A Clinical Study of Go-Ghrita Nasya In Management of Ardhavabhedaka W.S.R to Migraine

Migraine is primarily a headache disorder derived from a Greek word meaning "half-head." The pain typically begins early in the morning on one side of the head and can occur as frequently as several times a week or as infrequently as once every few years. The intensity of the pain ranges from fairly mild to almost unbearable1. The clinical presentation of migraine varies from patient to patient and over time. Migraine is the 3rd most prevalent and 7th leading cause of disability worldwide2. It is more common in women than in men (2:1 to 3:1), and a family history is present in more than 60% of cases3. Although there is no direct reference to migraine in Ayurvedic texts, its symptoms fall under Shirahshoola, a Nanatmaja Vyadhi of Vata dosha4. The disease Ardhavabhedaka, described under Shiroroga and caused by vitiated Vata dosha, presents symptoms like half-head pain with intermittent episodes similar to those of migraine5. Acharya Sushrut mentions 11 types of Shiroroga, one of which is Ardhavabhedaka. In Ardhavabhedaka, pain is felt in the nape of the neck, eyebrows, temporal region, ears, eyes, and half of the frontal region6, resembling paroxysmal unilateral headache associated with vertigo and pain of varying intensity, very similar to migraine.  Migraine affects the head region, known as Urdhvajatrugata sthana. The nostrils are considered the doorway to the brain, as expressed in the phrase "Nasa hi shiraso dwaram." The nasal route of administration is, therefore, the most effective route for treating Urdhvajatrugat vikara7. For this reason, the effect of go ghrita nasya on migraine has been selected for a review study which has been told in Baishaja rathnavali shiroroga chikitsa prakarna adhyaya 65th chapter.

OBJECTIVES

1.To review the literature of Ardhavabhedaka and Migraine

2. To observe the efficacy of Go-ghritanasya in the management of Ardhavabhedaka

Source of data

Clinical data

Subjects of either sex attending the OPD and IPD of Ashwini Ayurvedic Medical College and Hospital, Davanagere were selected for the study. Also subjects are selected from medical camps conducted under the college.Patients were selectd consisting of 40 subjects using simple randomization. Complete details of the clinical trail and rights of the participants were explained and informed consent was obtained from each participant or guardians of them from the Institutional Ethical Committee clearance has been obtained for the study.

METHOD OF PREPARATION

Cow’s milk is collected from healthy cow, is boiled. This is to ensure that the milk is free from bacteria and is safe for consumption. Once the milk has cooled down, the cream part is separated and collected. The fermentation to the milk cream is done just day before. Then churned to extract butter using a wooden churner. And then butter is heated in a pan over medium flame. The butter has to boil till the water content evaporates and there is a visible layer of solid at the bottom of pan. This ghee is filtered and stored in a dry, air tight container.

Inclusion Criteria

? Patients of either sex with age group between 18 to      50 years.

? Either sex

? Both fresh and chronic case will be selected

? Symptoms include bheda, toda, akasmattosa, prakashaasahishnuta, pakshat, dashahat

Exclusion Criteria

? Other types of shirashoola such as anantavata, suryavartha, pittajashirashoola, kaphajashirashoola, dustapratishaya, peenasa will be excluded.

? Referred pain in one half of the head due to disorders of eye, ear, nose, throat, teeth etc., will be excluded. • Patients with complicated migraine, status migrainosus, ophthalmic migraine, hemiplegic migraine, retinal migraine, basilar artery migraine etc., will be excluded

? Patient is suffering from DM,HTN,CA,Tb any other general debilitating health condition, needing surgical intervention and other systemic illness are excluded

?                                       Anaemic / iron deficiency anemia patient is excluded.

Clinical method of Administration

• The subjects were instilled medicine through nasal route for 7 days once in every month for 3 consecutive months.

•                                      8 drops of Goghrita nasya in each nostril will be instilled

•                      (According to Ayurvedic Formulary of India 1 drop =0.05ml 16 drops=0.8ml)

Subjective Parameters;

Ardhaparshwashoola (half side of head)

• BhedatodavatShoola

• Prakashasahishnuta

• Akasmattosa, • Pakshat, Dashahat

Objective Parameters:

MIDAS 97 scoring will be done as follows.

1.Severity of Headache:

0 = No headache

1 = Mildheadache, patient is aware onlyif he or she pays attention on it.

2= Moderate headache, can ignore at times.

3= Severe headache,can’t ignore but he or she can do his or her usual activities

4=Excruciating headache, can do anything

2.Frequency of headache:Assessed in term of frequency in days

0 = Nil

1= >20 days

2= 15 days

3= 10 days

4= < 5 days

3.Duration of headache: assessed in terms of hours or day

0 = Nil

1= 1- 3 Hours / day

2= 3-6 hours / day

3=6-12 hours /day

4=More than 12 hours /day

4.Nausea:

0= Nil

1= occasionally

2= Moderate but does not disturb routine work

3= severe, disturbing routine work

4= Severe enough, small amount of fluid regurgitating from mouth

5.Vomiting

0=nil

1=feeling of giddiness

2=pt feels as if everyting is revolving

3=revolving signs + black outs

4=unconscious

6.Aura

0=Nill

1=Lasts for 5 minutes

2=Lasts for 15 minutes

3=Lasts for 30 minutes

4=Last for 60 minutes

RESULTS

1. Ardhaparshwashoola

2. Bedatodavatshoola

3. Prakashasahishnuta

4. Severity

5. Frequency

6. Duration of Attack

7. Nausea

8. Vomiting

9. Aura

1. 1. 1. 1. Ardhaparshwa Shoola

In this work of 40 patients studied in Ardhavabhedaka statistical analysis shows that the mean score which was 2.3 before the treatment was reduced to 1.875 after the treatment with 81.52% improvement and it is statistically highly significant with T test (p<0.001). 

Graph shows statistical analysis of Ardhaparshwa Shoola

2. Bhedatodavat Shoola

In this work of 40 patients studied in Ardhavabhedaka statistical analysis shows that the mean score which was 2.075before the treatment was reduced to 1.85 after the treatment with 89.15% improvement and it is statistically highly significant with T test (p<0.001). 

Graph shows statistical analysis of Bhedatodavat Shoola

3. Prakashsahishnuta

In this work of 40 patients studied in Ardhavabhedaka statistical analysis shows that the mean score which was 1.3 before the treatment was reduced to 0.65 after the treatment with 50% improvement and it is statistically highly significant with T test (p<0.01) and after follow up mean reduced to 1.15 with 88.46% improvement and it is statistically highly significant with T test (p<0.001). 

Graph shows statistical analysis of Prakashsahishnuta

4. Severity

In this work of 40 patients studied in Ardhavabhedaka statistical analysis shows that the mean score which was 2.325 before the treatment was reduced to 0.55 after the treatment with 23.65% improvement and it is statistically highly significant with T test (p<0.01) and after follow up mean reduced to 1.9 with 81.72% improvement and it is statistically highly significant with T test (p<0.001). 

Graph shows statistical analysis of Severity

5. Frequency

In this work of 40 patients studied in Ardhavabhedaka statistical analysis shows that the mean score which was 2.275 before the treatment was reduced to 0.75 after the treatment with 32.96% improvement and it is statistically highly significant with T test (p<0.01) and after follow up mean reduced to 1.85 with 81.31% improvement and it is statistically highly significant with T test (p<0.001). 

Graph shows statistical analysis of Frequency

Overall Result of The Treatment on Ardhavabhedaka