Migraine

ayurvedic aspect of migraine

1. welcome

2. Disease review

3. Migraine Migraine  is a primary headache disorder characterized - recurrent headaches-moderate to severe Affect- one half of the head-pulsating in nature- last 2 -72 hrs Associated symptoms -nausea, vomiting, and sensitivity to light, sound, or smell worse - physical activity

4. Up to one-third of people have an aura Aura - a short period of visual disturbance - signals that the headache will soon occur.

5. Cause Environmental and genetic factor About two-thirds of cases run in families Changing hormone levels - as migraines affect slightly more boys than girls before puberty The underlying causes of migraines are unknown.

6.  psychological conditions-depression, anxiety, and bipolar disorder

7. Signs and symptoms self-limited, recurrent severe headache associated with autonomic symptoms. Variable-severity of the pain, duration, and frequency –attack Migrainosus -longer than 72 hours.

8. Phases of migraine 4 phases not all phases are necessarily experienced   prodrome - occurs hours or days before the headache  aura - which immediately precedes the headache pain  - also known as headache phase   postdrome - the effects experienced following the end of migraine attack

9. Prodrome phase Prodromal - 60% of those with migraines  2 hrs to 2 days before- pain or the aura. symptoms may include- altered mood, irritability, depression or euphoria, fatigue, craving for certain food, stiff muscles (especially in the neck), constipation or diarrhea , and sensitivity to smells or noise

10. Aura phase Aura- transient focal neurological phenomenon - occurs before or during the headache appear gradually –starts over a number of minutes and last less than 60 min. Symptoms - visual, sensory or motor in nature Vision -  scintillating scotoma

11. Sensory - feeling of pins-and-needles -one side in the hand and arm-spreads to the nose–mouth area on the same side.   Motor symptoms- weakness- lasts longer than one hour

12. Pain phase headache - unilateral, throbbing, and moderate to severe intensity. comes on gradually -- aggravated by physical activity. bilateral pain -40% of cases neck pain is commonly associated with it pain lasts- 4 to 72 hours in adults

13. pain- accompanied by nausea, vomiting, sensitivity to light, sound, smells, fatigue and irritability. Other symptoms- blurred vision, nasal stuffiness, diarrhoea, frequent urination, pallor, or sweating.

14. Postdrome phase symptoms occurring once the acute headache has settled. sore feeling in the area where the migraine was. impaired thinking for a few days after the headache has passed. Other symptoms -feel tired, head pain, cognitive difficulties, gastrointestinal symptoms, mood changes, and weakness

15. Triggers Migraines may be induced by triggers Physiological aspects- stress, hunger, and fatigue   Psychological stress -50 to 80% cause.

16. Hormonal influences -menarche, oral contraceptive use, , perimenopause , and menopause Migraines typically do not occur during the second and third trimesters 

17. Diagnosis The diagnosis - based on signs and symptoms according to  International Headache Society - the " 5, 4, 3, 2, 1 criteria “ Five or more attacks. Four hours to three days in duration

18. Two or more of the following: Unilateral (affecting half the head) Pulsating Moderate or severe pain intensity Worsened by or causing avoidance of routine physical activity One or more of the following: Nausea and/or vomiting; Sensitivity to both light and sound

19. Differential diagnosis similar symptoms- temporal arteritis , cluster headaches, acute glaucoma, meningitis and subarachnoid hemorrhage Temporal arteritis - over 50 years old, tenderness over the temple cluster headaches- one-sided nose stuffiness, tears and severe pain - orbits acute glaucoma is associated with vision problems

20. meningitis- with fevers subarachnoid hemorrhage - very fast onset  Tension headaches -typically occur on both sides, are not pounding, and are less disabling

21. Prevention Preventive - include medications, nutritional supplements, lifestyle alterations, and surgery. The goal - reduce the frequency, painfulness, duration of migraines, and to increase the effectiveness of abortive therapy.

22. Medication Guidelines consistent- topiramate ,  divalproex /sodium valproate ,  propranolol , and  metoprolol

23. Prognosis Long term prognosis in people with migraines is variable. There are four main patterns to the disease: symptoms can resolve completely symptoms can continue but become gradually less with time symptoms may continue at the same frequency and severity attacks may become worse and more frequent

24. Epidemiology 15% affect -Worldwide  It is more common in women at 19% than men at 11%. It most often starts at puberty and is worst during middle age. In some women they become less common following menopause

25. Treatment Initial -simple pain medication - ibuprofen and  paracetamol  for the headache.  medication for the nausea, avoidance of triggers Specific medications such as  triptans  or  ergotamines  may be used

26. History early description fount in the  Ebers papyrus- written around 1500 BC in ancient Egypt  The word "migraine" is from the Greek  - hemikrania - "pain on one side of the head"   ( hemi- ), "half", and ( kranion ), "skull".

27. Ardhavabhedaka causes Suppression of natural urges Indigestion Intake of dry food, Oily and spicy food Exposure to sunshine for prolonged period,fog,cold fasting Anger, jealousy, grief, stress etc Intake of dry, pungent and salty food etc Talking loudly

28. symptoms Pakshat kupyati maasat vaa swayameva cha shamyati ati vridhastu nayanam sravanam vaa vinashayet [A H. u 23] Yasya uthamaga ardhamateeva jantho : sambhedha toda bhrama shoolajushtam , pakshadhashaahad adhava api aakasmaat t asya ardhavabhedakam tritasyat vyavasthade . [S S . u 25/15]

29. Acc to charaka and madhavacharya - vata or vata kaphaja disease Acc to SS- tridoshaja Acc to AH- vataja disease

30. Treatment Abhyanga Sneha pana Nasyam Lepa Pariseka kabala Shirovasti Dhoomapana Raktamoksha Agni karma over bhru,lalata,shangha

31. Nasya Avapeeda nasya - Shireesha beejam , apamarga moolam , bala moola triturated in water Nasya with sthira rasa vamshi moola , vacha and pippalli Vamshimoola,karpoora or manassila with honey yasti with honey or chandana and honey aja ksheera Samana nasya-kakolyadi grta , moorvadi grta , ksheerabala taila, dhanwantara tailam , anu taila , satbindhu taila.

32. Lepa yogas Lepa on fore head with prapunnada mixed with amla dravya drugs pacify Pitta Dosha like chandana ,   karpoora , Jatamansi

33. Shiro Dhara   ksheerabala taila,  chandanadi taila- Vata involvement is high. - ksheera dhara (cow milk)- is done when Pitta involvement is more - Takra Dhara (buttermilk)- is done when there is Vata involvement.

34. Kavala graha –   with  chandanadi taila, maha narayana taila Shirovasti –   Any vata-pitta pacifying oils are beneficial for this purpose.

35. Internal medicine Pathyadi khwada  –  used in the treatment of headache, earache, pain in temporal region, migraine etc. Shirashooladi vajra rasa  –  used in the Ayurvedic treatment of headache, migraine, tension headache, vascular headache etc. Mayura ghrita Bhoonimbadi khwada  – Used in fever, cold, sinusitis, headache Kumaryasava

36. G odanthi bhasma  –  250 mg of this medicine is given twice a day. In many occasions, it gives immediate relief from migraine, within 20 – 30 minutes, much faster than Paracetamol

37. THANK YOU