Vaidya Balendu Prakash
Ayurvedic Consultant
+919837028544
balenduprakash@gmail.com
www.ayrvedamigraineclinic.com
www.ayurvedapancreatitisclinic.com
• Common primary episodic headache
disorder characterized by various
combination of neurologic, gastrointestinal
and autonomic symptoms
2
• 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
•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
Definition
No pain
Score
0
Mild
1-3
Moderate
4-6
Severe
7-8
Worst
possible
9-10
 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, 53:988-994
Grade
Definition
ScoreI
I
Minimal
0-5
II
Mild
6-10
III
Moderate
11-20
IV
Severe
21+
Abortive
NSAIDs
Analgesics
(Along with antiemetics)
Narcotics
Ergot Alkaloids
Triptans
Prophylactic
Beta blockers
Antidepressants
Calcium antagonists
 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
Mouth, Esophagus pH
6-7
Interhepatic bile
pH 7.5
Bile in gall bladder
pH 7.6 – 8.6
Duodenum
pH 5.5 – 6.5
Gastric pH
– 3.5
Pancreatic juice p
Ileum
pH 6.5 – 7.5
Caecum pH
5.5 – 7.5
1.8
Rectum
6.1 – 7.5
pH

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 consent
 120 days regular and paid treatment
 Long term follow up
 Collaborative 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
at
16th Migraine Trust
International Symposium,
18 - 20 September 2006
The 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, Sweden
Poster 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
7.3 gm/day
Rat
(Daily Dose)
0.7 gm
(Equivalent)
2.23 gm
(Three times)
7.45 gm
(Ten times)
Mice
(Daily Dose)
1.47 gm
(Equivalent)
3.04 gm
(Two times)
6.48 gm
(Four times)
• No LD50 at 5 gm (maximum) dose
• Well tolerated in all groups
Prakash et al. IJTPR 2010
GI
G II
G III
Control Normal* Medium
G IV
High
GV
Satellite
Animals
20
20
20
20
20
Treatment
(day)
Sacrifice
(day)
Mortality
180
180
180
180
180
181
181
181
181
211
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, 2012
 Funding Agency: Ipca Laboratories Limited,
Mumbai
Particulars
Ayu Gr ( 32 )
Conv Gr ( 38 )
Sex (Female/Male)
Age Group
History (In years)
Frequency 2-4
(monthly)
>4
24/8
18-51
1-20
14
27/11
18-52
1-28
13
18
25
Intensity (VAS)
MIDAS Score
Headache Days
7-10
20-55
1628
5-10
16-55
2139
Particulars
Ayu Gr ( 32 )
Associate Symptoms
Nausea
27
Vomiting
24
Photophobia
26
Phonophobia
30
Relieving Factors
Conv Gr ( 38 )
34
31
35
32
Painkillers and Sleep
Particulars
Moderate to Severe
pain with need of
Prophylaxis + Rescue
Mild pain with no
need of medication
Symptom free
VAS
MIDAS
Headache Days
Ayu Gr ( 13 )
Conv Gr ( 26 )
0
26
10
0
2
97/24
( 8.1 : 2 )
446 /103
( 37.2 : 8.6)
726/100
( 60.5 : 8.33)
0
111/213
( 8.2 : 4.3 )
889/656
( 34.2 : 25.2)
1511/544
(58.1 : 20.9)
Particulars
Ayu Gr ( 13)
Associate Symptoms:
Nausea
Vomiting
Photophobia
Phonophobia
Lost to follow up
Conv Gr ( 26 )
11/4
10/0
13/5
13/1
23/25
20/6
24/24
22/17
1
1
Ayurvedic Group
Conventional Group
Ayurvedic 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