Lifestyle - A common denominator for the onset and management of migraine headache: Complementing traditional approaches with scientific evidence :[PAUTHORS], International Journal of Yoga (IJoY)

PERSPECTIVE
Year : 2019 | Volume : 12 | Issue : 2 | Page : 146--152

Lifestyle - A common denominator for the onset and management of migraine headache: Complementing traditional approaches with scientific evidence

MS Vasudha, NK Manjunath, HR Nagendra
Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana a Deemed to be University, Bengaluru, Karnataka, India

Correspondence Address:
M S Vasudha
Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana University, Prashanthi Kutiram, Jigani Hobli, Anekal Taluk, Bengaluru - 560 106, Karnataka
India

Abstract

Background: Ayurveda and Yoga have gained popularity in the management of various chronic health problems associated with pain including migraine headache. It is evident from both scientific as well as traditional literature that stress, diet, sleep, and exposure to extreme climatic conditions act as triggering factors for the onset of migraine. Hence, it is essential to focus on lifestyle including diet as important factors for prevention and as adjuvant factors in the management of migraine headache. Aim: The aim was to propose a new perspective to the understanding of migraine headache keeping in view the role of lifestyle including diet. Methods: Classical Ayurveda texts and traditional Yoga scriptures were used to compile information on the role of lifestyle including diet in the onset and management of migraine headache. This was complemented by PubMed-based review of scientific literature. Outcome: Ayurveda texts provide an extensive information about the basic understanding, causes, precipitating factors, and management of migraine headache, while Yoga texts refer to the concept of mental stress (adhi) leading to physical health problems (vyadhi). It is evident from the literature that diet, sleep, exposure to extreme climatic conditions, and mental stress play an important role in the onset and management of migraine headache. Conclusion: Lifestyle appears to be the common factor for both onset and management of migraine headache.

How to cite this article:
Vasudha M S, Manjunath N K, Nagendra H R. Lifestyle - A common denominator for the onset and management of migraine headache: Complementing traditional approaches with scientific evidence.Int J Yoga 2019;12:146-152

How to cite this URL:
Vasudha M S, Manjunath N K, Nagendra H R. Lifestyle - A common denominator for the onset and management of migraine headache: Complementing traditional approaches with scientific evidence. Int J Yoga [serial online] 2019 [cited 2023 Mar 20 ];12:146-152
Available from: https://www.ijoy.org.in/text.asp?2019/12/2/146/257630

Full Text

Introduction

A migraine is one of the most common primary headache disorders, characterized by unilateral, pulsatile, or throbbing sensations in the head. It is associated with greater degree of disability and is triggered by psychological and physiological stressors.[1] A number of intrinsic and extrinsic factors can trigger an episode of migraine. The important triggers are stress, food, fasting, sleep deprivation, and change in weather conditions.[2] The need for lifestyle modification, including physical exercise, healthy habits, proper diet, and stress adaptability, has become essential factors in the management of most chronic ailments like migraine. Exploring this understanding as per Ayurveda and Yoga texts and correlating it with available scientific literature aims at providing a value addition with supporting evidence in the management of migraine headache.

Ayurveda, an ancient system of Indian medicine, defines health as a state of well-being resulting from a synergistic balance in Doshas (principal systems functions - Vata, Pitta, and Kapha), Dhatu (body tissues), Mala (excretory products), and Agni (digestive fire). A blissful state of Atma (spirit), Indriya (sense organs), and Manas (mind) is also said to be important to achieve the state of positive health.[3] Migraine headache is referred as Ardhavabedhaka under the classification of Shiroroga (diseases related to the head region) in Ayurveda treatises.[4] The pain associated is one-sided, intense, and piercing in nature. The onset of Ardhavabhedaka is attributed to various causes, such as fasting, intake of dry food items, alcohol, weeping, suppression of natural urges, daytime sleeping, anxiety, fear, and grief. The line of treatment for migraine involves administration of samshodhana (Panchakarma-Bio-purificatory techniques) with special mention of kaya virechana (therapeutic purgation),[5] diet and lifestyle regulation. Pathya ahara (wholesome regulated diet) and vihara (wholesome regulated lifestyle) are the primary approaches to maintain homeostasis of all dosha's for prevention and management of diseases. Scientific literature also shows that diet, lifestyle, and stress can contribute to increased prevalence of migraine headache and their understanding helps in its management.[6]

According to Yoga, migraine is considered as an adhija vyadhi (mind-body disorder)where the disturbances in the mind influence the flow of Prana (the vital force/breath) resulting in physical problems and affecting the weakest system in the body.[7] Yogic principles of diet are based on trigunas (the three inherent qualities of food), which emphasize on intake of healthy and nourishing vegetarian diet. The concept of achara and vichara denoting healthy activities such as practice of asana, right thoughts, and attitude, respectively, play a key role in the prevention and management of diseases.

Scientific literature mentions diet and lifestyle as migraine triggers and also states that education on the same plays a major role in its prevention.[6] Complementing the traditional understanding with scientific evidence, therefore, would add value in designing a more holistic and integrative line of treatment. Hence, this concept paper aims at compiling information from both traditional and modern literature to present a new perspective to the management of migraine headache.

Methods

Seven major texts of Ayurveda which included Bruhtrayis (three major texts), Laghutrayis (three minor texts) and Yoga Ratnakara were reviewed, and relevant information was compiled under two headings: (i) factors responsible for the onset of migraine and (ii) factors which play a key role in the management of migraine apart from conventional Ayurveda therapies. The factors were further categorized into two (i) diet and (ii) lifestyle (stress, sleep, habits, and others). The texts reviewed included Charaka samhita, Sushruta samhita, Ashtanga Hridaya, BhavaPrakasha, Madhava nidana, Sharangadhara samhita, and YogaRatnakara. The compilation also includes information on headache-related disorders (shiroroga), as migraine is grouped under this category in some Ayurveda texts.

Similarly, an attempt was made to classify the appropriate information from ancient Yogic texts under the categories mentioned above. The texts included Upanishads, Bhagavadgita (B.G.), Hatha Yoga Pradipika, Patanjali Yoga Sutras (P.Y.S), Shatdarshana and Yoga Vasishta. Although we found no direct mention of migraine headache in the texts, selected concepts related to disease and pain were considered.

Furthermore, a focused search of modern literature was conducted using PubMed as the data base during July 2018. Since the objective was to derive complementary information to the traditional understanding and not to do a systematic review, we considered PubMed as the only search engine for this purpose. The keywords used for the search were lifestyle, diet, stress, sleep in relation to a migraine headache. The type of articles considered included review articles, cross-sectional studies, randomized controlled trials, cohort studies, and surveys.

Description of common factors responsible for the onset and management of migraine

Further to the compilation, the concepts have been described to arrive at an understanding of diet and lifestyle as common factors which would play an important role in both onset and management of a migraine.

The etiological factors as mentioned in Ayurveda treatises, Yogic scriptures, and modern medical research show lot of similarities.

Studies show that stress is one of the four most acknowledged triggers. The other three are fatigue, not eating on time and lack of sleep.[8] The triggers are also broadly classified as dietary causes and lifestyle based causes which includes stress.

Factors responsible for the onset of migraine headache

Role of diet in the onset

Concepts based on Ayurveda texts

The etiological factors described here are the concepts propounded by the great Ayurveda scholars known as Acharya (an accomplished practitioner and teacher known for his wisdom in Ayurveda). Acharya Charaka mentions independent and specific nidana (causes) for the onset of Ardhavabhedaka (migraine), whereas Acharya Vagbhata has explained only Samanya shiroroga nidana (general etiology of headache) which triggers any type of Shiroroga (diseases of the head) including Ardhavabhedaka (migraine). The other Ayurveda texts have also outlined similar details. The important verses in Sanskrit and their translation to English are cited under respective sections.

Acharya Vagbhata in the Ayurveda treatiz e“Ashtanga Hridaya” under Uttarasthana (A.H.U) explains the samanya nidana (general etiology) as:

Dhūmātapatuṣārāmbukrīḍātisvapnajāgaraiḥ |Utsvēdādhipurōvātabāṣpanigraharōdanaiḥ | A.H.U. 23/1 ||Atyambumadyapānēna kr̥mibhirvēgadhāraṇaiḥ |Upaghātamr̥jābhyaṅgadvēṣādhaḥpratatēkṣaṇaiḥ || A.H.U. 23/2 ||Asātmyagandhaduṣṭāmabhāṣyādyaiśca śirōgatāḥ |Janayantyāmayān dōṣāḥ || A.H.U. 23/3 ||.

The smoke, sunlight, dew, playing in water, excessive sleep, keeping awake at night, excessive sweating, stress, wind, suppression of tears, crying, excessive intake of water and alcohol, helminthic infection, suppression of natural urges, avoidance of hygiene, dislike towards abhyanga (massage), constant gazing, bad odor, excessive talking may increase the ama formation leading to accumulation of dosha in the head region causing various diseases of the head region.[9]

Acharya Charaka in Siddhisthana (C.Si) explains the specific etiology as:Rūkṣātyadhyaśanāt pūrvavātāvaśyāyamaithunaiḥ|Vēgasandhāraṇāyāsavyāyāmaiḥ || C.Si. 9/74 ||.

The intake of dry items, excessive intake of food, less intake of food, exposure to wind, controlling the natural urges of tears, sexual drive, bowel, and bladder evacuation vitiate the vata.[5]

Most of the causative factors mentioned under samanya nidana (general etiology) aggravate vata, pitta, and kapha and vitiate rakta. From the available information on samanya nidana of shiroroga and specific nidana of Ardhavabhedaka, the etiological factors have been classified as aharaja nidana (dietary causes), viharaja nidana (lifestyle causes), and manasika nidana (mental causes).

Specific dietary causes (aharaja nidhana) and the underlying mechanisms:

Adhyashana (consumption of food before the digestion of previous meal): It leads to ama formation which enters the circulation and vitiates rakta. When it lodges in ardhashiras (one side of the head), it produces Ardhavabhedaka[5]Amla ahara (sour food): Excessive intake of sour food articles which have laghu (light), snighdha (unctuous), and ushna (hot) guna (quality) does the vilayana (melting down) of kapha and pitta rakta dooshana (vitiate pitta and rakta)Anashana (intake of less food): It may be abhojana/alpamatra bhojana (not taking food/taking less food) which leads to rikta kosta (empty stomach) and vata prakopa (aggravation)[5]Atisheetambu pana (intake of excessively cold water): It causes agnimandya (weak digestion) leading to the formation of ama (byproduct of improper digestion). Sheeta guna (cold quality) which vitiates vata in turn causes sankocha (constriction) of sira (arteries) in the body. It causes kapha prakopa (aggravation of kapha)by its snigdha (unctuous), manda (slow)and guru (heavy) guna causing raktadusti (vitiation of blood), srotodusti (vitiation of body channels) in the shiras (head)leading to ardhavabhedaka[5]Ati madya sevana (excessive intake of alcohol): It leads to dooshana of pitta and rakta (vitiation of pitta and blood). It also causes the vidaha (inflammation)of rakta by its ushna (hot), vyavayi (diffuse), vikasi (spreading nature) gunas (qualities), results in kshobha (constriction)of raktavaha sira (disturbance in blood vessels), which leads to vatadi prakopa (aggravation of vata)and shiroroga (diseases of the head)[9]Guru Ahara (heavy food): It leads to agnimandya (weak digestion), causes kapha prakopa there by acting as a trigger for headache[9]Rookshashana (dry food): It causes vata prakopa which leads to formation of kledamsha (waste) leading to the srotorodha (blockage of channels) leading to ArdhavabhedakaSambhojana (eating food which is completely filling): It causes tridosha prakopa and cause amotpatti (production of ama) leading to shirashoola (headache).[5]

Concepts according to Yoga texts

Taittiriya Upanishad summarizes the importance and role of food in an individual's life. It says: “Annam Brahmeti vyajanaat,” i.e. food is Brahman (Universal consciousness), because it is food from which all beings are born, sustain and finally merge into. Food, therefore, plays an important role in health and disease.[10]

Hatha Yoga Pradipika explains food along with yama (restraints on behavior) and niyama (observances). It mentions that food taken should be of moderate quantity, pleasant, and sweet leaving one-fourth of the stomach empty. Food items which are sour, pungent, and hot-like mustard, alcohol, fish, meat, curds etc., reheated food, salty food are those advised to be avoided.[11]

The B.G. explains the importance of diet in the context of disease as follows:

Āyuḥsattvabalārōgyasukhaprītivivardhanāḥ|Rasyāḥ snigdhāḥ sthirā hrṛdyā āhārāḥ sāttvikapriyāḥ || B.G. 17/8 ||Kaṭvamlalavanṛātyuṣnṛatīkṣnṛarūkṣavidāhinaḥ|Āhārā rājasasyēṣṭā duḥkhaśōkāmayapradāḥ || B.G. 17/9 ||Yātayāmaṃ gatarasaṃ pūti paryuṣitaṃ ca yat|Ucchiṣṭamapi cāmēdhyaṃ bhōjanaṃ tāmasapriyam || B.G. 17/10 ||.

Food in the mode of goodness increases the duration of life, purify one's existence and gives strength, health, happiness, and satisfaction. Such food are sweet, juicy, nourishing, and palatable and are known as Satvic food. Foods that are too bitter, too sour, salty, pungent, dry and hot, are liked by people in the modes of passion. Such foods cause pain, distress, and disease. These are Rajasic foods. The food cooked for more than 3 h before being eaten, which is tasteless, stale, putrid and unclean, is food liked by people in the mode of ignorance. It is called Tamasic food. Hence, it can be postulated that the rajasic and tamasic food when consumed inappropriately trigger diseases associated with pain as both of them aggravate pitta which is a principle factor in the onset of headache.[12]

Complimenting concepts based on scientific literature

Scientific evidence shows that the food we consume acts as a potential trigger for migraine and is second to stress responsible for its onset.

Food items, such as dairy, processed food, fermented, pickled and marinated food, and those which contain nitrates (hot dogs, salami, and bacon), tyramine (aged cheese, beans, citrus fruits, avocado, banana, onion, red wine) caffeine and histamine (seafood),[13] are found to be the triggers of migraine.

The onset of headache due to the above can be understood by theories of brain-gut axis where a sensitive nervous system develops hyperexcitability as a response to multiple environmental and immunological factors.[14]

Diet and nutrition can also bring about neurogenic and vascular inflammatory changes. Following ingestion of certain food, studies show that the rate in which neurons synthesize neurotransmitters is influenced.[15] This can be supported by studies where decreased serotonin levels have shown to trigger migraine and diet can contribute to increase in serotonin levels.[16]

Role of lifestyle in the onset of migraine headache

Concepts according to Ayurveda (viharaja karana)

The following factors are known to trigger the onset of migraine according to Ayurveda texts:

Avashyaya/Tushara sevana (excessive exposure to mist): It increases vata and kapha because of its sheeta guna (cold quality)[5]Atapa sevana (excessive exposure to sunlight): This causes vilayana of kapha and aggravation of pitta guna results in raktadusti[9]Atimaithuna (excessive sexual indulgence): It causes shukra kshaya (oligospermia) which inturn leads to vata dusti (vitiation of vata) and causes shiroroga (disease of the head)[5]Ayasa (fatigue/exertion): Fatigue can be both physical and mental in origin. Physical fatigue occurs due to ativyayama (excessive exercise), and mental fatigue may be due to rodana (crying), chinta (worrying), etc., All these causes increase rooksha guna, leading to shoshana of dhatus in the body. The vata getsvitiatedin ardha shiras (half part of the head)to produce ardhvabhedaka (migraine)[9]Diwa swapna (day sleep): It causes kapha prakopa (vitiation of kapha)and increases medas leading to raktadusti (vitiation of blood)and avarodha in the shiras (blockage in blood vessels)to produce vata prakopa and shirashoola (headache)[9]Pragvata (exposure to cold breeze from eastern direction): This causes vata kapha prakopa by increasing sheeta guna. This causes sankocha of siramukha in shiras (obstruction of blood vessels) to produce shiroroga (headache)[9]Ratri jagarana (keeping awake during night): It does prakopa of vata by its rookshaguna[9]Vega dharana (suppression of natural urges): Suppression of urges such as chardi (vomiting)and kshavatu (sneezing), induces vata prakopa[9]Asatmendriyartha samyoga (improper stimulation of sense organs) is considered an important factor for trigger of diseases as Ayurveda considers the sense organs to be the route to the brain. Constant glare, starring, bright light, loud noise, certain types of smell could trigger migraine.[9]

Role of lifestyle in health and disease according to Yoga

Yoga encompasses factors which are physical, mental, social, and spiritual in nature which can influence health and disease. The principles might appear general and subtle, but plays vital role in the overall understanding of health and disease.

Acharya Patanjali has provided the most comprehensive description of the five stress producing factors called Kleshas. They are Avidya asmita raga dwesha and abhiniveshaha.

Ignorance, ego, desire, dislike, and fear of change are the five stress producing factors. The fivefold kleshas areresponsible for the onset of dukha (pain) which may be physical or mental. Diseases are considered as dukha and can be overcomed through cittavritti nirodha (regulation of mental modifications). We could overcome the fivefold klesha by practicing kriyayoga (tapas [austerity], swadhyaya [self study], ishwarapranidhana [surrendering to the divine])and by ashtanga yoga (Eight limbs of Yoga).[17]

Acharya Patanjali also mentions about cittavikshepa (obstacles) as the impediments in the path of achieving the control of mind. Cittavikshepa leads to dukha (pain). They are vyadhi (disease), styana (mental laziness), samshaya (doubt), pramada (lack of enthusiasm), alasya (physical lethargy), avirati (craving for sense pleasure), bhrantidarshana (illusionary vision), alabdhabhumikatva (despair due to failure to concentrate) and anavasthitatva (unsteadiness in concentration). There are seven methods mentioned by Patanjali as a remedy and for the sake of simple study, we could understand that keeping a positive attitude, practicing breathing techniques, and meditation on various objects help one to get rid of the vikshepa.[17]

The Lifestyle modifications are better understood by knowing more on yamas (restraints) and niyamas (observances) as explained in P.Y.S.

Ahiṁsā-satya-asteya brahmacarya-aparigrahāḥ yamāḥ ‖P.Y.S. 2/30‖Śauca saṁtoṣa tapaḥ svādhyāy-eśvarapraṇidhānāni niyamāḥ ‖ P.Y.S. 2/32‖.

The yama (ethical living) guidelines have been mentionedas ahimsa: nonviolence, non-harming, satya: truthfulness, honesty, asteya: Nonstealing, to the extent that one should not even desire something that is not his own, brahmacharya: Walking in awareness of the highest reality, remembering the divine and practicing the path of celibacy, aparigraha: Non possessiveness, nongreedy, nonindulgence.

The niyamas (ethical observances) are shaucha:Cleanliness and purity of body and mind. It results in purification of the subtle mental essence, brings pleasantness, mastery over the senses, and capability for self-realization, santosha:Contentment or comfortable acceptance of what one currently has. It brings joy and happiness from within, tapah: Through training of the senses, there comes a destruction of mental impurities and an ensuing mastery over the body and the mental organs of senses and actions, svadhyaya:Self-study, reflection on sacred words, and study of the scriptures. Through this one attains communion with the underlying natural reality, Ishvarapranidhana: Surrender and dedication to the Supreme Being or Causal Source, devotion, and surrender of fruits of practice. It helps in achieving the state of perfect concentration (samadhi). Yama and Niyama when not practiced as applicable to common man can, therefore, lead to diseases.[17]

Scientific literature on lifestyle as a trigger in the onset

An episode of migraine is triggered by external factors such as fatigue, fasting, sleep disruption, exercise, and weather conditions.[18]

Fatigue has been evaluated and has been significantly seen 12 h before a migraine episode.[19]

Studies demonstrate that peripheral and central sensitization of the trigeminovascular projection to the dural vasculature can exacerbate neuronal responses to innocuous mechanical and noxious intracranial dural inputs. This is considered a reason for trigger of migraine following physical activities such as exercise.[20]

Sleep has been extensively studied as a cause of migraine. Lack of sleep, excess of sleep lead to migraine[21] and migraineurs report poor sleep quality and daytime tiredness when compared to non-migraineurs.[22] Reduced serotonin,[23] increased catecholamine's[24] and hypothalamic orexinergic system[25] play a role in the onset of migraine. Orexin-containing neurons in the hypothalamus fire in wakeful states, and disruption of orexinergic signaling results in excessive sleepiness. Orexinergic cells affect not only monoaminergic activity across the sleep cycle but also pain modulation. The melatonin levels which get synthesized by the pineal gland during darkness may not trigger migraine but may predispose the onset of headache leading to awakening from sleep.[26]

Since hypothalamus is said to be involved in physiological functions as a regulator for homeostasis and therefore plays a key role in sleep cycle, thirst, feeding, arousal, and urination. Hypothalamic activation has been demonstrated in migraine during and before an episode of migraine in imaging studies.[27] We, therefore, understand how lifestyle plays a role as a trigger of migraine.

Role of stress as a triggering factor

Ayurveda explains the concept of pragyaparadha (intellectual blasphemy). This unrighteousness is the main cause of somatic diseases and can induce all the pathological conditions.[28] Stress can be therefore considered as pragyaparadha. It is a factor due to which a person cannot perform optimum levels of intellectual functions and cannot discriminate between right and wrong. This increases Vata and hence aids manifestation of shoola (pain).

According to the Yoga text - Yoga Vasista, the concept of “Adhija vyadhi” explains about the diseases originating from stress and “Anadhija vyadhi” explains the diseases which are not due to stress. The duality of likes - dislikes, love – hatred, etc. which govern human emotions start creating imbalance at the level of manomaya kosha and when intensify cause “Adhi's.”[7] These conflicts bring about the speed in mind and is termed “stress.” The repetition brings in the response of anxiety, depression, anger and affects the various systems. This is a state of mind described in P.Y. Sas “kshipta” featured by agitation and restlessness and predominant with rajas. The B.G. illustrates the process of how stress can lead to manifold problems. Repeated thinking and dwelling on the same thoughts have been identified as source of all problems. This leads to attachment, desire, anger, delusion, memory loss, lack of discrimination, and finally destroys oneself.[12]

According to Scientific literature, stress can be due to physical, mental or psychological factors. A study on 3259 civil servants has shown that high strain jobs with low social support is associated with migraine.[29] It is found that prolonged stress activates immune system and may facilitate pain. The pro-inflammatory mediators such as tumor necrosis factor alpha, interleukin (IL)-1beta, IL-6 and nitrous oxide are activated due to stress leading to migraine.[30]

Factors which play an important role as an adjuvant in the management of migraine

The comprehensive Ayurvedic approach in the management of migraine

The first line of treatment for migraine is nidana-parivarjana (abstinence from etiological factors). The objective is to reduce the frequency of attacks and to improve the quality of life. By adapting dinacharya (daily regimen) and rutucharya (seasonal regimen), the frequency of headache episodes has reduced. Pitta individuals have strong agni (digestive power), and the dietary causes such as overeating of spicy food aggravate Pitta, leading to the formation of ama and further can trigger headache. Therefore, they are advised to avoid Pitta aggravating food. Lifestyle-based causes (Viharaja nidana), such as, weather-related causes, exposure to sunlight, wind, improper bowel, inadequate sleep and excessive exercise should be avoided as they increase pitta and therefore increase the tendency of shoola (pain).[4]

The description given in Sharangadhara Samhita Parishistam (S.P) provides a comprehensive recommendation of diet (Pathya-Apathya) in the management of headache.

Śāli yavaṁ māṁsa rasaṁ vārtākuñca paṭolakam |Drākṣādāḍimakharjūraphalani ca payastathā ||Niśāpānaṁ nadīsnānaṁ gandhadravya niśevaṇam |Śirorogeṣu sarveṣu hitamuktaṁ yathāyatham ||Dravyāṇi ca atitīkṣṇāni durjarāṇi ca yāni vā |Tānyaniṣṭapradānyatra tīkṣṇāśca nikhilāaḥ kriyāaḥ || (S.P 66).

Intake of red rice, barley, meat soup, snake gourd, grapes, pomegranates, dates, drinking milk at night is indicated in the management of all types of headache including migraine. Excessive exercise and strong smell are always contraindicated in the management of headache.[31]

Stress explained as manasika nidana, requires satvavajaya chikitsa for its management. A detailed counseling restores adaptability and is essential to alleviate the condition.

Another unique concept in the management is Sadvritt a (personal conduct). It brings in good health and control over senses and desires, therefore, influencing the control and treatment of any disease including headache.

Although diet, lifestyle, and code of conduct have been mentioned in the management of Ardhavabhedaka (migraine), Ayurveda provides a line of treatment which involves snehana (internal and external oleation), shodhana (purificatory teachniques), shamana (pacificatory therapy), vamana (therapeutic vomiting), virechana (therapeutic purgation), basti (enema) and nasya (nasal errhines) as antahparimarjana chikitsa (internal cleansing therapies). Lepa (medicated paste application), upanaha (poultice), swedana (fomentation), and shirobasti (oil retention on the head) are mentioned as bahirparimarjana chikitsa (external cleansing therapies) and siravyadha and agnikarma are the shastra pranidhana (surgical therapies) for the management of migraine headache.[4]

Therapeutic yoga - a customized approach in the management of migraine

Yuktāhāra-vihārasya yukta-ceṣṭasya karmasu |Yukta-svapnāvabodhasya yogo bhavati duḥkha-hā || B.G. 6/17 |||.

The Gita, explains that the one who follows the right diet, lifestyle, does proper actions, whose hours of sleeping and waking up are regulated can mitigate pain (disease) through Yoga.

Yoga emphasizes on healthy and nourishing food for the management of illness. Modern-day psychosomatic diseases are fostered by the inappropriate diet and wrong eating habits. If the mind is controlled through Yoga, the craving for wrong food and the discrimination between right and wrong would be clear in individuals to bring in better health to the society.[12]

Yama and Niyama enhance the internal healing capacity due to the cultivation of right habits and moral-ethical living. Harming animals is an act of violence. Therefore, Yogic concepts suggest avoiding Non-vegetarian food and to follow the path of ahimsa to avoid the increase in rajas leading to diseases. In this way aspects of yama and niyama can be adapted in disease management.[17]

The beneficial effects of yoga in the management of disorders have been explained in Hatha yoga pradipika. By the practice of asana, an individual attains steadiness of the body and mind, diseaselessness and lightness of the body. The text describes that the practice of asana such as matsyendrasana (fish pose) and pashchimottanasana (seated forward bend pose) improves digestive fire (jataragni) and therefore alleviates diseases.[11]

Pranayama practices are known to help in balancing the flow of subtle energy across the nadi. The three practices, right nostril breathing, left nostril breathing and alternate nostril breathing which use uni-nostril voluntarily regulated breathing aim to stimulate, relax, and balance the flow of prana across the two main nadis - Ida and Pingala.[11]

Yoga also prescribes reduced sensory stimulation and sensory withdrawal through the process called pratyahara as an important technique.[17] Considering the precipitating factors for migraine headache, intense focusing as involved in dharana shall be avoided. Perhaps, meditation which takes an individual to an effortless state of expansion featured by alertful rest should be the practice of choice.

Hatha yoga pradipika in addition talks about the internal cleansing practices called “Kriya.”

Hence, an integrated approach involving asana (physical postures), pranayama (regulated breathing), kriya (cleansing techniques), meditation, and relaxation techniques are used in the management of migraine headache.[11]

Scientific literature on Conventional medical concepts of management

While the conventional medical approach prescribes oral analgesics as a symptomatic treatment in the management of migraine, equal importance has been given for regulating lifestyle and diet.

Modern nutritionists encourage mindful eating behaviors along with restriction of carbohydrate, gluten, alcohol, and caffeine. This is said to fit well with lifestyle management including stress reduction, adequate sleep, regular exercise, and weight management.[13]

In a study during Ramadan, the most common triggers for headache were stress, physical activity, change in weather and fasting. While 50% achieved relief by nonsteroidal anti-inflammatory drugs, 45% achieved through sleep.[32] Another study has shown that stress management has advantages compared to pharmacological treatments and the therapeutic effects are maintained for at least 7 years.[33]

Conclusion

Lifestyle including stress and diet as major factors plays an important role for the onset and management of migraine headache. Traditional approaches would provide a better understanding of the preventive and management strategies, and the combination of Ayurveda and Yoga therapy shall provide long-term solutions to the management of migraine which is one of the most disabling headache disorders of the present day.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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