Ardhavabhedaka is one among the 11 types of Shirorogas described in Ayurvedic classical texts. It is a type of headache where pain is localized to one half of the head. It can be correlated with migraine based on the similarity in etiology, pathology, symptoms and treatment principles. This study is conducted with the aim to compare the effect of ‘Sharkara Mishrita Dugdha Nasya’ and ‘Murchita Gritha Nasya’ in the management of Ardhavabhedaka. Two groups of 15 patients each were administered these two types of Nasya drugs for seven days. Patients were assessed on the basis of clinical parameters. Results show good effect on all symptoms of Ardhavabhedaka in both groups but Murchita Ghrita Nasya show better effect than Sharkara Mishrita Dugdha Nasya.Among 15 patients in Group-A, 7 patients (36%) showed good response and among 20 patients in Group-B, 3 patients (16 %) showed good response after the treatment. The response obtained after 28 days of treatment and the study reveals that in Group – B Murchita Ghrita Nasya shows very good response in treating the Ardhavabhedaka. Sharkara acts as Vatapitta hara, Dugdha &amp; Murchita Ghrita acts as Tridoshaghna

Hiremath, Veerayya

S. Pujari, *Santosh

English

Ayushdhara (E-Journal)

AYUSHDHARA             ISSN: 2393-9583 (P)/ 2393-9591 (O)  An International Journal of Research in AYUSH and Allied Systems AYUSHDHARA | May - June 2017 | Vol 4 | Issue 3  1159          A COMPARATIVE CLINICAL STUDY ON SHARKARA MISHRITA DUGDA NASYA AND MURCHITA GHRITA NASYA ON ARDHAVABHEDAKA W.S.R. TO MIGRAINE Santosh S. Pujari1*, Veerayya Hiremath2 *1PG Final year Scholar, 2Professor & Head, PG Department of Shalakya Tantra, SVM Ayurvedic Medical College, Ilkal, Karnataka, India.  KEYWORDS: Ardhavabhedaka, Sharkara Mishrita Dugda, Murchita Ghrita Nasya, migraine, Ayurveda.               ABSTRACT  Ardhavabhedaka is one among the 11 types of Shirorogas described in Ayurvedic classical texts. It is a type of headache where pain is localized to one half of the head. It can be correlated with migraine based on the similarity in etiology, pathology, symptoms and treatment principles. This study is conducted with the aim to compare the effect of ‘Sharkara Mishrita Dugdha Nasya’ and ‘Murchita Gritha Nasya’ in the management of Ardhavabhedaka. Two groups of 15 patients each were administered these two types of Nasya drugs for seven days. Patients were assessed on the basis of clinical parameters. Results show good effect on all symptoms of Ardhavabhedaka in both groups but Murchita Ghrita Nasya show better effect than Sharkara Mishrita Dugdha Nasya. Among 15 patients in Group-A, 7 patients (36%) showed good response and among 20 patients in Group-B, 3 patients (16%) showed good response after the treatment. The response obtained after 28 days of treatment and the study reveals that in Group - B Murchita Ghrita Nasya shows very good response in treating the Ardhavabhedaka. Sharkara acts as Vatapitta hara, Dugdha & Murchita Ghrita acts as Tridoshaghna.  INTRODUCTION  The disease Ardhavabhedaka is one among the 11 types of Shirorogas considered by our Acharyas1. The causes of Ardhavabhedaka are excessive intake of Ruksha padarthas, Adhyashana, Purva vata sevana, Atimaithuna (excessive coitus), Vegadharana (suppressing of natural urges), Atishrama (excessive work) in which pain is appreciable in one half of the Shiras, Shanka, Bru, Lalata, and in Karna pradesha.2 The attacks of Ardhavabhedaka will be once in three days/fifteen days and once in a month as per classics3. As per Acharya Charaka and modern science it is said that Ardhavabhedaka, if left untreated it leads to diseases like deafness and blindness2. Hence an early treatment intervention is needed for Ardhavabhedaka.  It can be correlated with migraine based on the similarity in etiology, pathology, symptoms and treatment principles. Headache is becoming common problem worldwide in these days. In that around 35% of patients are suffering from migraine headache4. Migraine does not shorten the life, but in severe cases a state of chronic exhaustion may occurs. Very rarely persistent cerebral symptoms remain with some irreversible vascular changes have occurred. A large group of people fails to get the achieved results and is refractory to treatment. In spite of advanced modern technology and medicine the treatment of migraine is not complete.  We get elaborate description of the disease Ardhavabhedaka and its treatment in our classics. Acharya Sushrutha mentioned that Nasya is said to be the ultimate treatment of Ardhavabhedaka when all other treatment fails5. Yogarathnakara also mentioned a same line of treatment for Suryavartha and Ardhavabhedaka in which Nasya is included6. So, a clinical study is planned to assess the efficacy of Nasya in the management of Ardhavabhedaka. AIMS & OBJECTIVES  To evaluate the effect of Sharkara Mishrita Dugdha Nasya’ in the management of Ardhavabhedaka. Research Article *Address for correspondence Dr Santosh S. Pujari PG Final year Scholar, PG Department of Shalakya Tantra, SVM Ayurvedic Medical College, Ilkal, Karnataka, India.  Email: pujar9943@gmail.com AYUSHDHARA, 2016;4(3):1159-1164 AYUSHDHARA | May - June 2017 | Vol 4 | Issue 3  1160  To evaluate the effect of Murchita Gritha Nasya in the management of Ardhavabhedaka.  To compare the effect of ‘Sharkara Mishrita Dugdha Nasya’ and ‘Murchita Gritha Nasya’ in the management of Ardhavabhedaka. MATERIALS AND METHODS Study design: A Randomized comparative clinical study Source of patients Patients suffering from Ardhavabhedaka selected from OPD and IPD of R.P.Karadi Ayurvedic hospital attached to SVMAMC Ilkal.  Diagnostic criteria Clinical features of Ardhavabedaka as per the classical texts.  Uttamanga ardhabhaga sambhedha1  Toda  Bhrama  Prakasha Asahisnatha Inclusion Criteria The subjects fulfilling the following conditions were included.  1. Patients suffering from classical signs and symptoms of Ardhavabedhaka. 2. Patients of either sex between the age group of 16 to 60 years. 3. Patient fit for Nasya karma. Exclusion Criteria The following Subjects were excluded from the study: 1. Referred pain in one half of the head due to disorders like eye, ear, nose, Throat, teeth, etc.  2. Subjects with other systemic disorders like Tuberculosis, HIV etc.  3. Patients with Complicated migraine, ophthalmic migraine, retinal migraine, basilar artery migraine. Intervention  30 Subjects clinically diagnosed to have Ardavabhedaka were registered randomly and categorized in to two groups consisting 15 subjects in each groups.  Group A was administered Nasya with Sharkaramishrita Dugdha while Group B was given Nasya with Murchita Ghrita Nasya. Treatment duration was 7 days. Post treatment follow up was done on 14th day, 21th day & 28th day. The dose for Nasya is 6 drops of drug in each nostril.  Procedure of Nasya  Nasya is a type of drug administration through nasal route. Nasya is done with classical procedure i.e. Abhyanga (local massage) with oil is followed by Swedana (sudation). After sudation 6 drops of drug is administered in each nostril in a supine position followed with deep breaths. When drug is felt in throat patient sits up and spit out the drug and secretions from throat. The procedure is followed by saline gargles. Assessment criteria  Assessment was done on clinical (subjective) parameters after grading them on 5 point scale from 0-4. Assessment was done before treatment, after treatment and on follow ups. Subjective parameters  Uttamanga ardhabhaga sambhedha, Toda, Bhrama, Prakasha Asahisnatha Grading  Subjective criteria Symptom Score Uttamanga ardhabhaga sambhedha Intolerable pain 4 Disturbs the normal work 3 Not disturbs the normal work 2 Pain tolerable 1 No pain 0 Todha Over 24 hours or continuous 4 12 – 24 hours 3 3 – 12 hours 2 0 – 3 hours 1 No pain 0 Santosh S. Pujari, Veerayya Hiremath. Sharkara Mishrita Dugda Nasya and Murchita Ghrita Nasya on Ardhavabhedaka  AYUSHDHARA | May - June 2017 | Vol 4 | Issue 3  1161 Bhrama Continuous 4 Once in a week 3 Once in 15 days 2 Once in a month 1 No attack 0 Prakasha Asahisnatha Intolerable 4 Severe 3 Moderate 2 Mild 1 Normal 0 OBSERVATIONS & RESULTS  Out of total 30 patients registered for study 17 were male while 13 were female. Maximum patients i.e. 50% patients were in age group 21-30 years. 43.33% of the patients were having a chronicity of more than 1 year. All the 30 patients present with Ardha shiro bhagha samvedana, while 60% were having Toda and 56.66% have Bhrama & Prakasha asahisnuta each. Most of the patients i.e. 60% have more frequent symptoms during winter season. All the patients were habituated to tea while a great proportion i.e. 56.67% has habit of coffee. 2/3rd patients have problems related to sleep.  Results on various clinical parameters indicated a good response with decrease in severity of all four symptoms after the treatment which get further improved on 1st, 2nd & 3rd follow ups. The following table shows improvement in subjective parameters with their statistical analysis. 1. Uttamanga ardhabhaga sambhedha: A Comparative assessment at different time points in two groups Uttamanga ardhabhaga sambhedha Group A Group B Total P value BT 3.53±0.52 3.40±0.51 3.47±0.51 0.481 AT 2.40±0.51 1.93±0.46 2.17±0.53 0.013* AF 1 1.93±0.46 1.33±0.49 1.63±0.56 0.002** AF 2 1.13±0.35 1.07±0.46 1.10±0.40 0.658 AF 3 1.00±0.76 0.53±0.64 0.77±0.73 0.079+ 2. Toda: A Comparative assessment at different time points in two groups Toda Group A Group B Total P value BT 3.47±0.52 3.47±0.52 3.47±0.51 1.000 AT 2.00±0.53 2.00±0.65 2.00±0.59 1.000 AF 1 2.13±0.52 1.73±0.70 1.93±0.64 0.087+ AF 2 1.53±0.64 1.20±0.56 1.37±0.61 0.140 AF 3 0.87±0.74 0.60±0.63 0.73±0.69 0.299 3. Bhrama: A Comparative assessment at different time points in two groups  Bhrama Group A Group B Total P value BT 3.33±0.49 3.20±0.41 3.27±0.45 0.426 AT 2.20±0.56 2.00±0.53 2.10±0.55 0.326 AF 1 2.07±0.70 1.40±0.63 1.73±0.74 0.011* AYUSHDHARA, 2016;4(3):1159-1164 AYUSHDHARA | May - June 2017 | Vol 4 | Issue 3  1162 AF 2 1.53±0.74 1.20±0.56 1.37±0.67 0.176 AF 3 0.93±0.80 0.27±0.46 0.60±0.72 0.009** 4. Prakasha asahishnuta : A Comparative assessment at different time points in two groups  Prakasha asahishnuta Group A Group B Total P value BT 2.67±0.49 1.87±0.64 2.27±0.69 0.001** AT 1.60±0.74 0.93±0.70 1.27±0.78 0.017* AF 1 1.60±0.63 1.20±0.41 1.40±0.56 0.050* AF 2 1.47±0.64 0.93±0.70 1.20±0.71 0.039* AF 3 1.13±0.74 0.40±0.63 0.77±0.77 0.007** DISCUSSION  Ardhavabhedaka is one among the 11 types of Shirorogas considered by our Acharyas. It is counted as one among four specific shirorogas.1 It is a most commonly found problem nowadays. Ardhavabheadaka is a disease of Urdhvajatru specially the Shiras which has a peculiar nature to be studied. Exactly the Swabhava of Ardhava-bhedaka cannot be compared to a modern disease. A comparison can be given as a unilateral headache. This term has been given under the study of migraine, which is one of the vascular diseases having manifestation with periodical relapses  There is difference of opinion regarding the Doshic predominance among Acharyas. Sushruta considers it as Tridoshaja. Charaka has explained it as either to be purely Vataja or Vatakaphaja. Vagbhata opines that only Vata dosha is involved. He has dealt with Ardhvabheadaka after explaining Vataja shiroroga. If aggravated Vata occupies whole of the Shiras it is Vataja shirashoola, where as if it occupies only half of the Shiras then it is called Ardhavabhedaka. Similarly in Bhela Samhita, Madhava nidana, Yogaratnakara, Bhava-prakasha it is considered as either purely Vataja or Vata kaphaja. Videha of Nimitantra opines it to be Vatakaphaja.   The observation reveals that Ardhava-bhedaka is more common in age group of 21-30 years. Bhatia et al reported that mean age of onset of migraine is 22 years7. This is because these individuals have to face both physical and mental strains. In clinical groups on the basis of sex the incidence in male was observed to be high i.e., 53.3% in Group-A and 66.7% in Group-B. This is because male were more exposed to external whether and having more stress and tension. In clinical groups on the basis of study the incidence was observed to be high in Business men in Group-A i.e.,4 (26.7%), and more students in Group-B i.e.,6 (40%). This is because mental as well as physical strain and untimely food habits.  It was observed that the chronicity range was from more than 1 year in both the groups. Bhatia et al reported that highest number patients diagnosed with migraine have chronicity between 1-3 years. 7 This may be due to delayed or improper diagnosis and treatment. Moloney et al also described that half of the cases of migraine either may not be diagnosed properly or may be treated improperly8. Among the patients selected for the study, majority of patients were of mixed food habits. Tea and coffee was observed as most common addictions among patients of migraine. Leira et al also reported role of tea and coffee as triggering factor of migraine.9  Sharkara Mishrita Dugdha & Murchita Ghrita was selected for the purpose of Nasya. Nasya karma was selected, because Nasya is said to be main line of treatment in Shirorogas and also as a prophylactic measure. Among 15 patients in Group-A, 7 patients (36%) showed good response and among 20 patients in Group-B, 3 patients (16 %) showed good response after the treatment. The response obtained after 28 days of treatment and the study reveals that in Group – B Murchita Ghrita Nasya shows very good response in treating the Ardhavabhedaka. Sharkara acts as Vatapitta hara, Dugdha & Murchita Ghrita acts as Tridoshaghna. Vata is responsible for all the activities in the body weather it is physiology or pathology. Hence Vata is the leader among Tridoshas. Vata vahini siras carry impulse throughout the body, so Vata should be protected and maintained in its equilibrium state.   Study revealed that, response in reduction of severity of Shoola was promising in group-B compared to that of group-A which may be due to various drugs used in Murchhana of Ghrita. These drugs pacify all three Dosha and are more Santosh S. Pujari, Veerayya Hiremath. Sharkara Mishrita Dugda Nasya and Murchita Ghrita Nasya on Ardhavabhedaka  AYUSHDHARA | May - June 2017 | Vol 4 | Issue 3  1163 specifically have effect on Vata dosha, thus helping in more effectiveness in Ardhavebhedaka which is Tridoshaj disease with predominance of Vata dosha. Pathyahara and Vihar plays an important role in prevention and control of Ardhavabhedaka. This is also reported by various studies that improper diet may be the trigger of migraine. Mode of Action of Nasya  Regarding the mechanism of action of Nasya karma, the hypothesis is it acts both at local and systemic levels, by direct contact with nerve terminals or uptake of drugs by the nasal mucosa.  Explanation regarding the action through local levels or direct contact with nerve terminals 10 (Gerber Bitta 1997).  It is currently known in the literature that the trigeminal nerve, through its trigemino- vascular system is deeply involved in the genesis and maintenance of pain in headache syndromes. The nasal mucosa which comes in contact with drugs applied directly involved in Nasya therapy is supplied with both the ophthalmic as well as maxillary branches of the trigeminal nerve. Direct counter irritation or stimulation to these nerve terminals could cause changes in the trigeminal ganglion itself. The result of these hypothetic changes in the firing of trigeminal neurons could lead to alleviation of pain.  The ptergopalatine ganglion could also be involved in the local effects of Nasya. This ganglion lies on the anterior wall of the pterygopalatine fossa right below the maxillary nerve and it is easily accessible through the nasal cavity. The pterygopalatine ganglion has sensory, para-sympathetic and sympathetic fibers from carotid plexus. Direct stimuli to these sympathetic fibers could cause changes in the carotid vascular motility, helping to alleviate the symptoms of headache.  Explanation regarding generalized action by absorption of the drug (Srinivas Hejamadi Gurudip Singh 1984) Vriddha Vagbhata was first to narrate the mode of drug action by Nasya karma. The medicine administered will reach the Sringataka srotos and spreads to the Siras of eye, ear and throat etc and to the head (Murdha). The authors like Arunadatta have followed the same path of description. Sushrutha described Sringataka marma as a Sira marma situated at the site of union of Siras supplying to the nose, eye, ear, and tongue. Scholar Indu in his commentary on Astanga Sangraha has opined that Sringataka is the inner side of middle part of head. (Siras antarmadhya) probably this may be referred to paranasal areas consisting air sinuses and blood vessels.  CONCLUSION  This study has shown that the disease Ardhavabhedaka is more common in the age group of 21-30 years and also males are affected more. Common etiology being Vegadharana, Divaswapna, Manasantapa, Adhyasana, consumption of chocolate, cheese, nuts like ground nuts, cashew nuts have precipitated and aggregated the headache attack. This has to be avoided in order to prevent the onset of headache attack.  The analysis of the results of the trial confirms that Murchita Ghrita Nasya is very effective than Sharkara Mishrita Dugdha nasya. Nidana parivarjana is very much necessary to control the severity of the disease as well as in avoiding the disease due course. REFERENCES 1. Sushruta - Sushurtasamhita with Nibandha Sangraha Commentary of Sri Dalhanacharya and Nyayachandrika panjika of Sri Gayadas acharya on Nidanasthana. Chaukhambha Orientalia, Varanasi, 7th edition 2002. Uttara tantra, chapter25, verse 3-4. 2. Agnivesha - Charakasamhita with Ayurveda Dipika commentary of Charkapani. Chaukhambha surabharathi prakashana, Varanasi, reprint 2000. Sidhi sthan, ch-9, verses 74-76. 3. Sushruta - Sushurtasamhita with Nibandha Sangraha Commentary of Sri Dalhanacharya and Nyayachandrika panjika of Sri Gayadasacharya on Nidanasthana. Chaukhambha Orientalia, Varanasi, 7th edition 2002. Uttara tantra, chapter25, verse 15. 4. Davidson’s Principles and practice of medicine. Churchill Living stone, Sydney,19th edition – 2002, Pp: 1118 – 1119. 5. Sushruta - Sushurtasamhita with Nibandha Sangraha Commentary of Sri Dalhanacharya and Nyayachandrika panjika of Sri Gayadasacharya on Nidanasthana. Chaukhambha Orientalia, Varanasi, 7th edition 2002. Uttara tantra, chapter26, verse 31. 6. Yogarathnakara - Vaidhya Prabha hindi commentory by Indradev tripaty and Dr.Dayashankar tripaty. Krishnadas Academy, Varanasi,1st edition,1998. - Shiroroga nidana chikitsa prakarana – 52, 53. 7. Bhatia MS, Gupta R. Migraine: Clinical pattern and psychiatric comorbidity. Industrial Psychiatry Journal. 2012;21(1):18-21. doi:10. 4103/0972-6748.110943. AYUSHDHARA, 2016;4(3):1159-1164 AYUSHDHARA | May - June 2017 | Vol 4 | Issue 3  1164 8. Moloney MF, Johnson CJ. Migraine Headaches: Diagnosis and Management. Journal of Midwifery & Women’s Health, 2011;5(3):282-292. DOI: 10.1111/j.1542-2011.2011.00024.x  9. Leira R1, Rodríguez R. Diet and migraine. Rev Neurol. 1996 May;24(129):534-8. 10. Deshpande G S, Joshi A H. Hypothetical evaluation of action of nasya on central nervous system. IAMJ;2014;2(4):607-612.      Disclaimer: AYUSHDHARA is solely owned by Mahadev Publications - A non-profit publications, dedicated to publish quality research, while every effort has been taken to verify the accuracy of the content published in our Journal. AYUSHDHARA cannot accept any responsibility or liability for the articles content which are published. The views expressed in articles by our contributing authors are not necessarily those of AYUSHDHARA editor or editorial board members.  Cite this article as:  Santosh S. Pujari, Veerayya Hiremath. A Comparative Clinical Study on Sharkara Mishrita Dugda Nasya and Murchita Ghrita Nasya on Ardhavabhedaka w.s.r. to Migraine. AYUSHDHARA, 2016;4(3):1159-1164. Source of support: Nil, Conflict of interest: None Declared  

A COMPARATIVE CLINICAL STUDY ON SHARKARA MISHRITA DUGDA NASYA AND MURCHITA GHRITA NASYA ON ARDHAVABHEDAKA W.S.R. TO MIGRAINE

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A COMPARATIVE CLINICAL STUDY ON SHARKARA MISHRITA DUGDA NASYA AND MURCHITA GHRITA NASYA ON ARDHAVABHEDAKA W.S.R. TO MIGRAINE

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