Abstract – Dr. Chamashi Damindra Ranaweera
chamadamindra@gmail.com
Effect of Shirovirechana (Nasya Karma) on Migraine: An Ayurvedic Perspective
Concept of Migraine (Ardhavabhedaka) in Ayurveda.
Shirah (head) is considered as “Uttamanga” among all the Angas of the Sharira (body) and it is the Ashraya of the Prana and all Indriyas (organs).
According to Acharya Charaka, there are five types of Shirorogas in Sutrasthana
E. g.:
[ ] Vataja
[ ] Pittaja
[ ] Kaphaja
[ ] Sannipataja
[ ] Krimija.
According to Acharya Sushruta, there are eleven types of Shirorogas
E. g.:
[ ] Vatika
[ ] Paittika
[ ] Kaphaja
[ ] Sannipatika
[ ] Raktaja
[ ] Kshayaja
[ ] Krimija
[ ] Suryavarta
[ ] Anantvata
[ ] Ardhavbhedaka
[ ] Shankhaka
In Ayurveda, migraine is most closely correlated with Ardhavabhedaka, a type of Shiroroga (head disease) described in classical texts. The word Ardhavabhedaka comprises of two components,
Ardha = half
Avabheda = breaking, perforating or bursting out type of pain / piercing pain
Thus, Ardhavabhedaka refers to severe, splitting pain affecting one half of the head, matching the classical migraine presentation.
Definition of Ardhavbhedaka
According to Acharya Sushruta, if one half of the head develops severe tearing and pricking pain, giddiness and piercing pain, suddenly after a fortnight or ten days. This should be diagnosed as Ardhavbhedaka caused by all the three Doshas.
According to Acharya Vagbhatta, pain in half side of head is considered as Ardhavbhedaka. The episodes of pain arise in the interval of fifteen days or one month and the pain subsides by itself. If the condition becomes aggravated, it may even impair the functions of the eye and ear.
Rupa of Ardhavabhedhaka
According to Acharya Charaka, the features of Ardhavbhedaka are severe pain in half side of the head, affecting particularly neck, eye brows, temporal region, ear, eye and forehead. The pain is like cutting by the sharp objects or piercing in nature.
Acharya Sushruta has mentioned severe piercing and tearing pain in one half of the head associated with giddiness. These features appear every fortnightly or ten days or any time.
Acharya Vagbhatta has mentioned Ghata (occipital region according to Indu and Parietal region according to Arundatta) and all the Shirogata Sandhis in addition where the pain occurs. He has also emphasized on its paroxysmal nature and said that it comes in every Paksha (fortnightly) or Masa (Month). The headache subsides by itself.
Acharya Charaka has described the prominently involved sites as Manya (neck), Bhru (eyebrow), Shankha (Temporal region), Karna (ear), Akshi (eye) and Lalata (fore head). In addition, Acharya Vagbhatta mention one extra site i.e., Ghata (occipital region).
Panchakarma Procedures
1) Nasya Karma: Administration of drug or medicated oil through the nose is known as Nasya Karma. Acharya Charaka has not mentioned specific duration of the Nasya therapy. According to Sushruta, Nasya may be given repeatedly at the interval of 1, 2, 7 and 21 days depending upon the condition of the patient and the diseases he/ she suffer.
2) Basti Karma: In Ardhavbhedaka, Niruha Basti prepared with Vatashamaka drugs should be given followed by Anuvasna Basti prepared with Ghrita and Taila.
3) Upnaha: Poultice of Vatashamaka drugs like Dashmoola mixed with hot milk wrapped in a cloth in the paste form can bandaged around the head.
4) Shirobasti: In Shirobasti, a special cap opened at both ends is prepared from thick and firm leather, having height of 12 Angula is tied around the head and medicated oil is filled into this. In Ardhavbhedaka, Vata and Vatakapha Shamaka medicated oils like Dasmoola Taila are used.
5) Dahana Karma: It is indicated in the last when the pharmacological approaches are not responded in Ardhavbhedaka. According to Acharya Charaka, Dahana should be done at Shankha and Lalaata Pradesha, limited to dermal layer (Twak Daha) with the help of Sharkandagra or Godanta. Acharya Bhela has prescribed Pippali for Dahana Karma.
6) Shiro-Abhyanga: Massage over head with medicated oil.
Shirovirechana (a type of Nasya Karma) is considered a highly effective Ayurvedic therapy for managing migraines (known as Ardhavabhedaka or Shira: shoola in Ayurveda), with clinical studies showing significant reductions in pain intensity, frequency, and duration of attacks. It works by eliminating accumulated Doshas (biological humors, primarily vitiated Vata and Kapha, sometimes Pitta) from the head and neck region.
Ayurvedic Perspective and Mechanism of Action :
नासा हि शिरसो द्वारम्। ” (Nāsa hi śiraso dvāram)
“The nose is the gateway to the head”.
This principle is fundamental to the Ayurvedic treatment known as Nasya Karma (nasal administration of medicines).
* Direct Route to the Brain: The shloka emphasizes that the nasal passage provides a direct route to the Shiras (head) and Mastishka (brain).
* Therapeutic Application: By introducing medicated oils, powders, or juices through the nostrils, practitioners can effectively manage and treat a wide range of Urdhvajatrūgata diseases (ailments of the head, neck, and sensory organs like eyes, ears, and throat).
* Removal of Doshas: Medication administered via the nose helps to eliminate accumulated doshas (vitiated bodily humors/toxins) from the head and sinus areas, thereby promoting overall health and preventing major illnesses.
* Central Nervous System (CNS) Impact: Due to the connection between the nasal mucosa and the CNS, Nasya therapy is also used to manage stress, improve neurological functions, and enhance consciousness.
“Gateway to the Brain”: In Ayurveda, the nose (Nasa) is considered the direct doorway to the head (Shira) and consciousness. Administering medication through the nasal passage allows the therapeutic agents to act directly on the cranial cavity and central nervous system, bypassing hepatic metabolism.
* Balancing Doshas: Migraine is primarily attributed to an imbalance of Vata (nervous system, pain) and Pitta (metabolism, inflammation), sometimes with Kapha (congestion) involvement. Shirovirechana helps balance these Doshas in the head region, which is crucial for long-term relief.
* Detoxification (Shodhana): Shirovirechana is a Shodhana (purification) therapy that mobilizes and expels morbid Doshas and toxins (Ama) from the sinuses and head channels, promoting clarity of the sense organs (Indriya bodhana).
* Neurovascular and Neuroendocrine Effects: The rich vascular supply of the nasal mucosa allows for rapid absorption of the medicated substances, which can directly stimulate olfactory nerve endings connected to the limbic system and hypothalamus in the brain. This stimulation helps regulate the nervous and endocrine systems, which play a role in pain perception and stress response.
References :
1) Charaka Samhita – Sutra, Siddhi Sthana
2) Sushruta Samhita – Uttara Tantra
3) Ashtanga Hridaya Samhita – Uttarasthana
4) Ayurveda for changing life – Dr. Chandra Abeysekara
5) Maharshi Charakaayurved
Keywords: Nashya, Headache, Migraine, Ardhavabhedhaka, Shiroroga, Ayurveda