Effect of Shirodhara in the Management of Vatika Shiroroga: A Case Study
The most typical primary headache is called Vatika Shiroroga (Tension Headache). According to the International Headache Society, 46% of people worldwide experience headaches in general, 42% experience tension-type headaches, 11% experience migraines, and roughly 3% experience chronic tension headaches. It is produced due to contraction of the muscles of head & neck & psychological factors like stress and strain aggravates the condition. Shirodhara is a significant Ayurvedic therapeutic method which has significant effect on the body's neuro, immuno, physio and psychological systems. Several studies have been carried out to evaluate the efficacy of Shirodhara in many diseases. The trial drug Dashamoola Taila for Shirodhara procedure showed highly significant reduction in symptoms like Ghat-Sambhidhyate (Cutting type of pain in posterior aspect of neck), Sankhanistoda, Akshinishkasanvat peeda, Bhrumadhya peeda, Nishakal Ativedna etc. Thus, Shirodhara with Dashamoola Taila is effective in the management of the Vatika Shiroroga (Tension Headache). The patient received Shirodhara treatment with Dashmoola Taila for 3 sessions of 7 days each with a gap of 3 days.
Introduction
The main requirements in the current era are speed and accuracy. Everyone must deal with a busy, competitive, and demanding life, to earn bread and butter. Individuals are unable to give their bodily and mental health any thought. Charaka claims that manaha-santapa is the primary cause of the illness Shiroroga [1]. Shiroroga, which is classified as Urdhwajatrugata Vikara, has Shirahshoola as one of its primary symptoms. While Acharya Charaka identified five different Shiroroga types in Sutra Sthan [2] and four different Shiroroga types in Sidhi Sthan [3], Acharya Sushruta [4], Bhaishjya Ratnawali [5], and Yogaratnakara[6] each classified eleven different Shiroroga types.
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 [7]. 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.
Shirodhara is a special non-invasive Ayurvedic treatment. The effectiveness of its non-invasive technique in treating headaches, sleeplessness, hypertension, stress, and anxiety has been demonstrated to be good or even better. Shiro means head, while dhara means for dripping. Shirodhara is a method in which a constant stream of oil or liquid is dropped to the forehead for 35minutes to 1 hour. Total treatment of Shirodhara is done for 7, 14 and 21 days [8].
Case Report
A 22-year male patient reported in Rishikul campus, Department of Panchkarma (OPD no.4197/23467) complaining of severe pain in bilateral temporal region, forehead, occipital region and both eyes. The pain mostly gets aggravated at night, sleep disturbed due to headache, irregular bowel in the last 2-3 years.
| S.NO. | Complaint | Duration |
|---|---|---|
| 1 | Pain in bilateral temporal region (Shankhanistoda) | 2-3years |
| 2 | Pain in forehead (Bhrumadhya peeda) | 2-3years |
| 3 | Pain in occipital region (Ghatsambheda) | 2-3years |
| 4 | Pain in both eyes (Akshinishkashanvat peeda) | 2-3years |
| 5 | Disturbed sleep | 2-3years |
| 6 | Irregular bowel | 2-3years |
History of Present Illness
According to patient, he was asymptomatic 3 years before when gradually started pain in bilateral temporal region, forehead, occipital region, and both eyes. The pain mostly aggravated at night. Patient complaint also about disturbed sleep due to headache and irregular bowel for 3 years. With this complaint he came to Rishikul campus, department of Panchkarma, for ayurvedic treatment. General Examination BP- 122/82mmHg PR- 84/min. Pallor- absent Icterus- absent Cyanosis- absent Lymphadenopathy- absent
Systemic Examination
GIT - NAD Respiratory system- NAD Cardiovascular system – NAD Central Nervous System- NAD
Therapeutic Focus and Assessment
Stress is one of the causes of Vataprakopa. Dashmoola taila is having the property of Ushana, Tridosha Shamaka. Dosha Karma: Pacifies mainly Vata dosha and normalizes Kapha dosha functions.
Dhatu Effect: Rasa, Mamsa, Asthi.
Organ’s Effect: Nerves, Muscles, Bones & Joints.
Main Indication: Vata disorders. The analysis of Dashmoola Taila was done before using it for therapeutic purposes. The amount of oil for Shirodhara was 1.5-2 litre at 40degree c. The Shirodhara was planned in the following manner.
Purvakarma
The patient was examined and ensured indications for Shirodhara as patient had a headache, disturbed sleep and a stressed state.
Preparation of Patient: Asked the patient to complete her natural urges like bowel and bladder evacuation, then head and neck-shoulder massage was given. Patient was advised to lie down in supine position and Dhara Patra was fixed 4 Angula above the forehead. The eyes were covered with cotton pads. The ears were closed with cotton buds.
Preparation of Drug: The oil was warmed at a temperature of 39-40 degree C on induction and maintained throughout the procedure (the temperature was confirmed from the patient as it was Sukhoshna).
Pradhana Karma
Poured lukewarm oil into dripping apparatus i.e., Dharapatra made up of metal having Varti inserted into the nozzle. Varti hung down so that the tip of the Varti from forehead was maintained at the level 4 Angula [8] above the forehead of the patient.
The oil then allowed to flow through Varti on the forehead and a continuous stream of oil was maintained. The vessel oscillated during the procedure so that oil dripping was all over the forehead. The scalp was massaged intermittently. The oil was collected which drained from the head and the same was made warm again and used for Shirodhara. The stream was maintained continuously and the temperature was maintained constant throughout the procedure. Shirodhara was done in 3 sitting for a period 45 minutes for 7 days with gap of 3 days.
Patient Assessment
Paschat Karma
After the Shirodhara process was completed; the head of the patient was wiped out and dried. This was followed by a short duration of rest and massage of the head and after 2 hours lukewarm bath. The patient was advised to have a Pathya Ahara [5] (light diet). The patient was advised to be in Nivat Sthan for 4 hours.
Therapeutic Intervention
No internal medication was given during this period.
| S.No. | Subjective-Parameter | Bt (Grading) | At1 (Grading) | At2 (Grading) | At3 (Grading) | Follow Up |
|---|---|---|---|---|---|---|
| 1 | Shankhanistoda | 6 (0- 10) | 4 | 1 | 0 | 0 |
| 2 | Ghatasambheda | 6 (0- 10) | 4 | 1 | 0 | 0 |
| 3 | Bhrumadhya evam Lalatativedna | 6 (0- 10) | 4 | 1 | 0 | 0 |
| 4 | Shrotranishkasanvat peeda | |||||
| 5 | Akshinishkasanavat peeda | 6 (0- 10) | 4 | 1 | 0 | 0 |
| 6 | Sandhimokshanvat peeda | |||||
| 7 | Shiroghurna | |||||
| 8 | Disturbed sleep | 6 (0- 10) | 2 | 0 | 0 | 0 |
| 9 | Sirajalsphuran | |||||
| 10 | Nishakal-ativedna | 4 (0-4) | 1 | 0 | 0 | 0 |
| 11 | Frequency of headache/week | 4 (0-4) | 1 | 0 | 0 | 0 |
| 12 | Duration of headache in hours/day | 4 (0-4) | 1 | 0 | 0 | 0 |
Result: Marked improvement.
Discussion
Majority of headaches are of primary type and TTH accounts for a large portion. The methods used to treat TTH are symptomatic and mostly involve techniques for reducing stress, such as yoga, meditation, physical therapy, and local massage etc. Shirodhara is a type of relaxation therapy that induces serenity without inducing drowsiness, hypnosis, or other significant states of altered consciousness. It is a form of passive meditation used to calm down agitated psycho motor behaviour. Due to constant flow of Dhara dravya over the forehead a vibration area is generated which stimulates nerve endings. A little amount of acetyl choline is released when the autonomic nervous system’s nerve endings are aroused. This small amount of acetyl choline generated reduces blood pressure, which decreases the central nervous system’s activity and has a tranquillizing effect. From Ayurvedic point of view vitiated Vata Dosha is the triggering factor for pathogenesis of disease symptom produced in Vatika Shiroroga (TTH). Due to the Snehan properties of the oil used in the shirodhara and the medhya impact of the medications employed in the preparation of medicated oil, shirodhara calms the Vata dosha. There are ten primary Chetna Kendras (nadi chakras) located throughout the body, and they are all interconnected. Shirodhara stimulates the two chakras located in the head region, the Aagya chakra (between the eyebrows) and the Brahma randhra (upper part of the forehead).
Conclusion
Shirodhara showed significant improvement in severe pain in bilateral temporal region, forehead, occipital region and both eyes. The sleep disturbance due to headache was reduced after Shirodhara. It provided significant relief in the grading of the NRS on the 7th, 14th and 21days of Shirodhara.
It showed marked improvement in the NRS grading. It showed appropriate responsiveness to the stress system. This therapy found highly effective in the management of stress and related disorders.
References
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Agnivesha (2010) Charaka Samhita. In: Tripathi R, et al. (Eds.), Vidyotini Hindi commentary. Sutra Sthana 17/6, Chaukhambha Sanskrit Pratishthan, Delhi, India, pp: 257.
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