Featured Case

MODERN DIAGNOSIS: Migrane

ABOUT THE DISEASE:

Migraine is a neurological condition that typically causes painful headache attacks that occur with additional symptoms, such as sensitivity to light, sound, smell, or touch.

Causes: There are many migraine triggers that are continually reported, including:

• bright lights
• severe heat, or other extremes in weather
• dehydration
• changes in barometric pressure
• hormone changes in people assigned female at birth, like estrogen and progesterone fluctuations during menstruation, pregnancy, or menopause
• excess stress
• loud sounds
• intense physical activity
• skipping meals
• changes in sleep patterns
• use of certain medications, like oral contraceptives or nitroglycerin
• unusual smells
• certain foods
• smoking
• alcohol use
• traveling                       

Signs & Symptoms: The common symptoms are as follows- 

• nausea
• vomiting
• difficulty speaking
• numbness or tingling
• sensitivity to light and sound

The condition often runs in families and can affect all ages. People assigned female at birth are more likely than people assigned male at birth to be diagnosed with migraine.

People describe migraine pain as:

• pulsating
• throbbing
• perforating
• pounding
• debilitating

It can also feel like a severe, dull, steady ache. The pain may start out as mild. But without treatment, it can become moderate to severe. Migraine pain most commonly affects the forehead area. It’s usually on one side of the head, but it can occur on both sides or shift.

In this case report, a 35-year-old female patient presented with mild continuous headaches which became severe on and off with nausea, vomiting and irritation for 15 years. Sometimes associated with poor eyesight since 1 month. In spite of taking other standard of care, the condition persisted and hence she opted for Ayurvedic treatments and approached Dr Partap Chauhan. Based on the clinical evaluation, the physician diagnosed the condition as migraine and Ayurvedic diagnosis as Shirashoola. 

Table 1. Symptoms tabulated at baseline

Diagnosis & Treatment:  The diagnosis of migraine is determined based on clinical history, reported symptoms, and by ruling out other causes. The most common categories of migraine headaches (or attacks) are episodic versus chronic, and then those without aura and those with aura.The cause is identified, and then the apt treatment is given. Migraine can’t be cured, but your doctor can help you manage migraine attacks by treating the symptoms when they occur, which may lead to fewer attacks in general. Treatment can also help make migraine less severe.

Treatments generally resorted to in Migranes are as follows:

Your treatment plan may include a combination of:

• lifestyle adjustments, including stress management and avoiding migraine triggers
• OTC pain or migraine medications, like Nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen (Tylenol)
• prescription migraine medications that you take every day to help prevent migraine headaches and reduce how often you have headaches
• prescription migraine medications that you take as soon as an attack starts to keep it from becoming severe and to ease symptoms
• prescription medications to help with nausea or vomiting
• hormone therapy if migraines seem to occur in relation to your menstrual cycle
• counseling
• alternative care, which may include meditation, acupressure, or acupuncture

Prognosis: Most migraine attacks last about 4 hours. If they’re not treated or don’t respond to treatment, they can last for as long as 72 hours to a week. In migraine with aura, pain may overlap with an aura or may never occur at all.

Reference

1. https://www.healthline.com/health/migraine#treatment

AYURVEDA DIAGNOSIS: Shirashoola

ABOUT THE DISEASE:

In this case report, a 35-year-old female patient presented with mild continuous headaches which became severe on and off with nausea, vomiting and irritation for 15 years. Sometimes associated with poor eyesight since 1 month. In spite of taking other standard of care, the condition persisted and hence she opted for Ayurvedic treatments and approached Dr Partap Chauhan. Based on the clinical evaluation, the physician diagnosed the condition as migraine and Ayurvedic diagnosis as Shirashoola. 

The word ‘Shira’ stands for head and ‘shoola’ means pain. This is also called as Shiroruk, Shiropida  or Shirovedana. Headache, also known as shirashoola in Ayurveda, is a type of shiroroga (diseases of the head). It may occur as a symptom of some underlying disease or as a problem in itself. Shirashoola is classified into eight types based upon the cause and the dosha involved. 

Causes: 

Ahara- Excessive eating, preferring  ruksha ahara, liquids - alcohol in excess, food which aggravates dosha altogether and individually are causative factors.

Vihara- Exposure to smoke, frost, breeze, dew, vishamashana, adyashana, ratri jagarana, diva swapna, atapa dhuma sevan, asatmya gandha sevana, exposure to bright and high intensity light, light stimuli, placing pillows in wrong height, aversion to abyanga, indulging in water sport, chinta, krodha, shoka, lamenting, weeping, bhaya, Vega dharana of mutra, mala, kshavatu and nidra,  weight lifting, talking too much and too loudly. 

Environmental factors 

Ayogya upchara - genetic, hereditary, or other diseases 

Abhighataja

Types of Shirashoola and their lakshanas: 

Ayurveda classifies a headache into the following types: 

Vataja: This type of headache occurs due to an imbalance in the vata dosha. It usually causes loss of balance while walking. 

Pittaja: It originates in pitta dosha and leads to a burning sensation along with headache. 

Kaphaja: It is caused due to kapha and occurs with cold and cough. 

Sannipatika: The vitiation of tridoshas causes a sannipatika headache, and it could show symptoms from any or all of the types of headaches mentioned above. 

Ananta vata: In this type of headache, pain is felt all over the head with accompanying nausea and giddiness.

Ardhavabhedaka: It involves pain in half of the head.

Samkhaka: In this type of headache, pain is confined to the left and right sides of the head, which swells and become red.

Suryavarta: This type of headache follows the path of the sun – it starts in the morning, increases till midday, and decreases as the sun goes down. 

But in this case report, the treating physician has not specified the type of headache. 

Treatment & rationale of treatment as specified by the treating physician:

In general the treatments given for Shirashoola are as follows: 

Basti karma 

Nasya karma 

Lepa 

Virechana (purgation) karma 

Seka 

Snehana 

Shirodhara 

The treating physician explains that the line of treatment he has adopted is Vata shamana, Pitta shamana and Vedana shamana. Medhya and Rasayana chikitsa is also incorporated in the treatment. 

Sadhyasadhyata: The cause of the shirashoola plays an important role in determining the sadhyasadhyata. If the cause can be addressed, then there is curability. But if the cause persists, then the condition is not curable. 

Reference:

1. Caraka Samhita. Su. 17
2. Sushruta Samhita. Utt.25

In this case report, a 35-year-old female patient presented with mild continuous headaches which became severe on and off with nausea, vomiting and irritation for 15 years. Sometimes associated with poor eyesight since 1 month. In spite of taking other standard of care, the condition persisted and hence she opted for Ayurvedic treatments and approached Dr Partap Chauhan. Based on the clinical evaluation, the physician diagnosed the condition as migraine and Ayurvedic diagnosis as Shirashoola. 

Assessment: Only subjective parameters were assessed to analyse the outcome of the ayurvedic treatment. 

Subjective parameters: The symptoms are tabulated date wise, to assess the outcome of the treatment. 

Table 1. Date-wise documentation of symptoms