Vaidya Balendu PrakashAyurvedic Consultant

+919837028544balenduprakash@gmail.com

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