Migraine is a recurrent neurological disorder characterized by moderate to severe throbbing or pulsating headaches, typically affecting one side of the head. In some cases, it is preceded by warning symptoms called aura, which include visual disturbances, tingling sensations, or difficulty speaking.

Migraine is often correlated to the condition ‘Ardhavabhedaka’ in Ayurveda. The term Ardhavabhedaka translates to ‘half-head splitting pain’, aptly describing the one-sided and intense nature of migraines.

Ayurvedic view of migraine:

1.Pathogenesis(Samprapti) of migraine:

• The primary cause of migraines is Vata and Pitta aggravation.
• Aggravated Vata dosha affects the nervous system, leading to hypersensitivity, while an increase in Pitta dosha results in inflammation, heat, and burning sensation.
• In severe cases, Kapha dosha involvement leads to heaviness, dull pain, and congestion.
• Migraine is associated with Rakta dushti(vitiation of blood), which worsens the condition.

2.Nidana(Causes):

• Dietary factors: Excessive consumption of spicy, sour, salty, or fried foods, irregular meal times, and fasting.
• Lifestyle factors: Excessive stress, irregular sleep patterns, overexposure to sunlight, or loud noises.
• Mental/emotional factors: Anxiety, anger, and suppressed emotions.

CLINICAL SYMPTOMS OF MIGRAINE:

Clinical symptoms of migraine have four phases. Here’s a detailed explanation of each phase and its associated symptoms:

1.Prodrome Phase(Pre-headache phase):

• It occurs hours to days before the onset of the headache.

Symptoms:

• Mood changes: Irritability, depression, or euphoria.
• Fatigue or energy fluctuations: Feeling unusually tired or hyperactive.
• Food cravings: Craving specific foods such as sweets or salty snacks.
• Neck stiffness: A sense of tightness or discomfort in the neck and shoulders.
• Increased urination: Frequency of voiding urine.
• Yawning: Repeated and excessive yawning, sometimes related or unrelated to fatigue.

2.Aura Phase(Experienced by 20-30% of migraine sufferers):

• Aura occurs before or during the headache and that is caused by transient disturbances in brain activity. These symptoms usually develop gradually over 5-60 minutes.

Symptoms:

a)Visual Disturbances:

• Flashes of light, zig-zag patterns, or blind spots.
• Tunnel vision or blurred vision.

b)Sensory symptoms:

• Tingling or numbness in the face, arms, or hands.
• “Pins and needles” sensation.

c)Language difficulties:

• Difficulty speaking or finding the right words(dysphasia).

Motor Symptoms(rare):

• Weakness or paralysis on one side of the body(hemiplegic migraine).

3.Headache Phase(Main attack phase):

• It is the most disabling phase, lasting 4-72 hours if untreated.

Symptoms:

Pain characteristics:

• Intense, throbbing, or pulsating pain, often on one side of the head(unilateral).
• In some cases, the pain shifts sides or occurs on both sides(bilateral).
• Severity: Moderate to severe pain that worsens with physical activity.

Associated symptoms:

• Nausea and or vomiting.
• Sensitivity to light(photophobia), sound(phonophobia), or smells(osmophobia).
• Cognitive difficulties, such as trouble concentrating or memory lapses.

Autonomic symptoms:

• Tearing redness of the eye.
• Nasal congestion or runny nose.

4.Postdrome Phase(Migraine hangover):

• It occurs after the headache resolves and lasts for 1-2 days.

Symptoms:

• Fatigue: Feeling drained or exhausted.
• Mental fog: Difficulty concentrating or thinking clearly.
• Mood changes: Depression or mild euphoria.
• Residual pain: A dull headache or sensitivity in the previously affected areas.

CLASSIFICATION OF MIGRAINES:

• Migraines are classified based on their clinical presentation, symptoms, and associated features.
• The International Classification of Headache Disorders(ICHD-3)provides a detailed framework for migraine classification. Here is an in-depth explanation:

1.Migraine without Aura(Common Migraine):

• This is the most common form of migraine accounting for 70-80% of cases.

CLINICAL FEATURES:

• Recurrent headache attacks lasting 4-72 hours.
• Pain is typically unilateral, pulsating, and moderate to severe in intensity.
• The headache is aggravated by physical activity.
• Associated symptoms include nausea and/or vomiting and sensitivity to light(photophobia) or sound(phonophobia).

Diagnostic criteria(ICHD-3):

• At least 5 attacks fulfilling the criteria.

Headache with at least 2  of the following features:

• Unilateral location.
• Pulsating quality.
• Moderate to severe intensity.
• Aggravation by routine physical activity.

During the headache, at least 1 of the following:

• Nausea and/or vomiting.
• Photophobia/Phonophobia.

2.Migraine with Aura(Classic Migraine):

• Aura refers to transient neurological symptoms that precede or accompany a headache.

CLINICAL  FEATURES:

• Reversible neurological symptoms lasting 5-60 minutes, typically developing gradually.

Aura symptoms include:

• Visual disturbances: Flashes of light, zigzag lines, blind spots.
• Sensory symptoms: Numbness, tingling, or “pins and needles” sensation.
• Speech disturbances: Difficulty finding words or forming sentences.

Diagnostic criteria(ICHD-3):

• At Least 2 attacks fulfilling the criteria.

Aura with at least 1 of the following symptoms.

• Visual(most common).
• Sensory(eg: tingling, or numbness).
• Speech/language disturbances(eg: aphasia).
• Motor weakness(in rare cases).

At Least 3 of the following features:

• Aura spreads gradually over >5.
• Each aura symptom lasts 5-60 minutes.
• Aura is unilateral.
• Aura is followed by a headache within 60 minutes.

3. Chronic Migraine:

• Defined by frequent headache attacks occurring over a prolonged period.

CLINICAL FEATURES:

• Headaches occur  15 or more days per month for at least 3 months.
• Of these, at least 8 days per month must fulfill migraine criteria.
• Typically evolves from episodic migraine due to medication overuse, stress, or other factors.

4. Hemiplegic Migraine:

• A rare subtype of migraine with aura that involves motor weakness.

CLINICAL FEATURES:

• Aura includes unilateral motor weakness(hemiparesis).
• Other aura symptoms such as visual or sensory disturbances may also occur.
• It can be familial(genetic) or (without family history).

5. Retinal Migraine(Ocular Migraine):

• Characterized by transient monocular visual loss associated with migraine.

CLINICAL FEATURES:

• Sudden onset of visual disturbances(eg: blind spots, loss of vision)in one eye.
• Visual symptoms are reversible and typically last 10-60 minutes.
• It may be followed by a migraine headache.

6. Menstrual Migraine:

• It occurs in hormonal changes during the menstrual cycle.

CLINICAL FEATURES:

• Attacks occur exclusively during the perimenstrual period(two days before to three days after menstruation).
• Associated with falling estrogen levels.
• It tends to be more severe and resistant to treatment than non-menstrual migraines.

7.Vestibular Migraine:

• Migraine with predominant vestibular symptoms(affecting balance and spatial orientation).

CLINICAL FEATURES:

• Episodes of vertigo, dizziness, or imbalance lasting minutes to hours.
• It may or may not be accompanied by a headache.
• Often associated with nausea, vomiting, and photophobia.

8. Abdominal Migraine:

• It is more common in children than adults and involves gastrointestinal symptoms.

CLINICAL FEATURES:

• Recurrent episodes of abdominal pain, nausea, and vomiting without headache.
• Pain is usually located around the midline or near the navel.
• It may evolve into typical migraine later in life.

9. Status Migrainosus:

• A severe and debilitating migraine attack that lasts more than 72 hours.

CLINICAL FEATURES:

• Intense, unrelenting headache with nausea, vomiting, and sensitivity to light/sound.
• Often requires emergency medical attention.

10.Medication -Overuse Headache(Rebound Migraine):

• Occurs due to excessive use of migraine medications.

CLINICAL FEATURES:

• Chronic headache worsened by frequent use of pain relievers(eg: triptans, NSAIDs).
• Typically resolves after medication withdrawal.

Other subtypes:

• Silent Migraine: Aura symptoms without headache.
• Ophthalmologic Migraine: Weakness of eye muscles leading to drooping eyelid(ptosis) or double vision.

TRIGGERS OF MIGRAINE:

Migraines are influenced by triggers, which can vary between individuals. Recognizing these triggers is crucial for effective management and prevention. Below are the most common clinical triggers of migraines:

1. Stress and Emotional factors:

• Acute stress
• Chronic stress.
• Post-stress relaxation: Migraines may occur after the stress subsides(weekend migraines).

2. Sleep disturbances:

• Insufficient sleep.
• Oversleeping.
• Jet lag or shift work.

3. Hormonal changes:

This is particularly seen in women.

• Menstruation-related migraines.
• Pregnancy or postpartum.
• Menopause or hormone replacement therapy.
• Usage of oral contraceptives.

4. Dietary Triggers:

• Skipped meals.
• Certain food items .
• Dehydration.

5. Sensory Stimuli:

• Bright or flickering lights: Screen glare, sunlight, or fluorescent lightning.
• Loud noises: Concerts, noisy environments, or sudden loud sounds.
• Strong odors: Perfumes, cleaning products, or smoke.

6. Weather and environmental changes:

• Barometric pressure changes: Before or during storms.
• Temperature extremes: Hot and cold weather.
• High altitudes: Oxygen levels vary at high altitudes.
• Air quality: Pollution or allergens.

7. Physical Factors:

• Excessive physical exertion: Vigorous exercise or sudden intense activity.
• Posture-related strain: Poor ergonomics or prolonged sitting.
• Neck or shoulder tension: Often associated with stress.

8. Medication and substances:

• Medication overuse: Frequent use of pain relievers(eg: NSAIDs, triptans)can cause rebound headaches.
• Certain drugs: Vasodilators(eg: nitroglycerin), oral contraceptives, or hormone therapy.
• Substance withdrawal: Abrupt cessation of caffeine or certain drugs.

9. Genetic and Family History:

• Inherited predisposition: Migraines often run in families, and genetic factors can influence trigger sensitivity.

10. Miscellaneous factors:

• Overstimulation or fatigue: Overuse of screens or excessive sensory input.
• Seasonal allergies: Inflammatory responses to allergens can trigger headaches.
• Medical conditions: Combined conditions like hypertension, depression, or anxiety.

TREATMENT OF MIGRAINE IN MAURYA AYURVEDA HOSPITAL:

At Maurya Ayurveda Hospital, we provide advanced migraine care through ayurvedic therapies, acupuncture, physiotherapy, and rejuvenating internal herbal medications.

AYURVEDIC MANAGEMENT PROVIDED IN OUR HOSPITAL:

INTERNAL MEDICATIONS GIVEN IN MIGRAINE ARE:

• Pathyakshadhatryadhi Kashayam.
• Varanaadi Kashayam.
• Shirah Shuladi Vajra Rasa Tab.
• Sudarshana vati.
• Avipathi Choornam.
• Thrivruth Lehyam.
• Migracin Tab.

EXTERNAL TREATMENTS GIVEN IN MIGRAINE ARE:

1. THALAM:

 

It is a traditional Ayurvedic therapy that involves applying a specially prepared medicinal paste to the crown area. Normally here we apply Thalam for about the duration of full treatment. Kachooradi with Balahatadi Thailam made to paste, gives the best result for migraine. Or Balahatadi Thailam alone can also be used.

Benefits of Thalam in Migraine:

• It relieves headaches and reduces pain intensity.
• It calms the nervous system.
• It balances Vata and Pitta dosha.
• It improves blood circulation.
• It eases sensory overload.
• It reduces stress and anxiety.
• It improves sleep quality.

2. NASYAM:

Nasyam is a panchakarma therapy that involves the administration of herbal oils, or powders through the nostrils, as the nose is considered the gateway to the head.

A gentle head, face, and neck massage is given using medicated oils. Then mild steaming (Swedana) is given to the face and neck to open the nasal pores. The patient is asked to lie on their back with their head tilted slightly backward. Then the medicated oil or powder is administered drop by drop into each nostril. The patient rests for a few minutes to allow the medicine to penetrate and work effectively. The patient is encouraged to spit out any mucus or phlegm.

Marsha ناسيام and Pratimarsha Nasyam are two types of Nasyam we normally perform here.

a)Pratimarsha Nasya:

• It is a milder, daily-use variant of Nasya therapy. It involves the administration of small quantities(1-2 drops) of medicated oil for preventive care, maintenance of health, and balancing of the doshas. Usually, Anu Taila is preferred.

b)Marsha Nasya:

• It is a therapeutic procedure involving the administration of a larger quantity(6-10 drops) of medicated oil, powder through the nostrils. Usually, we use Ksheerabala Taila here.

The other types of Nasya which is also beneficial for Migraines are:

a)Shodhana Nasya(Cleansing Nasya):

• It detoxifies by removing excess doshas and toxins.
• It is useful for migraines caused by chronic congestion or toxin buildup.

b)Shamana Nasya(palliative Nasyam):

• Focuses on pacifying aggravated doshas, especially Vata and Pitta, to reduce intensity.

c)Brimhana Nasya(Nourishing Nasyam):

• Strengthens the nervous system and head region,making it less prone to migraine triggers.

Avoid exposure to cold, dust, and strong winds. Light meals are recommended.

Benefits of Nasyam in Migraines:

• It detoxifies and clears blockages.
• It balances Vata and Pitta doshas.
• It improves blood circulation.
• It relieves stress and tension.
• It reduces the frequency and intensity of attacks.
• It nourishes the nervous system.
• It relieves the associated symptoms.

3. NADI SWEDAM:

Nadi Sweda is an important localized sweating therapy (Swedana) in Ayurveda. Here a steamer device or boiler is used to produce steam. Haline capsule(it is cut open) and are normally added to the water before producing steam. Then the steam is directed to the affected part using a hose or tube. Here we usually give face steam. The therapy typically lasts 10-15 minutes, depending on the individual’s condition.

Benefits of Nadi سويدا in Migraine:

• It relieves headaches and stiffness.
• It improves blood circulation.
• It balances Vata and Kapha dosha.
• It relieves stress and anxiety.
• It helps in detoxification.
• It aids in the opening of channels(Srotas).
• It alleviates sinus-related migraines.

4. SHIROLEPA:

Applying a medical paste in the forehead area is known as Shiro Lepa. The paste is evenly applied to the forehead. After the paste dries usually (30-60) minutes, the paste is gently washed off using lukewarm water. Normally Rasnadi Choornam/Kachooradi Choornam warmed in Jambeera(lemon juice) gives the best results in Migraine.

Benefits of Lepam in Migraine:

• It provides a cooling and soothing effect.
• It relieves stress and tension.
• It improves blood circulation.
• It reduces detoxification and reduces inflammation.
• It aids in relaxation and promotes sleep.

5. SHIRO DHARA:

Shirodhara is a classic ayurvedic therapy that involves the rhythmic pouring of warm medicated oil or other liquids on the forehead. The liquid is chosen based on the patient’s dosha imbalance.

The liquid is gently heated to body temperature and poured like a continuous stream onto the forehead from a vessel(dhara pot) hanging above. The procedure typically lasts for about 30-60 minutes.

Normally we perform Tailadhara(using Ksheerabala Taila) which seems to be extremely effective.

Benefits of شيرودهارا:

• It is effective for headaches and migraines.
• It calms the nervous system.
• It improves sleep.
• It balances doshas.
• It enhances cognitive function.
• It relieves hormonal imbalances.
• It aids in detoxification. 

PHYSIOTHERAPY AND ITS BENEFITS IN MIGRAINE:

Physiotherapy is a non-invasive approach to managing migraines, particularly when they are associated with musculoskeletal issues, tension, or posture-related triggers. Migraines often arise from a combination of factors including stress, neck stiffness, poor posture, and muscle imbalances, which physiotherapy addresses comprehensively.

Key physiotherapy techniques for Migraine:

1. Manual Therapy:

• It releases tension in the cervical(neck) and upper thoracic regions.

Techniques:

• Joint mobilizations for neck and shoulders.
• Soft tissue massage to reduce muscle tightness.

Benefits:

• Improves blood flow to the head and neck.
• Reduces the severity of migraines by alleviating tension.

2. Postural Training:

• Corrects poor posture that may strain the neck and shoulders.

AIM:

• Ergonomic advice for workstations.
• Strengthening exercises for postural muscles.

Benefits:

• Reduce chronic strain on muscles contributing to migraines.
• Improves long-term spinal health.

3. Cervical Spine Mobilization:

• Restores proper joint function in the neck.

Techniques:

• Gentle manual mobilization to improve range of motion.

Benefits:

• Reduces nerve irritation and stiffness.
• Addresses tension headaches often linked to migraines.

4. Myofascial Release:

• Targets trigger points and tight fascia in the neck, shoulders, and head.

Techniques:

• Sustained pressure on trigger points.

Benefits:

• Relieves localized muscle tightness.
• Reduces headache frequency and intensity.

5. Relaxation techniques:

• Reduces stress and improves overall relaxation.

Techniques:

• Breathing exercises.
• Progressive muscle relaxation.

Benefits:

• Addresses stress-induced migraines.
• Promotes a sense of calm and relaxation.

6. Strengthening and stretching Exercises:

• Improves flexibility and muscular support.

Techniques:

• Stretching neck, shoulder, and upper back muscles.
• Strengthening exercises for postural stability.

Benefits:

• Prevents overloading of neck muscles.
• Reduces tension-related triggers.

7. Vestibular Rehabilitation:

• Treats dizziness and balance issues associated with vestibular migraines.

Aim:

• Balance exercises.
• Eye and head movement coordination.

Benefits:

• Reduces vertigo and nausea.
• Improves overall balance and coordination.

8. Electrotherapy:

• Provides pain relief through nerve stimulation.

Techniques:

• Transcutaneous Electrical Nerve Stimulation(TENS).
• Ultrasound therapy for muscle relaxation.

Benefits:

• Reduces pain and intensity during migraine episodes.
• Enhances local circulation and relaxation.

Benefits of Physiotherapy in Migraine Management:

• Pain Relief: Targets the physical triggers of migraines, such as muscle tension and joint dysfunction.
• Improved posture: Helps prevent migraines triggered by poor posture and ergonomic stress.
• Reduced Frequency: Regular therapy lessens the recurrence of migraines by addressing root causes.
• Stress management: Provides relaxation techniques to reduce stress-induced migraines.
• Holistic care: Compliments other treatments like acupuncture or Ayurveda for comprehensive migraine management. 

ROLE OF ACUPUNCTURE IN MIGRAINE:

Acupuncture is an effective complementary treatment for migraines, offering a holistic approach to pain relief and prevention. Below is a detailed explanation of its role, techniques, and benefits.

Techniques used in Acupuncture for Migraine:

1. Traditional Needle Acupuncture:

Fine needles are inserted into specific points, including the head, neck, hands, and feet.

Common points for migraine include:

• L14(Hegu): Located on the hand, it reduces head and facial pain.
• GB20(Fengchi): At the base of the skull, it relieves headaches and tension.
• LV3(Taichong): On the foot, balances energy flow and reduces stress.
• ST36(Zusanil): Improves overall vitality and circulation.
• SP6(Sanyinjiao): It’s about three-finger width above the inner ankle.
• PC6(Neiguan): On the inner forearm three fingers width above the inner ankle. It balances hormonal migraines and relieves stress.

Electroacupuncture:

• A mild electrical current is applied through needles to enhance stimulation and improve results for chronic migraines.

Acupressure and its advantages:

Acupressure involves applying gentle pressure to specific points(acupoints) on the body, which are believed to correspond to meridians or energy pathways.

• Here fingers are used to locate the acupoint based on its anatomical location.
• Using thumb, index finger, or knuckles to apply firm and comfortable pressure.
• Then massage the point in circular motions for 1-3 minutes.
• While massaging, focus on deep, slow breathing to enhance relaxation.
• And perform this on both sides of the body.
• It has to be done during the early stages of migraine(prodrome phase) to prevent progression.
• Similar points chosen to do needling are considered to do acupressure.

Benefits of Acupuncture for Migraine:

• Reduces Migraine frequency and intensity.
• Minimizes medication dependency.
• Manages stress and anxiety.
• Improves sleep quality.
• Long-term relief.

ROLE OF YOGA AND PRANAYAMA IN MIGRAINE:

Yoga and Pranayama play a significant role in managing migraines by addressing the physical, mental, and emotional triggers associated with the condition. They work to reduce stress, improve blood circulation, and relax the nervous system, offering both preventive and therapeutic benefits.

Benefits of Yoga and Pranayama in Migraine Management:

• It aids in stress reduction.
• It improves blood flow.
• It helps in hormonal balance.
• It helps in relieving muscle tension.
• It promotes relaxation.

 YOGA TECHNIQUES AND BENEFITS  FOR MIGRAINE:

1.Sukhasana(Easy pose) with forward bend:

• Sit cross legend. Extend your arms forward and bend gently, keeping your back straight.
• It calms the mind and stretches the back and shoulders.

2.Balasana(Child’s pose):

 

• Sit on your heels, stretch your arms forward, and lower your torso to the ground.
• Release tension in the back and neck promotes relaxation.

3.Setu Bandhasana(Bridge pose):

 

• Lie on your back, bend your knees, and lift your hips.
• It improves blood flow to the brain and reduces stress.

4.Viparita karani(Legs-up-the-wall pose):

• Lie on your back with your legs resting vertically against a wall.
• It enhances circulation, relieves headache symptoms, and calms the nervous system.

5. Shavasana(Corpse pose):

• Lie flat on your back with arms relaxed at your sides, focusing on your breath.
• It induces deep relaxation and alleviates stress.

PRANAYAMA TECHNIQUES AND BENEFITS FOR MIGRAINE:

1.Nadi Shodhana(Alternate Nostril Breathing):

• Close the right nostril and inhale through the left, then close the left nostril and exhale through the right. Repeat alternatively.
• It balances the nervous system, reduces stress, and improves focus.

2. Anulom-Vilom:

• A variation of alternate nostril breathing with longer exhalations than inhalations.
• It soothes the mind and controls emotional triggers.

3.Bhramari(Humming bee breath):

• Close your eyes, cover your ears with your fingers, and hum softly while exhaling.
• Reduces mental agitation and relieves headache symptoms.

4.Sheetali and sheetkari Pranayama:

• Inhale through a curled tongue(Sheethali) or clenched teeth(Sheetkari) and exhale normally.
• Cools the body and mind, reducing the intensity of migraines.

 This has to be practiced daily for 15-30 minutes for sustained benefits. It has to be performed either in the early morning or evening. Also, it has to be avoided during an active migraine unless in a relaxed, restorative posture.

DIETARY REGIMEN OF MIGRAINE:

A migraine diet involves identifying and consuming foods that reduce the likelihood of triggering migraines while avoiding potential dietary triggers. Diet can play a significant role in managing migraines certain kinds of foods, beverages, or eating habits can influence the frequency and severity of migraine attacks.

1. Maintain regular eating patterns:

• Skipping meals or irregular eating can lead to low blood sugar levels, which is a common migraine trigger.
• Eat a small portion of balanced meals every 3-4 hours.
• Avoid fasting for long periods.

2. Stay hydrated:

• Dehydration can directly contribute to headaches and migraines.
• Drink at least 3 liters of water daily.
• Limit diuretics like caffeine or alcohol that can hydrate the body.

3. Avoid common migraine-trigger foods:

Some common foods are known to trigger migraines in susceptible individuals. The most common ones include:

• Aged cheese( Eg: blue cheese, cheddar, parmesan).
• Fermented or pickled foods(Eg: sauerkraut, kimchi).
• Smoked or cured meats.eg:(salami pepperoni).
• Processed foods like hot dogs, sausages, and bacon.
• Food items added with Monosodium Glutamate(MSG), artificial sweeteners, etc.

 

DISCLAIMER: The information provided in this article is intended solely for educational  purposes. Treatment decisions should be made exclusively by a well-qualified Ayurvedic physician. Self-medication is strongly discouraged.

Maurya Ayurveda Hospital,opposite to Sabine Hospital,Pezhakkapilly P.O,Muvattupuzha,Ernakulam;PIN:686673,Contact no:9947183000

Email: [email protected]

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