GJRMI - Volume 6, Issue 12, December 2017 by Dr. Hari Venkatesh.K.Rajaraman

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ISSN 2277 â&#x20AC;&#x201C; 4289 www.gjrmi.com Editor-in-chief

Dr Hari Venkatesh K Rajaraman

Managing Editor Dr. Shwetha Hari

Administrator & Associate Editor Miss. Shyamala Rupavahini

Advisory Board Prof. Rabinarayan Acharya Dr. Dinesh Katoch Dr. S.N.Murthy Dr. Mathew Dan Mr. Tanay Bose Dr. Nagaraja T. M.

Editorial board Dr. Nithin Ujjaliya Mr. Sriram Sridharan Dr. Ashok B.K. Dr. Madhu .K.P Dr. Sushrutha .C.K Dr. Vidhya Priya Dharshini. K. R.

Honorary Members - Editorial Board Dr Farhad Mirzaei Dr. Sabarinath Subramaniam Dr. Yogitha Bali

INDEX – GJRMI - Volume 6, Issue 12, December 2017 INDIGENOUS MEDICINE Ayurveda – Shalakya Tantra – Case Study MANAGEMENT OF MENSTRUAL COMPOUND – A CASE STUDY Naveen B S*, Mamatha K V

MIGRAINE

WITH

INDIGENOUS

DRUG 127–132

COVER PAGE PHOTOGRAPHY: DR. HARI VENKATESH K R, PLANT ID – INFLORESCENCE OF TRIDAX PROCUMBENS L.* OF THE FAMILY ASTERACEAE PLACE – OFF KANAKAPURA ROAD , BANGALORE, KARNATAKA, I NDIA *BOTANICAL NAME VALIDATED FROM www.theplantlist.org AS ON 30/12/2017

Case Study MANAGEMENT OF MENSTRUAL MIGRAINE WITH INDIGENOUS DRUG COMPOUND – A CASE STUDY Naveen B S1*, Mamatha K V2 1

Associate Professor, Department of Shalakyatantra, Sri Sri College of Ayurvedic Sciences & Research Hospital, Bangalore. 2 Professor, Department of Prasuti Tantra and Stree Roga, S.D.M.College of Ayurveda, Kuthpady, Udupi. *Corresponding Author: E-Mail: navs009@gmail.com; Mob – 9844991405.

Received: 09/11/2017; Revised: 25/12/2017; Accepted: 28/12/2017

ABSTRACT Menstrual migraine has been on a high from past decade and has been one of the major reason to lower the potentiality of female population. Though not seen through the month, its onset ranging from 4–5 days prior to menstruation to a few days after menstruation, it is observed to cause a lot of physical and psychological changes in a female. It is need of the hour to address this major concern, develop effective screening techniques, cost effective treatment methodologies to restore the health status of female. This article intends to throw light on an indigenous drug compound which showed promising result in a single case study of menstrual migraine.

KEYWORDS: Menstrual Migraine, Indigenous Drug Compound

Cite this article: Naveen B S1, Mamatha K V (2017), MANAGEMENT OF MENSTRUAL MIGRAINE WITH INDIGENOUS DRUG COMPOUND – A CASE STUDY, Global J Res. Med. Plants & Indigen. Med., Volume 6 (12): 127–132

Global Journal of Research on Medicinal plants & Indigenous medicine || GJRMI ||

Global J Res. Med. Plants & Indigen. Med. | Volume 6, Issue 12 | December 2017 | 127–132

INTRODUCTION Migraine is frequently associated with mens truation in female migraineurs, and consequently it is commonly referred to as menstrually associated migraine. The trigger thought to be partially responsible for menstrually associated migraine is a significant drop in circulating estrogen that is noted during 2–3 days prior to onset of menses. It is estimated that approximately 50% of women have an increased risk of experiencing migraine during the premenstrual phase of decreasing estrogen levels (Martin, V. T. & Lipton, R. B, 2008). Principles of Ayurveda i.e maintenance of health status, and managing the disease after its occurrence can only be achieved when the basic entities of like – the tridoshas (the three humours) – Vata, Pitta, Kapha doshas are in an equilibrium state. Migraine in ayurveda, is a condition which is said to occur mainly due to the derangement of vata dosha along with kapha, when associated with menstruation is considered to be due to apana vata vaigunya (derangement of subtype of vata dosha) which further moves in the opposite direction and results in aches like migraine (Premvati Tewari, 2012). Thus the formulation – an Indigenous drug compound was framed and tried over a patient with menstrual migraine and was found to be effective. The details of which are as followsCASE REPORT Basic information of the patient Age : 27 years Sex : Female Religion : Hindu Occupation : Software Engineer Socioeconomic status : Middle class. Marital Status : Married Hospital : Sri Sri College of Ayurvedic Science & Research Hospital, Bangalore Time of Intervention : August 2017

Consent

: Written Consent taken from the patient.

Pradhanavedanaviseṣa (chief complaints) Half Sided headache since eight months Vartamanavyadhivṛtta (history of present illnesses) Patient was apparently normal eight months back, when she started to develop severe excruciating half sided headache. She noticed it a few days prior to her menstruation every month. Pain was seen more on right half of the head usually, which was preceded by irritability, visual disturbances and irritability. Pain was said to come down after the onset of menstruation. Pain impacted her routine work, for which she reported to the OPD. Purvavyadhivṛtta (history of past illness) No complaints of any major health concerns in the past. Cikitsa Vṛttanta (treatment history) Patient initially ignored the condition for first two months, but once she observed that her routine work was impaired due to headache, she visited a nearby chemist and self-medicated herself with painkillers to combat the condition, details of which are not available. Kulaja Vṛttanta (family history) No family history of migraine or gynecological pathologies found in the family members. Vaiyuktika Vṛttanta (personal history) Aharaja A Vegetarian by diet, with regular appetite, regular intake of spicy foods, less of affection towards sweets, evening intake of snacks in the form of chats, fried foods, and coffee, consumption of beverages like coffee or tea three to four times a day. No other habits of smoking or alcohol.

Global Journal of Research on Medicinal plants & Indigenous medicine || GJRMI ||

Global J Res. Med. Plants & Indigen. Med. | Volume 6, Issue 12 | December 2017 | 127–132

Viharaja A Software employee by profession, sedentary life style, constant exposure to conditioned air for over eight hours a day, with irregular food and sleep pattern due to work. She travels for two hours every day to reach work place in an air-conditioned four wheeler. Sleep pattern is not fixed, as it is liable to change every now and then due to work. Aggravating factors - Work stress, Coffee occasionally, disturbed sleep, few days prior to menstruation. Menstrual History – Regular, once every twenty eight days. No history of clots, pain, or any other irregularities seen. Examination Vitals were normal. Cardiovascular system, respiratory system and per abdomen examinations had shown no deformity. Prakṛti (constitution) - kaphavataja. Astavidhaparikṣa Nāḍi (pulse) was vātāja. Mūtra (urine) – regular, with normal frequency and color. Mala (stool) was regular – once a day without any difficulty in initiation of the urge or completion. Jihvā (Tongue) was sāma (coate d suggestive of improper digestion). Śabda (spe ech) - Normal speech. Sparśa (touch) was dry. Dṛk (eyes) Prakritha (Normal without any dryness, congestion). Akṛti (appearance) was moderate. Visual Acuity – Both eyes without spectacles – 6/6, Right Eye – 6/6, Left Eye – 6/6, Near vision - N6. Intra Ocular Pressure (Icare tonometer) Right Eye Left Eye

: 15 : 14

Para Nasal Sinuses – Bilaterally within normal limits, no tenderness seen over para nasal sinuses.

Differential diagnosis – Migraine, Migraine with Aura, Menstrual Migraine, Menstrual Migraine with aura, Headache due to systemic causes Diagnosis – Menstrual Migraine with Aura Treatment protocol Patient was advised Indigenous drug compound – a combination of - Shatavari (Asparagus racemosus Willd.), Haridra (Curcuma longa L.), Brahmi (Bacopa monnieri (L.) Wettst.), Nimba (Azadirachta indica A. Juss), Tagara (Valeriana jatamansi), (JLN Sastry, 2008) in a dosage of 6gms twice daily with Luke warm water after food for a period of one month and followed up for a period of one month. Patient was also advised to consume wholesome food, timely sleep, avoidance of air-condition and migraine triggers to maximum. OBSERVATIONS Table 1 shows that the patient had half sided headache few days prior to menstruation, which was associated with aura. Symptoms of Headache few days prior to menstruation showed a marked improvement that it was not seen in the consecutive cycle, nor was it associated with aura. Generalized headaches were reported occasionally by the end of thirty days of drug administration, whereas the same was not reported by second follow-up of sixty days. The other parameters that were assessed showed that the patient had migraneous triggers when she consumed coffee, junk food, and when under stress. Symptoms of Nausea and vomiting, general debility before and after the onset of headache, visual disturbances before onset, visual disturbances after onset, general irritability after onset, were seen to come down markedly by the first follow-up of thirty days. Feature of general irritability before the onset persisted by the end of thirty day followup, where as was said to have come down by second follow-up of sixty days (Table 2).

Global Journal of Research on Medicinal plants & Indigenous medicine || GJRMI ||

Global J Res. Med. Plants & Indigen. Med. | Volume 6, Issue 12 | December 2017 | 127–132

Table – 1 - Score for Menstrual Migraine (MM) to evaluate the patients with findings suggestive of Menstrual Migraine on the day of visit to OPD and follow-ups. Parameter

Finding

Points

Absent

Present

Headache is seen few days before Menstruation

Absent

Present

Headache is seen during Menstruation Headache is seen few days after Menstruation

(Symptoms) Half sided Headache

On the Day of visit

AT – 1st visit (30days)

AT – 2nd visit (60days)

Absent

Present

Absent

Present

Absent Aura is seen before the onset Present of Headache

0 0

Table – 2 - Parameters that were assessed, on the day of visit, after treatment and on follow-up. Parameters

Finding

Present (Caffeine, food, Other diets) Absent Nausea Present

Triggering antigens

Vomiting / Before Onset

Points On the day of visit spicy 1 1 0 1

AT – 1st AT – visit 2nd visit (30days) (60days) 1 0

Absent

Vomiting / Nausea after Onset

Present

Absent

General Debility before Onset

Present

Absent

General Debility after

Present

Global Journal of Research on Medicinal plants & Indigenous medicine || GJRMI ||

Global J Res. Med. Plants & Indigen. Med. | Volume 6, Issue 12 | December 2017 | 127–132

Absent

Visual Disturbances Present before Onset Absent

Visual Disturbances after Onset

Present Absent

General Irritability before onset General Irritability after onset

Present Absent Present Absent

Onset

1 0

1 0 1 0

Table – 3 – Impact on Symptom effects:

Symptom effect Impact on sleep Impact on daily activities (sports, leisure) Impact on school or work How much trouble

On the day of visit Mild

AT – 1st visit (30days) None

Moderate Mild

Severe

AT – 2nd visit (60days) None Mild

Moderate None

Moderate Moderate Mild

Impact on sleep leading to disturbances due to symptoms of migraine were said to be mild on the day of visit, but markedly came down after thirty days of drug intervention and was not seen to relapse by second follow-up of sixty days.

thirty days and was seen to be under control by the end of second follow-up of sixty days (Table 3). DISCUSSION

Impact in daily activities and generalized trouble caused by the migraine was said to be moderate at the time of examination but then on came down to a milder extent by the end of second follow-up of sixty days, but still showed its persistence even when mild headaches were seen to occur.

Pathogenesis of menstrual migraine can be derived as, being caused due to vata prakopaka nidana (factors aggrevating vata dosha), leading to obstruction of apana vata, thereby deviating the normal route of it to various parts of the body, especially to the oordhwa jatru (parts above the shoulder), and producing various types of aches, particularly half sided headache.

Impact on school and work place, hindering the productivity was severe on the day of recruitment where as it came down to a moderate extent by the end of first follow-up of

To find a solution to the condition, an indigenous drug compound consisting was formulated and was advised in a dosage of six

Global Journal of Research on Medicinal plants & Indigenous medicine || GJRMI ||

Global J Res. Med. Plants & Indigen. Med. | Volume 6, Issue 12 | December 2017 | 127–132

grams, twice daily with Luke warm water after food. The condition was observed after a period of thirty days and sixty days then on. The results were seen promising right after first follow-up and a marked improvement by the end of second follow-up of sixty days. Drug action when introspected upon could be – Shatavari (Asparagus racemosus), being a potent rejuvenator, known for its action on garbhashaya (uterus), also said to clear the channels and restore normalcy of doshas. Brahmi (Bacopa monnieri) – Known for its medhya action (nootropic), being a sheeta dravya (cold in potency) it relieves mano vikaras like anxiety, irritability, intolerances. Haridra (Curcuma longa), a potent antioxidant and anti-inflammatory, relieves the body from toxins and inhibits biosynthesis of inflammatory prostaglandins thereby checks headache, Nimba (Azadirachta indica) due to its lekhana (scraping) activity and being ushna (hot) by nature when given in combination with REFERENCES JLN Sastry, (2008), Dravyaguna Vijnana vol II. 3 rd edition. Varanasi:Chaukhamba orientalia Martin, V. T. & Lipton, R. B., (2008). Epidemiology and Biology of

Tagara (Valeriana jatamansi) which is also a ushna dravya (hot), cleanses srotas (channels) and there by allows the other drugs a target specific action. Tagara (Valeriana jatamansi) also possesses the activity of initiating sleep and also a potent pain reliever, stabilizes sleep and also reduces pain. CONCLUSION Overall effect of the drug in the patient was found to show a marked improvement in checking the migraine as well as uplifting the health status of the patient. Menstrual migraine has been posing as a major grievance for female population in the present era. It is of utmost importance that a cost effective, simple treatment modality is framed to curb the condition and uplift the general wellbeing of a female. This study gives scope for further research to be carried on larger samples and then on adopted as an effective modality in treating the condition.

Menstrual Migraine. Headache. The Journal of Head and Face Pain, pp. S124-S130. Premvati Tewari, (2012), Ayurvediya Prasutitantra Evam Striroga, Part II, Striroga (Gynecology), Chaukhambha Orientalia, pg- 35.

Source of Support: NIL

Conflict of Interest: None Declared

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