Headache Currents
HEADACHE CURRENTS—CLINICAL REVIEW
Ayurveda – The Science of Healing Trupti Gokani, MD
Background.—Migraine is generally recognized as a complex condition, which is often challenging to treat. Patients are often open to novel approaches to understanding why this pain occurs and how to prevent future attacks. Methods.—Ayurvedic medicine, which is a 5000-year-old healing system, offers additional understanding on this disease by categorizing patients into a unique dosha (mind–body) type. Specific herbals, dietary modifications, and lifestyle changes have been utilized for thousands of years to create balance in the system to improve chronic conditions. Conclusions.—Evaluating migraine patients utilizing the Ayurvedic model allows patients and practitioners a further layer of understanding and offers additional treatment options for the patient. Key words: Ayurveda, dosha, migraine
INTRODUCTION Ayurveda is recognized as one of the oldest healing systems known to mankind. Ayurveda is a Sanskrit word which literally means “the science” of life. This is the knowledge of health and disease predisposition based on understanding oneself as an individual in an environment that is constantly influencing us to shift and change from our baseline state of balance. Our current Western, allopathic, view of medicine is to base treatment on presenting symptoms. Medications and injectables are often used to treat the symptoms, allowing relief of the symptoms at hand. Preventive medications are given to decrease the severity of disease and give relief of acute symptomatology. The Eastern, specifically Ayurvedic, approach offers a layer on the allopathic model. In this approach, healing the mind and body involves taking active steps toward understanding how to achieve a balanced state by changing lifestyle, eating habits, and using herbals. In this approach, steps are taking to create a balanced physiology, which if completely balanced, should allow symptoms to resolve.
THE ORIGIN OF AYURVEDA There is some controversy on exactly when the practice of Ayurveda began, as it was first passed down in an oral tradition, and not written in texts. Many believe its origins date back over 5000 years. The Vedic civilization in Southeast Asia migrated south to From the Zira Mind and Body, Ltd, Glenview, IL, USA. Address all correspondence to T. Gokani, Zira Mind and Body, Ltd, 1332 Waukegan Road, Glenview, IL 60025, USA. Accepted for publication March 2, 2014. ............. Headache © 2014 American Headache Society
create Ayurveda and north to create Traditional Chinese Medicine and Homeopathy. Ancient rishis spent countless of hours meditating together, and the concepts of Ayurveda became known to them. A rishi is considered, in Ayurveda, to be an enlightened saint or a sage of insight. Supposedly, rishis were given information directly from God. Rishis studied nature and were felt to understood the natural law of the universe, including natural human rhythm and the connection to the world. The oral tradition began as rishis passed on this knowledge from one generation to then next. During this time, individuals were studied as unique beings who became imbalanced when their systems became disconnected with nature. Disease manifestation occurred when the natural healing of the body was impaired. Eventually, this knowledge was written in a text, the CharakaSamhita. This text is still considered one of the most authoritative texts on Ayurveda. Vaidyas (Ayurvedic physicians) carried this knowledge with them and treated many patients using this approach. The approaches to treatment, involving dietary changes, herbals, use of massage, and purification practices, all offer novel ways to balance the physiology. Eventually, this Ayurvedic knowledge spread to other parts of the world. In 1835, the British imposed a ban on Ayurveda to allow Western medicine to flourish. Ayurveda was still quietly practiced, and continued to survive during this time. Ayurvedic centers were not supported, and were, in fact, suppressed from spreading this ancient wisdom. After India gained independence in 1947, Ayurveda slowly became practiced again in larger numbers. Finally, in 1971, Ayurveda was allowed into India’s official state health care system. From that time on, Ayurveda flourished not only in India, but in Greece, Europe, Japan, Australia, and Russia, along with North and South America. With its widespread practice, understanding migraine from an Ayurvedic perspective can be helpful to our understanding of this disease process as a whole.1
WHY STUDY AYURVEDA? I believe that our goal, in addition to treating symptoms with medications and injections, should also be to allow patients to understand why they are suffering and to offer them tools to find balance. We have been blessed with modern medicine in that it provides us with many options to treat severe headaches and associated symptoms so that our patients do not suffer needlessly. Medications are also offered to assist with treating the disease. According to Ayurveda, having a migraine is considered “a spiritual intervention from the divine.”2 The severe pain of the migraine is believed to occur so we can be reminded of our imbalanced state. The pain is meant to encourage us to become ............. Conflict of Interest: None.
1103
1104 | Headache | June 2014
more connected not only with ourselves but also with the natural laws that define us.3
WHAT ARE THE ELEMENTS? Understanding Ayurveda requires understanding the Ayurvedic concept of elements. All living things, according to Ayurveda, are made up of 5 elements, also called Mahabhutas. What defines us, and allows us to manifest in a unique way, is the proportion of these elements within us. Each element has a quality to it. It is this quality that conveys the final effect of the element on our nature.1
THE FIVE AYURVEDIC ELEMENTS The five Ayurvedic elements are Air, Space, Fire, Earth, and Water. The first element, Air, is also known as Vaya. This represents the body’s gaseous exchange, such as breathing. The second element is Space, also known as Akasha. This is the emptiness in the body’s channels. Fire is the third element. Fire represents the metabolic activity needed to process thoughts, along with releasing digestive enzymes. The fourth element, Earth, represents structure and stability. Water, the fifth element, gives us moisture and fluidity.1 These elements do not represent the actual physical substance itself, but the qualities of the substance. By stating that an individual contains a high amount of the fire element, it does not mean that they have “fire” in them. What this implies is that the individual may have many of the fire qualities, such as heated state, irritable nature, and too much acid production (reflux).
THE DOSHA OR MIND–BODY TYPE To fully understand the Ayurvedic principles, one needs to be comfortable with the classification of living beings into Dosha types.1 With the premise that everything is made up of five Ayurvedic elements, the dosha is the unique combination of elements that each person has. There are three doshas, Vata, Pitta, and Kapha. The Vata dosha is a combination of Air and Space elements. The Pitta dosha is a combination of Fire and Water elements. The Kapha dosha is a combination of Earth and Water elements. Each of these dosha types manifests in a unique way, based on the elements of which they are composed.
THE VATA DOSHA Individuals that are mainly created with Air and Space elements, the Vata type, often tend to have a need to stay active. Vata personalities are enthusiastic and vivacious but also tend to be very excitable. These individuals do not like routine and often find themselves shifting from one activity to the next. The Vata individual often needs harmony for the day and finds benefit in slowing down and doing calming activities such as yoga. There are specific poses that Vata individuals may benefit
Headache Currents from, and they respond to yoga that focuses on hip opening and improving digestive function. Suitable breath work and meditation need to be recommended balancing this mind–body type to calm an often anxious mind.4 Foods that are beneficial are warm, cooked foods, as this type tends to become dry and cold very easily.
THE PITTA DOSHA Individuals that are comprised of Fire and Water elements manifest with the Pitta dosha type. Pitta types tend to be perfectionistic, organized, and determined. These personalities have a tendency to become angry and irritable if they become stressed. Pitta individuals benefit from adding relaxation to their daily routine. Yoga techniques that involve twisting the spine may be beneficial to them.4 Foods for the Pitta type individual (or one that has a Pitta imbalance) should be sweet and cool.
THE KAPHA DOSHA Individuals composed of Earth and Water elements manifest with the Kapha dosha type. Kapha types tend to be compassionate, calm, and relaxed. These personalities are the ones least affected by stress. Kapha individuals can become heavy and congested easily, so for them adding movement to their day is essential. Exercise that involves standing and moving is very important.4 Foods that are light and dry best keep this state in balance.
HOW IS HEADACHE VIEWED FROM AN AYURVEDIC PERSPECTIVE? Headache is also known as Shirah Shula, in Sanksrit, with Shirah meaning head. Shirah Shula is defined based on the dosha involved. In addition to categorizing headache into doshic imbalance, the cause of the pain arising from nervous tissue or bone structures helps dictate the treatment of head pain. Depending on which dosha is being influenced, different headache types will manifest. Vata type headaches are often located in the cervical/occipital regions and have a throbbing component to them. These headaches are generally not as severe in intensity and often do not have any associated features such as light sensitivity, smell sensitivity, nausea, or vomiting associated with them. Sound sensitivity may be present, as it reflects an excitable nervous system. These headaches are most often induced by stress, especially when the daily routine of sleeping and eating are not followed in a regular fashion. Pitta type headaches are often located in the retro-orbital/ temple regions and have a sharp, intense component to them. These headaches are often moderate to severe in intensity and associated with nausea, vomiting, and light sensitivity. Pitta, the fire state, is often linked to the development of inflammation.
1105 | Headache | June 2014
Thus, the use of anti-inflammatory medications, herbals, or injections is understood as helping this type of headache. Kapha type headaches are often located in the frontal areas. This headache is often associated with congestion and allergies. These headaches can worsen with changes in season, especially in the spring season.5 People with headache may present with combinations of doshic imbalances. For example, one may have a Pitta-Vata headache or a Vata-Kapha headache. These headaches need to be treated by balancing out both of these imbalanced states.
WHAT DOES IT MEAN TO BE HEALTHY? According to Ayurveda, one is healthy if one has a balanced doshic state. In addition, digestion must be healthy, all tissues need to be in balance, and excretory functions should be optimal. Lastly, the mind needs to be clear and blissful. Our western view of being healthy does not have as stringent a set of criteria as Ayurvedic medicine.1
POLYPHARMACY When offering treatments to headache patients, we are often left with utilizing a multitude of medications, many of which may have interactions requiring monitoring. Patients can begin to suffer side effects from the medications and, occasionally, we prescribe more medications to mitigate a previous medication’s side effects.1 We can all incorporate the Ayurvedic understanding of the root causes of disease and limit the multiple medications prescribed by balancing out the system utilizing nonmedication approaches. This model of balancing the dosha is something that any patient can start to do at any stage of disease.
DRUG SIDE EFFECTS The three main categories of medications that can lead to systems imbalance are acid blockers, antibiotics, and steroids. These medications are extremely effective if used in short courses but can lead to imbalances in the organ systems that originally caused the problem, according to the Ayurvedic philosophy of disease. For example, treating chronic reflux with chronic suppression of stomach acid, using a proton pump inhibitor (PPI), can lead to deficiencies in magnesium and vitamin B12. “Hypomagnesemia, symptomatic and asymptomatic, has been reported rarely in patients treated with PPIs for at least 3 months, in most cases after a year of therapy. Serious adverse events include tetany, arrhythmias, and seizures. In most patients, treatment of hypomagnesemia required magnesium replacement and discontinuation of the PPI.”6 In Ayurveda, the key to longevity and optimal health resides in the strength of digestion. Any digestive issues need to be corrected utilizing an Ayurvedic diet, herbals to balance the state and yoga/meditation to balance the mind.
Headache Currents By ignoring the heated, Pitta, state, and using medications to mask the underlying problem, not only does a condition continue, but secondary side effects from medications can begin to occur. Antibiotics are required if a bacterial infection is in question, but there are many situations in which patients present with sinus complaints of congestion, and antibiotics are not warranted. In this scenario, the antibiotics may prohibit the growth of not only unhealthy strains of bacteria but also healthy strains that are needed to maintain gut function. Many migraine patients respond to short course of steroids for their attacks of pain. The concern with chronic steroid use is the effect that they have on the hypothalamic–pituitary–adrenal axis. Steroids may help when the adrenals are unable to release appropriate amounts of cortisol during times of pain or stress. In our clinic, we have found that 90% of patients are adrenally fatigued.7 The issues with utilizing steroids are the concerns that they can elevate glucose levels, leading to weight gain, along with potentially damaging the adrenal system. In addition, steroids can lead to dysbiosis and reduction of healthy bacteria counts in the digestive lining.8 Thus, the utilization of medications that are commonly prescribed to migraine patients can lead to more harm than good the longer and more often these patients stay on these medications.
THE BRAIN AND THE MIND In Neurology, we often separate the structural brain and its complicated biochemistry, from the mind, which is often deemed to fall into the realm of Psychiatry. Ayurveda considers the brain and the mind to function as one unit. In fact, the mind, and the health of one’s emotional state, dictates the health of the body.1 The three mind states in Ayurveda are Sattva, Rajas, and Tamas. A Sattvic mind is balanced, creative, and engaged in acts that promote altruism. A Rajasic mind is one that is governed by passion and can become angry and disruptive. A Tamasic mind is one that leads to apathy and sluggishness. An Ayurvedic goal is to obtain a Sattvic mind by performing activities to help others, eating foods that heighten this state, and performing daily exercises such as yoga and meditation to increase this state of being.
INTEGRATION OF ALLOPATHIC MEDICINE WITH AYURVEDIC MEDICINE Clinicians have the opportunity to utilize the numerous tools available to assist migraine patients. Ayurvedic medicine offers one more tool, in conjunction with offering medications and injectables. In addition to obtaining a headache history and collecting information on migraine attack history, we can evaluate the Ayurvedic system and discover contributing factors to the migraine attacks. For example, asking patients to comment on their digestive history can add another layer of treatment options. If a patient complaints of constipation or gas/bloating, which are
1106 | Headache | June 2014
a marker of an imbalanced Vata state, the practitioner can offer Vata balancing herbals and Ayurvedic dietary recommendations. Gathering information on the mind state and sleep patterns can open up treatment options utilizing herbals that can bring the sleep and mind into balance by strengthening the circadian rhythm and the adrenal system. All of this can be done while utilizing traditional Western medical approaches. Utilizing the Ayurvedic model helps us better understand patient types and possibly choose medications that may be more effective for that type of individual. Beta blockers or serotonin reuptake inhibitors, with their anxiolytic effects, may help the Vata type individual who has an anxious mind, for example. It may not be just the choice of food, but how the food is prepared that can influence this Vata type. Warm foods can be recommended with emphasis to stay away from cold items.
CONCLUSION Ayurveda, with its 5000-year-old science, offers a novel way to understand patients with migraine headaches. Ayurveda incorporates a fundamental understanding of a patient’s unique dosha type and offers tools to bring the dosha into balance using herbals, yoga, lifestyle changes, and meditation. We can combine this approach with our modern use of medications and injections to understand why some patients respond well to certain treatment protocols and others do not. We can also use this model to explain the various types of headaches many of our patients have. This model helps explain a patient suffering with headaches of different locations, severity, and associated symptoms by con-
Headache Currents necting these symptoms with the doshic imbalance state. In addition, our patients often complain of digestive, hormonal, and other systems-based issues. The Ayurvedic model brings an understanding that the body works as a system, with migraine being a manifestation of many systems that have become imbalanced, thus generating severe pain. References 1. Sharma H, Clark C. Contemporary Ayurveda: Medicine and Research in Maharish Ayurveda, 1st edn. New York: Churchill Livingstone Publisher (Elsevier); 1997. 2. Lad V. Textbook of Ayurveda, Volume Two: A Complete Guide to Clinical Assessment. Albuquerque, NM: The Ayurvedic Press; 2007. 3. Apte J, Kshirsagar S Ayurvedic Certification Training Materials. 2006. http://www.eattasteheal.com/eth_resources.htm. 4. Lad V. Ayurveda: A Practical Guide: The Science of Self Healing. Twin Lakes, WI: Lotus Press; 1985. 5. Lad V. Ayurvedic Perspectives on Selected Pathologies. Albuquerque, NM: The Ayurvedic Press; 1998. 6. Protonix. 2008. http://www.rxlist.com/protonix-drug.htm. 7. Rossabach J, Gokani T “Adrenal Fatigue in Migraine Patients: A Common Clinical Finding?” 2014. 8. Watson B. Gut Solutions: How to Solve Your Digestive Problems Naturally. Clearwater, FL: Renew Life Press; 2004.
Book Recommendations Simon D. Wisdom of Healing. New York: Harmony Books, 1997 Lonsdorf N. The Ageless Woman. Santa Barbara, CA: MCD Century Publications, LLC, 2004 Gokani T. Ayurvedic Approach to Migraines. 2014
HEADACHE CURRENTS—CLINICAL REVIEW
Ayurveda – The Science of Healing Trupti Gokani, MD
Background.—Migraine is generally recognized as a complex condition, which is often challenging to treat. Patients are often open to novel approaches to understanding why this pain occurs and how to prevent future attacks. Methods.—Ayurvedic medicine, which is a 5000-year-old healing system, offers additional understanding on this disease by categorizing patients into a unique dosha (mind–body) type. Specific herbals, dietary modifications, and lifestyle changes have been utilized for thousands of years to create balance in the system to improve chronic conditions. Conclusions.—Evaluating migraine patients utilizing the Ayurvedic model allows patients and practitioners a further layer of understanding and offers additional treatment options for the patient. Key words: Ayurveda, dosha, migraine
INTRODUCTION Ayurveda is recognized as one of the oldest healing systems known to mankind. Ayurveda is a Sanskrit word which literally means “the science” of life. This is the knowledge of health and disease predisposition based on understanding oneself as an individual in an environment that is constantly influencing us to shift and change from our baseline state of balance. Our current Western, allopathic, view of medicine is to base treatment on presenting symptoms. Medications and injectables are often used to treat the symptoms, allowing relief of the symptoms at hand. Preventive medications are given to decrease the severity of disease and give relief of acute symptomatology. The Eastern, specifically Ayurvedic, approach offers a layer on the allopathic model. In this approach, healing the mind and body involves taking active steps toward understanding how to achieve a balanced state by changing lifestyle, eating habits, and using herbals. In this approach, steps are taking to create a balanced physiology, which if completely balanced, should allow symptoms to resolve.
THE ORIGIN OF AYURVEDA There is some controversy on exactly when the practice of Ayurveda began, as it was first passed down in an oral tradition, and not written in texts. Many believe its origins date back over 5000 years. The Vedic civilization in Southeast Asia migrated south to From the Zira Mind and Body, Ltd, Glenview, IL, USA. Address all correspondence to T. Gokani, Zira Mind and Body, Ltd, 1332 Waukegan Road, Glenview, IL 60025, USA. Accepted for publication March 2, 2014. ............. Headache © 2014 American Headache Society
create Ayurveda and north to create Traditional Chinese Medicine and Homeopathy. Ancient rishis spent countless of hours meditating together, and the concepts of Ayurveda became known to them. A rishi is considered, in Ayurveda, to be an enlightened saint or a sage of insight. Supposedly, rishis were given information directly from God. Rishis studied nature and were felt to understood the natural law of the universe, including natural human rhythm and the connection to the world. The oral tradition began as rishis passed on this knowledge from one generation to then next. During this time, individuals were studied as unique beings who became imbalanced when their systems became disconnected with nature. Disease manifestation occurred when the natural healing of the body was impaired. Eventually, this knowledge was written in a text, the CharakaSamhita. This text is still considered one of the most authoritative texts on Ayurveda. Vaidyas (Ayurvedic physicians) carried this knowledge with them and treated many patients using this approach. The approaches to treatment, involving dietary changes, herbals, use of massage, and purification practices, all offer novel ways to balance the physiology. Eventually, this Ayurvedic knowledge spread to other parts of the world. In 1835, the British imposed a ban on Ayurveda to allow Western medicine to flourish. Ayurveda was still quietly practiced, and continued to survive during this time. Ayurvedic centers were not supported, and were, in fact, suppressed from spreading this ancient wisdom. After India gained independence in 1947, Ayurveda slowly became practiced again in larger numbers. Finally, in 1971, Ayurveda was allowed into India’s official state health care system. From that time on, Ayurveda flourished not only in India, but in Greece, Europe, Japan, Australia, and Russia, along with North and South America. With its widespread practice, understanding migraine from an Ayurvedic perspective can be helpful to our understanding of this disease process as a whole.1
WHY STUDY AYURVEDA? I believe that our goal, in addition to treating symptoms with medications and injections, should also be to allow patients to understand why they are suffering and to offer them tools to find balance. We have been blessed with modern medicine in that it provides us with many options to treat severe headaches and associated symptoms so that our patients do not suffer needlessly. Medications are also offered to assist with treating the disease. According to Ayurveda, having a migraine is considered “a spiritual intervention from the divine.”2 The severe pain of the migraine is believed to occur so we can be reminded of our imbalanced state. The pain is meant to encourage us to become ............. Conflict of Interest: None.
1103
1104 | Headache | June 2014
more connected not only with ourselves but also with the natural laws that define us.3
WHAT ARE THE ELEMENTS? Understanding Ayurveda requires understanding the Ayurvedic concept of elements. All living things, according to Ayurveda, are made up of 5 elements, also called Mahabhutas. What defines us, and allows us to manifest in a unique way, is the proportion of these elements within us. Each element has a quality to it. It is this quality that conveys the final effect of the element on our nature.1
THE FIVE AYURVEDIC ELEMENTS The five Ayurvedic elements are Air, Space, Fire, Earth, and Water. The first element, Air, is also known as Vaya. This represents the body’s gaseous exchange, such as breathing. The second element is Space, also known as Akasha. This is the emptiness in the body’s channels. Fire is the third element. Fire represents the metabolic activity needed to process thoughts, along with releasing digestive enzymes. The fourth element, Earth, represents structure and stability. Water, the fifth element, gives us moisture and fluidity.1 These elements do not represent the actual physical substance itself, but the qualities of the substance. By stating that an individual contains a high amount of the fire element, it does not mean that they have “fire” in them. What this implies is that the individual may have many of the fire qualities, such as heated state, irritable nature, and too much acid production (reflux).
THE DOSHA OR MIND–BODY TYPE To fully understand the Ayurvedic principles, one needs to be comfortable with the classification of living beings into Dosha types.1 With the premise that everything is made up of five Ayurvedic elements, the dosha is the unique combination of elements that each person has. There are three doshas, Vata, Pitta, and Kapha. The Vata dosha is a combination of Air and Space elements. The Pitta dosha is a combination of Fire and Water elements. The Kapha dosha is a combination of Earth and Water elements. Each of these dosha types manifests in a unique way, based on the elements of which they are composed.
THE VATA DOSHA Individuals that are mainly created with Air and Space elements, the Vata type, often tend to have a need to stay active. Vata personalities are enthusiastic and vivacious but also tend to be very excitable. These individuals do not like routine and often find themselves shifting from one activity to the next. The Vata individual often needs harmony for the day and finds benefit in slowing down and doing calming activities such as yoga. There are specific poses that Vata individuals may benefit
Headache Currents from, and they respond to yoga that focuses on hip opening and improving digestive function. Suitable breath work and meditation need to be recommended balancing this mind–body type to calm an often anxious mind.4 Foods that are beneficial are warm, cooked foods, as this type tends to become dry and cold very easily.
THE PITTA DOSHA Individuals that are comprised of Fire and Water elements manifest with the Pitta dosha type. Pitta types tend to be perfectionistic, organized, and determined. These personalities have a tendency to become angry and irritable if they become stressed. Pitta individuals benefit from adding relaxation to their daily routine. Yoga techniques that involve twisting the spine may be beneficial to them.4 Foods for the Pitta type individual (or one that has a Pitta imbalance) should be sweet and cool.
THE KAPHA DOSHA Individuals composed of Earth and Water elements manifest with the Kapha dosha type. Kapha types tend to be compassionate, calm, and relaxed. These personalities are the ones least affected by stress. Kapha individuals can become heavy and congested easily, so for them adding movement to their day is essential. Exercise that involves standing and moving is very important.4 Foods that are light and dry best keep this state in balance.
HOW IS HEADACHE VIEWED FROM AN AYURVEDIC PERSPECTIVE? Headache is also known as Shirah Shula, in Sanksrit, with Shirah meaning head. Shirah Shula is defined based on the dosha involved. In addition to categorizing headache into doshic imbalance, the cause of the pain arising from nervous tissue or bone structures helps dictate the treatment of head pain. Depending on which dosha is being influenced, different headache types will manifest. Vata type headaches are often located in the cervical/occipital regions and have a throbbing component to them. These headaches are generally not as severe in intensity and often do not have any associated features such as light sensitivity, smell sensitivity, nausea, or vomiting associated with them. Sound sensitivity may be present, as it reflects an excitable nervous system. These headaches are most often induced by stress, especially when the daily routine of sleeping and eating are not followed in a regular fashion. Pitta type headaches are often located in the retro-orbital/ temple regions and have a sharp, intense component to them. These headaches are often moderate to severe in intensity and associated with nausea, vomiting, and light sensitivity. Pitta, the fire state, is often linked to the development of inflammation.
1105 | Headache | June 2014
Thus, the use of anti-inflammatory medications, herbals, or injections is understood as helping this type of headache. Kapha type headaches are often located in the frontal areas. This headache is often associated with congestion and allergies. These headaches can worsen with changes in season, especially in the spring season.5 People with headache may present with combinations of doshic imbalances. For example, one may have a Pitta-Vata headache or a Vata-Kapha headache. These headaches need to be treated by balancing out both of these imbalanced states.
WHAT DOES IT MEAN TO BE HEALTHY? According to Ayurveda, one is healthy if one has a balanced doshic state. In addition, digestion must be healthy, all tissues need to be in balance, and excretory functions should be optimal. Lastly, the mind needs to be clear and blissful. Our western view of being healthy does not have as stringent a set of criteria as Ayurvedic medicine.1
POLYPHARMACY When offering treatments to headache patients, we are often left with utilizing a multitude of medications, many of which may have interactions requiring monitoring. Patients can begin to suffer side effects from the medications and, occasionally, we prescribe more medications to mitigate a previous medication’s side effects.1 We can all incorporate the Ayurvedic understanding of the root causes of disease and limit the multiple medications prescribed by balancing out the system utilizing nonmedication approaches. This model of balancing the dosha is something that any patient can start to do at any stage of disease.
DRUG SIDE EFFECTS The three main categories of medications that can lead to systems imbalance are acid blockers, antibiotics, and steroids. These medications are extremely effective if used in short courses but can lead to imbalances in the organ systems that originally caused the problem, according to the Ayurvedic philosophy of disease. For example, treating chronic reflux with chronic suppression of stomach acid, using a proton pump inhibitor (PPI), can lead to deficiencies in magnesium and vitamin B12. “Hypomagnesemia, symptomatic and asymptomatic, has been reported rarely in patients treated with PPIs for at least 3 months, in most cases after a year of therapy. Serious adverse events include tetany, arrhythmias, and seizures. In most patients, treatment of hypomagnesemia required magnesium replacement and discontinuation of the PPI.”6 In Ayurveda, the key to longevity and optimal health resides in the strength of digestion. Any digestive issues need to be corrected utilizing an Ayurvedic diet, herbals to balance the state and yoga/meditation to balance the mind.
Headache Currents By ignoring the heated, Pitta, state, and using medications to mask the underlying problem, not only does a condition continue, but secondary side effects from medications can begin to occur. Antibiotics are required if a bacterial infection is in question, but there are many situations in which patients present with sinus complaints of congestion, and antibiotics are not warranted. In this scenario, the antibiotics may prohibit the growth of not only unhealthy strains of bacteria but also healthy strains that are needed to maintain gut function. Many migraine patients respond to short course of steroids for their attacks of pain. The concern with chronic steroid use is the effect that they have on the hypothalamic–pituitary–adrenal axis. Steroids may help when the adrenals are unable to release appropriate amounts of cortisol during times of pain or stress. In our clinic, we have found that 90% of patients are adrenally fatigued.7 The issues with utilizing steroids are the concerns that they can elevate glucose levels, leading to weight gain, along with potentially damaging the adrenal system. In addition, steroids can lead to dysbiosis and reduction of healthy bacteria counts in the digestive lining.8 Thus, the utilization of medications that are commonly prescribed to migraine patients can lead to more harm than good the longer and more often these patients stay on these medications.
THE BRAIN AND THE MIND In Neurology, we often separate the structural brain and its complicated biochemistry, from the mind, which is often deemed to fall into the realm of Psychiatry. Ayurveda considers the brain and the mind to function as one unit. In fact, the mind, and the health of one’s emotional state, dictates the health of the body.1 The three mind states in Ayurveda are Sattva, Rajas, and Tamas. A Sattvic mind is balanced, creative, and engaged in acts that promote altruism. A Rajasic mind is one that is governed by passion and can become angry and disruptive. A Tamasic mind is one that leads to apathy and sluggishness. An Ayurvedic goal is to obtain a Sattvic mind by performing activities to help others, eating foods that heighten this state, and performing daily exercises such as yoga and meditation to increase this state of being.
INTEGRATION OF ALLOPATHIC MEDICINE WITH AYURVEDIC MEDICINE Clinicians have the opportunity to utilize the numerous tools available to assist migraine patients. Ayurvedic medicine offers one more tool, in conjunction with offering medications and injectables. In addition to obtaining a headache history and collecting information on migraine attack history, we can evaluate the Ayurvedic system and discover contributing factors to the migraine attacks. For example, asking patients to comment on their digestive history can add another layer of treatment options. If a patient complaints of constipation or gas/bloating, which are
1106 | Headache | June 2014
a marker of an imbalanced Vata state, the practitioner can offer Vata balancing herbals and Ayurvedic dietary recommendations. Gathering information on the mind state and sleep patterns can open up treatment options utilizing herbals that can bring the sleep and mind into balance by strengthening the circadian rhythm and the adrenal system. All of this can be done while utilizing traditional Western medical approaches. Utilizing the Ayurvedic model helps us better understand patient types and possibly choose medications that may be more effective for that type of individual. Beta blockers or serotonin reuptake inhibitors, with their anxiolytic effects, may help the Vata type individual who has an anxious mind, for example. It may not be just the choice of food, but how the food is prepared that can influence this Vata type. Warm foods can be recommended with emphasis to stay away from cold items.
CONCLUSION Ayurveda, with its 5000-year-old science, offers a novel way to understand patients with migraine headaches. Ayurveda incorporates a fundamental understanding of a patient’s unique dosha type and offers tools to bring the dosha into balance using herbals, yoga, lifestyle changes, and meditation. We can combine this approach with our modern use of medications and injections to understand why some patients respond well to certain treatment protocols and others do not. We can also use this model to explain the various types of headaches many of our patients have. This model helps explain a patient suffering with headaches of different locations, severity, and associated symptoms by con-
Headache Currents necting these symptoms with the doshic imbalance state. In addition, our patients often complain of digestive, hormonal, and other systems-based issues. The Ayurvedic model brings an understanding that the body works as a system, with migraine being a manifestation of many systems that have become imbalanced, thus generating severe pain. References 1. Sharma H, Clark C. Contemporary Ayurveda: Medicine and Research in Maharish Ayurveda, 1st edn. New York: Churchill Livingstone Publisher (Elsevier); 1997. 2. Lad V. Textbook of Ayurveda, Volume Two: A Complete Guide to Clinical Assessment. Albuquerque, NM: The Ayurvedic Press; 2007. 3. Apte J, Kshirsagar S Ayurvedic Certification Training Materials. 2006. http://www.eattasteheal.com/eth_resources.htm. 4. Lad V. Ayurveda: A Practical Guide: The Science of Self Healing. Twin Lakes, WI: Lotus Press; 1985. 5. Lad V. Ayurvedic Perspectives on Selected Pathologies. Albuquerque, NM: The Ayurvedic Press; 1998. 6. Protonix. 2008. http://www.rxlist.com/protonix-drug.htm. 7. Rossabach J, Gokani T “Adrenal Fatigue in Migraine Patients: A Common Clinical Finding?” 2014. 8. Watson B. Gut Solutions: How to Solve Your Digestive Problems Naturally. Clearwater, FL: Renew Life Press; 2004.
Book Recommendations Simon D. Wisdom of Healing. New York: Harmony Books, 1997 Lonsdorf N. The Ageless Woman. Santa Barbara, CA: MCD Century Publications, LLC, 2004 Gokani T. Ayurvedic Approach to Migraines. 2014
