Migraine

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Evidence Based Ayurvedic Treatment for Migraine
Vaidya Balendu Prakash Director
Padaav Specialty Ayurvedic Treatment
Centre. Western express highway, Varsave, Thane
401208 Maharashtra, India. Tel [phone]
Fax [phone] Mobile 91
9322492770 Email padaav_at_gmail.com   Website
www.padaav.com
VCP Cancer Research Foundation (SIROs) Off Turner
Road, Clement Town, Dehra Dun 248 002,
India Tel [phone],
2643443 Mobile [phone] Fax 91 135
2640909
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Migraine

• Common primary episodic headache disorder
• Greek word Hemicrania-half of the head
• Not necessarily unilateral, can be bilateral
• Characterized by various combination of
• neurologic, gastrointestinal and autonomic
• symptoms

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Migraine-Facts

• The most common form of disabling primary
  headache
• 19th among debility causing disease
• worldwide WHO criteria
• In India, prevalence stands at 15-20
• Effects women more than men, ratio 31

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International Headache Society (IHS)
Criteria Migraine without Aura
A. Idiopathic, recurrent headache (gt 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
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IHS criteria Migraine without aura
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
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Visual Analog Scale (VAS)

• 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
• 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

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Migraine Disability Assessment Scale(MIDAS)

• To evaluate the impact of migraine headache on
  ability to function at work, home and social
  situation
• Evaluated every 90 days
• Reference Stewart WF, Lipton RB et al An
  international study to assess relaibility of
  MIDAS Score, Neurology 1999, 53988-994

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Symptoms Accompanying SevereMigraine Attacks

• Nausea 87
• Photophobia 82
• Light headedness 72
• Scalp tenderness 65
• Vomiting 56
• Visual disturbances 36
• Paresthesia 33
• Vertigo 33
• Altered consciousness 18

n500
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Etiopathogenesis

• No known cause
• Certain theories have been put forward-
• Genetic basis of migraine
• Vascular theory of migraine
• Neuronal theory of migraine
• 5-HT in migraine
• Dopamine in migraine
• Sympathetic nervous system in migraine

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Transformed Migraine

• Chronic Migraine
• 4 hours /day for gt 15 days /month
• Evolution from episodic migraine to
  
• frequent migraine
• ? Medication overuse

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Effects on Migraine

• Aggravating Factors Sustained exertion,
  traveling,
• red wine, cheese, chocolates, hunger,
  lack of sleep, menses, odors, diarrhea
• Relieving Factors Sleep, exhilaration, Pain
  killers,
• Pregnancy

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Treatment of Acute Attack of Headache

• Analgesics
• Migraine specific drugs-
• Should be taken as soon as the headache
  component of
• the attack is recognized
• Dont delay the treatment till Headache becomes
• unbearable

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Triptans

• Selective 5-HT 1B/1D receptor agonists
• Mechanism of action
• cranial vasoconstriction (contraction of
  coronary arteries)
• peripheral neuronal inhibition
• inhibition of 2nd order neurons of
  trigemino-cervical
• complex (pain pathways)
• inhibit release of vaso-active peptides
• Sumatriptan most widely studied

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Preventive Therapy In Migraine

• ß-blockers, anticonvulsants, tricyclic
  anti-depressant,
• calcium channel blocker, riboflavin,
  magnesium
• Long-term administration of these drugs have
  adverse
• effects usage should be minimal, and under
  close
• medical supervision.

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Meeting the Needs

• Ayurvedic treatment protocol comprising diet,
  life-style
• and medicines
• Empirical clinical data from the 2002 to 2006 at
• Chandigarh and Karnataka

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Chandigarh Total Enrollment 131/104(1st June,
2002 to 31st December, 2004)
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Distribution of Patient (Age Sex)
n104
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History of Migraine
34
n104
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Frequency of Attacks Day 0
n104
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Aggravating Factors

• Weather 52
• Noise 41
• Food 38
• Traveling 29
• Light 28
• Tension 26
• Stress 19
• Hunger 15
• Disturbed sleep 8
• Odors 2

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Associated Symptoms

• Nausea/Vomiting 16
• Photophobia 10
• Refraction Error 9
• Anemia 6
• Blurred Vision 5
• Hemianopia 5
• Fever 5
• Dental infection 6
• Trauma 7
• Ear ache/Tinnitus 6
• Fatigue 10
• Sweats 5
• Abdominal pain 6

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Duration of AyT
n104
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Response to AyTn104
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Karnataka Total Enrollment 267(15th May, 2005
to 31st March, 2006)

• 267 migraine patients
• IHS criteria for diagnosis
• Ayurvedic diagnostic parameters
• Uniformity in symptoms

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Distribution of Migraine Patients(Age Sex)
n267
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History of Migraine
n 267
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Frequency of Attacks Day 0
n267
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Ayurvedic Treatment

• Combination of five Classical Ayurvedic
  Formulations
• Dietary Modifications - devoid of acid enhancing
  food items

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Duration of AyT
n267
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Impact of AyT on Frequency ofAttacks (p lt
0.05)n267
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Impact of AyT on Intensity Visual Analog Scale
(VAS)
n 101
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Impact of AyT on Migraine Disability Assessment
Scale (MIDAS
p Value .00267 X 10 -3
Impact 62.2 Reduction
n 101
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Response to AyT on Associated Symptoms
n267
No. of Patients
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Response to AyT on Associated Symptoms
n 267
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Response 90 days of AyT
n 101
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VCPCRFs criteria for assessment
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Poster presented and discussed at16th
International Symposium on Migraine, London, UK
(September 2006)Poster abstractCephalalgia,
26, 11, 1367
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Poster Presented at 13th International headache
Congress,28th June 2nd July 2007, at Stock
home, Sweden. Poster abstract - Cephalagia,
2007, 27, 745
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Benefits

• Improves working efficiency
• Significant reduction in paying visit to
  emergency and
• pain killers
• Saves from possible side effects

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Next Steps

• An opportunity for dispensing Ayurvedic
  physicians to
• incorporate Integrated migraine treatment
  protocol in
• their clinical practice

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Our Strengths
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Key Benefits

• Service to the society
• Social and professional recognition
• Promotion of evidence based therapeutic
  ayurveda

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Thank You