Vaidya Balendu PrakashAyurvedic Consultant
www.ayrvedamigraineclinic.comwww.ayurvedapancreatitisclinic.com
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• Common primary episodic headache disorder characterized by various combination of neurologic, gastrointestinal and autonomic symptoms
• In India, prevalence stands at 15-20%
• Effects women more than men, ratio 3:1
World ATLAS of Migraine
A. Idiopathic, recurrent headache (=> 5 attacks)
B. 4-72 hours duration *
C. Pain characteristics (2/4)
• Unilateral location
• Pulsating quality
• Moderate to severe intensity **
• Aggravation by routine physical activity
D. During attack (1/2)
• Nausea and / or Vomiting
• Photophobia and phonophobia *children, sleep; ** untreated or unsuccessfully treated
E. At least one of the following
• No secondary cause for headache
• Secondary cause suggested but ruled
out by investigations
• Secondary cause present but
migraine does not occur for the first
time in close temporal relation to the
disorder
Assessment of severity of pain on a 10 point visual analog scale
Should be used every 30 days for the evaluation of the severity of pain
Definition Score
No pain 0
Mild 1-3
Moderate 4-6
Severe 7-8
Worst possible
9-10•Reference: Amelia Wlliamsol, Barbara Hoggart Pain, a review of three commonly used pain rating scales. Journal of clinical nursing; August 2005, volume 14 issue 7, 798-804
To evaluate the impact of migraine headache on ability to function at work, home and social situation
Evaluated every 90 days
Grade Definition ScoreI
I Minimal 0-5
II Mild 6-10
III Moderate 11-20
IV Severe 21+
Reference: Stewart WF, Lipton RB et al An international study to assess relaibility of MIDAS Score, Neurology 1999, 53:988-994
Abortive Prophylactic
NSAIDs Beta blockers
Analgesics Antidepressants
(Along with antiemetics) Calcium antagonists
NarcoticsErgot AlkaloidsTriptans
GI and Renal side effects with NSAIDs and Ergots
30 % of patients fail to respond to a particular triptans (Headache 2005, Feb;45 (2):156-162)
Triptans- potential risk in increasing blood pressure and mild and transient effects on coronary artery tone
Triptans contraindicated in many diseases
(Am J Med 2005 Mar: 118 Suppl 1:368-448)
• Chronic Migraine
• 4 hours /day for > 15 days /month
• Evolution from episodic migraine to
frequent migraine
• ? Medication overuse
Shleshma-pitta vs Migraine
Reference: Madhav Nidan (Classical Ayurvedic text; describing
etio-pathogenesis and diagnosis of the diseases)
• Irregular eating habits such as, wrong food combination, quantity and timings• Long gap or intermittent eating pattern, crash dieting• Stale, over salty, spicy, sour food items• Over use of tea coffee, aerated drinks and deep fried food • Arrestation of basic urges like sleep, hunger, urine, stool etc.• Irregular life style, anxiety, worry and lack of exercises• Use of certain drugs and diseases affecting the hepato-billiary system
Migraine is an outcome of unregulated diet, life style and / or hepato-billiary disorder
Acid–Alkali imbalance causing physiological changes and reflexes in gastro–intestinal tract causing symptoms of Shleshma–pitta vs Migraine
Gastric pH 1.8 – 3.5
Caecum pH 5.5 – 7.5
Duodenum pH 5.5 – 6.5Ileum pH 6.5 – 7.5
Interhepatic bile pH 7.5
Bile in gall bladder pH 7.6 – 8.6
Pancreatic juice pH 8.8
Rectum pH 6.1 – 7.5
Mouth, Esophagus pH 6 - 7
Regulated diet (3 meals + 3 snacks) 1600 calories / day
Eight hour sleep Combination of five classical Ayurvedic
Formulations (Herbo – minerals)
•Narikel Lavana •NUMAX*•Rasonvati •Godanti Mishran
IHS diagnostic Criteria for migraine without aura
VAS and MIDAS scoring to access severity and impact at day 0, 30, 60 and 90
Individual consent120 days regular and paid treatmentLong term follow upCollaborative experimental and clinical
studies
• Retrospective: 1985 to 2002• Prospective – I: June 2002 to Dec 2004
(Chandigarh)• Prospective - II: May 2005 till date
(Karnataka, Maharashtra, Uttarakhand, Uttar Pradesh, Andhra Pradesh and Haryana)*
• Prospective - III: June 2007 till date (HQ: Dehradun)
• Randomized controlled clinical trail on refractory and chronic migraine patients at AIIMS, New Delhi (2012-2014….ongoing)
Poster Presented and Discussed
at16th Migraine Trust
International Symposium,18 - 20 September 2006The Conference Centre, Kensington Town Hall,
London, UK
Poster Presented at 13th Congress on Headache organized by International Headache Society,
28th June to 2nd July 2007, at Stockholm, SwedenPoster abstract published in Cephalalgia, 2007, 27, 745
Poster Presented at 52nd Meeting of the American Headache Society, 24th – 27th June 2010, at Los Angeles, USA
Poster abstract published in Headache 2010; 50 (Suppl 1): 53
Research Paper on
“Response of Ayurvedic
therapy in the treatment of
migraine without aura”
Vaidya Balendu Prakash,
S Raghavendra Babu,
K Suresh Kumar Published in the International Journal of Ayurveda Research,
Publication of AYUSH, Department of Health & Family Welfare, Government of India
Case studies on prophylactic ayurvedic therapy in migraine patients
Vaidya Balendu Prakash, Nitin Chandurkar, Tejashri Sanghavi
2012 / Volume 2 / Issue 2 / e17
TANG / www.e-tang.org
Recommended Human Dose
Rat (Daily Dose)
Mice (Daily Dose)
7.3 gm/day
0.7 gm(Equivalent)
1.47 gm(Equivalent)
2.23 gm(Three times)
3.04 gm (Two times)
7.45 gm (Ten times)
6.48 gm (Four times)
• No LD50 at 5 gm (maximum) dose• Well tolerated in all groups
Prakash et al. IJTPR 2010
G I G II G III G IV G V
Control
Normal*
Medium
High Satellite
Animals (♂ = ♀)
20 20 20 20 20
Treatment (day)
180 180 180 180 180
Sacrifice (day)
181 181 181 181 211
Mortality
2 2
Randomised controlled clinical trial to evaluate prophylactic properties of ayurvedic treatment protocol in refractory and chronic migraine patients
Department of Neurology, AIIMS, New Delhi Investigators: Prof (Dr) Manjari Tripathi (PI),
Prof (Dr) A K Mahapatra, Vaidya Balendu Prakash (Co- PI)
Date of commencement: 1st April, 2012Funding Agency: Ipca Laboratories Limited,
Mumbai
Particulars Ayu Gr ( 32 )
Conv Gr ( 38 )
Sex (Female/Male)
24/8 27/11
Age Group 18-51 18-52
History (In years)
1-20 1-28
Frequency(monthly)
2-4 14 13
> 4 18 25
Intensity (VAS) 7-10 5-10
MIDAS Score 20-55 16-55
Headache Days 1628 2139
Particulars Ayu Gr ( 32 )
Conv Gr ( 38 )
Associate Symptoms
Nausea 27 34
Vomiting 24 31
Photophobia 26 35
Phonophobia 30 32
Relieving Factors
Painkillers and Sleep
Particulars Ayu Gr ( 13 )
Conv Gr ( 26 )
Moderate to Severe pain with need of Prophylaxis + Rescue
0 26
Mild pain with no need of medication
10 0
Symptom free 2 0
VAS 97/24 ( 8.1 : 2 )
111/213( 8.2 : 4.3 )
MIDAS 446 /103 ( 37.2 :
8.6)
889/656( 34.2 : 25.2)
Headache Days 726/100 ( 60.5 : 8.33)
1511/544(58.1 : 20.9)
Particulars Ayu Gr ( 13) Conv Gr ( 26 )
Associate Symptoms:
Nausea 11/4 23/25
Vomiting 10/0 20/6
Photophobia 13/5 24/24
Phonophobia 13/1 22/17
Lost to follow up
1 1
Conventional Group
Conventional Group
Ayurveda group has significant and sustainable effect in the prevention of Migraine
Ayurvedic treatment was well tolerated without any adverse event
Thank You