A Review of Vatika Shiroroga and its Ayurvedic Management
The modern man must cope with the variety of difficulties such as stresses, and anxieties. One or more psychosomatic disorders have been linked to etiopathogenic mental elements such as excessive crying, anguish, fear, and terror. Regular and unnatural eating habits, repressing natural urges, less time of relaxation and a lack of proper sleep are inseparable components of our routine, that drain the body's energy and eventually result in disease. Most psychosomatic disorders are caused by a combination of these physical elements and persistently stressful psychological states. One such psycho-somatic is tension headache that is comparable to Vatika Shiroroga is mentioned in Ayurvedic texts. The Vataja-Shiroroga is a violent headache attack that has no apparent explanation, gets worse at night, and is eased by applying pressure, a bandage, or fomentation to the head. This attack is thought to be caused by the derranged Vayu. Its management requires thorough understanding of the condition, application of Nasya, Shirodhara, Dhumpaan, and correct aahaar-vihaar in addition to the ayurvedic medications that fall under the category of medhaya medications.
Introduction
The main requirements of the current era are speed and accuracy. Everyone must deal with a busy, competitive, and demanding life to handle their circumstances. People are unable to give any thought to their bodily and mental health. According to Acharya Charaka ‘manaha-santapa’ is the primary cause of the illness Shiroroga. Shiroroga, which is classified as Urdhwajatrugata Vikara, has Shirahshula as one of its primary symptoms. Acharya Charaka has detailed five types of Shiroroga in Sutra Sthana [1] and four types in Sidhhi Sthana [2] in contrast to the eleven forms of Shiroroga that Acharya Sushruta [3], Bhavamishra [4], and Yogaratnakara [5] have categorised.
According to the International Headache Society, 46% of people worldwide have an active headache disorder, 11% have migraines, 42% have tension headaches, and 3% have chronic daily headaches [6].
Being a serious issue, it requires a treatment that is both efficient and secure. Since the beginning of time, countless analgesics have been introduced to the arsenal of the contemporary doctor only to demonstrate its futility. Although there is a wide range of medications available in modern therapeutics to manage this disease, these medications come with substantial side effects and have a habit-forming character. The pursuit of safer management is therefore crucial.
Ayurvedic Review
Shirah is one of the three main vital organs of the body, and according to Ayurveda, it is where the Prana, or life resides. Shirah has been regarded by Acharya Charaka as the supreme and most important component of the body i.e., Uttamanga [7]. The Vata Pradhan Tridoshaj Nidan causes the vitiation of the Vata-dominant Tridosha, which penetrates Shirah Pradesh and manifests the following symptoms of Vatika Shiroroga.
Symptoms of Vatika Shiroroga
Due to severe exhaustion from carrying heavy loads and walking long distances, loud and excessive conversation, unhealthy drinks, vigil, exposure to cold wind, sexual activity, urge control, injury, excessive vomiting and purgation, tears, grief, fear, anxiety etc., Vata becomes aggravated and vitiated and enters the Shirah Pradesh and cause these symptoms. Vata is responsible for a great deal of pain, especially in the temporal areas, as well as a burning sensation and excruciating agony in the nape, middle of the eyebrows, and forehead. The entire head swirls and feels as though it is broken on sutures. The venous plexuses have severe throbbing, and the neck becomes stiff. There is dizziness and discomfort in the ears. The eyeballs appear to be coming out (owing to pain). Applications that are luscious and heated provide comfort to the patient [8].
According to Acharya Vagbhatta
The symptoms of Maruta (Vata) aggravation include extreme pain that pricks in both temples, a sense of intense pain as though the Ghata (region above the temples) opens up, the centre of the brows and the forehead fall out, painful ears, and ear noise. Eyes that feel as though they are being pulled out, a head that reels and feels loose in all of its joints, intense pulsations in the network of blood vessels, rigidity in the lower jaw and shoulders, sensitivity to light, running in the nose, relief from pain (headaches) on occasion for no apparent reason, and lessening of their severity with massage, oil application, and fomentation. This is Shiras-tapa (of Vata origin) [9].
Modern Review [10]
A tension headache is a disorder characterised by pain or discomfort in the forehead, scalp, or neck, which is frequently accompanied with tension in the nearby muscles. The most typical sort of headache is a tension headache, or tension-type headache as it is medically known, however the exact causes are yet unknown. Usually, a stress headache a widespread, mild to moderate discomfort that many patients describe as feeling like a tight band is running bilaterally back from the forehead around the sides of the head to the occipital and may also involve the back of the neck muscles. Tension headaches may be accompanied by several other symptoms including:
- Neck pain or jaw discomfort.
- A clicking sound when opening the jaw
- Tenderness in the scalp, neck or shoulder muscles
- Insomnia (difficulty sleeping)
- Fatigue
- Irritability
- A tight band or vise on the head all over (not just in one point or one side) Worse in the scalp, temporal region and back of the neck
- Occasionally, loss of appetite
Treatment
General Management of Shiroroga [11]
Commonly in all type of headache the following preventive measures should be taken – Nidana Parivarjana: From the perspective of treatment, the etiological elements responsible for headaches should be avoided. Typically, refrain from denying desires, mind control by pranayam is beneficial. Additionally, avoid other Aharaja and Viharaja Hetus.
Samshodhana Chikitsa: Shirovirechana-Nasyakarma has been recommended as a key technique for therapy in Urdhavajatrugata Rogas. Consequently, frequent usage of Nasya with special use of medications recommended for these disorders must be done in headaches.
Samshamana Chikitsa: The vitiated doshas should be brought to normalcy by Nidana parivarjana along with using medications based on Samanya Vishesh principles, according to the predominant exhibiting dosha.
Other Measures: Yogratnakara has described the following measures for Shiroroga. Snehana, Upanaha, Svedana, Dhumpana, Lepa, Langhana, Parisheka, Agnikarma, Raktamokshana, Shirobasti These measures should be applied after considering the predominance of dosha and other general considerations of the patient.
Chikitsakrama (Line of Treatment)
- Nidana Parivarjana
- Shamana (Guggulu, Aasava, Ghrita etc.)
- Shodhana (Vamana, Virechana, Shirovirechana, Basti)
- Snehanasya Pradhamana Shirobasti
- In Bhaishajya Ratnavali, General line of treatment for Shiroroga has been described which are Svedana, Nasya, Dhumpana, Virechana, Lepa, Vamana, Langhana, Shirobasti, Raktamokshana, Agnikarma, Upanaha, Purana Ghrita and Shashtika Shali.
Specific Management of Vataja Shiroroga [12]
The following alleviating measures should be implemented in management of Vataja-Shiroroga
- Snehana (oleation),
- Swedana (formulation),
- Navana (nasal medication),
- Lepa (local application),
- Seka (irrigation),
- Dhuma (himigation) along with Vata-Shamaka drinks, food and hot poultices,
- Dahakarma (Cauterization) is advisable in Vatika Shiro Rogas, which can be relieved by other measures.
- The medicines advised are:
- Taila – Rasnadi taila, Baladi taila, Trivrit taila, Bala taila
- Ghrita – Maha Mayura Ghrita, Mayura Ghrita Pathya-Apathya [13]
Pathyapathya for headache is stated only in Bhaisajya Ratnavali –Shirorogadhikara.
Chikitsa Upakrama:
- Swedana (Heating), Nasya, Dhumpana Virechana (Purgative), Lepa,Vamana (Vomiting), Langhana (Fasting), Shirobasti, Raktamokshana, cauttery on the frontal and supra orbital region, Upanaha.
- Diet consuming old Ghrita, Shali, Shashtikshali, Yusha (soup) Milk, Dhanvamansa, Ghritapura.
- Vegetables Patolam, Shigru, Vastuka, Karvellaka
- Fruits Mango, Aamlaki, Dadima, Matulunga, Lemon, Grapes, Coconut
- Liquid diet Milk, Oil, Coconut water, Kanji, Takra (Churned curd).
- Medicines Pathya, Kushta, Bhringaraj, Kumari, Musta, Ushira, Karpura, Gandhasar Apathya: Unwholesome diet and recreation
- Vegadharanam (Holding of the urges) Sneezing, Yawning, Micturition, Sleep, Lacrimation,
- Stool excretion.
- Unwholesome diet
- Consuming cooked and uncooked food, impure water,
- Dahi, lassi, cold drinks, water of the rivers of Sahyadri, Vindhyas, Kapha producing diet.
- Apathya Vihara (Unwholesome recreation)
- Teeth-brushing (Dantadhavanam), day sleeping
Discussion
Ayurvedic texts describe Shiroshool as an independent disease entity rather than a symptom as Shiroroga. Among them Vataj Shiroroga is most frequently seen due to the causative factors like Uchcha and Atibhashana, Ratri Jagran, Vega Sandharana, Bhaya, Shoka etc. Due to the busy life of current era, all human beings are usually adopting most of these Nidanas. Among the Nidanas, Manastaapa is having an important role. Mansika nidanas like Bhaya, Shoka, Trasa etc. along with other nidanas will result in vataprakopa and hence leading to the Vataj Shiroroga. The Manasikabhavas like Chinta, shoka, bhaya etc. causes Jatharagni-mandya and khavaigunya. Due to Jatharagni-mandya, Apakva Annarasa is formed (Ama), Malarupi-kapha is increased in amount and goes to Rasa-Rakta Samvahana in Shirah. Their Sanga occurs due to Khavaigunya in Shirah. It leads to Vata Prakopa and causes Vataj Shiroroga.
Conclusion
Shirah is considered as uttamanga because it is the place for Prana and Indriyas. So rogas affecting shirah should be treated with immediate concern. Shirashool term used by Ayurvedic classics mainly represent Shiroroga. Even though it involves Tridoshas, it is classified further based on the dosha predominance. Among them, Vataja Shiroroga is most commonly seen due to the broad causative factors. Psychogenic factors triggering Vataj Shiroroga are Shoka, Bhaya, Trasa etc. Tension headache is having stress as the main causative factor. So, tension headache is condition which can be taken under the heading of Vataj Shiroroga. So, the Nindan, Lakshan and upashaya of Vataj Shiroroga resembles tension type headache. To conquer such problem which is common and hindrance in day-to-day activities is a great challenge. First of all, patients should avoid shokadi causative factors. Shirovirechana-Nasyakarma plays a vital role in treating Urdhavajatrugata Rogas like Vataj Shiroroga. These therapies along with shaman chikitsa and pathye aahaar helps in relieving Vataj Shiroroga.
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