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					It is a type of shiro roga

 Reference is found in almost
        all samhitas
 Shiro rujati martyana vatapittakaphastribhihi I
sannipatena raktena kshayena krimibhistathaII
suryavartanantavatardhavabhedakashankhakI
         ekadasha prakarasy lakshana
               sampravakshyetII
                        (su.utt.25\2)
  11 TYPES OF SHIROROGA
oVataja
oPittaja
oKaphaja
oSannipataj
oRaktaja
oKshayaja
oKrimija
oSuryavarta
oAnantavat
oArdhavabhedaka
oshankhaka
Ardhe tu murdhna: so ardhavabhedaka I
                   (va.utt.23\7)

The disease in which there is pain in one
      side of the head is called as
           ardhavabhedaka
      Yasyottamangardhamativa janto:
    sambhedtodabhramashoolajushtamI
        pakshaddashahadathava S
      pyakasmattasyardhabheda…..II
               (su.utt.25|15)


 the person whose half of utamanga has
very severe pain like bheda toda bhrama
  shoola and which reoccurs after 10 or
    15days is said to be suffering from
            ardhavabhedaka.
 Rukshatyashanat purvavatavashyayamaithunai:I
   vegasandharanayasavyayamai:kupitoSnila:
  kevala sakapho vaSrdha gruhitva shirastata:
manyabhrushankhakarnakshilalatardhativedanamI
 shastrarininibha kuryattivra soSrdhavabhedaka:
nayanam vaSthava shrotramativrudhovinashayet
                                  (ch.si.9|74)
HETU

ruksha padartha
adhyashana
purvavatasevana
avashyasevana
maithun
vegasandharana
aayas
vyayam
    SAMPRAPTI
       Hetusevana

Vataprakopa kaphaprakopa

Grahanirmiti at ardha shira

     ardhavabhedaka
             LAKSHANA
severe pain at
o   Neck
o   Brow region
o   Temporal region
o   Ears
o   Eyes
o   Forehead
o   Pain is described as if being cut by
    sharp instruments
           UPADRAVA
o   Chakshurendriya nasha
o   Srotrendriya nasha
        MIGRAINE

     A severe reoccurring
  headache, usually affecting
only one side of the head, that
is charectorized by sharp pain
 and is often accompanied by
  nausea, vomiting and visual
         disturbances.

  Also called as hemicrania,
   megrim, sick headache
          AETIOLOGY
o Aetiology of migraine is largely
  unknown
o Genetic predisposition - usually family
  history is seen
o Hormonal influence-
 female predominance
 Some women tend to have migraine
  attacks at certain points of their
  menstrual cycle
    PRECIPITATING FACTORS
o   Dietary precipitants- cheese,
    chocolates, red wine
o   Psychological factors- stress
o   Disturbed sleep pattern
o   Drugs
o   Physical exertion
o   Visual stimuli
o   Auditory stimuli
o   Weather changes
o   hunger
         HOW COMMON IS
           MIGRAINE
o   World- 15-20% of women and 10-15%
    of men suffer from migraine
o   In India 15-20% of people suffer from
    migraine
o   Adults-female: male ratio is 2:1
o   In childhood migraine, boys and girls
    are affected equally until puberty when
    predominance shifts to girls
    PATHOPHYSIOLOGY
Vascular theory-
o Intracerebral blood vessel constriction
  – aura
o Intracranial/extra cranial blood vessel
  vasodilatation-headache

Serotonin theory-
o Decreased serotonin levels linked with
  migraine
o Specific serotonin receptors found in
  blood vessels of brain
             3                                        4
                                                   Chemicals in the
                                                   brain cause blood
Changes in nerve
                                                   vessel dilation and
cell activity and
                                                   inflammation of the
blood flow
                                                   surrounding tissue
may result in visual
disturbance,
numbness or
tingling, and
dizziness.



                                                       5
              2                                    The inflammation
Electrical impulses                                irritates the trigeminal
spread to other                                    nerve, resulting in
regions of the brain.                              severe or throbbing pai

                                      1
                        Migraine originates deep
                        within the brain
        CLASSIFICATION
o   Migraine with aura
o   Migraine without aura
o   Complicated migraine
       PHASES OF ACUTE
          MIGRAINE
o   prodrome
o   aura
o   headache
o   postdrome
          PRODROME
o Vague premonitory symptoms that
  begin from 12 to 36 hrs before the aura
  and headache
o Symptoms include:-
 yawning
 Excitation
 Depression
 Lethargy
 Craving or distaste for various foods
o Duration- 15-20min
               AURA
o Aura is a warning or signal before
  onset of headache
o Symptoms include
 Flashing of lights
 Zig zag lines
 Difficulty in focussing
o Duration:15-30 min
            HEADACHE
o   Headache is generally unilateral and is
    associated with symptoms like:
o   Anorexia
o   Nausea
o   Vomiting
o   Photophobia
o   Phonophobia
o   Tinnitus

o   Duration:4-72 hrs
            POSTDROME
o   Following headache, patient complains
    of
o   Fatigue
o   Depression
o   Severe exhaustion
o   Some patients feel unusually fresh

o   Duration: few hrs to 2 days
CLINICAL FEATURES
      MIGRAINE WITHOUT
            AURA
o   No aura or prodrome

o   Unilateral throbbing headache may be
    accompanied by nausea and vomiting

o   During headache patient complains of
    photophobia or phonophobia
MIGRAINE WITH AURA
o   Aura or prodrome is present

o   Unilateral throbbing headache and
    later becomes generalized

o   Patient complains of visual
    disturbances and may have mood
    variations
          DIFFERENTIAL
            DIAGNOSIS
o   Headaches have numerous causes

o   It is one of the common locations of
    pain

o   Primary headache-headache without
    any organic cause
o   Secondary headache-headache
    associated with organic causes
      PRIMARY HEADACHE

o   Tension type headache

o   Cluster headache

o   Migraine headache
TENSION TYPE HEADACHE
o   Pain begins in back of the head and
    upper neck
o   Described as pressure encircling head
    with most intense pressure over
    eyebrows
o   Pain is mild and unilateral
o   Not associated with aura
o   Pain occurs infrequently, without any
    pattern
    CLUSTER HEADACHE
o   Pain typically occurs once or twice
    daily
o   Each episode of pain lasts from 30-
    90minutes
o   Attacks tend to occur at about the
    same time everyday
o   Pain is located around or behind eye
o   Affected eye becomes red inflamed
    and watery
o   Nose of affected side may become
    congested and running
    SECONDARY HEADACHE
o   head and neck trauma
o   Transient ischemic attack
o   Carotid artery inflammation
o   Temporal arteritis
o   Brain tumors
o   Seizures
o   Meningitis
o   Encephalitis
o   Hypertension
o   Hypothyroidism
o   Problems with eye ear nose throat
    teeth
            DIAGNOSIS
o Medical history
o Headache diary maintaining records of
  site, frequency, duration of pain and
  associated symptoms)
o Migraine triggers- stress, diet etc.
o Organic disease must be excluded
 Other pointers include-family history of
  migraine
    age of onset
    presence of aura
o Menstrual association
        COMPLICATIONS
o   Nausea
o   Vomiting
o   Vascular headache
o   Visual impairment
o   Cerebrovascular accident
o   Photophobia
o   Vertigo
o   Abdominal pain
o   Eye pain
             PROGNOSIS
o   migraine usually doesn't represent a
    significant threat to health
o   In rare cases, people with migraine
    may be at risk of serious complications
o   A severe migraine may result in a
    stroke possibly due to prolonged
    constriction of blood vessels
o   For many people migraines eventually
    go into remission and sometimes
    disappear completely particularly as
    they age.
          INVESTIGATIONS
Usually done to exclude secondary
 causes

o   EEG

o   CT brain

o   MRI
          PREVENTION
o   understanding you headache triggers
    can help you avoid foods and
    situations that cause your migraine
o   Avoid smoking
o   Avoid alcohol
o   Avoid artificial sweeteners
o   Get regular exercise
o   Get plenty of sleep each night
o   Reduce stress by relaxing and
    meditating
TREATMENT
    Tatha S rdhavabhedake vyadhau
      praptmanyaccha yadbhavet I
shirishmulakfalairavapedo S nayerhita:II
                  (su.utt 26\31)

oLineof treatment is similar to that of
            suryavartak
 oAvapidana nasya with sirish mula
           and phala rasa.
 Vanshmulakakarpurairavapida prayojayet I
avapido hitashchatra vachamagadhikayuta :I
                      (su.utt 26/32)

       Two yoga of avapidana nasya
             are mentioned
      oVanshmoola and karpor-kalka
          made by adding water
       oVacha + pippali kalka nasya
Madhukenavapido va madhuna saha sanyuta:I
mana : shilavapido va madhuna chandanen va II
                          (su.utt26\33)

  Avapidana nasya of yashtimadhu +honey
                  Chandan+yashti+honey
Teshamante hitam nasya sarpirmadhurasanvitam I
sarivotpalkushthani madhukam chamlapeshitam II
                   (su.utt.26\34)

 oMedicines  of sweet taste
 processed into ghee form is
 also beneficial.
 Chatu: snehottama matra shira:kaya virechanam I
nadiswedoghrutam jirnam bastikarmanuwasanam ii
                           (ch.chi.9\78)


  oGhruta, taila vasa majja- sevana in
  uttam matra
  oShirovirechana
  oKayavirechana
  oNadisweda
  oPurana ghruta
  oNiruha basti
  oAnuwasana basti
  oshirobasti
 According to yoga ratnakara



oRaktamokshana
oMilk+ghee  nasya
oMilk intake, ghee intake
oVirechana
oFumigation
oshirolepa
    TREATMENT GOALS FOR
     MIGRANT SUFFERER
o   Reducing the attack frequency and
    severity
o   Avoiding escalation of headache
    medication
o   Educating and enabling the patient to
    manage the disorder
o   Improving the patients quality of life
 MIGRAINE MANAGMENT
Non pharmacological treatment
o Identification of triggers
o Meditation
o Relax techniques
o Psychotherapy


Pharmacological treatment
o Abortive treatment
o Preventive treatment
  ABORTIVE TREATMENT

Non specific treatment-
o Aspirin
o Paracetamol
o Ibuprufen
o diclofenac
    ABORTIVE THERAPY
Specific treatment-
Ergot alkaloids:-ergotamine
                  dihydroergotamine
Triptans:- sumatriptan
          rizatriptan
Antinauseant drugs:- metaclopramide
                       chlorpromazine
Triptans work best in 1st couple of hrs of
 attack
Ergotamine works at any time during the
 attack
     MODE OF ACTION
ERGOTAMINE
o Structurally similar to amines
  serotonin dopamine
o Interact with multiple receptors in
  these symptoms
o Causes constriction of blood vessels
o Wide range of effect
       MODE OF ACTION
TRIPTANS:-

o   Serotonin is involved in migraine
    attack
o   Triptans mimic the action of serotonin
o   Triptans act on receptors at smooth
    muscle cells of brain vessels
o   They are an advance over ergots
PREVENTIVE THERAPY
o   Beta blockers – e.g.. Propanolol
o   Calcium channel blocker –
    eg.verapamil
o   TCA3 – amitriptylene
o   SSRI’s –fluxetine
o   anticonvulsant- - sodium valproate
o   Anti histaminic - cyproheptadine
NEED FOR PROPHYLACTIC
     TREATMENT
o   Abortive drugs should not be used for
    more than 2-3 times a week
o   Long term prophylaxis improves
    quality of life by reducing frequency
    and severity of attacks
          INDICATION OF
           PROPHYLAXIS
o   Patients who have very frequent
    headaches (more than 2-3/week)
o   Attack duration> 48hrs
o   Headache severity is extreme
o   Migraine attacks are accompanied by
    severe aura
o   Contraindication to acute treatment
o   Unacceptable adverse effects occur
    with acute migraine treatment
o   Patients preference
    KEY TOWARDS SUCCESSFUL
     MIGRAINE TREATMENT
o Listen to patients
o Migraine is mixed up with lot of things:-
 emotional factors-husbands, bosses,
  general dissatisfaction with life
 sleep disturbances
 hormonal changes
o If you do not address this, you will not be
  treating your patients
o Don’t just throw drugs at your patients
o Be attentive and empathetic

				
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