E Book Ayurvision 2010

CME IN AYURVEDA ON
“CURRENT UNDERRSTANDING AND MANAGEMENT OF ARDHAVABHEDAKA

WITH AN UPDATE ON MIGRAINE”
26th and 27th November 2010
SOUVENIR
Exploring the new frontiers in academic and

scientific Ayurveda
Dept. of Ayurveda,
Kasturba Medical College,
Manipal University, Manipal
1
CME IN AYURVEDA ON
“CURRENT UNDERSTANDING AND MANAGEMENT OF
ARDHAVABHEDAKA WITH AN UPDATE ON MIGRAINE”
ORGANIZED BY:-
DEPT. OF AYURVEDA
Kasturba Medical College
Manipal University
Manipal
2
From the desk of H. O. D……….
Ayurvision
A MISSION WITH A VISION
Before the days of modern medicine, societies around the world had their own ways
of preventing and treating illness. These were based on local beliefs, religion and
culture. Ayurveda, is one such system. It started in India thousands of years ago with
roots in the Indian culture and religion. Roughly translated, "Ayurveda" means "the
science of life."
“It needed a scientific age for the world to appreciate the full dignity of Ayurveda
as a holistic system of perfect health. Now it has become clear to the world of
science that every thing in the universe has its basis in the „unified field‟ and
everything can be successfully handled from this one area. It is this that has
authenticated Ayurveda‟s holistic approach to perfect health for both individual
and society. Ayurveda today stands as the technology of the „unified field‟ for
perfect health of the individual of the nation, and of the world as a whole”
- Maharishi Mahesh Yogi
India has a large infrastructure for teaching and clinical care training under Indian
systems of Medicine and teaching and training has been availed of according to the
curriculum set up by the Central Council of Indian Medicine. The diagnosis and
treatment of various ailments, use of drugs and Ayuvedic profession as a whole has
its basis to the education based on authoritative texts recognized for these systems,
but, the scientific validation of the treatment has not been done on a wide scale. The
off take and output from these institutions has so far been limited and has not been
able to meet the standards for scientific enquiry. In the present era of globalization
and development of a world market for Ayurveda as a whole (education, research and
medical care delivery), research and development is needed.
3
Ayurvision is a step towards standardizing Ayurvedic Clinical practice, based on
which depends the quality and standards of research. Ayurveda is Intellectual
Property of we Indians. Every Indian has the right to protect it.
Today, Too much emphasis is laid on modern medicine at the level of Ayurvedic
education thereby neglecting Ayurvedic tradition and practice. Ayurvedic profession
is looked down by the public greatly because graduates of Ayurveda sideline their
science and resort to unethical practice of Modern Medicine, truly a sort of quackery.
Emphasis needed to improve the quality and standards of Ayurvedic Education,
accountability of the Profession and standardization of Ayurvedic medicines.
It is unfortunate that Graduates of Modern medicine are deprived of any knowledge

of this science during their education. If an effort is made to expose students of
modern medicine to the principles and practice of Ayurveda, either during their
graduation level training or during their Internship period, we can hope for a better
interaction among these practitioners in future. Medical Council of India, IMA and
Central Council Of Indian Medicine should come to single platform and discuss this
issue, as to how to implement this.
Evidence based Ayurveda
While talking of searching and applying evidence base to Ayurveda, we need to

understand that in conventional sense, the term is primarily coined to help in clinical
decision making in the light of best among overwhelmingly available evidences
within modern medicine. Conventional modus operandi of applying evidence base to
medical practice therefore is limited to screening of best evidences that help in
decision making. Thereby, defining the best evidence and finding them pragmatically
in a clinical setting are the only real challenges.
Referring to Ayurveda, however, the issue of applying evidence base needs to be

redefined in reference to its unique propositions. There is a ubiquitous agreement
upon the traditional evidences of Ayurveda of which experience, long-term use, and
textual classical references form a large sum.
The issue of evidence base in Ayurveda therefore requires to be dealt at various levels
like documentation of existing evidences, designing diagnostic and clinical
parameters which can act as evidence to help in decision making and generating more
evidences in reference to the safety and efficacy pertinent to Ayurvedic practice. This
is the time when we need to understand that bringing evidence base to the practice of
Ayurveda is mandatory if it is thought to be raised as a medical system where
predictability and dependability are featured as key components.
4
Ayurvedic Industry and Academia
Ayurveda need more academic backup and evidence. I call upon Ayurveda Industry
to strengthen and support academic research and clinical documentation of their
products and standardizing the products to International standards, instead of simply
adopting unconventional methods like advertising the products in lay magazines and
news papers with unscientific methods and evidence less, false claims. These
practices may lead to people start looking at Ayurveda with a commercial angle and
ultimately losing their faith and trust on the science itself. We need to build up
Ayurvedic academic centers at par with Oxford or Cambridge University type of
Institutions in India or abroad in future.
" The future belongs to those who fuse intelligence with faith and who, with
courage and determination, grope their way forward from chance to choice, from
blind adaptation to creative evolution" - Charles Merriam
Through this Ayuvision we propose to explore the new frontiers in academic and
scientific Ayurveda.
Dr. M. S. Kamath MD (Ayu.)

Additional Professor & Head
Department of Ayurveda
KMC, Manipal.
Manipal University
Tel. 0820 29 22105
mail : msk9msk@yahoo.com
5
Program Schedule
Day 1. 26th November 2010

Morning Session:
Sl. No Time Events
1. 08.00 – 09.00 Registration
2. 09.00 – 10.00 Inauguration
3. 10.00 – 10.30 High Tea
4. 10.30 – 11.30 Management of Headache past, present and future by Prof. B. M. Hegde
Current Understanding and Management of Migraine by Dr. Vasudeva
5. 11.30 – 12.30
Acharya, Associate Professor, Dept. of Medicine, KMC Manipal.
6. 12.30 – 02.00 Lunch Break
Afternoon Session:
Sl. No Time Events
Analysis of Nidana Panchaka of Ardhavabhedaka by Dr. Zenica, HOD, Dept. of
1. 02.00 – 03.00
P.G. Studies in Panchakarma, Alva’s Ayurveda Medical College, Moodbidri.
2. 03.00 – 04.00 Free Paper Session (By Delegates – 6 minutes for each paper)
3. 04.00 – 04.30 Tea Break
4. 04.30 – 05.30 Poster Presentation (Competition for Delegates – Size of Poster 30”X40”)
Day 2. 27th November 2010

Morning Session:
Sl. No Time Events
1. 09.00 – 10.00 Differential Diagnosis of Ardhavabhedaka by Dr. Srilatha, Assistant
Professor, Dept. of P.G. Studies in Kayachikitsa, S.D.M. Ayurvedic College,
Udupi, Karnataka.
2. 10.00 – 10.30 Tea Break
3. 10.30 – 11.30 Current Understanding of Ardhavabhedaka with Modern Prospective by Dr.
U. Indulal, Deputy Director, Technical, The Arya Vaidya Chikitsalayam &
Research Institute, 136 – 137, Ramanathapuram. PO. Coimbatore,
Tamilnadu.
4. 11.30 – 12.30 Management of Ardhavabhedaka by Shamanoushadhis by Dr. Prasanth,
Professor, Dept. of Kayachikitsa, Ayurveda Mahavidyalaya, Hubli, Karnataka.
5. 12.30 – 02.00 Lunch Break
Afternoon Session:
Sl. No Time Events
Management of Ardhavabhedaka by Panchakarma by Vd. M. Prasad, Ayurveda
1. 02.00 – 03.00 Vachaspati, Director, Sunethri Ayurvedashram and Research Centre, Trikkur,
Trissur, Phone: 09446229370
2. 03.00 – 03.30 Break
3. 03.30 – 04.30 Panel Discussion
4. 04.30 – 05.00 Valedictory Function Followed by High Tea
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AYURVISION – 2010
CME ON CURRENT UNDERSTANDING AND MANAGEMENT OF
ARDHAVABHEDAKA WITH AN UPDATE ON MIGRAINE
26th & 27th November 2010
Chair person : Dr. Sripathi R Rao

Dean, KMC, Manipal.
Co- Chair person : Dr. M.S. Kamath HOD
Dept. of Ayurveda, KMC, Manipal.
Organizing Secretary:
Dr. Basavaraj – Associate Professor
Reception committee: Transport Committee & Accommodation

Chairmen – Dr. Kamath Madhusudhan Chairmen – Dr. Shripathi Adiga
Dr. Soumya Dr. Preetam
Dr. Suprabha Dr. Harish
Dr. Prasanna Rao Dr. Sumashri
Mrs. Laxmi Mr. Chandrashekar
Mrs. Bharathi Mr. Anul
Mr. Ganesh Mrs. Vani. C
Miss. Sumangala
Miss. Sahana
Mr. Mahesh
Food & Catering Committee: Scientific Committee:
Chairmen – Dr. Kamath Madhusudhan Chairmen – Dr. K.J. Malagi
Dr. Nagaraj Dr. Kamath Madhusudhana
Dr. Deepak Dr. Anupama Nayak
Dr. Sapna Dr. Preetam
Miss. Revathi Mr. Md. Asif
Mrs. Geetha Ayurvision e-book:
Miss. Anusha Chief Editor – Dr. Kamath Madhusudhana
Mr. Vasanth
Miss. Sumangala
Miss. Sahana
Mrs. Sumathi
Master of Ceremony: Dr. Anupama Nayak
7
Contents:
01. Management of Headache past, present and future by
Prof. B.M. Hegde………
…………………………………………………………. 09
02. Current Understanding and Management of Migraine by

Dr. Vasudeva Acharya………
………………………………………………………….. 11
03. Analysis of Nidana Panchaka of Ardhavabhedaka by

Dr. Zenica D’souza…………
……………………………………………………………. 14
04. Differential Diagnosis of Ardhavabhedaka by

Dr. Srilatha ………………..
…………………………………………………………. 19
05. Management of Ardhavabhedaka by Shamanoushadhis by

Dr. Prasanth……………….
…………………………………………………………. 28
06. Management of Ardhavabhedaka by Panchakarma by

Vd. M. Prasad……………….
…………………………………………………………… 33
07. Current Understanding of Ardhavabhedaka with Modern Prospective by

Dr. U. Indulal……………….
………………………………………………………… 37
08. Abstract
…………………………………………………………. 47
8
Headache
Professor BM Hegde,
hegdebm@gmail.com
“The ultimate lesson all of us have to learn is unconditional love, which includes not only
others but ourselves as well.”
Elisabeth Kubler-Ross
Pain has been human kind‘s greatest enemy from ―times out of mind‖; is the most important curse
even today and shall remain the same for all times to come. Doctors of all hues, ranging from the
mother of all healing wisdoms Ayurveda to the most modern hi-tech ultra specialty medicine, have
only been fighting this menace without much success to date. Pain of all kinds brings man to a
doctor for relief and it is our primary obligation to ―cure rarely, comfort mostly but, to console‖ him
always. ―Knowledge‖ wrote Karl Popper, a great thinker of England, ―advances not by repeating
known facts but by REFUTING false dogmas.‖ The world will never progress unless people can
think out of the box. History of medicine is replete with experiences of human suffering due to our
NOT THINKING but, only following false myths in medicine. Progress needs to be encouraged.
Change is life and stasis is death. Knowledge should change to evolve. Let us THINK together
about this enigma called headache.
When a patient with headache confronts you either in your office or hospital; first think of him/her
as a headache. One does not get a headache. On the contrary, most of the time, one becomes a
headache for himself and his doctor! This takes us to the crux of the headache dilemma that most, if
not all, primary headaches are in the human mind. There are three basic types of primary headaches-
migraine, tension headache and, cluster headaches (also called suicide headaches as the pain and its
frequent clustering could become unbearable to the patient). There are umpteen other known causes
of headaches ranging from common cold to cancer, which fall outside the purview of this write up,
together classed as secondary headaches.
The problem for mankind has been the unravelling the secrets of human mind which is at the root of
all headaches. Where is the mind? Never mind! What is the mind? Is it matter? If it is matter, where
is it? Finally what is matter? Mind is everywhere and, if one thinks of it as matter, it is nowhere
because there is no matter. Hans Peter Durr, the present President of the Max Planck Institute of
Physics in Munich, the greatest living physicist at 86 years, had shown that ―matter is not made up
of matter.‖ Matter and energy are the two faces of the same coin. The mind, otherwise called
individual consciousness, is only a part of the universal consciousness. We are all interconnected
although looking solid and distinct for out word appearances. The non duality of mind and matter is
called a-duality by Hans Peter Durr, who admits that he is ―only a child playing on the sands of the
beach while the vast sea of Indian wisdom of yore stares at me‖. They had called it as ―advaitha‖
thousands of years ago.
Another great German physicist, Fritz Albert Popp, had elegantly shown that every human atom
inside every cell emits photon lights which he has been able to record. Even if he applied a small
amount of ointment on his palm the photon lights in his brain and leg also changed simultaneously.
This synchrony is what is called health. When our cells are not in sync, we get illnesses-headache is
one such illness. Be that as it may, Popp also showed that our photons vibrate with the photons of
others when we interact with them. We are all parts of the same whole:
9
(Om poornamadhah poornamidham, poornath poornamudhachyathe.
Poornasya poornamadhay, poornamevaavshishyathe.)
Now you will be able to understand what I said in my first sentence that the patient IS a headache
when he says s/he HAS a headache. Tension headaches, cluster headaches, as also, the syndrome of
migraine, initially get born in the human mind. Our efforts at making them tranquil by the
conventional methods, many times, do not work since we follow the reductionist idea of relaxation
which is relaxation of the body to relieve muscle tension etc. That has its limited role but, the
relaxation of the mind goes much farther than all that yoga asanaas and praanaayama of the
commercial variety. You need to go deep into your ―praana‖, the real spirit, the essence of the
human being. Even the heart has its mind! The only way to be truly relaxed is to have genuine
―universal compassion, including compassion for one‘s own self.‖ To be truly compassionate it is as
important to forgive others as it is to forgive oneself for the past deeds good or bad, as otherwise, in
the deep recesses of the mind, the past keeps haunting you. The new definition of health, therefore,
is ―enthusiasm to work and enthusiasm to be compassionate.‖ In the correct sense of the word that is
true health. One could have any disease and still be healthy. Sharing and caring is the meaning of
genuine spirituality. Spirituality, thus defined, has very little to do with ritualistic religion.
Modern medicine‘s concept of organ-based diseases has come to an end. In her beautiful paper
entitled The end of the disease era, published in the American Medical Journal (2004; 116: 179) Dr.
Mary Tinnetti writes: ―
“The time has come to abandon disease as the focus of medical care. The changed spectrum of
health, the complex interplay of biological and non-biological factors, the ageing population, and
the inter-individual variability in health priorities render medical care that is centered on the
diagnosis and treatment of individual diseases at best out of date and at worst harmful. A primary
focus on disease may inadvertently lead to under-treatment, overtreatment, or mistreatment.”
Pain killers of all kinds are dangerous. They are one of the leading killers among the 2.5 million that
die annually in the US alone of Adverse Drug Reactions. Nearly 2 lakhs die due to gastric bleeding
alone according to Late Glen Gordon. Local ointments (in the US patches) of analgesics are
available for all pains including headaches. For the poor man the best I have found is an ointment
made up of black pepper made into a paste with curds. When applied on the forehead this does
wonders for the pain along with the doctors‘ empathy works wonders at the immune system level, in
addition. Rich patients can go for the US patches of capsaicin which is the same that black pepper
has. The mainstay of all headache treatments boils down to making the patients‘ mind truly tranquil,
if one could! Washing out hatred, greed, jealousy, super ego and pent up anger is not an easy job,
but is doable if one tries hard. With that kind of cleaning one develops universal compassion that
soothes all aches and pains in the mind: consequently, in the body as well.
“If you want others to be happy, practice compassion. If you want to be happy, practice
compassion."
The Dalai Lama
10
Migraine : Pathophysiology and Management
Dr VasudevaAcharya MD, DNB
Associate Professor
Department of Medicine
KMC Manipal
Email: acharyavasudev@yahoo.com
Introduction
Headache is among the most common reasons that patients seek medical attention. Migraine is the
second most common cause of primary headache. Migraine afflicts approximately 15% of women
6% of men. Migraine is described as a syndrome of benign episodic headache associated with
certain features such as sensitivity to light, sound etc., often accompanied by symptoms of
neurologic dysfunction like nausea, vomiting , photophobia, vertigo, confusion and visual
disturbances.
Pathogenesis.
The sensory sensitivity that is characteristic of migraine is probably due to dysfunction of

monoaminergic sensory control systems located in the brainstem and thalamus.
There is considerable evidence that intracranial vasodilatation, long thought to be causal, in fact
occurs in response to the neurologic events of migraine. The most widely accepted theory proposes
that early in an attack, vasoactive peptides (particularly calcitonin gene-related peptide) are released
from the primary sensory nerve terminals that innervate meningeal blood vessels. These peptides
activate perivascular trigeminal nerves and cause dilatation of arteries as well as perivascular
inflammation and extravasation of proteins. First-order neurons terminate in the trigeminal nucleus
caudalis in the brainstem. They activate second-order neurons that ascend to the thalamus, and from
there third-order neurons project to higher cortical centers. If uninterrupted, this process causes pain
and can lead to hyperalgesia.
Pharmacologic and other data point to the involvement of the neurotransmitter 5-hydroxytryptamine
(also known as serotonin). The antimigraine effects of triptans relate to their ability to stimulate 5-
HT1B and 5-HT 1D receptors, which are located on both blood vessels and nerve terminals.
Data also support a role for dopamine in the pathophysiology of certain subtypes of migraine. There
is dopamine receptor hypersensitivity in migraineurs which is proved by the fact that dopamine
receptor antagonists are effective therapeutic agents in migraine.
Migraine genes identified by studying families with familial hemiplegic migraine reveal
involvement of ion channels, suggesting that alterations in membrane excitability can predispose to
migraine.
Activation of sympathetic nervous system is the likely cause of nausea, vomiting and other
autonomic symptoms. Sensitivity to light, sound and smell is theorized to result from abnormal
brain-stem modulation of sensory information. The aura is postulated to cortical spreading
depression which is most easily triggered in the occipital cortex.
11
Management
Once a diagnosis of migraine has been established, it is important to assess the extent of a patient‘s
disease and disability. Patient education is an important aspect of migraine management. A patient
should understand that migraine can be modified and controlled by lifestyle adjustments and
medications, but it cannot be eradicated. At the same time patient also should understand that
migraine is usually not a life-threatening illness.
Nonpharmacologic management
The specific triggers should be identified and avoided. A healthy diet, regular exercise, regular sleep
patterns, avoidance of excess caffeine and alcohol would be helpful. Since the stresses of everyday
living cannot be eliminated, lessening one‘s response to stress by various techniques is beneficial in
many patients. These may include yoga, hypnosis and conditioning techniques such as biofeedback.
Therapy for acute attack of migraine
The mainstay of therapy is the judicious use of one or more of the many drugs that are effective in
migraine. The selection of the optimal regimen for a given patient depends on a number of factors,
the most important being the severity of attack. Mild attacks are managed by oral drugs with
efficacy rate of 50-70%, while severe attacks warrant parenteral therapy.Nonsteroidal anti-
inflammatory agents, 5HT receptor agonists and dopamine receptor antagonists constitute three
major classes of drugs used in treatment of acute attack of migraine.
1. NSAIDs : Both severity and duration of a migraine attack can be reduced by NSAIDs.
However effect of these agents is less than optimal in severe attacks.
2. 5-HT1 agonists: Ergotamine and dihydroergotamine are nonselective receptor agonists,
while the triptans are selective 5-HT1B/1D receptor agonists.Sumatriptan, Rizatriptan and
zolmitriptan are commonly available triptans. Side effects are common but often mild and transient.
They are contraindicated in individuals with history of cardiovascular or cerebrovascular disease.
Nasal formulations of zolmitriptan is also available. Parenteral dihydroergotamine or sumatriptan
relieves symptoms rapidly in 70-90% of patients.
3. Dopamine antagonists: Oral dopamine antagonists like Metoclopramide enhances the gastric
absorption of triptans and hence should be considered as adjunctive therapy in migraine.
Preventive treatment for migraine:
Migraine prophylaxis is indicated in following situations:
1. Attacks more than 2 per week

2. Duration of each attack >48 hours
3. Attacks of extreme severity
4. Attacks accompanied by prolonged aura
5. Presence of contraindications for acute treatment
12
6. Symptoms substantially interfering daily routine despite acute treatment
7. Special situations like hemiplegic migraine
The exact mode of action of these drugs is unclear. Patients are usually started on a low dose of
chosen treatment, the dose is then gradually increased, up to a reasonable maximum to achieve
clinical benefit. Drug must be taken daily and there is usually a lag of at least 2-12 weeks before
effect is seen. The following drugs are used in prevention of migraine.
1.Betablokers : Propranolol (40-120mg)
2.Tricyclics : Amitriptyline (10-75mg)
3. Anticonvulsants :Sodium valproate (400-600mg), Topiramate (25-200mg)
4. Serotonergic drugs :Flunarizine (5-15mg)
The probability of success with any one of antimigraine drug is 50-70%. Many patients are able to
discontinue medication and experience fewer and milder attacks for long periods, suggesting that
these drugs may alter the natural history of migraine.
13
ANALYSIS ON THE NIDANA PANCHAKA OF
ARDHAVABHEDAKA
Dr. Zenica D‟souza
Asst Prof & I/C HOD.
Postgraduate dept of Panchakarma.
Alva‟s Ayurveda Medical College,
Moodabedri.
mÉëÉhÉÉÈ mÉëÉhÉpÉ×iÉÉÇ rÉ§ÉÉÍ´ÉiÉÉÈ xÉuÉåïÎlSìrÉÉÍhÉ cÉ|

rÉSÒ¨ÉqÉÉ…¡qÉ…¡ÉlÉÉÇ ÍvÉUxiÉSÍpÉkÉÏrÉiÉå || -cÉ. xÉÔ 17/12
Ayurveda has given prime importance to Shirah, considering it as one of the three vital organs of
the body where the Prana resides. Charaka has considered Shirah as the supreme structure of the
body which is known as the Uttamanga. This Uttamanga is the abode for Jnanendriyas. It is one
among the Jeevitha Dhama and is also the Moola of the Shareera.
Shirashoola is a common manifestation of this vital organ Shiras experienced by almost

everyone in their life time at some time or other. ‗Ardhavabhedaka‘ is clinically an important type
of shirashoola because it is one among the commonly encountered headaches by individuals that
drags them to clinicians very often. Presenting itself as an episodic paroxysmal headache, this
manifestation adversely influences productivity and routine life style of sufferer thereby
representing a substantial health care burden both clinically and economically. These reasons make
it essential for us to understand and analyse about this particular disease ‗Ardhavabhedaka‘ and then
venture into its treatment.
UÉåaÉqÉÉSÉæ mÉUÏ¤ÉåiÉ iÉiÉÉå AlÉliÉUÇ AÉæwÉkÉÇ|

iÉiÉÈ MüqÉï ÍpÉwÉMç mÉ¶ÉÉiÉç ¥ÉÉlÉ mÉÔuÉïÇ xÉqÉÉcÉUåiÉç|| - cÉ.xÉÔ 20/20
The tools for understanding and diagnosing a disease in Ayurveda are the Nidana Panchaka. In
this paper, an analysis on the Nidana Panchaka of the disease ‗Ardhavabhedaka‘ is attempted.
Even though Charaka explains about Shirorogas in Sutra Stana and Chikitsa stana, a detailed
description of the disease ‗Ardhavabhedaka‘ is seen in Siddhi Stana along with three other varieties
of Shiro Vikaras. He mentions and explains about five types of Shiro Rogas namely Vataja, Pittaja,
Kaphaja, Sannipataja and Krimija Shiro Roga in Sutra and Chikitsa stana. Later he adds the
description of Ardhavabhedaka, Shankhaka, Suryavarta and Anantavata in Siddhi Stana. In
Astodareeya chapter, while numbering Shiro Roga, the Sankhya samprapti is Pancha. However,
Ardhavabhedaka finds a mentioning in Sutra Stana 7th chapter in the context of kshavatu vega
dharana and 17th chapter while giving examples for Shiro Roga.
The term ‗Shiro Roga‘ stands for a group of diseases related to the Shiras which present with the
cardinal feature pain. Charaka mentions Shiro Ruk as one among the Nanatmaja Vata vikara.
ÍvÉUÉå UÉåaÉ vÉoSålÉ ÍvÉUÉåaÉiÉvÉÔsÉ ÃmÉÉ ÂeÉ AÍpÉSÏrÉiÉå - qÉkÉÑMüÉåvÉ

ÍvÉUÉå UÉåaÉ vÉoSxrÉ vÉÔsÉ LuÉ ÂeÉÉMüUå uÉë¨ÉiuÉÉiÉç| - cÉ¢ümÉÉÍhÉ
14
‗Ardhavabedhaka‘is a Shoola Pradhana Shiro roga pertaining to half of the head. Bheda is
described as - ÍvÉÉU¶É pÉåS: ÍvÉUÉåÌuÉSÉUhÉqÉÏuÉ uÉåSlÉÉ |
Being a Vyadhi involving the Shiras, the term ‗ava‘ stands for bad prognosis.Thus literal
meaning of Ardhavabhedaka is perforating or bursting out like pain in one half of the head either
right or left. Chakrapani makes it clear by saying
- AkÉÉïuÉpÉåSÈ AkÉïqÉxiÉMüuÉåSlÉÉ| (cÉ¢ümÉÉÍhÉ. cÉ. xÉÔ 7/16)
In modern parlance the term Migraine is derived from Greekword ‗hemicrania‘ which means
half of head; it means a headache which effects half of head.
Nidanas
Charaka mentions specific nidanas for Ardhavabhedaka . Almost all other Acharyas mention
samanya nidanas of Shiro Roga.
AkÉÉïuÉpÉåkÉMü ÌlÉSÉlÉ
Â¤ÉÉirÉkrÉvÉlÉÉiÉç mÉÔuÉïuÉÉiÉÉuÉvrÉÉrÉqÉæjÉÑlÉæÈ| uÉåaÉxÉÇkÉÉUhÉÉrÉÉxÉ urÉÉrÉÉqÉæÈ MÑÌmÉiÉÉå AÌlÉsÉÈ|| - cÉ.ÍxÉ 9/74
Ruksha Ashana
This is a Vata prakopaka cause related to food. Even though major surveys are yet not conducted on
the prevalence of Migraine in India, anecdotal evidence suggest that Indian food habit of not having
breakfast and frequent fasting for religious causes are common triggers for Migraine. These food habits
contribute rukshata and laghuta. Intake of Caffeine in the form of tea coffee and cola may put a migraine
patient at risk for rebound headache. Habitual daily intake of 4 to 6 cups of tea, coffee and cola are
indicative of growing prevalence of Migraine in India. These products are Vata Pitta prakopaka and Rakta
dushaka.
Ati /Adhyashana
These causes contribute to Kapha prakopa, Agni mandhya and Ama utpatti which associates Vata
Dosha. Consumption of rich, heavy diet fermented and preserved food products like cheese, butter,
chocolates are again common triggers of migraine.
Purva Vata / Avashyaya
These are Vata prakopaka karanas by virtue of their sita guna. Consumption of refrigerated
foods, ice creams and drinks, living in air conditioned enviornment can be considered under this
cause in the present days.
Ati maithuna
15
Excess sexual intercourse causes Vata prakopa.(cha.ni.1/19). A dull headache commonly
bilateral felt on the back of the head (occipital area) occurs as sexual excitement mounts. It is
probably related to excessive contraction of head and neck muscles since it can be prevented or
relieved by deliberate relaxation of those muscle groups (Paulson and Kalwans 1974).
The second type of headache, more severe and expulsive in onset, appears immediately before
or at the moment of orgasm, presumably caused by the increase in blood pressure at that
time.(Adam 1939). Apart from this menstrual cycle, contraceptive pills, hormone therapy can trigger
attacks of migraine.
Vega Sandharana
UÉåaÉÉÈ xÉuÉåï AÌmÉ eÉÉrÉliÉå uÉåaÉÉåÌ®UhÉkÉÉUhÉæÈ| -A.¾û.xÉÔ 4/21
Vegoddhirana and Dharana play a vital role in the causation of many diseases including
Ardhavabhedaka. These causes are strong Vata prakopa and udavarta karanas. Charaka mentions the
manifestation of Ardhavabhedaka due to suppression of kshavathu vega. Furthermore shira shoola is
a manifestation due to Pureesha vega dharana. Bashpa nigraha is mentioned as a samanya karana for
Shira Shoola. These references strongly support the role of vega dharana in the manifestation of
Ardhavabhedaka.
Manasika vegas are dharaneeya vega. Extreme emotions cause vitiation of shareerika and manasika
doshas. Anger is enlisted as one among the causes of Sonita dusti. Furthermore headache is caused
due to sonita dusti. (Cha.su.24/13). Quite parallel to this, Shira Shoola is regarded as a symptom of
sonata dusti.(Cha.su.17/11).
Ayasa/Vyayama
Ati Vyayama and ayasa again are predominant Vata prakopaka and rakta dushaka karanas.
Isometric exercises that cause strain to the body can precipitate headache. Stress due to time
constaint, sustained exhertion, major hassles or losses, travelling, too much, too little or interrupted
sleeps are triggers for Migraine among individuals. When psychological stress is involved, the
migraine attack often occurs after the period of strain so that some patients tend to have attacks at
weekends or at the beginning of a holiday.
xÉÉqÉÉlrÉ ÌlÉSÉlÉ
xÉÇkÉÉUhÉÉiÉç ÌSuÉÉxuÉmlÉÉiÉç UÉ§ÉÉæ eÉÉaÉUhÉÉlqÉSÉiÉç | EccÉæpÉÉïwrÉÉSuÉvrÉÉrÉÉiÉç mÉëÉauÉÉiÉÉiÉç AÌiÉ qÉæjÉÑlÉÉiÉç ||

aÉlkÉÉSxÉÉiqrÉÉSÉbÉëÉiÉÉiÉç UeÉÉå kÉÔqÉ ÌWûqÉ AÉiÉmÉÉiÉç | aÉÑÂ AqsÉ WûËUiÉSÉlÉÉSÌiÉ vÉÏiÉÉqoÉÑxÉåAlÉÉiÉç ||
ÍvÉUÉåÍpÉbÉÉiÉÉiÉç SÒ¹ÉqÉÉSìÉåSlÉÉiÉç oÉÉwmÉÌlÉaÉëWûÉiÉç | qÉåbÉÉaÉqÉÉlqÉlÉxiÉÉmÉÉ SåvÉMüÉsÉÌuÉmÉrÉïrÉÉiÉç || - cÉ.xÉÔ 17/8
Apart from the specific nidanas mentioned by Charaka, the samanya nidanas also are to be
considered in the manifestation of the disease. Majority of the causes are Vata prakopaka. Pitta and
Kapha prakopaka karana as well as rakta dushaka karanas are observed.
Samprapti
- MÑÌmÉiÉÉå AÌlÉsÉÈ || MåüuÉsÉÈ xÉMüTüÉå uÉÉ AkÉïÇ aÉëWûÏiuÉÉ ÍvÉUxÉxiÉiÉÈ| - cÉ.ÍxÉ 9/74
uÉÉiÉÉSrÉÈ mÉëMÑümrÉÎliÉ ÍvÉUÍxÉ AxÉëÇ cÉ SÒwrÉÌiÉ | iÉiÉÈ ÍvÉUÍxÉ eÉÉrÉliÉå UÉåaÉÉ ÌuÉÌuÉkÉ sÉ¤ÉhÉÉÈ || -cÉ. xÉÔ 17/11
16
All Acharyas invariably accept the involvement of Vata dosha in the samprapti of
Ardhavabhedaka. This is justified by the cardinal feature pain.
vÉÔsÉÇ lÉiÉåï AÌlÉsÉÉiÉç...... A.¾û.xÉÔ 29/6
Vata is the arambhaka dosha in the samprapti. Charaka & Madhava attribute Kapha dosha
involvement at times along with Vata, while Sushrutha considers Tridosha involvement in the
manifestation of this condition. Vagbhata attributes Vata dosha.
The invariable involvement of Rakta as a dushya in Shiroroga is mentioned by Charaka. He

has included ‗Shiro-Ruk‘ in Shonitaja Roga. (Ch. Su. 24/13) Moreover, it has been clearly stated by
Charaka that the vitiated doshas after reaching Shirah vitiates Rakta in that stana to produce Shiro
Roga. Thus Rakta is the main dushya in Ardhavabhedaka. As Rakta dhatu is involved, the srotas
which carries the dhatu is also vitiated. The stana involved is dakshina or vama ardha shira.
The role of Vata probably represents a spreading front of excitation followed by depression
(kapha) of activity of cortical cells. The headache is caused by an in co-ordinated circulatory
response resulting in a sequence of vasoconstriction and vasodilatation of extracranial vessels and a
non specific effect of intracranial metabolic disturbance. This explains the role of Rakta along with
Vata in the manifestation.
Purvarupa
No specific Purvarupas are mentioned in the Samhitas for Ardhavabhedaka Shiroroga. But one
reference regarding Purvarupa of Shiroroga is available in Vaidya Vinod.
qÉlrÉÉaÉëWû aÉÑÂiÉÉ mÉÔuÉï iÉåwÉÉÇ mÉëeÉÉrÉiÉå

Laxana
.... uÉÉ AkÉïÇ aÉWûÏiuÉÉ ÍvÉUxÉxiÉiÉÈ | qÉlrÉÉ pÉëÔ vÉÇZÉ MühÉÉïÍ¤ÉsÉsÉÉOû AkÉåï AÌiÉ uÉåSlÉÉqÉç ||
vÉx§É AUÍhÉÌlÉpÉÉÇ MÑürÉÉïiÉç iÉÏuÉëÉÇ xÉÉå AkÉÉïuÉpÉåSMüÈ | lÉrÉlÉÇ uÉÉ AjÉuÉÉ ´ÉÉå§ÉqÉÌiÉuÉë®Éå ÌuÉlÉÉvÉrÉåiÉç|| cÉ.ÍxÉ 9/75-76
rÉxrÉÉå¨qÉÉÇaÉÉkÉïqÉiÉÏuÉ eÉliÉÉå: xÉÇpÉåS iÉÉåS pÉëqÉ vÉÔsÉeÉÑ¹qÉç||

mÉ¤ÉÉ¬vÉÉWûÉSjÉuÉÉÅmrÉMüxqÉÉ¨ÉxrÉÉkÉïpÉåSÇ Ì§ÉiÉrÉÉ½uÉxrÉåiÉç|| xÉÑ.E. 25/15
AkÉåï iÉÑ qÉÔklÉïÈ xÉÉå AkÉÉïuÉpÉåSMçÈ ||
mÉ¤ÉÉiÉç MÑümrÉÌiÉ qÉÉxÉÉ²É xuÉrÉqÉåuÉ cÉ vÉÉqrÉÌiÉ | AÌiÉ uÉ×®xiÉÑ lÉrÉlÉÇ ´ÉuÉhÉÇ uÉÉ ÌuÉlÉÉvÉrÉåiÉç || A.¾.E 23/7
Pain
Pain is the characterising feature in Ardhavabhedaka. It is a severe pain of perforating or bursting

type just like injury by weapon experienced in half of shiras covering the manya, bhru, shankha,
lalata, karna and akshi. Sushrutha describes the pain as shoola, bheda and toda. This laxana
contributed by Vata dosha and rakta dusti is given a lot of importance by Acharyas by explaining
the nature and type of pains; the anatomical sites involved, the severerity as well as the episodic
paroxysmal occurrence of the headache.
17
Migraine is a triad of paroxysmal headache, vomiting and focal neurological events. Patients with
all three are said to have classical migraine. Those with just paroxysmal headache with or without
vomiting and no focal neurological features are said to have common migraine. The headache may
persist for several days as a severe throbbing hemi cranial headache.
Bhrama
UeÉÈ ÌmÉ¨ÉÉÌlÉsÉÉiÉç pÉëqÉ qÉÉ.ÌlÉ 17/
This laxana is mentioned by Sushrutha for Ardhavabhedaka. It is contributed by Vata, Pitta

and rajas and involves the raktavaha srotas.
Typically, a classical migraine attack starts with a non specific prodroma of malaise and
irritability followed by an ‗aura‘ of a focal neurological event associated with a severe throbbing
pain.
Nayana shravana vinasha
These features are mentioned by Charaka and Vagbhata. They are seen in the advanced stage of
the illness.The aura of migraine is most often in the form of ‗fortification spectra‘, shimmering
silvery zigzag lines which march across the visual field over a short period, sometimes leaving a
trail of visual field loss. In some there is aphasia when the dominant side is involved. Photophobia
and vomiting is commonly involved.
Upashaya / anupashaya
All vyanjaka hetus of Ardhavabhedaka are anupashaya. Rest, calm environment, moderate climate,
fresh and easily digestable shad rasa ahara in right kala and pramana are a few upashayas in
Ardhavabhedaka.
An analysis on the vyadhi bodhaka nidanas of Ardhavabhedaka convey that it is a pain

predominant manifestation of half part of the head which is caused by predominantly prakupitha
prana and vyana vayu and rakta dusti. This understanding enables us to treat the disease better.
18
DIFFERENTIAL DIAGNOSIS OF ARDHAVABHEDAKA
Dr. Shrilatha Kamath
Assistant professor
PG Department of Kayachikitsa
SDMCA, Udupi.
Shalakya tantra is one such branch which has been uniquely named when classifying the
ashtangas of Ayurveda under which even the important branches like prasuti tantra, panchakarma,
etc. have not been separately mentioned. In general all the different types of diseases and treatment
occuring in any part of the body or in any age have been included under a common heading of
kayachikitsa. In specific terms, diseases of the whole body except urdhwanga and diseases occuring
in any age except baalya will be included in the heading of kayachikitsa. This suggests the
uniqueness of shalakya tantra.
In conventional allopathic medicine, among the different specialisations there is no branch as

diseases of head separately. Even the others like diseases of eyes, nose, throat, ear and scalp have
been dealt as separate branches. Only in our science all these have been grouped up and named
together as shalakya tantra. Their close vicinity, physiological and pathological relationships will
explain the cause for this. In general, shiroroga term has been used for a disease which presents
predominently with the symptom of shirashula. Though shirorogas have to include the diseases of
eyes etc. as they are present in the shiras only, they are excluded and defined.
ÍvÉUÉåaÉiÉiuÉålÉ lÉÉxÉÉÌSUÉåaÉåwuÉÌmÉ mÉëÉmiÉåwÉÑ iÉÉlÉç ÌuÉWûÉrÉæuÉÉ¹ÉåSUÏrÉå mÉëÉå£üÉÇUiÉÉlÉåuÉ ÍvÉUÈvÉÔsÉsÉ¤ÉhÉÉlÉç UÉåaÉÉlÉç mÉëmÉccÉålÉ uÉ£ÑüqÉÉWû-
mÉ×jÉÌaÉirÉÉÌS | Cha.Su.17
Shiras consists of prana along with the other indriyas in its abode. Classics have mentioned
that diseases which affect the shiras have to be treated early, as shiras is considered as a pradhana
marma and marma paripalana is a must for maintaining health.
mÉëÉhÉÉÈ mÉëÉhÉpÉ×iÉÉÇ rÉ§É Í¤ÉiÉÉÈ xÉuÉåïÎlSìrÉÉÍhÉ cÉ |

rÉSÒ¨ÉqÉÉlaÉqÉlaÉÉlÉÇ ÍvÉUxiÉSÍpÉkÉÏrÉiÉå || Cha.Su.17/12||
½ÑSrÉå qÉÔÎlkÉï oÉxiÉÉæ cÉ lÉ×hÉÉÇ mÉëÉhÉÉÈ mÉëÌiÉÌ¸iÉÉÈ |
iÉxqÉÉ¨ÉåwÉÉÇ xÉSÉ rÉ¦ÉÇ MÑüÌuÉïiÉ mÉËUmÉÉsÉlÉå || 9 ||
AÉoÉÉkÉuÉeÉïlÉÇ ÌlÉirÉÇ xuÉxjÉuÉ×¨ÉÉlÉÑuÉiÉïlÉqÉç |
EimÉ³ÉÉÌiÉïÌuÉkÉÉiÉ¶É qÉqÉÉïhÉÉÇ mÉËUmÉÉsÉlÉqÉç || 10 || Cha. Si. 9/9-10
As is well known, when the roots of a tree gets diseased or destructed the whole tree gets
destroyed, similarly when the shiras (refered as mula of sharira) gets diseased, it produces a serious
malady in the whole body. So early and effective treatment for shirorogas is compulsary.
ÍqÉjrÉÉSØ¹É ÌuÉMüÉUÉ ÌWû SÒUÉZrÉÉiÉÉå iÉjÉæuÉ cÉ |

iÉjÉÉ SÒwmÉËUqÉ×wOûÉ¶É qÉÉåWûrÉårÉÑÈ ÍcÉÌMüixÉMÇ |(xÉÑ.xÉÔ.10/6)
Sushruta refers that if a disease is not properly examined, interpreted and diagnosed the
physician will be confused regarding the treatment. So diagnosis should always be perfect. It should
19
be done only after a absolute differential diagnosis. Only then a proper suitable target oriented
treatment is possible in the disease.
In numbering of the shirorogas though there is a bit of difference of opinion as charaka says
only 5, Sushruta, Madhavakara, bhavamishra 11 and Vagbhata says 19, ultimate opinion about the
shirogata rogas is the same, i.e. disease having headache as the cardinal feature.
Ardhavabhedaka or ardhabheda is a type of shiroroga where severe headache in the half

portion of the head is a presenting cardinal feature. The disease is produced due to vata kapha
pradhana tridoshas.
Among the total 11 shirorogas mentioned, 5 are doshaja and the others are kshayaja, krimija,
ardhavabhedaka, anantavata, suryavarta and shankhaka. Thus when diagnosing the disease
ardhavabhedaka the other diseases which present with the symptom headache have to be excluded
using the clinical manifestations and investigations.
For a proper, systematic and easy differentiation of the diseases, they can be categorised into,
1) Disorders which can be differentiated easily.
2) Disorders coming in the way of diagnosis.
Among the 11 diseases, pittaja, kaphaja, raktaja, kshayaja, krimija and shankhaka fall under
the first category and the other diseases like anantavata, vataja shiroroga, sannipataja shiroroga and
suryavarta can be included in the second group.
To have a clear picture of the disease migraine viz-a-viz ardhavabhedaka, the same should be
elaborately understood first. Later the other diseases which need differentiation will be discussed.
Though in the list of 11 shiro (gata)rogas mentioned by sushruta, vataja is the first one and for
differentiation purposes it will be considered later. The easily differentiated disorders will be taken
into consideration first for exclusion.
ARDHAVABHEDAKA
Nidana:
Â¤ÉÉirÉkrÉvÉlÉÉiÉç mÉÔuÉïuÉÉiÉÉuÉvrÉÉrÉqÉæjÉÑlÉæÈ |
uÉåaÉxÉÇkÉÉUhÉÉrÉÉxÉurÉÉrÉÉqÉæÈ MÑüÌmÉiÉÉåÅÌlÉsÉÈ || 74 ||
MåüuÉsÉÈ xÉMüTüÉå uÉÉÅkÉïÇ aÉ×WûÏiuÉÉ ÍvÉUxÉxiÉiÉÈ | Cha.Si.9/74-75|
Even other nidanas which increase vata and kapha can be taken here to produce this disease.
This disease is of two types vata and vatakaphaja. Based on the presentation the migraine gets
included in vataja ardhavabhedaka and when there is unilateral sinusitis it is considered as
vatakaphaja ardhavabhedaka. This is supported by the fact that sushruta refers this disease as
tridoshaja and charaka explains the usage of pratishyaya chikitsa in ardhavabhedaka.
Clinical fatures:
Character of pain- Severe pain, Friction type (shastra arani nibha), bheda, toda, Pain in half of neck,
brows,temporal, ears, eyes and forehead. Time factor which is quoted as once in 10, 15, 30 days or
suddenly is the unique feature helping in diagnosis.
-
Aggravating & relieving factors
20
Disease has a sudden onset which begins without reason and it also subsides by itself.
Associated symptoms-
Giddiness, Eye disease and Ear disease(naasha-if disease aggravates) are mentioned.
qÉlrÉÉpÉëÔvÉXçZÉMühÉÉïYvÉçÈCsÉsÉÉOûÉkÉåïÅÌiÉuÉåSlÉÉqÉç || 75 ||
vÉx§ÉÉUÍhÉÌlÉpÉÉÇ MÑürÉÉï¨ÉÏuÉëÉÇ xÉÉåÅkÉÉïuÉpÉåSMüÈ |
lÉrÉlÉÇ uÉÉÅjÉuÉÉ ´ÉÉå§ÉqÉÌiÉuÉ×®Éå ÌuÉlÉÉvÉrÉåiÉç | Cha.Si.9/75-76|
Diseases considered here-
Different types of migraine

Cluster headache
Unilateral sinusitis.
PITTAJA SHIROROGA-
Nidana:
MüOèuÉqsÉsÉuÉhÉ¤ÉÉUqÉ±¢üÉåkÉÉiÉmÉÉlÉsÉæÈ |
ÌmÉ¨ÉÇ ÍvÉUÍxÉ xÉÇSÒ¹Ç ÍvÉUÉåUÉåaÉÉrÉ MüsmÉiÉå ||22|| Cha.Su.17/22|
qÉlÉxiÉÉmÉÉ…. Cha.Su.17/10
The different etiological factors like usage of katu, amla, lavana foods, madya, exposure to
anger or any other manastapa indicate the vitiation of the annavaha srotas along with pitta dushti.
Headache thus produced due to disorders of gastrium are included. Exposure to atapa increases the
headache of acute maxillary sinusitis
.
Clinical features:
Character of pain- Severe burning sensation with pain, feeling as though the burning coal covers the
body, and smoky sensation from the head are the diagnostic features of pittaja shiroroga.
Relieving factors (upashaya anupashaya)- Sheeta prayoga (exposing to cold foods and cold climate)
and night time relieve the symptoms. The severe burning sensation and the relief by cold articles
indicate the underlying inflammatory process of either acute sinusitis or gastritis producing the
symptom of headache
.
Associated symptoms- Burning in nose and eyes, Giddiness, Sweating, Fever, Altered consciousness
and Thirst indicate the diseases like Tumours of trigimenal nerve and Post herpetic neuralgia
S½iÉå ÃerÉiÉå iÉålÉ ÍvÉUÈ vÉÏiÉÇ xÉÑwÉÔrÉiÉå |

S½åiÉå cÉ¤ÉÑwÉÏ iÉ×whÉÉ pÉëqÉÈ xuÉåS¶É eÉÉrÉiÉå ||23||
vÉÏiÉÇ xÉÑwÉÔrÉiÉå vÉÏiÉÍqÉcNûÌiÉ || Cha.Su.17/23-24||

21
Acute sinusitis
APD related headache
Tumours of trigimenal nerve
Post herpetic neuralgia
KAPHAJA SHIROROGA:
Nidana:
AÉxrÉÉxÉÑZÉæÈ xuÉlmÉxÉÑZÉæaÉÑïÃÎxlÉakÉÉÌiÉpÉÉåeÉlÉæÈ |
¤sÉåwqÉÉ ÍvÉUÍxÉ xÉÇSÒ¹È ÍvÉUÉåUÉåaÉÉrÉ MüsmÉiÉå || Cha.Su.17/24||
……..ÉSuÉvrÉÉrÉÉiÉç mÉëÉauÉÉiÉÉSÌiÉqÉæjÉÑlÉÉiÉç ||8||
aÉlkÉÉSxÉÉiqrÉÉSÉbÉëÉiÉÉSìeÉÉåkÉÔqÉÌWûqÉÉiÉmÉÉiÉç |
aÉÑuÉïqsÉWûËUiÉÉSÉlÉÉSÌiÉ vÉÏiÉÉqoÉÑxÉåuÉlÉÉiÉç ||
…….qÉÉSìÉåSlÉÉSÕ|wmÉÌlÉaÉëWûÉiÉç |
qÉåbÉÉaÉqÉÉlqÉlÉxiÉÉmÉÉWåûvÉMüÉsÉÌuÉmÉrÉïrÉÉiÉç || Cha.Su.17/8-10||
Consuming food articles like guru, snigdha, sheet jala, getting exposed to avashyaya, vata,
gandha, raja, dhuma, hima etc. will lead to or aggravate the symptoms of sinusitis due to nasal
allergy as is well known pratishyaya is a nidanarthakra vyadhi to shiroroga. Sedentary life style and
lazing down is also a cause to increase both the allergic manifestations or even chronic sinusitis. The
nidana ama includes the headache induced due to indigestion.
Clinical fatures:
Character of pain- Mild dull headache, Heaviness of the head, Stiffness, Coldness and Dozing are
the diagnostic features of kaphaja shiroroga.
Aggravating & relieving factors- It Aggravates as the night progresses and subsides by opposite
qualities of kapha like ushna laghu etc.
Associated symptoms- Secretions in shira and throat, Reduced pulsations, Swelling in orbit and face,
Drowsiness, Laziness, Loss of taste, Vomiting and Itching in the ears.
The dull ache includes chronic sinusitis and also the ache of intra cranial tumors. Heaviness
and stiffness are the two features seen as a consequence of filled up sinuses as movement will
aggravate pain. Frontal sinusitis presents with dozy and lazy feeling. Early morning pain and
vomiting are unique to sinus affliction. Increased secretions suggest posterior sinus disease. Orbit
and facial swelling suggest ethmoidal and maxillary sinus involvement.
ÍvÉUÉå qÉlSÃeÉÇ iÉålÉ xÉÑmiÉÇ ÎxiÉÍqÉiÉpÉËUMüqÉç |

pÉuÉirÉÑimÉ±iÉå iÉlSìÉ iÉjÉÉÅÅsÉxrÉqÉUÉåcÉMü || Cha.Su.17/25||

Chronic sinusitis
Acute rhinitis
Intra cranial tumor
22
RAKTAJA SHIROROGA-
Nidana:
All pittakara nidanas are responsible for rakta dushti.
Clinical fatures:
Character of pain- Tenderness is considered to be the cardinal feature of the disease along with the
association of pittaja symptoms like burning, fever etc.
Aggravating & relieving factors- Sheeta and ratri kala
Localised tenderness associated with burning pain is only seen when there is a palpable
inflammation. Cranial arteritis is a condition which afflicts more of the superficial temporal artery
and sometimes all the arteries of the cranium. Here the arteries will be thick, palpable tender and
non pulsatile
.
KSHAYAJA SHIROROGA-
Nidana:
x§ÉÏ mÉëxÉÇaÉÉiÉç ApÉÏbÉÉiÉÉiÉç AjÉuÉÉ SãWûMüqÉïhÉÉ |

Í¤ÉmÉëÇ xÉÇeÉÉrÉiÉã M×ücNíûÈ ÍvÉUÉãUÉãaÉÈ ¤ÉrÉÉiqÉMüÈ || ÌuÉSãWû
The nidanas mentioned in this disease refer to the different causes of vatavridhi and
dhatukshaya which in turn can give rise to pakshaghata, pandu like diseases
.
Clinical fatures:
Character of pain- Sudden onset, Severe pain and Pricking type of pain are diagnostic.
Aggravating & relieving factors- Sweda, Vamana, Dhuma, Raktamokshana and nasya aggravate the
symptoms as they worsen the kshaya which is the cause of the disease. Vatahara measures like
bruhmana help.
Associated symptoms- Emptiness, Giddiness, Restless eyes, Unconsciousness and Fatigue and also
other vata pitta symptoms
uÉÉiÉÌmÉ¨ÉÉiqÉMü ÍsÉaXÇ urÉÉÍqÉ´ÉÇ iÉ§É sÉ¤ÉrÉãiÉç |

pÉëqÉÌiÉ iÉÑ±iÉã vÉÔlrÉÇ ÍvÉUÉãÌuÉpÉëÉliÉlÉã§ÉiÉÉ|
qÉÔcNûÉï aÉÉ§ÉÉuÉxÉÉS¶É ÍvÉUÉãUÉãaÉã ¤ÉrÉÉiqÉMãü || ÌuÉSãWû
uÉxÉÉ oÉsÉÉxÉ¤ÉiÉxÉÇpÉuÉÉlÉÉÇ ÍvÉUÉãaÉiÉÉlÉÉÍqÉWû xÉÇ¤ÉrÉãiÉç |
¤ÉrÉmÉëuÉ×iÉÈ ÍvÉUxÉÉãÍpÉiÉÉmÉÈ Mü¹ÉãpÉuÉãiÉç EaÉëÂeÉÉã AÌiÉqÉÉ§ÉqÉç ||
xÉÇxuÉãSlÉcNûSïlÉ kÉÔqÉlÉxrÉæÈ AxÉ×ÎauÉqÉÉã¤Éæ¶É ÌuÉuÉ×Ì®qÉãÌiÉ | xÉÑ. E. 25
23
Severe headache seen in the prodromal phase of stroke(in 1/3 rd of the cases in cerebral
infarction or ischemia) indicate ekadesha raktakshaya. Anemia and Hypoglycemia as a cause of
headache is also produced due to the kshaya pathogenesis.
KRIMIJA SHIRIROGA-
Nidana:
ÌiÉsÉ¤ÉÏUaÉÑQûÉeÉÏhÉïmÉÔÌiÉxÉÎQèMühÉïpÉÉåeÉlÉÉiÉç |
YsÉåSÉåÅxÉ×YMüTüqÉÉÇxÉÉlÉÉÇ SÉåwÉsÉxrÉÉåmÉeÉÉrÉiÉå ||27||
iÉiÉÈ ÍvÉUÍxÉ xÉÇYsÉåSÉiÉç Ì¢üqÉrÉÈ mÉÉmÉMüqÉïhÉÈ |
eÉlÉrÉÎliÉ ÍvÉUÉåUÉåaÉÇ eÉÉiÉÉ oÉÏpÉixÉsÉ¤ÉhÉqÉç || Cha.Su.17/27-28||
Clinical fatures:
Character of pain- Severe pain, Pricking type of pain, Destructive(eaten up), Incising or excising
type and Burning pain with other samanya krimi lakshanas.
Associated symptoms- Blood stained watery nasal discharge, Itching, Swelling, Foul smell, Itching
in palate, Cough, Tinnitus, Delerium, Fever and Reduced strength are the other symptoms of the
disease. The last three symptoms indicate the affliction of cranium and according to the area
afflicted the symptoms like delerium etc. are seen. Intracranial abscess, encephalitis and meningitis
produced usually due to the bacterial infection can be considered here.
urÉ±cNåûSÃeÉÉMühQÕûvÉÉåTüSÉæaÉïirÉSÒÈÎZÉiÉqÉç |
Ì¢üÍqÉUÉåaÉÉiÉÑUÇ ÌuÉ±ÉiÉç Ì¢üqÉÏhÉÉÇ SvÉïlÉålÉ cÉ || Cha.Su.17/29||
ANANTAVATA-
Nidana:
SÒ¹É SÉåwÉÉx§ÉrÉÉå……….. Cha.Si.9/84-86
Clinical fatures:
Character of pain- Severe pain, Pain in eyes, brows, temporal, manya and ghata(lower neck) and
Sudden onset pain is diagnostic.
Associated symptoms- Temporal pulsations, Eye diseases and Lock jaw are the important associated
features which are necessary for the diagnosis which are seen depending on the affliction of the
branches of the trigeminal nerve.
….qÉlrÉÉmÉ¶ÉÉ®ÉOûÉxÉÑ uÉåSlÉÉqÉç || 84 ||
iÉÏuÉëÉÇ MÑüuÉïÎliÉ xÉÉ cÉÉÍ¤ÉpÉëÔvÉXçZÉåwuÉuÉÌiÉ¸iÉå |
24
xmÉlSlÉÇ aÉhQûmÉÉµÉïxrÉ lÉå§ÉUÉåaÉÇ WûlÉÑaÉëWûqÉç || 85 ||
xÉÉåÅlÉliÉuÉÉiÉxiÉ……… | Cha.Si.9/84-86
Trigeminal neuralgia
SHANKHAKA-
Nidana:
U£üÌmÉ¨ÉÉÌlÉsÉÉ SÒ¹ÉÈ……….. Cha.Si.9/71
Clinical fatures:
Character of pain- Severe pain, Burning, Toda and Cutting type of pain are seen in the disease.
Associated symptoms- Redness, Swelling (daruna shopha) in shankha, later spreads to gala and
obstructs the gala associated with trushna, murcha, jwara, pralapa and bhrama are observed in this
disease.
……..vÉXçZÉSåvÉå ÌuÉqÉÔÎcNïûiÉÉÈ |
ÌiÉuÉëÂaSÉWûUÉaÉÇ ÌWû vÉÉåTüÇ MÑüuÉïÎliÉ SÉÂhÉqÉç || 71 ||
xÉ ÍvÉUÉå ÌuÉwÉuÉ²åaÉÏ ÌlÉÂkrÉÉvÉÑ aÉsÉÇ iÉjÉÉ |
Ì§ÉUÉ§ÉÉeeÉÏÌuÉiÉÇ WûÎliÉ vÉXçZÉMüÉå lÉÉqÉ lÉÉqÉiÉÈ || 72 ||
mÉUÇ §rÉWûÉeeÉÏuÉÌiÉ cÉåiÉç mÉëirÉÉZrÉÉrÉÉcÉUåiÉç Ì¢ürÉÉqÉç | Cha.Si.9/71-72|
SANNIPATAJA SHIROROGA-
Nidana:
Factors mentioned in ekadoshaja types of shiroroga.
Clinical fatures:
Character of pain- Severe pain, Burning sensation and Heaviness indicate tridosha involvement.
Aggravating & relieving factors- Vata hara measures help as it is the inevitable dosha in shirashula.
Associated symptoms- Giddiness, Tremors, Intoxication, Thirst and Drowsiness
uÉÉiÉÉcNÕûsÉÇ pÉëqÉÈ MüqmÉÈ ÌmÉ¨ÉÉWûÉWûÉå qÉSxiÉ×wÉÉ|

MüTüÉWÒûÃiuÉÇ iÉlSìÉ cÉ ÍvÉUÉåUÉåaÉå Ì§ÉSÉåwÉeÉå || Cha.Su.17/26||
25
Subacute sinusitis
SURYAVARTA
-
Nidana:
xÉlkÉÉUhÉÉSeÉÏhÉÉï±æqÉïÎxiÉwMüÇ U£üqÉÉÂiÉÉæ |
SÒ¹Éæ SÕwÉrÉiÉxiÉccÉ SÒ¹Ç iÉÉprÉÉÇ ÌuÉqÉÔÎcNïûiÉqÉç | Cha.Si.9/79
Any vata or pitta vitiating factors other than these can also produce the disease. The term
mastishka quoted here which gets vitiated and liquified due to the nidanas and the santapa, is not
applying to the brain as is literally taken. But it refers to the area in the shiras where the doshas get
collected and gets liquified in the disease. Though charaka has not identified kapha dosha sushruta
mentions tridosha and also nimi says clearly in the samprapti about the involvement of tama and
kapha. In the ratrikala tama and kapha increases, produces srotorodha, in turn increases vata and
causes ruja. Due to suryasantapa in noon kapha vilayana occurs and later pain gradually reduces.
Clinical fatures:
Character of pain- Severe pain, Pain in eyes, brows, temporal and forehead and also typical diurnal
variation increasing in mid day
Aggravating & relieving factors- Pain will be mild in the morning, Aggravates in noon and Subsides
in evening. Also alternative relief by cold or hot articles is observed in patients.
xÉÔrÉÉåïSrÉåÇÅvÉÑxÉÇiÉÉmÉÉSèSìuÉÇ ÌuÉwrÉlSiÉå vÉlÉæÈ |

iÉiÉÉå ÌSlÉå ÍvÉUÈvÉÔsÉÇ ÌSlÉuÉ×k±É ÌuÉuÉkÉïiÉå || 80 ||
ÌSlÉ¤ÉrÉå iÉiÉÈ xirÉÉlÉå qÉÎxiÉwMåü xÉÇmÉëvÉÉqrÉÌiÉ |
xÉÔrÉÉïuÉiÉïÈ xÉ………| Cha.Si.9/80-81|
Frontal sinusitis
VATAJA SHIROROGA-
Nidana:…..
EccÉæpÉÉïwrÉÉprÉÉÇ iÉÏ¤hÉmÉÉlÉÉiÉç mÉëeÉÉaÉUÉiÉç |

vÉÏiÉqÉÉÃiÉxÉÇxmÉvÉÉïfrÉuÉÉrÉÉ²åaÉÌlÉaÉëWûÉiÉç ||16||
EmÉuÉÉxÉÉSpÉÏ±ÉiÉÉÌ²UåMüÉ²qÉlÉÉSÌiÉ |
oÉÉwmÉvÉÉåMüpÉrÉ§ÉÉxÉÉ°ÉUqÉÉaÉÉïÌiÉMüvÉïlÉÉiÉç ||17||
ÍvÉUÉåaÉiÉÉÈ ÍxÉUÉ uÉ×²Éå uÉÉrÉÑUÉÌuÉvrÉMÑümrÉÌiÉ |
iÉiÉÈ vÉÔsÉÇ qÉWû¨xrÉ uÉÉiÉÉiÉç xÉqÉÑmÉeÉÉrÉiÉå || cha.su.17/16-18||
26
Headache produced due to excessive exhertion like speaking in high pitch, night awakening,
exposure to cold breeze, controlling urges, hunger and emotions is included here. Stress is a initiator
and also a precipitator of headache in types of migraine.
Clinical fatures:
Character of pain- Intermittent pain, Severe pain, Pricking, cutting, burning type of pain and Pain in
temporal, neck, forehead are diagnostic of vataja type.
Aggravating & relieving factors-Subsides and occurs without identified reason.Night time
aggravates the symptom. Tying, fomentation, massage and oleation subsides the condition.
Associated symptoms- Giddiness, Increased pulsations, Eye pain, Photophobia, Tinnitus, Neck
stiffness, Lock jaw and nasal discharge are also noticed.
ÌlÉxiÉÑ±åiÉå pÉ×vÉÇ vÉaÉÉæ bÉÉOûÉ xÉÇÍpÉ±iÉå iÉjÉÉ |
xÉpÉëÔqÉkrÉÇ sÉsÉÉOûÇ cÉ iÉmÉiÉÏuÉÉÌiÉuÉåSlÉqÉç ||19||
uÉkrÉåiÉå xuÉlÉiÉÈ ´ÉÉå§Éå ÌlÉwM×üwrÉåiÉå CuÉÉÍ¤ÉhÉÏ |
bÉÔhÉïiÉÏuÉ ÍvÉUÈ xÉuÉï xÉÇÍkÉprÉ CuÉ qÉÑcrÉiÉå ||20||
xTÑüUirÉÌiÉ ÍxÉUÉeÉÉsÉÇ xiÉprÉiÉå cÉ ÍvÉUÉåkÉUÉ |
ÎxlÉakÉÉåwhÉqÉÑmÉvÉåiÉå cÉ ÍvÉUÉåUÉåaÉåÅÌlÉsÉÉqÉïMåü || Cha.Su.17/19-21||
The increased pulsations indicate the condition of migraine. This is the reason why
vagbhata has mentioned ardhavabhedaka as a type of vataja shiroroga. So when diagnosing
ardhavabhedaka it is not possible to exclude vataja type. Ardhabheda is a special type of vataja
shiroroga. To conclude when migraine is seen in half of the head as a typical presentataion, the
diagnosis will be ardhavabheda and when migraine is seen in whole head, it is vataja shiroroga.
All diseases which present with the severe globalised pain and which is not localised to one
region of head gets included here.
It can include-
Neuralgia- Trigeminal, temperomandibular and glossopharyngeal
Vascular headache (Migraine, Hypertension, S.A. hemorrhage, Aneurysm, Alcohol,

Thrombosis, Giant cell arteritis)
Referred headache (Eyes-Refractive errors, glaucoma, iritis; Ears-Otitis, mastoiditis, E.T.blockage,

8thnerve lesions, furunculosis, tumors; Teeth- Infected sockets & dental roots; Paranasal sinus
disease; Neck- cervical disease
Metabolic causes (hypoglycemia, alkalosis, acidosis. )
Functional headache(Benign)
27
“MANAGEMENT OF ARDHAVABHEDAKA BY
SHAMANOUSHADHI”
DR.A.S.PRASHANTH
Professor
Department of Post Graduate Studies
Ayurveda Maha Vidyalaya
Hubli, Karnataka – 580024
Telephone: 0836-2335575
Mob: +91-94481-35575
Mail: drprashanthas@gmail.com
Introduction:
Ardhavabhedaka named because of its classical symptom i.e. severe pain in the half of the
frontal region and due to various similarities in the clinical features it is usually compared with
Migraine headache. Ardhavabhedaka as described in Ayurvedic texts, under the context of
Shirorogas by many Acharayas. Acharya charaka considered this disease is because of vitiation of
vata or vatakapha. Acharya vagbhata opines that this disease is due to the vitiation of vata alone.
Whereas Acharya sushruta considered this disease due to the vitiation of tridosha.It is one such
shool producing disease, which is characterized by severe headache and episodic in nature.
Samprapti: (Pathogenesis)
The pathogenesis of disease starts from aggravation of dosha and it is consequent to

indulgence in etiological factors. Hence, renunciation of etiological factors is the first code of
treatment. In pathogenesis, Nidana is the efficient cause, dosha are the material cause and dosha
dushya sammurchchana is the essential cause.
The habitual use of substances having identical properties aggravates the dosha. Regarding
vitiation of doshas, the etiological factors of Ardhavabhedaka are mainly of vata kaphaja (as per
charaka) and tridoshaja (as per sushruta).
Simultaneously some of the Nidanas also cause khavaigunya in Srotas, Which is necessary
for Sthanasamshraya of dosha (4th stage of samprapti kriyakala). Etiological factors mentioned in
classics for the vitiation of channels (Srotodushti) should be considered for Khavaigunya too. All
these factors viz. dosha dushti, khavaigunya, dushyadushti and agnimandhya are of profound
importance in pathogenesis of a disease.
Symptoms:
o Severe pain in half of the head, there by causing excruciating pain in the sternomastoid region,
eyebrows, temples, ears, eyes and forehead of that half side
o Piercing pain suddenly after a fortnight or ten days
o If exceedingly aggravated, this ailment may even destroy the eyes and the ears of the patient
o Giddiness
28
General line of treatment for Ardhavabhedaka:
For treatment of this ailment, the therapies to be used are as follows:-
1. Catuh-sneha (four types of Sneha – Taila, Ghrita, Vasa, Majja) to be taken in heavy dose.
2. Siro-virechana (inhalation therapy for the elimination of morbid matter from the head)
3. Kaya-virechana (emesis and purgation therapy for the elimination of morbid matter from the
body).
4. Nadi-sweda.
5. Jirna ghrita (10 yrs old ghee).
6. Niruha and Anuvasana types of medicated enema.
7. Upanaha.
8. Shirobati.
9. Dahan (cauterization).
10. Therapies prescribed for pratishaya and shiro roga.
11. Lepa, Jangal mamsa, Ksheeranna bhojana, Ghrita sevana are indicated.
12. Siraveda is also indicated by Acharya Sushruta.
SPECIFIC SHAMANOUSHADHI‟S IN ARDHAVABHEDAKA:
Kashayam:
1. Pathyakshadhatryadi / Pathya Shadangam Kashayam: (Sharangadhara Samhita)

Ingredients: Hareetaki, Vibheetaki, Amalaki, Bhunimba, Nimbha, Nisha and Guduchi.
Indications: Shirashoola, Ardhavabhedaka, Suryavartha, Sankhaka etc
Usage: Internal
Dosage: 60ml twice daily on empty stomach.
2. Varanadi Kashayam: (Ashtanga Hrudaya)

Ingredients: Varana, Sairyaka, Dhana, Morata, Vilva, Vishanika, Karanja etc
Indications: Shirashula, Gulma, Vidradhu, Medoroga etc
Usage: Internal
3. Drakshadi Kashayam: (Ashtanga Hrudaya)

Ingredients: Draksha, Madhooka, Lodhra, Madhuka, Kashmarya, Sariba, Mushta etc
Indications: Jwara, Madatyaya, Chardi, Bhrama etc
Usage: Internal
4. Kalyanakam Kashayam: (Ashtanga Hrudaya)
Ingredients: Sariba, Nishadwaya, Parnidwaya, Manjishta, Nagakesara, Ela etc
Indications: Unmada, Apasmara, Visha, Pandu etc
Usage: Internal
5. Vidaryadi Kashayam: (Ashtanga Hrudaya)

Ingredients: Vidari, Panchangula, Vrishchikali, Vrishchiva, Devahwa etc
Indications: Kshaya, Gulma, Shoola, Vata Pitta Vikaras
Usage: Internal
Arishtam:
1. Abhayarishtam: (Bhaishajya Ratnavali)
29
Ingredients: Abhaya, Draksha, Vidanga, Madhuka pushpa, Guda etc
Indications: Arshas, Kshaya, Pandu, Jwara, Visha etc
Usage: Internal
2. Dasamoolarishtam : (Bhaishajya Ratnavali)

Ingredients: Dasamoola, Chitraka, Pushkaramoola, Lodhra, Guduchi, Dhatri etc
Indications: Kshaya, Shoola, Kasa, Swasa, Mutra vikaras etc
Usage: Internal
Rasoushadhi:
1. Shirashooladi Vajra Rasa :

Ingredients: Parada, Gandhaka, Lohabhasma, Tamrabhasma, Guggulu, Triphala, Kushta, Madhuka,
Gokshura, Vidanga, Dashamula etc
Indications: Suryavarta, Anantavata, Sankhaka, Ardhavabhedaka
Usage: Internal
Dosage:125 to 250mg
2. Svarna Soota Sekhara Rasa :

Ingredients: Svarna Bhasma, Parada, Gandhaka, Tankana, Vatsanabhi, Tamra Bhasma, Trikatu,
Dhattura Bija, Caturjataka, Bilva Phala Majja, Sankha Bhasma, Kacura, Bhringaraja Svarasa
Bhavanartha etc
Indications: Amlapitta, Chardi, Hikka, Sitapitta, Hrllasa
Usage: Internal
Dosage:125 to 250 mg b.i.d/t.i.d
3. Vata Vidwamsa Rasa:

Ingredients: Rasa, Gandhaka, Naga Bhasma, Vanga Bhasma, Loha Bhasma, Tamra Bhasma,
Nischandra Vyoma Bhasma, Kana, Tankana, Sunthi, Maricha , Pippali, Nagara, Vatsanabha,
Vyosha, Vara, Citraka, Markava, Kushta, Nirgundi, Bhanu Dugdha, Mahi Dhatrika Nira, Chandrika
Nira, Nimbu Nira etc
Indications: Vataja Sula, Vataja Grahani, Kapha Roga, Sutika Vata
Usage: Internal
Dosage:250mg
4. Ekangaveera Rasa:
Ingredients: Sudha Gandhaka, Mrta Suta, Kanta Lauha Bhasma, Vanga Bhasma, Naga Bhasma,
Tamra Bhasma, Abhra Bhasma, Tikshana Bhasma, Nagara, Maricha, Kana, Vara Drava, Vyosha
Drava, Nirgundi Drava, Vahni Drava, Markavaja Drava, Sigru Drava, Kushta Drava, Dhatri Drava,
Visa Musti Rasa, Arka Rasa, Hata Rasa,Ardraka Rasa etc
Indications: Ardita, Dhanurvata, Avabahuka, Vataroga
Usage: Internal
Dosage:125mg
4. Brihat Soota Sekhara Rasa:[SUTA SHEKHARA RASA]
Ingredients: Suddha Suta, Tankana, Vatsa Nagaka, Sunthi, Marica, Unmatta Bija, Pippali,
Gandhaka, Tamra Bhasma, Ela, Tvak, Patra, Nagakesara, Sankha Bhasma, Bilva Majja, Kacoraka,
Bringa Raja Rasa etc
Indications: Amla Pitta, Chardi, Gulma, Kasa, Grahani, Tridoshaja Atisara
30
Usage: Internal
Dosage:125mg
6. Manasamitra Vati Gulika: (Sahasrayoga)

Ingredients: Bala, Nagabala, Vilva, Sankhapushpi, Pushkara, Vacha etc
Indications: Manasa vikaras
Usage: Internal
Dosage: 500mg tablets twice daily after food.
Ghrita:
1. Mayura Ghrita: (Charaka)

Ingredients: Dasamoola, Bala, Rasna, Triphala, Madhuka, Mayura pakshi etc
Indications: Shiroroga, Ardita, Urdhwajatru Rogas etc
Usage: Internal
2. Mahamayura Ghrita : (Charaka)

Ingredients: Same like Mayura Ghrita, Added more Kalka like Triphala, Jeevaniya gana etc
Indications: Shiroroga, Kasa, Swasa, Shosha etc
Usage: Nasya, Paana, Abhyanga, Vasti prayoga
3. Varanadi Ghrita : (Ashtanga Hrudaya)

Ingredients: Varana, Sairyaka, Dhana, Morata, Vilva, Vishanika, Karanja etc
Indications: Shirashula, Gulma, Vidradhu, Medoroga etc
Usage: Internal
Taila:
1. Kumkumadi Taila: (Yogaratnakara)

Ingredients: Kumkuma, Chandana, Lodhra, Raktacandana, Ushira, Manjishta etc
Indications: Mukha roga, Twak vikaras
Usage: External application
2. Bala Hathadi Taila : (Sahasrayoga)

Ingredients: Bala, Amalaki, Guduchi, Mudga, Masha etc
Indications: Shiroruja
Usage: External application over the head
3. Asana Vilwadi Taila : (Sahasrayoga)

Ingredients: Asana, Vilva, Bala, Guduchi etc
Indications: Shiroroga, Karnaroga
4. Bala Dhatryadi Taila : (Sahasrayoga)

Ingredients: Bala, Amalaki, Guduchi, Ushira, Hrivera, Chandana, Yasti etc
Indications: Shiroroga, Netraroga, Pitta Vata Vikaras
5. Rasnadi Taila : (Charaka)

Ingredients: Rasna, Shaliparni, Prishniparni, Brihati, Kantakari, Gokshura etc
Indications: Shiroroga
31
Usage: Nasya
6. Baladya Taila : (Charaka)

Ingredients: Bala, Madhooka, Yashtyahva, Vidari, Chandana etc
Indications: Shiroroga, Urdhwagata rogas, Pitta Vikaras
Usage: Nasya
Choorna:
1. Krishnadi Vati : (Sahasrayoga)

Ingredients: Kundurushkam, Sahasravedi, Sanninayakam etc
Indications: Shirashoola
Usage: External application over the forehead as paste with rose water
2. Rasnadi Choorna: (Sahasrayoga)

Ingredients: Sugandhavacha, Devadaru, Sanninayaka, Ashwagandha, Vacha etc
Indications: Shirashoola, Timira, Kapha vikaras etc
Usage: External application over the forehead as paste with rose water / ginger juice
3. Kachooradi Choorna: (Sahasrayoga)

Ingredients: Yashti, Bala, Dhatri, Chandana, manjishta, Ushira etc
Indications: Shirashoola, Daha, Bhrama etc
Usage: External application over the forehead as paste with rose water
Single Drugs:
1. Rasna:
Usage: Internal / Externally as Lepa can be applied
2. Tila:
Usage: Tila mixed with milk and made into paste and applied over forehead
Pathya & Apathya in Ardhavabhedaka:

Pathya:
1. Kriyakala: Swedana (Heating), Nasya Dhumpana, Virechana, Lepa, Vamana, Langhana,
Shirobasti, Raktamokshana, Dahan (cauttery) on frontal and supra orbital region, Upanaha.
2. Diet: Consuming old Ghrita, Shali, Shashtikshali, Yusha, Soup, Milk, Dhanvamansa,
Madhumusta, Sanyab, Ghritapura.
3. Vegetables: Patolam, Shigru, Vastuka, Karvellaka.
4. Fruits: Mango, Aamlaki, Dadima, Matulunga, Lemon, Grapes, Coconut.
5. Liquid Diet: Milk, Oil, Coconut water, Kanji, Takra.
6. Medicines: Pathya, Kushta, Bhringaraj, Kumari, Musta, Ushira, Karpura.
Apathya:
1. Holding of the natural urges like Sneezing, Yawning, Micturation, Sleep, Lacrimation, Stool
excretion.
2. Diet: Consuming cooked and uncooked food, Impure water, Curd, Lassi, Cold drinks, Water
of the rivers of Sahyadri, Vindhyas, kapha producing diet.
3. Activities: Teeth brushing, (dhantadhavana); Day sleeping (divaswapana).
32
Management of Ardhavabhedaka by Panchakarma
Vd.M.Prasad
Ayurveda vachaspathi.
Director
Sunethri Ayurvedashram and Research centre
Trikkur
Trissur
Cell:09446229370
Opening
This paper is not prepared on the basis of a theoretical platform. Rather, these are a clinician‘s
views. Ardhavabhedakam is basically a vatha-predominant condition and it is apparent that
sodhanachikitsa is of minimal significance in its management. But there are many clinical situations
where shamanachikitsa alone will not be sufficient. These points are discussed here. Situations
where patient cannot be managed in the OPD are also included for the sake of completion of the
subject. A case in which Shamana snehapana was seen very effective is included as on opening
note.
A case study
45 year old lady presented with severe episodic head ache for 2 years. Each episode lasted for 5
to 8 minutes, with at least one weekly episode. Attack starts as right-sided head ache, followed by
severe right-sided facial pain, which made her unconscious each time. No connection was elicitable
between the attacks and some other activity of daily living, like exertion, stress, food or so. She was
a widow, with medium physical built, otherwise healthy. No history of any other systemic ailments,
and was working as a storekeeper with negligible mental stress. They had tried all options of
medicines and all routine investigations were conducted. Analgesics showed short-term remissions,
but no cure. The case was evaluated in the OPD and later in the IPD. Based on the spectrum of
presentation, it was a case of ardhavabhedakam with vatha preponderance. No element of kapha or
pitha was evident. She was put on a mruduvirechanam with erandathylam in milk and then posted
for a samanasnehapanam with Kallyanaka Ghrtham. 30 ml of Ghrtham was given at bedtime
followed by one sip of warm milk. This continued for 15 day. The symptoms subsided completely
and the status is maintained for the last 4 years. She is on a regular use of some murdhathylam
(ksheerabala, if I am right) and no medicines are on the list.
Ardhavabhedakam
Like any other headache, ardhavabhedakam is a headache to the doctor as well as the person
who suffers it. It is more so than other regular headaches for its unpredictable onset, severity and
mysterious style of presentations. It is basically a type of vathika sirassoola, with case-specific
association of kapha, and almost-always dissociation of pitha.
In the textbooks it can be seen divided into two types, kevalavathika and kaphavathika. (Ref:
Caraka Samhitha). The causative factors identified are:-
33
1. dietary irregularities (rukshasana, atyasana, and adhyasana)
2. climatic exposures (wind from the east, fog)
3. sexual intercourse
4. withholding natural urges
5. stress (mental – ayasa)
6. physical strain (vyayama)
So these factors suggest chances of vathakopa, vatha pratilomya (udavarthajanya), and

agnidushti. Basically all these conditions of samprapthi are to be managed by samanachikitsa. But
there are situations which demand sodhanachikitsa. They are:-
1. Chronic course of the disease where the dosha/s become leena and does not yield to samana
chikitsa.
2. role of udavartha is very strong
3. Kapha has significant role in the samprapthi as shown clinically by shirogurutwam, sakapha-
vamanam and prasekam.
Ardhavabhedakam as upadrava
There are certain clinical conditions which precipitate ardhavabhedakam.

1. cervical conditions: manyasthambham
2. eye disorders: adhimantham
3. Sinus problems: acute exacerbations of chronic sinusitis
Treatment approach
The following approaches are adopted as and when needed.

1. kevalavatha chikitsa – vathika sirassoola.
2. sakapha vathika chikitsa
3. udavarthachikitsa
4. management of primary causes in secondary ardhavabhedakam
5. rasayana
Kevalavatha chikitsa
Samanayamchikitsa
snehanam: shamana snehapanam
swedanam:
mrudushodhanam: virechanam
Visheshachikitsa: based on sthana samsraya
snehanam: murdhathylam
swedanam
nasyam: shamanam and/or brumhanam.
The commonly used medicines for nasya are anuthylam, varanadi ksheeraghrtham and
ghrthamandam
virechanam (mrudusodhanam) in ardhavabhedakam- vathika

- erandathylam is used generally
- may be used with ksheeram, or as mixture with jambeeraswarasa, ardrakaswarasa
and saindhava
34
murdhathylams in ardhavabhedakam
- shirodhara
- shiropichu
- shirovasthi
Commonly used snehas include
- ksheerabala
- dhanwantharam
- balaswagandhadi
- baladhathryadi
- chandanadi
- vathasani
- vidaryadi yamakam
After a course of snehana it is ideal to do nasya for a few days.
Jatrurdhwa swedanam
Eventhough swedanam is contraindicated in jatrurdhwa, rational use of swedanam is practised

in kevala vatha. Murdhathyla done in a controlled temperature is a practical method for this
purpose.
More specifically, nadisweda is done here. Simple bashpasweda and ksheera bashpa sweda are the
commonly practised methods. In the latter, boiling mixture of balamula and ksheera are used.
Jatrurdhwa is subjected to abhyanga before this.
sakapha vathika chikitsa
Control of kapha is the first target. samanachikitsa is the rule here. Sodhana is indicated when the
level of kapha is prabhootha. The tools are
1. vamanam
2. shodhana nasyam
The commonly used medicines for nasyam are shadbinduthylam and anuthylam.
Udavarthajanya ardhavabhedakam
Vegadharana and the resultant udavartha lead to the manifestation of ardhavabhedakam. This
is a very common clinical situation. The most common vegas involved are mala, mutra, kshavathu
and nidra. Of these the first two are of specific clinical importance. Care should be taken in the
prasnapareeksha to get valid information about these habits. And once diagnosed the management
should be planned accordingly. Snehavasthi, (may be mathravasthi), kashayavasthi, phalavarthi,
and avapeetakasnehapanam are the treatments of choice here. Without addressing the udavartham
no medicine will work in such cases. Pippallyadi anuvasanathylam, dhanwantharam thylam, and
sukumaraghrtham are used for the snehavasthi. Simple madhuthylika vasthi is done as nirooha. A
course of yogavasthi is seen to give excellent results.
Ardhavabhedakam as upadrava
In situations where udavartham is precipitated as an upadrava of a pre-existing condition, that

should be managed first and then proper management is to be adopted for ardhavabhedakam.
Situations like chronic sinusitis needs proper shodhanachikitsa. All adhimanthas tend to precipitate
ardhavabhedakam. They should be managed properly. Degenerative problems of cervical spine are
to be managed independently and then focus should be shifted to ardhavabhedakam.
35
Ardhavabhedakam of „obscure‟ nidana
Many times ardhavabhedaka can be seen precipitating without any specific cause. But in such
cases, an observation made by Acharya Vagbhata in Ashtangasamgraha (chapter Roganutpadaneeya
of Sutrastana) may give very important clue. He comments that sirassoola can be manifested (along
with other many other disorders) in those individuals who do not care for ruthusodhanam. It is true
that all individuals who do not practice ruthusodhanam do not develop ardhavabhedakam. But in a
given case where the nidana is a near non-entity, this may open up a straight-forward path for an
effective management.
36
CURRENT UNDERSTANDING OF ARDHAAVABHEDAKA WITH
MODERN
PERSPECTIVE
INTRODUCTION
Dr. U. Indulal
The Arya Vaidya Chikitsalayam & Research Institute
136 – 137, Trichy Road,
Ramanathapuram. P. O,
Coimbatore – 641 045 Tamilnadu
dr.indulal@avpayurveda.com
Headache is the most frequent ailment tormenting mankind since time immemorial and it is now
considered to be the most common neurologic disorder. Under the broad heading of headache
comes a wide range of conditions, from benign exertional headache to more serious
conditions like a trigeminal neuralgia or the one induced by an intracranial neoplasm. It
is essential to make a correct differential diagnosis for the best benefit of the sufferer. Migraine
is the most common one among the multitude number of headaches. Despite this high
incidence and increased frequency of visits for medical care, Migraine continues to be an
enigma many times, as it is poorly understood, recognized and hence inadequately managed. It
is self limiting in nature and yet each attack may be accompanied by serious symptoms urging
the need to have accurate interpretation and apt care so as to reduce the burden of the patients.
There are clinical, social, political and economic barriers preventing an effective understanding
and management of migraine to happen. The medicines commonly available for migraine
are actually invented for other diseases and when taken causes moderate to serious side
effects. Thus it is natural that patients with migraine, being dissatisfied with conventional
medicine, look for alternative approaches like Ayurveda.
In the absence of any tests to confirm the diagnosis, a condition like Migraine can pose a
serious challenge to an Ayurveda physician and thus create chances of clinical pitfalls. For us,
head is of prime importance and anything affecting the head needs to be managed effectively
and immediately1. Siroroga chapters in classical texts, like that of Vagbhata, explain
everything affecting head including dandruff and premature greying.
Ardhaavabhedaka, the condition explained in classical treatises and that which is usually
correlated with migraine, has serious consequences like neurologic deficits if left
ineffectively treated2. In such a situation it is essential for the physician to whet his/her
diagnostic skills and to perfect his therapeutic competence. Though the conventional
management of migraine have its own scope and limitations, the modern understanding of
migraine helps us greatly, especially in diagnosis. We need to know when we can treat a
headache and when we cannot.
This paper/presentation is to quickly revise the classical concepts of ardhaavabhedaka, to

approach the modern understanding of migraine from that perspective and to use the
outcome of that approach for the following purposes:
37
1
Ashtangahridaya. Uttarasthana. 24. 58 - 59
2
Ashtangahridaya. Uttarasthana. 23. 9; Charakasamhita. Siddhisthana. 9. 76
1. To increase the accuracy of diagnosis

2. To develop a system for assessment of headache based on history and functional
impairment.
3. To develop a system for results of this assessment to be used for identification of
treatment options/recommendations
4. To develop systems that allow for consistent documentation and monitoring
5. To develop system for follow-up assessment that identifies success in management of
headache in primary care setting.
6. To develop a process that will remove barriers to referral to a specialist if indicated.
ARDHAAVABHEDAKA /
MIGRAINE
Susruta considers it to be a three dosha dominant condition3. Charaka considers it as a Vata-

Kapha dominant one4. Vagbhata e plains it as a mere Vata condition and places it along with
vataja sirastapa5. But when we look at the symptoms of Migraine, with our
understanding of these e planations, we find the role of all the three doshas in varying
intensities. Before doing that comparison let us quickly look at the details of Migraine.
Migraine has various definitions, each helping us to understand the condition in a better way:
§ It is a benign and recurring syndrome of headache, nausea, vomiting and/or other
symptoms of neurologic dysfunction in varying admi tures6.
§ It is a common, chronic, incapacitating neurovascular disorder characterized by

attacks of severe headache, autonomic nervous system dysfunction and in some
patients, an aura involving neurologic symptom7.
§ It is a familial disorder characterized by recurrent attacks of headache widely

variable in intensity, frequency and duration8.
PATHOGENESIS
The hypotheses behind the cause of migraine were initially vascular and later neurologic. The
vascular theory considered the headache phase of migraine attacks as that caused by e tracranial
vasodilatation and the neurological symptoms produced by intracranial vasoconstriction.
It was later proved that simple vasoconstriction and vasodilatation are
unlikely causes for the abnormalities in migraine. Though cerebral blood flow is altered in
3
Susrutasamhita. Uttaratantra. 25. 26
4
Charakasamhita. Siddhisthana. 9. 75
5
Ashtangahridaya. Uttarasthana. 23.7
6 th
Harrison‘s Principles of Internal Medicine, 16 Edition; p85
7
Migraine — Current Understanding and Treatment. Peter J. Goadsby, M.D., D.Sc., Richard B. Lipton, M.D.,
and Michel D. Ferrari, M.D., Ph.D. N Engl J Med 2002; 346:257-270
8
World Federation of Neurology
38
certain migraine attacks, all the clinical syndrome of this disease cannot be explained by that.
The neurologic theory suggests that neuronal abnormalities could be the cause of migraine
attack. Fortification spectrum is a migraine aura characterized by a slowly
enlarging visual scotoma with luminous edges. It is believed to result from spreading
depression, a slowly moving (2 or 3 mm/min), potassium liberating depression of cortical
activity, preceded by a wavefront of increased metabolic activity.
TRIGGERING FACTORS
39
o Bright lights or glare
o Noise
o Head or neck injury
o Weather changes
o Motion
o Odours
o High altitude
o Physical strain
• Lifestyle:
o Chronic levels of stress
o Skipping meals / Poor diet
o Disturbed sleeping pattern
o Smoking and drinking
• Hormonal
o Puberty
o Menopause
o Menstruation
o Pregnancy
• Emotional
o Anxiety
o Depression
o Anger
o Excitement
o ―let-down‖ approach
• Medications:
o Nitroglycerin
o Nifedipine
o Oral contraceptives
oHRT
• Dietary
FREQUENCY AND DURATION OF MIGRAINE

ATTACKS:
The frequency and duration varies from patient to patient. However the pattern of
occurrence could be depicted thus, from the available statistics:
i. Victims on an average have 1 or 2 daylong attacks every month

ii. 10 % of them get it every week
iii. 20 % experience them for 2 – 3 days
iv. 14 % have them for more than 15 days a month.
40
FOUR PHASES OF
MIGRAINE
There are four phases of Migraine – prodromal, aura, headache and postdrome9. This is
quite unlike most headaches. All migraine patients do not go through these phases either.
Prodromal phase:
Among them prodromal phase is experienced by 60% of the patients. The typical features of
this phase are difficulty in concentrating, yawning, fatigue and sensitivity to light and noise.
The duration of this phase would be a few hours to few days.
Aura
Phase:
30% of the patients undergo this phase. The typical features of this phase are visual illusions
of sparks and lights, often followed by blind or dark spots in the same configuration as the
earlier bright hallucinations. The duration of this phase would be 20 – 60 minutes.
Headache
Phase:
All patients, except those experiencing migraine variants, undergo this phase. Typical
features include excruciating pain accompanied by sensitivity to light and sound, nausea and
vomiting. The duration is usually 4 to 72 hours.
There are two major types of migraine - Migraine with aura is known as Classic Migraine and
Migraine without aura is known as Common Migraine. In Migraine without Aura, no focal
neurologic disturbance precedes the recurrent headaches. It is the most frequent type of
headache. In Migraine with Aura, premonitory sensory, motor or visual symptoms are
present. Focal neurologic symptoms are more common during the headache attacks than as
prodromal symptoms.
9
David W. Dodick, J Jay Gargus; Why Migraine Strike; Scientific American. August 2008. P 34 - 41
41
Severity Levels of
headache:
Mild: Patient is aware of a headache but is able to continue daily routine with
minimal alteration.
Moderate: The headache inhibits daily activities but is not incapacitating.
Severe: The headache is incapacitating.
Status: A severe headache that lasted more than 72 hours.
Postdromal Phase:
70% of the patients undergo this phase. It is characterized by persistence of sensitivity to

light and movement, as well as lethargy, fatigue and difficulty focusing. The duration of this
phase is a few hours to a few days.
MIGRAINE VARIANTS AND WARNING SIGNS
Migraine Variant is a migraine that exhibits in a form other than headache. It is

characterized by history of prolonged visual auras; atypical sensory, motor, or visual aura;
confusion, dysarthria; focal neurologic deficits; gastrointestinal manifestations; or other
constitutional symptoms with or without a headache. The diagnosis is determined by history
of paroxysmal signs and symptoms with or without cephalgia, a prior history of migraine
with aura, in the absence of other medical disorders that may contribute to the symptoms.
Many of these patients have a family history of migraine.
As we are dealing only with ardhaavabhedaka, we will not discuss these variants here.
However the causes for concern must be evaluated irrespective of the patient‘s past history of
headache. Warning signs of possible disorder other than primary headache are:
• Subacute and/or progressive headaches that worsen over time (months)

• A new or different headache or a statement by a headache patient
that "this is the worst headache ever."
• Any headache of maximum severity at onset.
• Headaches of new onset after the age of 50 years old.
• Persistent headache precipitated by a Valsalva maneuver
• Evidence such as fever, hypertension, myalgias, weight loss or scalp
tenderness suggesting a systemic disorder.
• Neurological signs that may suggest a secondary cause.
• Seizures.
42
DIAGNOSIS OF
MIGRAINE
There are no tests that confirm the diagnosis of primary headache. Greater experience on
the part of the clinician allows for a higher level of confidence in diagnosis. International
Classification of Headache Disorders (ICHD-II) criteria depend largely on a detailed
headache history and the exclusion of secondary cause for headache through a
physical and neurological examination.
I. POUNDing Migraine Screening and Scoring System10
P = Pulstaing quality
O = hOurs of duration 4 – 72
U = Unilateral location
N = Nausea or vomiting
D = Disabling intensity
Number of ―yes‖ answers to the above questions:
5 Migraine likely
3 – 4 Migraine possible
1 – 2 Migraine unlikely
II. The diagnostic criteria for Migraine are11:
A. At least 2 of 1 – 4, plus 1 of 5 or 6:
1. Unilateral location
2. Pulsating/throbbing quality
3. Moderate or severe intensity
4. Aggravation by routine activity
5. Nausea and/or vomiting
6. Photophobia and phonophobia
B. Aura criteria
1. One of more fully reversible aura symptoms

2. At least one aura symptom develops over more than 4 minutes or two or
more symptoms occur in a succession
10
Detsky ME, McDonald DR, Baerlocher MO, et al. Does this patient with headache have a migraine or need
neuroimaging? JAMA 2006;296:1274-83.
11
Diagnosis and Treatment of Headache, Institute of Clinical Systems Improvement; Modified from the
International Classification of Headache Disorders (ICHD – II)
43
3. Symptoms do not last more than 60 minutes
4. Attack follows within 60 minutes
C. Previous similar attacks
D. Organic disorder is ruled out by the initial evaluation or by diagnostic studies.

If another disorder is present, the headaches should not have started in close temporal
relationship to the disorder.
III. Chronic migraine
Chronic daily headache is not a diagnosis but a category that may be due to disorders
representing primary and secondary headaches. Headache (tension-type and/or migraine) on
greater than or equal to 15 days per month for at least three months is considered to be
chronic.
ASSESSMENT TOOLS
Two commonly used assessment tools are:
1. Migraine Disability Assessment Questionnaire (MIDAS)

2. Headache Impact Test (HIT – 6)
These tools are simple and help the physician and the patient to quantify the impact and the response to
adopted treatments or medicines. Both the questionnaires are attached.
With this available and essential information we will work on the diagnostic algorithm for
Migraine, as attached.
44
DIAGNOSTIC ALGORITHM
Patient presents with complaints of a Head ache
Critical First Steps:
• Detailed History
• Focused Physical Examination
• Focused Neurologic Examination
Causes for Concern Yes Consider Secondary

headache disorder
No
Meets criteria for Primary Headache disorder Specialty consultation

indicated
Yes Yes
Evaluate type of Primary Headache Refer to a specialist
Migraine
Categorise according to severity
Mild Moderate Severe Status
Treatments
Acute Prophylactic
Successful No Specialty consultation indicated
45
MIGRAINE DISABILITY ASSESSMENT QUESTIONNAIRE (MIDAS)
Instructions: Please answer the following questions about ALL the headaches you have had over the last 3 months. Write
your answer in the box next to each question. Write zero if you did not do the activity in the last 3 months.
1. Lost days from work

How many days in the last 3 months did you miss
work or school because of your headaches? (If you
do not attend work or school enter zero in the box.)
Days
2. Lost productivity days at work or school

How many days in the last 3 months was your productivity
at work or school reduced by half or more because of
your headaches? (Do not include days you counted in Days
question 1 where you missed work or school. If you do
not attend work or school enter zero in the box.)
3. Lost household workdays

On how many days in the last 3 months did you not
do household work because of your headaches?
Days
4. Lost productivity days at home
How many days in the last 3 months was your productivity
in household work reduced by half or more because of
your headaches? (Do not include days you counted in Days
question 3 where you did not do household work.)
5. Lost social days

On how many days in the last three months did you
miss family, social, or leisure activities because of Days
your headaches?
(Questions 1-5) Total: _______________________ Days
A. On how many days in the last 3 months did you

have a headache?
(If a headache lasted more than
1 day, count each day.) Days
B. On a scale of 0-10, on average how painful were

these headaches?
(Where 0 = no pain at all, and 10 = pain as bad as it can be.)
Days
After you have filled out this questionnaire, add the total number of days from questions 1 to 5 (ignore A and B).
Grade Definition Score
I Minimal or infrequent disability 0-5
II Mild or infrequent disability 6-10
III Moderate disability 11-20
IV Severe disability 21+
If your MIDAS score is 6 or more, please discuss this with your doctor.
46
Abstracts.
47
A CASE PRESENTATION OF ARDHAVABHEDAKA
Dr. Hari.G*,DrPrashanth.A.S**
ABSTRACT
It is regarding a case presentation of a patient attended in the Kayachikitsa OPD of Ayurveda

mahavidyalaya hospital, hubli. On 11th April 2010, a Hindu female patient of 35 years presented with
complaints of headache more severe in right side suffering since last 5 years.
The case was diagnosed as ardhavabhedaka and treatment was started. The patient got admitted in
the IPD on 22/04/10. She underwent therapies like nasya and shirodhara along with oral medication.
The patient was discharged on 28/04/10 after getting relieved of the complaints. She was advised to
continue oral medications.
The full details of the case will be presented.
*2nd Year Post Graduate Scholar, PG Dept of Kayachikitsa, Ayurveda Mahavidyalaya, Hubli.
** Professor & HOD, PG Dept of Kayachikitsa, Ayurveda Mahavidyalaya, Hubli.
48
Ardhavabhedaka in the present era.
Chaitra.S *
ABSTRACT.
Ardhavabedaka is jatrurdvagata vikara explained under Shiroroga by all the texts of Ayurveda. It presents
with excruciating bursting, pricking pain and piercing pain in one half of the head affecting eyebrows, ear,
eyes, forehead in affected half. When not treated in time will aggrevate further and causes impairment in the
sensory functions. All the authors have given importance to the involvement of Vata dosha as prime factor
in the pathology. Yet some opined association of Pitta and Kapha dosha. So various treatment modalities
have been explained like nasya, Snehana, shiribasti etc. In the present era Migraine is the condition which is
in par excellence with Ardhavabhedaka. It is a neurological syndrome characterized by unilateral, pulsating,
severe pain along with nausea, photophobia, phonophobia which indicates the involvement of eyes, ears and
sensory manifestations like Ardhavabhedaka. Even further the patients presents with different phases like
prodrome, aura, pain and postdrome phase which supports the ideas of ancient texts of Ayurveda regarding
the manifestation of this grave condition. The management of migraine is mostly symptomatic treatment. So
understanding of these conditions will help to adopt a apt treatment protocol.
Key words : Ardhavabhedaka, Migraine, Pain, Vata,Shiroroga, Jatrurdvagata vikara.
*Final year PG, dept of Kayachikitsa, SDMCA, Udupi.
49
“ RAKTA MOKSHANA IN ARDHAVABHEDAKA”
Dr.PRASANTH.D*, Dr.ZENICAA D‟ SOUZA**.
Being a time tested remedy Panchakarma, the unique contribution of Ayurveda has its special
advantage over other treatment protocols. Raktamokshana among them, even though a beneficial procedure
is very rarely practiced among routine chikista karmas due to the various risk factors associated with it.
Especially when it comes to diseases like Ardhavabhedaka, which is classified among the shirorogas the
practical application of Raktamokshana is still far behind in clinical practices.
Acharyas have varying opinions in the concept of doshic involvement on Ardhavabhedaka, but
taking a due consideration of samprapti we can understand that Raktamokshana can be a beneficial
treatment modality that can be practiced easily. Even in the modern parallels Ardhavabhedaka is considered
to be equivalent to Migraine which accepts the vascular theory as one of its pathophysiology.
Here in my paper , iam making a humble attempt to revive the practice of Raktamokshana through a
conceptual evalution in scientific lines that can prove beneficial in the treatment of Ardhavabhedaka after a due
exploration and consideration with various samhitas and contemporary paralells.
* Second year PG scholar, Department of Panchakarma, Alva‟s Ayuverdic Medical College,

Moodbidri.
**HOD and Assistant professor, Department of Panchakarma, AAMC, Moodbidri .
50
A CLINICAL MANAGEMENT OF MIGRAINE (ARDHAVABHEDAKA)
THROUGH
NASYA AND SHIRODHARA
Dr.D.Ragavendran* , Dr.Twinkle Gupta** , Dr.P.G.Subbanagouda***
ABSTRACT
BACKGROUND AND OBJECTIVES:
Migraine (Ardhavabhedaka) is one of the commonest Neurological disorders and is a chronic

condition of recurrent attacks, widely variable in intensity, frequency and duration. It is usually associated
with nausea, vomiting and visual disturbances. About 10-20% of the population is estimated to suffer from
it. 15% women and 6% of men are usually affected as it is more commonly seen in females and middle age
persons. Treatment of migraine available in modern science is having serious side effects. To tackle such
disease entities, Ayurveda, the ancient system of medicines, introduced a variety of effective natural
medications, which gives a befitting answer to it.
The objectives were to evaluate the efficacy of Navana Nasya and Shirodhara in Migraine
(Ardhavabhedaka) and to formulate a comprehensive therapy for Migraine (Ardhavabhedaka).
METHODS:
In the present study, 2 groups were made. Group A received Navana Nasya with Anutaila, Suvarna
Sutsekhara rasa with Pathyadi Kashaya as anupana. Group B received Shirodhara with Ksheerabala taila,
Suvarna sutsekhara rasa with Pathyadi kashaya. The duration for both the groups was 70-75 days with
follow up of 3 months.
RESULTS:
Both the groups, Group A and Group B provided highly significant results in all the parameters of
assessment. The comparative analysis of both the group showed statistically insignificant.
INTERPRETATION AND CONCLUSION:
Navana Nasya, Shirodhara along with Suvarna Sutsekhara rasa with Pathyadi Kashaya as Anupana
have showed better effect in the patients.
The life style modifications including Dietary habits too, counseling, drugs and relaxation techniques
which calms the mind will definitely going to help Migraine (Ardhavabhedaka).
KEY WORDS:
Migraine, Ardhavabhedaka; Navana Nasya; Anutaila; Shirodhara; Ksheerabala taila; Suvarana
Sutsekhara rasa; Pathyadi Kashya.
* 2nd Year Post Graduate Scholar, Dept of PG studies in Kayachikitsa, Ayurveda Mahavidyalaya,
Hubli.
** Alumni, MD (Ayu) in Kayachikitsa, Ayurveda Mahavidyalaya, Hubli
*** Professor & HOD, Dept of PG studies in Kayachikitsa, Ayurveda Mahavidyalaya, Hubli.
51
MANAGEMENT OF ARDHAVABEDHAKA
DR.ARUN J WILSON*, DR.JEAN GEORGE*, DR.ZANICA**.
ABSTRACT
Ardhavabhedaka means ― Ardha Mastaka Vedhana”
Ardhavabedhaka can be correlated with Migraine due to its cardinal feature ―half sided headache”.
Migraine is one of the common cause of recurrent headache, which constitutes 16% of the primary
headache and affect 10-20% of the general population, which is more prevalent among 35-40years old and
become 60% higher in lower income individuals. This illness affects their ability to work and to attend
institutions for higher learning, there by not getting higher paying jobs.
The modern drugs are not acceptable due to their drawbacks such as drug dependence, drug withdrawal
symptoms, relapse of headache within hours and chance of getting chronic headache.
Based on Ayurveda, Chikitsa is classified into two. ie, Shodhana and Shamana. In this poster
presentation, a humble attempt is made to highlight the different types of management told under Shodhana
eg-Dashamoola Kwatha Nasya, Shamana eg-Pathyadi Kwatha in classics. Rest of the things are discussed in
poster presentation

Moodbidri.
52
„„A clinical study to evaluate the efficacy of Shigruvadi Taila
Nasyakarma in Ardhavabhedaka‟‟
DR.PRIYA CHANDRAN* , DR.ZENICA D‟SOUZA**.
ABSTRACT.
Ardhavabhedaka is a condition in which pain is felt in the nape of the neck, eye brows, temporal
region, ears, eyes, half portion of the frontal region resembling paroxysmal unilateral headache associated
with vertigo and pain of varying intensity Very similar in line with the Migraine.
The term "migraine" refers to a syndrome of vascular spasms of the cranial blood vessels.
Symptoms of a migraine attack may include heightened sensitivity to light and sound (sonophotophobia),
nausea, auras, difficulty in speech and intense pain predominant on one side of the head. It is classified with
or without auras (seeing bright "spots" or "stars").
Migraine is one of the common causes of recurrent headache. It is three times more common in women
than men. More than 2/3rd of Migraine sufferers either have never consulted a doctor or have stopped doing
so. It is quite undiagnosed and undertreated, hence WHO ranks Migraine one among the World‘s disabling
medical illness.
Objective of the study is ‗To evaluate the efficacy of Shigruvadi Taila (Chikitsamanjari) Nasyakarma in the
management of Ardhavabhedaka‘.
The study is Single blind clinical study, comprising of 30 patients. Selection of patients is based on
diagnostic and a inclusion criteria with a special proforma with systemic history taking, physical
examination and investigations.
Nasyakarma is performed for 7 days with 8 drops of Shigruvadi Taila.
The results are assessed on statistical findings based on the parameters and statistically significant results
were found.
* Third year PG scholar, Department of Panchakarma, Alva‟s Ayuverdic Medical College,

Moodbidri.
**HOD, Department of Panchakarma, AAMC, Moodbidri .
53
Innovative Ayurvedic Practices in Ardhavabhedaka
Dr.Prasanth.D* ,Dr.K.N.Rajasekhar**.
Abstract.
Ayurveda- the science of life deals with a lot of pathological concepts for the diagnosis of a disease and its
treatment principles to combat a disease
Ardhavabhedaka is a condition of vata characterized by an obstruction in the gati of vata paralyzing it in

performing its activities by Kapha and thereby leading to various clinical symptoms .As per.the varied
opinions of Acharyas, it comes under Tridoshaja and Vata Kapha Pradhana Doshaja classification of
Vyadhi. Irrespective of the Doshic involvement, there are certain treatment principles that are explained in
Ardhavabhedaka which are not commonly practiced in day to day practice such as Agni karma,
Raktamokshana, Dhoomapana, Lepa, Paadaghaata etc ,Which can be practiced according to yukthi which
can provide very fruitfull results.
In this Poster a humble attempt is made, how to Innovately deal with a case of Ardhavabhedaka with
those procedures which are not commonly practiced in clinical practice today , but with those which have a
base in the treatment principles explained according to different treatises of Ayurveda in par with the
modern co – relate Migraine, which can provide fruitfull results.

Moodbidri.
54
Snehana in Ardhavabhedaka
Ravikanth K *
ABSTRACT:
Ardhavabhedaka is condition caused due to Shiro Marmabhighata with a typical presentation of severe
headache in one half of the head with the involvement of eyes, ears, temporal region, forehead and
eyebrows, it has been mentioned as serious ailment that can even destroy the physiological functioning of
eyes, ears etc. All the authors have accepted the involvement of Vata as main culprit in this condition and so
the controlling the Vata itself becomes the major part in the treatment. Migraine is the condition which is a
near correlation to Ardhavabhedaka with its typical presentation of one sided headache and different stages
like prodrome phase, aura phase, headache phase and postdrome phase with symptoms like nausea,
vomiting, photophobia, and visual, auditory and other sensory abnormalities. Even though there are
different treatment modalities mentioned Snehana had a major role in combating Vata dosha and also
Snehana causes tarpana and there by Marmaparipalana. This snehana can be done in various as snehapana,
bahya sneha, nasya etc. So only there is every need to understand the scope of Snehana in the treatment of
Ardhavabhedaka.
Keywords: Ardhavabhedaka, Migraine, Headache, Snehana, Shiromarma, Nasya.
*Final year PG, dept of Kayachikitsa, SDMCA, Udupi.
55
A Critical Review on Diagnosis and Treatment of Ardhavabhedak w.s.r to
Migraine.
Shweta.A.H1, Zenica D‟souza2, Vasant.Patil3.
Abstract
Migraine is one of the common causes of recurrent headache. It has troubled mankind from dawn of
civilization. Migraine symptoms correlate with Ardhavabhedaka. Neurovascular headaches are the second
most common primary headaches, which includes migraines and cluster headaches.
Migraine or severe headache is a risk factor for stroke in both men and women, especially before age
50. Migraine can be a challenging disease to diagnose because its clinical diagnosis based on symptoms that
are subjective and verifiable only by the patient. Many medications have been tried and a lot are still in
research work also, but these modern drugs are not acceptable due to their side effects. Also they cause drug
dependence, drug withdrawal syndrome, relapse of headache within few hours. Some drugs cannot be
prescribed in migraine associated with other medical illness.
Acharyas have given brief description of causes, symptoms and treatment of Ardhavabhedaka, but
still there are controversies in Dosha involvement. Precise diagnosis is the key for radical relief of
Ardhavabhedaka. The line of treatment told according to the stage of disease is not clearly mentioned. Here
an attempt is made to critically analyze the Nidana Panchaka, diagnosis and treatment based on Avastha.
1
Second year PG scholar, Department of Panchakarma, Alva‘s Ayuverdic Medical College, Moodbidri .
2
HOD and Assistant professor, Department of Panchakarma, AAMC, Moodbidri.
3
Lecturer, Department of Panchakarma, AAMC, , Moodbidri.
56
“A critical review of the, doshic predominance and its utility in
diagnosis and management of Ardhavabhedaka”
Dr. Preetham Krishanaji Lamani*,Dr.Shripathi Adiga H ;
Abstract
The desire of leading a happy, healthy and utile life and the deeds facilitating the same
have always rendered man susceptible to pain and pleasure. With the same validatory view,
Ayurveda, the science of life has described various methods of preventing as well as
combating the numerous diseases. According to International Headache Society, which
works with the purport of 'Advancing headache science, education and management and
promoting headache awareness worldwide' , about 10 – 20 % of the general population
experience headache which demands medical attention at one or the other point of their life.
Ardhavabhedaka is one among the Shirorogas described in the Ayurvedic classics. In spite
of the fact that all the three doshas are responsible for the manifestation of the disease
Ardhavabhedaka, based on the predominance of each dosha, it can be understood to be of
individual doshic variety besides its combination. The thorough understanding of nidana
and samprapti also establish this view. The classics have given wide range of treatment
modalities in managing shirorogas. They also explicate exclusive principles such as
avapeedana nasya, agni karma, rakta mokshana...etc., Thus, the proper understanding of
Ardhavabhedaka with emphasis on its doshic predominance, will aid us in selecting the
appropriate treatment modality at the earliest.
Key words: headache, tridosha,ardhavabhedaka, chikitsa
*PG Scholar, Department of Ayurveda, KMC, Manipal

**Assisstant Professor, Department of Ayurveda, KMC, Manipal
57
Delegates List for Ayurvision 2010
Sl. No. Name Place
1. Dr. V. Prem Anand Kanya Kumari
2. Dr. Prathibha. B.P. Mangalore
3. Ms. Agamya. S. Udupi
4. Dr. Hariprasad Suvarna Belthangady
5. Dr. Prathibha Puranika. K. Kundapura
6. Dr. D. Ragavendran Thanjavur
7. Dr. Hari. G. Thiruvananthapuram
8. Dr. Rajesh Ballaya Mangalore
9. Dr. Amrutha Bantwal
10. Dr. Jayanthi Hyderabad
11. Dr. Nayana. S. Pai. Moodbidri
12. Dr. Priya Chandran Kannur
13. Dr. Kasturi. R. Adiga. Manipal
14. Dr. Jean George Kozhikode
15. Dr. Raiby. P. Paul Moodbidri
16. Dr. Prasanth. D. Kollam
17. Dr. Arun. J. Wilson Tamil Nadu
18. Dr. Susha John Moodbidri
19. Dr. Raviprasad Hegde Hebri
20. Dr. Maneesh Ladhava Gadag
21. Dr. Raghavendrachar. H.M. Gadag
22. Dr. Jagadeesh. L Davangere
23. Dr. Vijayraj. M Gadag
24. Dr. Sapna Shetty (PGCPK Manipal) Mangalore
25. Dr. Sumashri. T. (PGCPK Manipal) Raichur
26. Dr. Preetam. K. Lamani. (PGCPK Manipal) Bagalkot
27. Dr. Roopak Nagaraj. (PGCPK Manipal) Udupi
28. Dr. Harish. L. (PGCPK Manipal) Davangere
29. Dr. Suprabha Shetty. (PGCPK Manipal) Udupi
30. Dr. Prasanna. A. Rao. (PGCPK Manipal) Udupi
31. Dr. Soumya Kumari. (PGCPK Manipal) Mangalore
32. Dr. Deepak. (PGCPK Manipal) Udupi
33. Dr. Shweta. A. Honnungar Bijapur
34. Dr. Anjali Raichur Bangalore
35. Dr. Vidyoth Kumar. P.V. Kannur
36. Dr. Prema Chandran Kanjangad
37. Dr. Vivekanandan Annamala Kannur
38. Dr. K.V. Narayanan Kasargod
39. Dr. K. Ravikanth Visakhapatnam
40. Dr. Chaitra. S. Bengaluru
41. Dr. Shrilatha. A. Udupi
42. Dr. Annette Sahana Soans Udupi
43. Dr. Riyaz Ernakulam
44. Dr. Manu. K Parli Palaghat
45. Mr. Gururaj Desai Udupi
46. Dr. Rachana. K Surathkal
47. Dr. Clifford Misquith Surathkal
58
DHANWANTARI DAY CELEBRATIONS -
2010
59
Authorised Dealer,
Kottakkal Arya Vaidya Sala,
Opp. Corporation Bank, Manipal
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CME IN AYURVEDA ON

“CURRENT UNDERRSTANDING AND MANAGEMENT OF ARDHAVABHEDAKA

Exploring the new frontiers in academic and

- Maharishi Mahesh Yogi

It is unfortunate that Graduates of Modern medicine are deprived of any knowledge

Evidence based Ayurveda

While talking of searching and applying evidence base to Ayurveda, we need to

Referring to Ayurveda, however, the issue of applying evidence base needs to be

Dr. M. S. Kamath MD (Ayu.)

Day 1. 26th November 2010

Day 2. 27th November 2010

Chair person : Dr. Sripathi R Rao

Reception committee: Transport Committee & Accommodation

Master of Ceremony: Dr. Anupama Nayak

02. Current Understanding and Management of Migraine by

03. Analysis of Nidana Panchaka of Ardhavabhedaka by

04. Differential Diagnosis of Ardhavabhedaka by

05. Management of Ardhavabhedaka by Shamanoushadhis by

06. Management of Ardhavabhedaka by Panchakarma by

07. Current Understanding of Ardhavabhedaka with Modern Prospective by

Poornasya poornamadhay, poornamevaavshishyathe.)

The sensory sensitivity that is characteristic of migraine is probably due to dysfunction of

Therapy for acute attack of migraine

Preventive treatment for migraine:

Migraine prophylaxis is indicated in following situations:

1. Attacks more than 2 per week

mÉëÉhÉÉÈ mÉëÉhÉpÉ×iÉÉÇ rÉ§ÉÉÍ´ÉiÉÉÈ xÉuÉåïÎlSìrÉÉÍhÉ cÉ|

Shirashoola is a common manifestation of this vital organ Shiras experienced by almost

UÉåaÉqÉÉSÉæ mÉUÏ¤ÉåiÉ iÉiÉÉå AlÉliÉUÇ AÉæwÉkÉÇ|

ÍvÉUÉå UÉåaÉ vÉoSålÉ ÍvÉUÉåaÉiÉvÉÔsÉ ÃmÉÉ ÂeÉ AÍpÉSÏrÉiÉå - qÉkÉÑMüÉåvÉ

- AkÉÉïuÉpÉåSÈ AkÉïqÉxiÉMüuÉåSlÉÉ| (cÉ¢ümÉÉÍhÉ. cÉ. xÉÔ 7/16)

Â¤ÉÉirÉkrÉvÉlÉÉiÉç mÉÔuÉïuÉÉiÉÉuÉvrÉÉrÉqÉæjÉÑlÉæÈ| uÉåaÉxÉÇkÉÉUhÉÉrÉÉxÉ urÉÉrÉÉqÉæÈ MÑÌmÉiÉÉå AÌlÉsÉÈ|| - cÉ.ÍxÉ 9/74

Purva Vata / Avashyaya

UÉåaÉÉÈ xÉuÉåï AÌmÉ eÉÉrÉliÉå uÉåaÉÉåÌ®UhÉkÉÉUhÉæÈ| -A.¾û.xÉÔ 4/21

xÉÇkÉÉUhÉÉiÉç ÌSuÉÉxuÉmlÉÉiÉç UÉ§ÉÉæ eÉÉaÉUhÉÉlqÉSÉiÉç | EccÉæpÉÉïwrÉÉSuÉvrÉÉrÉÉiÉç mÉëÉauÉÉiÉÉiÉç AÌiÉ qÉæjÉÑlÉÉiÉç ||

vÉÔsÉÇ lÉiÉåï AÌlÉsÉÉiÉç...... A.¾û.xÉÔ 29/6

The invariable involvement of Rakta as a dushya in Shiroroga is mentioned by Charaka. He

qÉlrÉÉaÉëWû aÉÑÂiÉÉ mÉÔuÉï iÉåwÉÉÇ mÉëeÉÉrÉiÉå

rÉxrÉÉå¨qÉÉÇaÉÉkÉïqÉiÉÏuÉ eÉliÉÉå: xÉÇpÉåS iÉÉåS pÉëqÉ vÉÔsÉeÉÑ¹qÉç||

Pain is the characterising feature in Ardhavabhedaka. It is a severe pain of perforating or bursting

UeÉÈ ÌmÉ¨ÉÉÌlÉsÉÉiÉç pÉëqÉ qÉÉ.ÌlÉ 17/

This laxana is mentioned by Sushrutha for Ardhavabhedaka. It is contributed by Vata, Pitta

Nayana shravana vinasha

An analysis on the vyadhi bodhaka nidanas of Ardhavabhedaka convey that it is a pain

In conventional allopathic medicine, among the different specialisations there is no branch as

mÉëÉhÉÉÈ mÉëÉhÉpÉ×iÉÉÇ rÉ§É Í¤ÉiÉÉÈ xÉuÉåïÎlSìrÉÉÍhÉ cÉ |

ÍqÉjrÉÉSØ¹É ÌuÉMüÉUÉ ÌWû SÒUÉZrÉÉiÉÉå iÉjÉæuÉ cÉ |

Ardhavabhedaka or ardhabheda is a type of shiroroga where severe headache in the half

1) Disorders which can be differentiated easily.

2) Disorders coming in the way of diagnosis.

Diseases considered here-

Different types of migraine

S½iÉå ÃerÉiÉå iÉålÉ ÍvÉUÈ vÉÏiÉÇ xÉÑwÉÔrÉiÉå |

Diseases considered here-

ÍvÉUÉå qÉlSÃeÉÇ iÉålÉ xÉÑmiÉÇ ÎxiÉÍqÉiÉpÉËUMüqÉç |

Diseases considered here-

All pittakara nidanas are responsible for rakta dushti.

Aggravating & relieving factors- Sheeta and ratri kala

x§ÉÏ mÉëxÉÇaÉÉiÉç ApÉÏbÉÉiÉÉiÉç AjÉuÉÉ SãWûMüqÉïhÉÉ |

uÉÉiÉÌmÉ¨ÉÉiqÉMü ÍsÉaXÇ urÉÉÍqÉ´ÉÇ iÉ§É sÉ¤ÉrÉãiÉç |

Diseases considered here-

SÒ¹É SÉåwÉÉx§ÉrÉÉå……….. Cha.Si.9/84-86