The pattern of Migraine headaches has changed during the pandemic. The very first wave of COVID created panic and therefore People reported an increase in attacks. During the interval between 1 st and 2 nd wave of Delta variant, people were a littler relaxed but work from home and irregular food habits once again contributed to increase in frequency of headaches. People also reported reduction as the stress of getting to work was lesser especially in females.

Migraine is a known disabling primary headache disorder characterized by periodic, unilateral, throbbing headaches with associated symptoms of nausea and vomiting usually beginning in childhood, adolescence or early adult life. It recurs in diminishing numbers and intensity during advancing years. It is divided into two subtypes, i.e.,

1. migraine with aura and
2. migraine without aura

Up to one-third of people with Migraine perceive an aura: a transient visual, sensory, language, or motor disturbance which signals that the headache will soon occur. Occasionally an aura can occur with little or no headache following it. Migraine is a chronic condition triggered by psychological and physiological stressors, and stress as a risk factor attributes to the problem in 50% of the migraineurs.

Migraine headache finds its mention under the classification of Shiroroga (Diseases related to the Head region) in both Charka and Sushruta Samhita. Ardhavabedhaka (Unilateral headache) is the closest type of headache with a description like Migraine.

The headache which is intense and is piercing in nature like a weapon is termed Ardhavabhedaka. The traditional texts of Ayurveda suggest that different Dosha’s are involved in the manifestation of Ardhavbhedaka. Acharya Sushruta opines Ardhavabhedaka to be a Tridoshaja vyadhi (a disease with involvement of all three body humours) and Acharya Charaka mentions it as a Vata – kaphaja Vyadhi. The treatment line involves the administration of Samshodhana (Bio-purificatory techniques or Panchakarma) with special mention of Kaya virechana (Purgation) for long term relief. Snehana (internal and external oleation), fomentation, medicines, virechana (purgation), dhoomapana (medicated smoking), using warm and unctuous food, lepa with vidangadi churna and krishna tila (black gingely seeds), nasya are the other treatment aspects mentioned.

Ayurveda also explains how diet, lifestyle and conduct contribute to the trigger of the disorder and this implies that pathya and apathya (following or not following dietary prescriptions respectively) play a role in the management of Migraine.

According to Yoga, Migraine can be classified under Adhija Vyadhi. The cause of the disease lies in the mind and therefore treated accordingly.

Studies on Ayurveda and Yoga have shown reduction in the number of attacks, average maximum duration of an attack, severity, signs such as nausea and vomiting. Certain studies have also shown reduction in analgesic requirement.

The association of Pitta with inflammatory processes was speculated in Pitta individuals. The genes related to Oxidative stress pathway were up-regulated and Oxidative stress is considered a key for Migraine trigger. Perhaps, the choice of Virechana (Therapeutic purgation) as part of bio-purificatory treatment is customized based on the predominance of Pitta and positive results are observed in line with the expected outcomes as mentioned in traditional Ayurveda texts.

Yoga therapy is very effective in maintaining psychological well-being and mental relaxation and therefore effective in the management of pain related conditions. Yoga can reduce the levels of stress biomarkers such as serum cortisol and can bring in autonomic modulation by improving vagal tone.

Modifying pain perception both at physical and mental levels is essential as pain is a complex sensory and emotional experience that can vary widely between people and even within an individual.

Therefore Ayurveda and Yoga therapy as combined intervention can help reduce symptoms and improve quality of life in patients with Migraine headache.

TIPS

Don’ts (apathya)

1. Aahara (food) – Caffeine, Cocoa, beans, nuts and peanuts, spicy food, oily food, fermented food, processed food such as cheese are some which need to be avoided.
2. Vihara (lifestyle) – Apathy, Stress, excessive travel, too much or too little sleep, hunger, fasting and excessive activity.

Do’s (pathya)

1. Regular practice of Yoga which includes Breathing exercises, Relaxation techniques, Pranayama ( Nadi Shuddhi and Bhramari), Chanting. (Special techniques of yoga should be learnt under the guidance of a trained yoga therapist)