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- 1. ICHD-3 AND YOGAIN SHIROROG: AN INTEGRATIVE APPROACH TO HEADACHE MANAGEMENT Created By : Abhinay Kureel NAIMINATH AYURVEDIC MEDICAL COLLEGE AND RESEARCH CENTER DEPARTMENT OF SHALAKYA TANTRA
- 2. LEARNING OBJECTIVES • •Understand ICHD 3 (International Classification of Headache Disorders, 3rd Edition) • • Explore Ayurvedic concept of Shirorog and its classifications • • Learn about yoga therapy and pranayama for headache management • • Understand the integration of modern and traditional approaches • • Examine evidence-based research on yoga for migraine and headache relief
- 3. INTRODUCTION TO ICHD3 • • International Classification of Headache Disorders, 3rd Edition • • Published by International Headache Society (IHS) • • Provides standardized diagnostic criteria for headache disorders • • Globally recognized classification system • • Updated from ICHD-2 with refined criteria and new entities
- 4. ICHD 3: MAJORCLASSIFICATIONS • PART 1: PRIMARY HEADACHES • • 1. Migraine • • 2. Tension-Type Headache (TTH) • • 3. Trigeminal Autonomic Cephalalgias • • 4. Other Primary Headache Disorders • PART 2: SECONDARY HEADACHES • • 5-12. Various secondary causes (trauma, vascular, infection, etc.) • PART 3: CRANIAL NEURALGIAS AND FACIAL PAIN • • 13-14. Cranial nerve disorders and other headaches
- 5. ICHD 3: PRIMARYHEADACHES - MIGRAINE • 1.1 Migraine without aura • • ≥5 attacks, 4-72 hours duration • • ≥2 characteristics: unilateral, pulsating, moderate-severe, aggravated by activity • • Nausea/vomiting OR photophobia/phonophobia • 1.2 Migraine with aura • • ≥2 attacks with reversible aura symptoms • • Visual, sensory, speech/language, motor, brainstem, or retinal • 1.3 Chronic migraine • • ≥15 headache days/month for >3 months
- 6. ICHD 3:TENSION-TYPE HEADACHE •2.1 Infrequent episodic TTH: <1 day/month • 2.2 Frequent episodic TTH: 1-14 days/month • 2.3 Chronic TTH: ≥15 days/month • Characteristics: • • Bilateral location • • Pressing/tightening quality • • Mild to moderate intensity • • Not aggravated by routine physical activity • • No nausea/vomiting • •photophobia/phonophobia
- 7. INTRODUCTION TO SHIROROGIN AYURVEDA • • Shiro = Head, Rog = Disease • • Encompasses various disorders of the head region • • Mentioned in classical texts: Charaka Samhita, Sushruta Samhita • • Head (Shira) considered as Uttamanga (superior organ) • • Seat of all sense organs and vital functions • • Controls Prana (vital force) and mental activities
- 8. CLASSICAL CLASSIFICATIONS OFSHIROROG • According to Acharya Charaka (5 types): • • Vataja, Pittaja, Kaphaja, Sannipataja, Krimija • According to Acharya Sushruta (11 types): • • Vataja, Pittaja, Kaphaja, Raktaja, Sannipataja • • Kshayaja, Krimija, Suryavarta, Anantavata • • Ardhavabhedaka, Shankhaka
- 9. VATAJA SHIROROG • Characteristics: •• Severe, sharp, pricking pain • • Pain like piercing needle • • Aggravates at night • • Associated with stiffness • • Giddiness and confusion • Modern Correlation: • • Tension-type headache • Treatment:Vata pacifying therapies, Nasya, Shirobasti
- 10. PITTAJA SHIROROG • Characteristics: •• Burning sensation in head • • Associated with heat and inflammation • • Aggravates in daytime/heat • • May have fever • • Redness of eyes • Modern Correlation: • • Inflammatory headaches • Treatment: Pitta pacifying therapies, cooling treatments,Virechana
- 11. KAPHAJA SHIROROG • Characteristics: •• Heaviness in head • • Mucus accumulation • • Stiffness and coldness • • Swelling around eyes • • Nasal congestion • Modern Correlation: • • Sinusitis-related headaches • • Cluster headaches • Treatment: Kapha pacifying therapies,Vamana, Nasya, Dhumapana
- 12. SPECIAL TRIDOSHAJA SHIROROGAS •Ardhavabhedaka (Migraine): • • Severe pain in half of head • • Pricking, tearing pain • • Mental confusion • • 10-15 days duration • Suryavarta: • • Starts gradually, peaks midday • • Subsides with sunset • • Related to sun's movement • Anantavata: • • Neck and shoulder involvement • • Stiffness in cervical region • • Eye symptoms
- 13. AYURVEDIC TREATMENT PRINCIPLESFOR SHIROROG • 1. Nidana Parivarjana (Avoid causative factors) • 2. Samshodhana Chikitsa (Purification therapies): • • Nasya (Nasal therapy) - Primary treatment • • Vamana (Therapeutic vomiting) - Kapha disorders • • Virechana (Therapeutic purgation) - Pitta disorders • • Basti (Therapeutic enemas) - Vata disorders • 3. Samshamana Chikitsa (Palliative treatments) • 4. External therapies: Shirobasti, Shirodhara, Shirolepa • 5. Lifestyle modifications andYoga
- 14. INTRODUCTION TOYOGA THERAPYFOR HEADACHES • • Ancient mind-body practice from India • • Combines physical postures (Asanas), breathing (Pranayama), and meditation • • Addresses multiple factors contributing to headaches: • • Stress reduction • • Muscle tension relief • • Improved circulation • • Nervous system regulation • • Hormonal balance • • Growing scientific evidence for headache management
- 15. MECHANISMS OFYOGA INHEADACHE RELIEF • 1. Stress Reduction: • • Activates parasympathetic nervous system • • Reduces cortisol levels • • Improves stress tolerance • 2. Physical Benefits: • • Relieves muscle tension in neck, shoulders • • Improves blood circulation to brain • • Enhances flexibility and posture • 3. Neurological Effects: • • Balances autonomic nervous system • • Increases vagal tone • • Reduces sympathetic overactivity
- 16. SCIENTIFIC EVIDENCE FORYOGAIN HEADACHE MANAGEMENT • Recent Research Findings: • • 2020 Neurology study: 3 months yoga reduced headache frequency and intensity • • Patients reduced migraine medication by ~50% • • Meta-analysis (2022): Significant reduction in pain intensity, frequency, duration • • Improved HIT-6 scores and MIDAS scores • • Better than medication alone • Specific Benefits: • • Reduced headache frequency: p<0.00001 • • Decreased pain intensity: p<0.0004 • • Improved quality of life scores
- 17. SPECIFICYOGA ASANAS FORHEADACHE RELIEF • 1. Child's Pose (Balasana) • • Calms nervous system, releases neck tension • 2. Cat-Cow Pose (Marjaryasana-Bitilasana) • • Relieves neck and spine tension • 3. Bridge Pose (Setu Bandhasana) • • Opens chest, relieves neck tension • 4. Legs Up the Wall (Viparita Karani) • • Reduces inflammation, promotes relaxation • 5. Corpse Pose (Savasana) • • Deep relaxation, stress relief
- 18. • Acute Relief(During a Headache): • Balasana (Child's Pose) • Savasana (Corpse Pose) • Viparita Karani (Legs-Up-The-Wall) • For Prevention: • Setu Bandha Sarvangasana (Bridge Pose) • Marjaryasana-Bitilasana (Cat-Cow Pose) • Adho Mukha Svanasana (Downward-Facing Dog) • Breathing (Pranayama) Nadi Shodhana (Alternate Nostril Breathing): Balances the nervous system and hemispheres of the brain.[ Highly effective for calming the mind and reducing stress, ideal for prevention. • Bhramari (Humming Bee Breath): The humming vibration has an immediate soothing effect on the nerves of the brain and forehead Recommended to mitigate active migraines by dissipating pain intensity.
- 19. PRANAYAMA TECHNIQUES FORHEADACHE MANAGEMENT • 1.Three-Part Breath (Dirgha Pranayama) • • Promotes diaphragmatic breathing • • Calms nervous system • 2. Alternate Nostril Breathing (Nadi Shodhana) • • Balances left and right brain hemispheres • • Reduces stress and tension • 3. Ocean Breath (Ujjayi Pranayama) • • Relaxes nervous system • • Helps during migraine episodes • 4. Bee Breath (Bhramari Pranayama) • • Calms mind, reduces anxiety
- 20. PRANAYAMA RESEARCH EVIDENCE •2023 Study on Pranayama as Adjuvant Therapy: • • 80 migraine patients (ICHD-3 criteria) • • Standard Medical Treatment (SMT) vs SMT + Pranayama • • 3-month intervention period • Results: • • Significant reduction in headache severity • • Decreased duration of headache episodes • • Improved HIT-6 scores • • Better MIDAS scores • • Pranayama group showed superior outcomes in duration and severity
- 21. INTEGRATION: ICHD 3,SHIROROG, AND YOGA • Correlation Approach: • ICHD 3 Ayurvedic Shirorog Yoga Therapy → → • • Migraine without aura Ardhavabhedaka Gentle asanas, Pranayama → → • • Migraine with aura Ardhavabhedaka Restorative poses, Meditation → → • • Tension-type headache Vataja/Anantavata Neck releases, Stress reduction → → • • Cluster headache Suryavarta Cooling pranayama, Relaxation → → • • Secondary headaches Various Shirorogas Targeted therapy based on cause → →
- 22. INTEGRATIVE TREATMENT PROTOCOL •Phase 1: Assessment • • ICHD-3 diagnostic criteria • • Ayurvedic Prakriti and Vikriti analysis • • Yoga therapy assessment • Phase 2:Treatment Plan • • Conventional medicine as needed • • Ayurvedic Panchakarma therapies • • Customized yoga program • Phase 3: Maintenance • • Regular yoga practice • • Lifestyle modifications • • Periodic Ayurvedic treatments
- 23. CONTRAINDICATIONS AND PRECAUTIONS •Yoga Contraindications: • • Severe acute headache/migraine episode • • Uncontrolled hypertension • • Recent head/neck injury • • Inverted poses during acute phase • Ayurvedic Considerations: • • Proper assessment of Dosha state • • Seasonal and constitutional factors • • Individual tolerance to treatments • General Precautions: • • Gradual progression in practice • • Professional guidance recommended • • Monitor response to treatments
- 24. CLINICAL CASE STUDYAPPROACH • Case Example: 35-year-old female with chronic migraine • ICHD-3 Diagnosis: Chronic Migraine (1.3) • • ≥15 headache days/month for 6 months • • Meets migraine criteria ≥8 days/month • Ayurvedic Assessment: Ardhavabhedaka (Vata-Pitta predominance) • • Stress-triggered, left-sided pain • • Associated with digestive issues • Yoga Intervention: • • 6-week program: 3 sessions/week • • Focus on stress reduction and neck releases • • Daily pranayama practice
- 25. KEY TAKEAWAYS • 1.ICHD-3 provides standardized modern diagnostic framework • 2. Ayurvedic Shirorog offers holistic understanding and treatment • 3.Yoga therapy shows strong evidence for headache management • 4. Integration of all three approaches offers comprehensive care • 5. Personalized treatment plans yield better outcomes • 6. Regular practice and lifestyle modifications are essential • 7. Professional guidance enhances safety and efficacy
- 26. CONCLUSION • The integrationof ICHD-3 classification, Ayurvedic Shirorog concepts, and evidence- based yoga therapy offers: • • Comprehensive diagnostic approach • • Holistic treatment strategies • • Evidence-based interventions • • Cost-effective management options • • Reduced dependency on medications • • Improved quality of life for patients • This integrative model represents the future of headache management, combining ancient wisdom with modern science.
- 27. REFERENCES • 1. HeadacheClassification Committee of IHS. ICHD-3. Cephalalgia. 2018;38(1):1-211. • 2. Charaka Samhita, Sutra Sthana, Chapter 17. Chaukhambha Publications. • 3. Sushruta Samhita, Uttara Tantra, Chapter 25-26. Chaukhambha Publications. • 4. Kumar A, et al. Effect ofYoga on migraine. PMC4097897. • 5. Long C, et al. Effectiveness of yoga therapy for migraine treatment. Am J Emergency Med. 2022. • 6. Effect of Pranayama as Adjuvant to Medical Treatment. PMC10666878. 2023. • 7. Kisan R, et al. Effect ofYoga on migraine: Clinical and autonomic functions. PMC4097897. • 8.Various Ayurvedic classical texts and modern research studies.
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