conceptual review: on vatika shirhashul w.s.r to …

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Vyas et al. World Journal of Pharmacy and Pharmaceutical Sciences

CONCEPTUAL REVIEW: ON VATIKA SHIRHASHUL W.S.R TO

TENTION HEADACHE

Dr. Hetal Vyas* and Dr. A. R. Dave

**

*Reader & HOD, Kayachikitsa Dept. Shree Gulab kunverba Ayurved Mahavidhyalay

Jamnagar.

**Associate Proffesor & HOD Kayachikitsa Dept. Institute for Post Graduate Teaching and

Research In Ayurveda. Gujarat Ayurveda University, Jamnagar-361008.

ABSTRACT

In 21st century competitive Yuga and stressful life worry, tension,

anxiety, fear, grief creates many psychosomatic disorders. Speed and

accuracy are the prime demands of modern era. The need of human

being is infinite but the availability is less to fulfill and our growing

needs have no end. Irregular and scrappy diet repressed hostility, anger

or frustration, long periods of study, lack of proper sleep, less time for

relaxation and suppression of natural urges are the inseparable parts of

our routine which enervate body and finally lead to the disease.

Tension headache is one of them, which can be compared with Vatika

Shirahshula described in Ayurvedic texts, as mental factors like

excessive weeping, grief, fear, terror have also been attributed in its aetiopathogenesis.

Kaplan and Sadock (1995) have reported that 82% patients are suffering from tension

headache. Nearly 80% of population will experience a tension type headache at sometime.

An estimated 1 year prevalence of 86% in women and 63% in men means that it is more

probable to have experience a tension type headache (in Denmark).

KEYWORDS: Vatika Shirahshul, Tension Type Headache (TTH), Shankhanishtoda.

INTRODUCTION

Shirah is a main control system of all bodily ailments. Alteration in the activity of the Shirah

influences all body tissues and also influenced by body tissues in an inverse order. The life

style in modern era creates so many psychological disorders. Vatika Shirahshula (TTH) is

most common among them, which makes suffer many people due to their run race. The main

WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES

SJIF Impact Factor 5.210

Volume 4, Issue 12, 1224-1241 Review Article ISSN 2278 – 4357

Article Received on

19 Oct 2015,

Revised on 09 Nov 2015,

Accepted on 29 Nov 2015

*Correspondence for

Author

Dr. Hetal Vyas

Reader & HOD,

Kayachikitsa Dept. Shree

Gulab kunverba Ayurved

Mahavidhyalay Jamnagar.


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habitat of Pranavayu which supports the mind and regulates the mental activities is Shirah.[1]

(A. H. Su. 12/4) Vata is the main Dosha involved in Shula.[2]

The International Association

for the study of pain (IASP) has defined pain as „an unpleasant sensory and emotional

experience associated with actual or potential tissue damage or described in terms of such

damage. In the Samprapti (pathogenesis) of Vatika Sirahshula, Vata takes important role,

which can compare to the nerve impulse and the seat of Vata is the CNS. Therefore, Vata

Vyadhi indirectly indicates the diseases of CNS.We can correlate the Vata with tension also.

Because tension means bodily tension and mental tension. Bodily tension means muscle

tension i.e. contraction of muscle. The whole muscular system as ready for action. Nerve

having the prime role for it. Vata having the Chala Guna (mobile). Mental tension means

high thinking, while also the function of Vata. So we can correlate the Vata with tension also.

Shankhanishtoda, Ghatasambheda and loss of sleep are all symptoms of vatika shirahshul we

can correlate with Tension type of Headache.

DEFINATION

Shirahshula is described in Ayurveda not only as the symptom of many diseases but also as

an independent disease entity as Shiroroga.

ßÖÐëÐë· Ö[ÆçÈ ßÖÐë·Ä ÖâÒÐáÊÞ Ðá¼Þ¹ßÍß¸ÏÄçÞ2(Ma. Ni. –Vijayarakshita)

Shankhbheda, Lalatbheda Shiroruk.[3]

Shirahshula is also mentioned as synonym of Shiroroga. Charaka has mentioned Shiroruk

(Shula) as separate disease among eight types of Vata-vyadhis.

TENSION HEADACHE

Constant dull, band like pain, tightness or pressure around forehead or, back of the head and

neck.[4]

CAUSES OF VATIKA SHIRHASHUL[5]

Aharaja Hetu (Dietary Factors) Viharaja Hetu (Recreational Factors) Manasa Hetu

(Psychological Factors)

Tikshnna pana (Strong alcohol

consumption) Uchchairbhashya (High tone speech) Bashpa (Excessive weeping)

Ati Vireka (Excessive purgation) Atibhashana (Excessive talking) Shoka (Grief)

Ati Vamana (Excessive vomiting) Prajagara (Night waking) Bhaya (Fear)

Shitamarutasparsha (Contact of cold wind) Trasa (Terror)

Ati Vyavayi (Excessive coitus)


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Vatika Shirahshula caused by mental factors only can be correlated with tension type

headache as excessive weeping, grief, fear and terror have also been attributed in its

pathogenesis.

CAUSES OF TENSION HEADACHE[6]

Stress (everyday hassles, family crises, heavy workloads, unpleasant work or social

situations).

Change in sleep regimen (shift work, oversleeping)

Skipping meals (a poor, scrappy diet)

Certain foods (caffeine, alcohol, cheese, chocolate)

Physical exertion

Environmental factors (sun glare, odours, smoke, ambient noise, fluorescent lighting,

sustained postures at video, terminals or while driving)

Female hormonal changes (menses, menopause, pregnancy, exogenous hormone use)

Medications used for concomitant medical conditions (nitrates, selective serotonin

reuptake inhibitors, antihypertensives).

Overuse of headache medication (analgesic and caffeine combinations butalbital

compounds, opiates, ergot)

Depression and anxiety

Vega Nigraha (Holding of natural urges of

motion & urination)

Upavasa (fasting)

Abhighata (Trauma/injury)

Vyayama (Excessive exercise)

Ati margakarshana (excessive walking)

Ati bharvahana (Heavy weight lifting)

All above mentioned causes specially

mental factors

Rasavahasrotodusti

Rasadhatukshaya due to Mental causes –

Rasadhatukshaya

Vataprakopa

Vatika Shirahshula


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Working in awkward positions or holding one position for a long time.

Clenching or grinding teeth (functional disturbances of masticatory muscle around the

temporomendibular joint)

Stiff joints and muscles due to arthritis of the neck or inflammation of the shoulder joints

may develop TTH.

Tight band around the forehead, heavy weight on top of head.

Eye strain caused by dealing with a large amount of paper work.

Coping strategies (avoidance, self criticism, lack of use of social supports)

Excessive worry

All work – no play

Long periods of study, typing or other concentration

Perfectionism

Injuries to the spine

Repress, hostility, anger, frustration

Low blood sugar, food allergy.

SIGN & SYMPTOMS

According to Ayurveda[7]

Symptoms Ch. Ma. Ni./ Su. Sa. A.H./A.S. Ha. Sam.

Shankhanishtoda + - + -

Ghatasambheda + - + -

Bhrumadhya Tapanam + - + -

Lalata Tapanam + - + -

Shrotranishkasanavat Pida + - + -

Akshinishkasanavat Pida + - + -

Shiroghrurnanam + - + -

Sandhimokshanavat Pida + - + -

Shirostambha + - + -

Shirajalasphurana + - + -

Bhavanti Tivra Nishi - + - +

Kandhara Hanugraha - - + -

Prakashasahyata - - + -

Ghranasrava - - + -

Vrishanaruja - - - +

Sudden relieved by itself - - + -

According to modern view

SIGN & SYMPTOMS OF TTH[6]

The headache starts at the back of the head and spread.


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Dull pressure or a squeezing pain (dull, steady, achy pain on both sides of the head) lasts

from half an hours to several hours or days).

Pain in TTH.

o Compressive - constrictive type.

o Non-pulsatile, evening time.

o Varied in intensity, frequency and duration long lasting.

o Commonly in occipital and bilateral region associated with muscle contraction.

Visual symptoms are absent.

Nausea, vomiting, anorexia, rarely present.

Photophobia, or phonophobia may be present.

Tenderness on the scalp, neck and shoulder muscles.

Insomnia.

Fatigue.

Irritability.

Difficulty concentrating.

Correlation Between The Symptoms of Vatika Shirahshula & Tention Type of

Headache.

Rupa of Vatika Shirahshula Symptoms of TTH

Shankhanistoda, Ghatasambheda etc. Typically involve entire head commonly

occipital and bilateral region.

Sayam Kala (Bhavanti Tivranishi) Moderately severe in evening time.

Prakasha Asahyata Photophobia

Shabda Asahisnuta Phonophobia

Shiroghrurnanam Giddiness

Nidra Alpata Disturbed sleep

SAMPRAPTI

The Samprapti of a disease refers to the process by which the vitiated Doshas react with

Dushyas and produces Kriyatmaka and Rachanatmaka changes in the target organ leading to

the manifestation of a disease. Otherwise the process of manifestation of disease is known as

Samprapti. In Samprapti – Nidana is the efficient cause, Dosha are the material cause and

Dosha – Dushya Sammurchana is the essential cause.

The Samprapti of Vatika Shirahshula is not mentioned by any Acharya on details in

Ayurvedic literature. But Acharya Charaka have described the Samprapti of Vatika

Sirahshula (Cha.su.17/18).


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Dosha Prakopa

Charaka described the Vatika Shirahshula in Nanatmaja Vikara as Shiroruk (Headache),

Shankha Bheda (Temoporal headache) and Lalata Bheda (frontal headache) which are the

main symptoms of Vatika Shirahshula.

In this disease the Manasika Hetu like tension, anxiety, depression produces various types of

diseases according to the Prakriti of a person.

Bhaya, Shoka etc.

Vatika shirahshula Vata Pradhana Prakriti

Ulcerative Colitis Pitta Pradhana Prakriti

obesity Kapha Pradhana Prakriti

So in this Vatika Shirahshula, Vata is the main Dosha to causing this disease.

In some types of Vatika Shirahshula Pitta is also in Kshaya stage and Kapha Vriddhi is also

present in some cases, but it is very mild.

There are two types of vitiation of Vata seen in this disease Vatika Shirahshula.

1) Dhatukshayajanya Vata Prakopa

2) Margavarodhajanya Vata Prakopa

Dhatukshayajanya Vata Prakopa

According to Acharya Charaka, due to Nidana (mainly Manasika), Dhatukshaya occurs, first

Rasa Dhatukshaya then ultimately all Dhatukshaya and leads to Vata Prakopa; then the Vata

comes into Prasara stage and leads to Sthanasanshraya in Raktavaha Srotasa (Shirajala

Sphurana) of Shirah (head) because Kha-vaigunya is there, due to Manovaha Srotasa Dushti

(Raja, Tama vitiate) and causing Vatika Shirahshula.

In the above Sloka “Saraksayat”, Sara mean Mastishka i.e. inner part of Kapala and Kshaya

means decrease of Snehadi qualities or very minute change in the composition.

ÐØÕÞÙàßÈ Æá\ÏßKÄ ßºKHÏÞÈÞÚ ºÞßÄßºKÄÈÞÄì”” (Cha. Vi. 58/13).

Rasa Dhatu Kshaya

Rakta Dhatu kshaya

Uttarottaro Dhatu Kshaya

Chayapurvaka vata Prakopa


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2) Margavarodhajanya Vata Prakopa

The etiological factors (Manasikabhava) like Chinta, Shoka, Bhaya etc. directly causes

(Jatharagnimandya). Due to Jatharagni-mandya, Apakva Annarasa is formed (Ama),

Sarabhuta Rasa is formed in very less amount, but Malarupi Kapha is increased in amount

and goes to circulation (Rasa-Rakta Samvahana) and also reach in head (Shirah). Their Sanga

occurs due to Khavaigunya, because this Chinta, Shoka etc. causes Khavaigunya in

Manovaha Srotasa due to Raja and Tama guna increase, which is situated in Shirah. It leads

to Vata Prakopa and causes Vatika Shirahshula.

ROLE OF MANASIKABHAVA ON AGNIMANDHYA

ÎÞqÞÏÞMÏOÏÕÙÄÚ ÄÚ ÊIÏÚ ºÞKÈ ÈÚ ¼àÏåßÄ”

ßºKÄÞÖëøÍÏøë¸Æá£¶ÖQÏÞ} Ê~¼Þ·Ðè£ • (Cha. Vi. 2/9).

It means the food eaten by one who is under anxiety grief, fear, anger, pain, having sedentary

habits, used to awaken at night will fail to be digested properly.

In Amotpatti also Manasikabhava are mentioned as a main causative factor.

øÞÎøê¸ÒêÍÎêÙæ\ÏÞåßÙÖëøÎÞÈêöç·ÍÏêÊÄMÎÈØÞ ÕÞ ÏÆKÈÞÈÎáÊáFÏÄç ÄÆMÏÎÎçÕ

ÊŒÆâÏßÄ”” (Cha. Vi. 2/8).

i.e. when the mind is afflicted with desire, anger, greed, infatuation, envy, shame, grief,

indignation, anxiety and fear will lead to Amotpatti which is the basic responsible factor

behind every disease. Because this Ama leads to Margavarodha followed by Dosha Prakopa

as mentioned in Ashtanga Hridaya. (A.H.8/4)Agnimandya leads to Amotpatti and results

Margavarodha. So this too having most important in Mārgāvarodhajanya Vataprakopa.


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chinta, Bhaya, krodha

Vitiates

Manas (Ubhayendriya, control all sence organs)

Incapable to Swa-Swa Visaya Grahana

Incapable of Rasanendriya Karma

Imbalance in diet intake

Indigestion

Arna

Dhatu/Dushya

Rakta is the main Dushya in all types of Shiroroga. Charaka also in Sutrasthana 24th

chapter

including Shiro-ruk in Rakta Pradoshaja Vikara.

In Vatika Shirahshula also Rakta is considered as main Dushya. It has also main role in

Samprapti.

Due to Manasikabhava like Chinta, Shoka, Bhaya etc. in 2nd

Samprapti Rasa Dhatukshaya

(vitiation) is developed. After then Rakta Dhatu also Kshaya (vitiates). In other hand in 3rd

Samprapti due to Agnimandya also Sarabhuta Rasa Kshaya is there and leads to Raktakshaya

automatically. This vitiates (Kshaya) Rakta goes to the circulation and Sthanasansraya in

Shirah. Due to Kshaya of Rakta Vata will be aggravated. Chala Guna of Vata is increased in

circulation. So that Shirajalasphurana, Sirasaithilya, Rukshata etc. symptoms are seen in the

patient of Vatika Shirahshula. Mainly Raktakshaya will be seen in upper part of the body

(Urdhvabhaga).

(Cha. Su. 17/11-18) So, Rasa and Rakta both Dhatus are take part in the Samprapti of Vatika

Shirahshula.


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Srotodushti/Khavaigunya

Acharya Charaka has mentioned the involvement of Shirogata Sira in diseases occurring in

head. He stated that the vitiated Dosha vitiate Rakta along with Shira situated in Shirah and

produce Shiroroga (Ch. Su. 17/18-22). So it means Raktavaha Srotasa Dushti occurs.

Rasavaha Srotodushti

In Charaka Vimana 5/13, Charaka also states that –

ÐØÕÞÙàßÈ Æá\ÏßKÄ ßºKHÏÞÈÞÚ ºÞßÄßºKÄÈÞÄì”” (Cha. Vi. 58/13).

Excessive indulgence of Manas in thinking can be the main vitiating factors for Rasavaha

Srotasa as mentioned in Charaka Samhita.

Raktavaha Srotasa

In view of Asrayasrayeebhava, vitiation of Pitta may lead to the vitiation of Rakta as stated in

Sushruta Sutrasthana.

øë¸ÖëøÍÏÞÏØëÊÕÞØÜÜÜÜÜÜßÊÄÚ ÊŒøëÊÎÞÊß¸Äç (Su. Su. 21/21).

ßÊkÊŒøêÊÃèÐçÕ ºÞÍàWÃÜÜÜÜÜÜÜÜÜÜÜÜÜÜ¥Øîøì ÊŒøëÊÎÞÊvÄ (Su. Su. 21/25).

Again Acharya Charaka has quoted that. (Ch. Su. 24/9-10).

Here Manasa Santapa and Krodha (anger) can be taken as mental factors.

Swedavaha Srotasa

UÕçÆÕÞÙàßÈ Æá\ÏßKÄ øë¸ÖëøÍÏèUÄÅÞ”” (Ch. Vi. 5/22).

According to Charakacharya, Krodha (anger), Shock (grief) and Bhaya (fear) can vitiate the

Swedavaha srotasa.


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Manovaha Srotasa

Manovaha Srotasa have not been separately mentioned in Charaka Samhita. It is however,

stated that the entire body represents the abode of the Manas and therefore all Srotasa of the

body should be considered as the Manovaha Srotasa.

¥ßºKÄÈÞßÄßºKÄÈÍÏÞÈøßºKÈèÎÈë¹ßÊ ßÕøîÄÚ ÎÈëÌáßgÎßÊ ßÕøîÄÞÚ ¼ÈÏÄàßÄ ÍÞÕ£””

(Ch. Su. 8/16; Chakrapani on Ch. Vi. 5/41).

The mind gets vitiated by non-thinking, excessive thinking or even thinking of frightening

nature.

Due to Chinta, Shoka, Bhaya etc. Raja and Tama, Manasika Dosha will be aggravated. So

Manovaha Srotasa also vitiated. In this way Manovaha Srotasa can be considered in the

Samprapti of Vatika Shirahshula.

Moreover, it has clearly stated that the vitiated Doshas after reaching Shirah vitiate Rakta

along with Sira i.e. blood vessels situated there, to produce Shiroroga.

ÄÄ£ßÖÐßØ ¼ÞÏÄç Ðë·Þ£ ßÕßÕ¸ÒpÃÞ£””

ÕÞÄÞÆÏ£ ÊŒøáMÏßKÄ ßÖÐUÏUq¢ º Æá\ÏßKÄ” ( Ch. Su. 17/11-18).

Adhisthana

The seat of disease is Shirah (head), Mana (mind).

Vyaktisthana

Shirah (head) and its appendages like Manya, Bhru, Shankha, Karna, Akshi, Lalata, Ghata,

Hanu, Sirogata Sandhi can be considered as Vyaktisthana of Vatika Shirahshula.

Agni

The main Agni involved in this disease is Jatharagnimandya is less functioning of enzymes

and local hormones of the gastrointestinal tract (G.I.T.).

Roga Marga

Madhyama Roga Marga/Marmesti Sandhigata Hence all the above factors i.e. Dosha

Prakopa, Dushya Dushti, Agnimandya, Kha-vaigunya and Srotodushti ultimately leads to

Sthana Samsraya in Shirah and causes severe pain in Shankha Pradesh (Shankhanishtoda),

Ghata Pradesha.


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Srotodushti Prakara

Sanga, Vimargagamana.

Samprapti of Vatika Shirahshula[8]

ßÖÐë·ÄÞ ßÖÐÞÕîfë ÕÞÏáÐÞßÕTÏ øáMÏßÄ”

ÄÄ£ ÖâÒ¢ ÎÙkUÏ ÕÞÄÞÄí ØÎáÊ¼ÞÏÄç”” (Ch. Su. 17/18).

As vitiated Vata Dosha effects the Shirodhamanies (nerves and blood vessels) the symptoms

due to reduce blood supply to scalp muscle and other tissues as mentioned earlier. Pain

occurring suddenly without any known cause and relieving by itself or also noted among

these cases. This can be differentiated from other Shirahshula by this specific symptom.

Pathogenesis of Teasion Headache[9]

TTH is common, the pathophysiology and likely mechanism remain unclear. Current

knowledge of the nociceptive (pain receptors) system suggests that the derivative pain of

TTH has a muscular origin. Muscular or myofascial pain tends to be dull and achy, poorly

localized and radiating, pain originating from cutaneous structures is sharp, localized and

non-radiating.

Most research has focused on a peripheral mechanism pertaining to pericranial muscle

tenderness, thus explaining the previous term muscle contraction headache. researches

who have attempted to find correlations between subjective complaints of pericranial

muscle tension and electromyographic changes during a headache have had conflicting

results.

Sustained muscles contraction from physical or emotional causes may compress

intramuscular arterioles, causing ischaemia, accumulation of noxious metabolites or both

results in localized tenderness.

Physical and emotional causes

Sustained muscles contraction

Compress intramuscular arterioles

Ischaemia


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Accumulation of noxious metabolites

Localized tenderness in head

TTH has a purely central mechanism and that muscle tension is an epiphenomenon.

Studies that suggest a sharp disorder with TTH have found reductions in platelet or serum

serotonin, epinephrine, nor-epinephrine and dopamine levels. These findings appear to

support the idea that an alteration in serotoninergic and monoaminergic central systems

results in depressed pain suppression and activated pain pathways in TTH (Normal level

these neurotransmitters that help nerves communicate).

Emotions have biochemical effects in the body and mental stress alone elicit muscle

contraction through the limbic system.


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Chronic TTH also may be associated with central opioid hypofunction with decreased

CSF beta endorphin levels and associated with exteroceptive suppression (ES2).

The cause of TTH is most likely multifactorial and best described by olesen‟s vascular

myogenic supraspinal model.

The convergence of multiple pain pathways – vascular, muyogenic supraspinal or all of

these that enter the caudate nucleus of the trigeminovascular system and, in combination

with other precipitating factors in a predisposed person, determine headache activation

threshold is met.

A genetic predisposition has been suggested by studies that found a threshold increased

incidence of chronic TTH in families.

Pathogenesis of TTH is complex and multifactorial with contributions that central,

peripheral, vascular, muscular, psychogenic.

Another chemical in the body that ma play a role in TTH is nitric oxide, which is

involved in the transmission of nerve impulses over production of nitric oxide has been

linked to chronic tension headache and substances that block the production of nitric

oxide have been shown to reduce the muscle lightness in TTH.

According to Jenson, extracranial myofascial nociception is one of them. Headache is not

related directly to muscle contraction and possible hypersensitivity of neurons in the

trigeminal nucleus caudalis has been suggested.

Bendtsen – described central sensitization at the level of the spinal dorsal horn/trigeminal

nucleus due to prolonged nociceptive inputs from pericranial myofascial tissue. The

central neuroplastic changes may affect regulation of peripheral mechanism and can lead

to increased pericranial muscle activity or release of neurotransmitters in myofascial

tissue. This central sensitization may be maintained even after the initial eliciting factors

have been normalized, resulting in conversion of ETTH into CTTH.

Correlation Between Samprapti of Vatika Sirahsula & Pathophysiological Mechanism

of Tension Headache

Role of Vata Nerve impulse; Tension.

In the Samprapti (pathogenesis) of Vatika Sirahshula, Vata takes important role, which

can compare to the nerve impulse and the seat of Vata is the CNS which already

described previously. Therefore, Vata Vyadhi indirectly indicates the diseases of CNS.

We can correlate the Vata with tension also. Because tension means bodily tension and

mental tension. Bodily tension means muscle tension i.e. contraction of muscle. The


1237


whole muscular system as ready for action. Nerve having the prime role for it. Vata

having the Chala Guna (mobile). Mental tension means high thinking, while also the

function of Vata. So we can correlate the Vata with tension also.

Role of Rasa and Rakta

Rasa and Rakta which are having the prime role among all Dhatu in the pathogenesis

(Samprapti) of Vatika Shirahshula. But the importance of the Rasa-Rakta complex, which

has the function of Preenana (nourishment) and Jeevana (supplying Prana – oxygen) to

the nervous system should also be taken into consideration.

If the blood flow is interrupted for only ten seconds, loss of consciousness, results an

interruption of four minutes causes irreversible damage to most cerebral cells. The normal

blood flow through the brain tissue of the adult average 50–55ml/100 gm of brain per minute.

For the entire brain of the average adult, this is approximately 750 ml per minute or 15% of

the total resting cardiac output. The O2 consumption of human brain averages about

3.5ml/100 gm brain per minute or 49 ml/min for the whole brain in an adult. It represents

approximately 20% of the total resting O2 consumption.

Any disturbance in these two functions can create a disturbance in the function of Vata. In

Ayurved also Rasa and Rakta Dhatukshaya occur. So the role of Rasavaha and Raktavaha

Srotasa in Samprapti can be understood.

Role of Agnimandya And Ama

Stress, strain, anxiety leads to Agnimandya and produce Ama which disturb the digestion

process. Pakvashaya is stated as the most important seat (Vishesa Sthana) of Vata.

Snigdha Ahara Dravya (lipids) are digested in the Pakvashaya and products of such digestion

are absorbed here for utilization of the structure of Mastiska and Vatavaha Srotasa (C.N.S.).

It is already mentioned that the chief of contain of nerve tissue is lipid. Most of fat digestion

and protein digestion occur in the small intestine and the end product of both protein and fat

digestion are absorbed in the small intestine. Therefore, the materials required in the structure

of the nervous system are made available in the Pakvashaya.

Certain bacteria especially colon bacilli are present in the absorbing colon. The substances

formed as a result of bacterial activity are vitamin K, Vitamin B12, thiamine, riboflavin etc.


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They all are essential for maintaining some of the functions of the CNS e.g. formation of

lipids from carbohydrate is in influenced by Vitamin B12.

Lots of Ayurvedic researches have established „Ama‟ as „Free radicals‟ in modern concept

with logical explanation. From the definition of free radicals that “It is an atom or molecule

which containing one or more unpaired electrons and exist in an incomplete metabolic state,

which requires neutralization by free radical scavengers”. We can be able to correlate the

concept of Ama viz. indicates undigested i.e. incomplete metabolic state in free radical forms.

When we enter into the cause of production of free radicals, it can be headed in two ways viz.

i) Exogenous factor and ii) Endogenous factors. The endogenous factor as being triggered by

the Manasikabhava like Chinta, Kama, Shoka, Bhaya etc. which ultimately lowers the

production of certain enzymes. As we know the production of enzymes regulated by neural

centers, requires healthy neural functions. Thus, deficiency of enzymes causes production of

free radicals which can be correlated with Mandagni state and production of Ama.

From the above description, it is evident that Manasikabhava are the factors in production of

Ama (free radicals).

In Ayurvedic aspect also due to Agnimandya the diet are also not properly digested. So the

digestion and absorption of protein and fat part are not done properly. It may leads to

deficiency of vitamins which is formed by bacterial activities and deficiency of such vitamins

leads to a disturbance of both structural and functional integrity of nervous system, the lipid

formation also impaired. Hence, the role of Agnimandya and Ama also taken into

consideration.

Role of Ama and free radicals in production of the disease mentioned in the tabular format.

Free Radicals Ama

Impaired action of free radical scavengers. Dhatvagni Daurbalya

Increased production of free radicals at the site. Sanchaya of Ama at the site of production.

Circulation of free radicals in the body. Prasara of Ama.

Starts reacting with the weak cell membrane. Sthanasanshraya at the site of Kha-vaigunya.

Production of disease. Production of Vyadhi.

In this way the Samprapti of Vatika Shirahshula and pathophysiological aspect of tension

headache correlates with each oth.


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CHIKITSA

General management of Shiroroga

Commonly in all types of headache the following preventive measures should be taken.

Nidana Parivarjana

According to the treatment point of view, the etiological factors which produce headache

should be avoided. Commonly rest, countenance without stress, avoiding the holding of the

natural urges, controlling the mind are very helpful. Also other Aharaja and Viharaja Hetus

should be avoided.

Samshodhana Chikitsa

Shirovirechana – Nasyakarma has been advised as the important method of treatment in

Urdhvajatrugata Rogas. Thus repeated use of Nasya with special medicine which are

indicated for such condition is to be put into practice in headache.

Samshamana Chikitsa

Simultaneous to Nidana Parivarjana, the vitiated Doshas should be brought to their normal

state by help of drugs, based on Samanya Vishesh principles, according to predominance of

the manifesting Dosha.

Other Measures

Yoga Ratnakara has described the following measures for Shiroroga.[10]

Snehana Upanaha

Swedana Dhumapana

Lepa Langhana

Parisheka Agnikarma

Raktamokshana Shirobasti

These measures should be applied after considering the predominance of Dosha and other

general considerations of the patients.

Satvavajaya

The term Satvavajaya implies the therapeutics for mental disturbances. This is secured best

by restraining the mind from desire for unwholesome object and the cultivation of Gnana,

Vijnana, courage, memory and Samadhi (concentration).The advice of the counseling in the

present time is no more considered to be only for psychiatric disorders, but also in the


1240


prevalence of disrupt psyche of a patient in need or parallel supportive therapy to alleviate his

conditions by making him able to cope up his illness with better adjustment and adaptation.

Psychological and psychodynamic methods are no more a palliative management but also a

curative treatment in those conditions, the basic approach is –

1) Assurance

2) Exchange or replacement of emotions viz. replacement of Kama, Krodha, Bhaya, Harsha,

Irshya etc. with appropriate emotions.

3) Psychoshock theory.

General Management of Shiroroga[11]

In Bhaishajya Ratnavali, general line of treatments for Shirahshula has been described which

is Swedana, Nasya, Dhumapana, Virechana, Lepa, Vamana, Langhana, Shirobasti,

Raktamokshana, Agnikarma, Upanaha, Purana Ghrita and Shashtika Shali.

MANAGEMENT OF TENSION HEADACHE[6]

Management of tension headache mainly divided into two groups viz. –

Pharmacological approach

Non-pharmacological approach.

Pharmacological

Abortive Therapy Prophylactic Therapy

Simple analgesics without caffeine NSAIDs

Simple analgesics with caffeine Tricycles antidepressants

NSAIDs Selective serotonin reuptake inhibitors

Muscle relaxants Monoamine Oxidase inhibitors

Narcotic analgesics

Barbiturate or acetaminophen compound

Non-pharmacological approach

Regulation of

Lifecycle

Psychological

counseling

Avoidance of

environmental precipitants Physical Therapy

Alternative

therapies

Maintain

regular sleep

Stress management

program Wear sunglasses Heat, ice, ultrasound Acupuncture

Take regular

meal Meditation

Avoid smoke, strong

odours, noisy area Electical nerve stimulation Acupressure

Avoid known

dietary triggers

Individual or family

psychotherapy Maintain proper posture

Stretching and

strengthening exercise for

affected musculature

Therapeutic

touch

Get regular

aerobic exercise

Behavioral

management Triggered point stretching AromaTherapy


1241


REFERENCES

1. Astanga Hridaya Su. Ch.12/4 -Sarvangsundari commentary by Arundatta, Krishna as

Academy, Varanasi.

2. (a)Charaka Samhita Chi. Ch.3 Edited by Yadavaji Trikamji Acharya, Chaukhambha

Sanskrit Sansthana, Varanasi. Pg. No.401

(b)Madhava Nidana Ch. 26/1 – Madhukosha commentary by Vijayrakshita and Shrikanta

Datta with hindi Vidhyotini commentary by Shastri S, Chaukhambha Sandskrita

Sansthana, Varanasi. Pg.No. 464.

3. Charaka Sumhita (Su.ch. 20/11) Edited by Yadavaji Trikamji Acharya, Chaukhambha

Sanskrit Sansthana, Varanasi. Pg.No. 113.

4. www.m.webmd.com.guide.tension.

5. (a)Charaka Sumhita (Su.ch. 17/16-17) Edited by Yadavaji Trikamji Acharya,

Chaukhambha Sanskrit Sansthana, Varanasi. Pg.No.100

(b)Harita Samhita – Sastu Sahitya Vardhaka Karyalaya Bombay.

6. www. healthline. com. TTH.

www. myoclinic. com -20019295.

www. medicinenet. Com. main. mobileart.

https://en.m Wikipedia. org. wiki. Tensi.

7. (a)Charaka Sumhita (Su.ch. 17/19,20,21) Edited by Yadavaji Trikamji Acharya,

Chaukhambha Sanskrit Sansthana, Varanasi. Pg.No. 100.

(b)Madhava Nidana Ch. 60/2 – Madhukosha commentary by Vijayrakshita and Shrikanta

Datta with hindi Vidhyotini commentary by Shastri S, Chaukhambha Sandskrita

Sansthana, Varanasi. Pg.No. 334.

©Astanga Hridaya Su. Ch.12/4 -Sarvangsundari commentary by Arundatta, Krishna as

Academy, Varana.

(d)Harita Samhita – Sastu Sahitya Vardhaka Karyalaya Bombay.

8. Charaka Sumhita (Su.ch. 17/18) Edited by Yadavaji Trikamji Acharya, Chaukhambha

Sanskrit Sansthana, Varanasi. Pg. No. 100.

9. www ncbi. nlm. nih. Gov. pubmed https.//en. M Wikipedia. Org. wiki. Tensi.

10. Yoga Ratnakar with Vidyotini Hindi Commentary, Chaukhambha Sanskrit Series

Varanasi.

11. Bhaishajya Ratnavali Vidhyotini tika, Chaukhambha Sanskrit Series Varanasi. 1962.

http://www.m.webmd.com.guide.tension/

conceptual review: on vatika shirhashul w.s.r to …

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