements, lifestyle alterations, yoga therapy, meditation. Prevention is recommended in those who have headaches more than two days a week, cannot tolerate the medications used to treat acute attacks, or those with severe attacks that are not easily controlled.
The goal is to reduce the frequency, painfulness, and/or duration of migraines, and to increase the effectiveness therapy. Another reason for prevention is to avoid medication overuse headache. This is a common problem and can result in chronic daily headache.

Exercise and migraine
Some people find that exercises that promote muscle relaxation can help manage the pain of migraines. Examples of types of mind-body exercises that can help encourage relaxation are:
• Meditation
• Progressive muscle relaxation
• Guided imagery
• Yoga
Diet and Migraine
There is no specific diet for people with migraine that helps with symptom relief. However, as mentioned previously, certain foods can be triggers for migraines in susceptible people. These foods include:
• red wines,
• aged cheeses,
• preservatives used in smoked meats (nitrates),
• monosodium glutamate,
• artificial sweeteners,
• chocolate, and
• dairy products.
Alcoholic beverages can also trigger migraine in some people.
Understanding the particular triggers of your migraines and avoiding these dietary triggers may help some sufferers decrease the frequency of attacks.

Simple home remedies useful in migraine headache:
1. Tender leaves of jasmine or tender leaves of pomegranate are taken along with a pinch of salt and crushed well to obtain fresh juice. Early in the morning, preferably in empty stomach, 2-3 drops of this fresh juice is instilled to both the nostrils. Procedure is repeated once again evening hours (6-7 pm). This reduces the severity of headache in migraine.
2. One fist full of Doorva grass (cynodan dactylon) is taken and its fresh juice is obtained. To this, 2 pinch of licorice powder is added and mixed well. This is consumed during the noon hours. Procedure is repeated for 20-30 days. This helps to reduce the severity of illness significantly.
3. Take coriander seed powder – 1 teaspoon. add it to one cup of water, leave it as it is at night, next day morning, drink it on empty stomach.
4. Soak 5 raisins and 5 almonds in water at night, next day morning, eat them.

Tips:

Do not take pain mitigating medicines frequently. Over intake of pain medicines may cause rebound headache and may eventually increase the frequency of migraines.

Make sure to sleep and eat at regular intervals.Make sure to sleep at least 7 hours at night.

• Avoid fasting. It will increase both Pitta and Vata dosha, worsening migraines. Do not skip meals.

Use a very mild deodorant / perfume.

Quit smoking and get rid of alcoholic addiction

Do not drink strong coffee / tea. Make it light.

Do not abruptly stop taking coffee or tea. Be very gradual in withdrawal.

Try to avoid pubs and clubs with loud music and flashy bright lights
Wear sunglasses wherever possible.

Make sure to have proper ventilation at your place. Do not use a/c for long period of time.

Early morning walking for 10 minutes in fresh air will help you immensely.

If you get time, go to a nearby Ayurveda center and get massage with herbal oils (once a week).Or take the oil and do massage yourself once a week and then take bath.

Use an umbrella or hat to protect yourself from direct Sun.

Avoid or restrict green chilli use.

You can have cinnamon, cardamom, clove, ginger and pepper.
Do not hear to loud sounds.

Try to control your anger.

Lower computer / TV screen brightness

Do not take too hot water bath or too cold water bath.

Watch for those things or foods that trigger a migraine attack. Make a list of them and avoid them.