Quest Journals

Journal of Medical and Dental Science Research

Volume 10~ Issue 9 (2023) pp: 46-51
ISSN(Online) : 2394-076X ISSN (Print):2394-0751
www.questjournals.org
Research Paper

TreatingChronicMigraine with Traditional Siddha

therapy- A case study
Dr Bhuvanagiri Sathya Sindhuja1, Injarapu Sankar2, Dr Ram Mohan Reddy3, Dr
Shweta Tiwari4
1
Patron, ; 2 Chief Healer ; 3,4Consultant Dr
1 2 ,3,4
, Dept of Siddha Medicine, Chakrasiddh health centre, Hyderabad, India

Abstract
Introduction: Migraine is a a very common disorder among all age groups. It is characterized by recurrent
attacks of headache with a sudden onset accompanied by usually unilateral or sometimes bilateral headaches.
Chronic migraine, a severe form of migraineis characterized bylong term persistent headache that is difficult to
treat or fails to respond to standard treatmentseven after avoiding all migraine triggers. Migraines, is thought
to be one of the economic and societal burden to the patients affecting his quality of life, work balance, social
activities, and family life.
Methods and Methodology: In Siddha, Migraine is described as Mandai soolai(severe headache) and is
classified under kapa diseases. Siddha believes in treating the disease at its root cause from within.The main
reason for most of the people choosing Siddha is due to its simplicity. Moreover, another foremost reason for
choosing it is due to less or no side effects when compared to usage of antibiotics. Here, we present a case of40-
year female patient suffering from chronic migraine from last22 years with c/o throbbing headache in right
temporal regionwhich lasted for 4 to 5 hours daily. It was associated with symptoms of nausea, vomiting, nasal
blockage, phonophobia, and photophobia. Her daily activities like walking, sleeping and working on computers
was getting difficult. The patient was treated with Siddhatherapy utilizing stimulation of Varmam points by
pressing (Amartthal) technique on OPD basis for 20 sessions with 4 sinus sessions and 2 gut sessions.
Result:The patient experienced no attack of migraine when she returned for a followup after 2 months
break.There was considerable reduction in Visual Analog Scale (VAS) score, Migraine‑ Induced Disability
Assessment Score, headache,duration&frequency, consumption of pain killers, and improved quality of life
indicating the therapeutic efficacy of Siddha treatment.
Conclusion:This article shows that Siddha therapy is a new treatment option as there is no permanent cure for
migraine and would help incutting the expensive medication cost with positive health benefits thus improved
quality of life.
Keywords: Chronic Migraine, Mandai soolai, Migraine-induced Disability Assessment score, Varmam
technique
Abbrevations:VisualAnalogScale (VAS),Migraine‑ InducedDisabilityAssessment Score (MIDAS),Years Lived
with Disability/Disease (YLD)

Received 11 Sep., 2023; Revised 22 Sep., 2023; Accepted 24 Sep., 2023 © The author(s) 2023.
Published with open access at www.questjournals.org

I. Introduction
Migraine is a chronic paroxysmal neurological disorder characterized by recurrent attacks of moderate
to severe headache with associated symptoms such as nausea, vomiting or dizziness [1]. The most characteristic
symptoms associated with migraine include photophobia, phonophobia, and gastrointestinal symptoms while
few may also have a primary complaint of dizziness, ear pain, or head heaviness (Thalai Kanappu), “sinus”
pain (Peenishangal), and even neck pain [2]. Routine physical activity, movement, or even throat infection
(Kural Kammal), running nose (Naasi neer paaychchal) can worsen the headache[3].Migraines occurs mostly in
the morning time, especially upon waking. Patients with chronic migraine experience migraine symptoms for 15
days or more in a month over a period of 3-4 months. During the episode people feel exhausted or weak but
otherwise are usually symptom-free between attacks[4].Some people have migraines at predictable times, such

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 TreatingChronicMigraine with Traditional Siddha therapy- A case study

as before periods or after stressful work.People who suffer from migraines can clearly identify the triggers like
alcohol, a certain type of food items, allergies,sunlight, loud noises and certain odors or perfumes, irregular
sleep,and missing meal[5].
The prevalence of migraine is on a rise globally. It is thought that around 12.8% of the world,
population is affected by migraine [6]. According to statistics, about 7%–10% of all headache patients convert
into Chronic Migraine patients; it is observed that migraine is more in females as compared to males with ratio
of 3:1. Studies show migraine to be a major cause of limiting day-to-day activities of daily living [7]. Those
having migraine attacks have a higher chance of developing sleep disorders, depression, anxiety and fatigue.
Thus, the economic and social burden of migraine is substantial, affecting patients’ quality of life in terms of
work, social activities and family life [8]. Migraine is currently the third leading cause of Years Lived with
Disability/Disease (YLD) among individuals under 45 years of age with peak incidence of occurrence in
adolescence and peak prevalence in middle age. Studies do support for its presence in about two third of the
cases in the family [9].In recent years, the management of migraine has advanced but there remains a group of
patients who continue to experience disabling headache despite optimal treatment. These patients remain
“refractory” and fails to respond to standard treatmentseven after avoiding all migraine triggers[10].
The management of migraine includes identifying the primary cause & headache type, addressing all
associated factors, and treating both with medications and behavioral treatments. Though, conventional
treatments give satisfactory result but can cause side effects so migraine sufferers find Complementary and
alternative medicine (CAM) therapies as a better option [11]. A study in China showed among 690 patients with
headaches, 492 were using CAM, out of which 46.4% were suffering from migraine[12]. Ayurveda,massage
therapy,Acupuncture, meditation&yoga therapy, cognitive behavior therapyare some of the popular methods of
CAM . The reason for acceptance of these therapy techniques is due to their simplicity and use of natural
medications causing no side effects [13].
Siddha therapy is also one such unique, ancient alternative treatment process popular in Southern part
of India. It relies mainly on natural remedies, dietary and lifestyle changes to cure a particular condition, it has
been found effective in curing migraine as well. In Siddha, Migraine is described as Mandai soolai(severe
headache) and is classified under kaba diseases. The physiological functioning of the body is mediated by three
humours, namely Kabam, Pittam and Vatham[14]. The popular belief in the Siddha system is that headaches
occurs when two out of these three humoursare dearranged. Many Siddhakars believe that when Silethuma naadi
or Kaba naadi goes out of balance, it would result into headaches or migraine. The line of treatment focuses on
normalizing the balance of the humour, so the disease is cured and body normalcy is regained[15].
Siddha is widely practised in India but there are no well-documented studies evaluating its safety and
efficacy. Hence, the aim of the study is to emerge Siddha therapy as a new treatment option for migrainewith no
side effects and helping incutting the expensive cost for medications which the patient has to take for many
years; providing positive health benefits and improving quality of life [16].
In this article, we present a case report of 40 year old woman with Chronic Migraine from last 22 years
who underwent 4 siddha sessions for reliving the severe headache and had a good result without complications.
The symptoms presented by patient at time of admission like sleeplessness, stiffness in neck, headache
associated with nausea & vomiting which were at scale 9 (severe) was lowered to 2 (mild) on completing the
treatment.

II. Methods and Methodology

Case Report
A 40-year old female from Hyderabad visited Department of Siddha, Chakrasiddh in Sept, 2022 with
complaints of throbbing pain in right temporal region, watery eyes associated with nausea and vomiting from
last 3-4 days. Headache occurred 3-4 times every day with severe intensity and use to last for 2 hours everytime.
Headache was alternating in right side or in left side but dominantly on right side. She noticed the stiffness in
her neck in morning times which use to reduce as day passes but headache intensity use to increase in day time.
Her triggers were mainly sunlight and loud noises along with stress of work at office. The associated symptoms
presented by patient at time of admission were sleeplessness, headache associated with nausea & vomiting and
anxiety.

Medical History
On taking complete medical history, there is no significant family history identified, but the patient
complained of gut issues mainly related to constipation atleast twice every week. The patient is non-diabetic,
non-hypertensive and recently was diagnosed with hypothyroidism but the condition is well under control with
the help of allopathic medications. She is pure vegetarian, non-alcoholic, and non-tobacco user. Her vitals were
within normal limits. On general examination, there was no pallor, icterus, clubbing of nails or oedema noted.

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 TreatingChronicMigraine with Traditional Siddha therapy- A case study

Routine CBC and urine investigations as well as CT scan of brain were carried out and findings were not of any
pathological significance though CT brain showed mild Maxillary sinusitis.
Her daily headaches with Visual Analog Scale (VAS) score up to 9 and Migraine‑ Induced Disability
Assessment Score (MIDAS) about 72, indicating severe disability. The patient was initially diagnosed for
migraine in the year 2012 and was put on painkillers as and when required. The pain killers gave her temporary
relief in migraine. From last few years, the attacks have increased both in frequency and intensity of pain. These
attacks were shifting from right and left but more in right temporal region. The pain was throbbing in nature
with severity 9 on VAS and was associated with vomiting. She consulted many allopathic physicians but got
symptomatic relief only. She consulted a neurologist who gave Botulinum toxin A injections in neck six months
but then resistance to the drug developed and pain continued [17].
From last 1 year due to office problems, her anxiety levels were increased leading to frequent attacks of
migraine with more intensity. Infact, from last few months, she was working from home due to travelling and
sound which was initiating her headache episodes more. She was also avoiding her family functions and dayouts
with family so her family life was getting perturbed. She was having low blood pressure and her weight was
decreasing. While examination, her BP was 100/70 mmHg and weight 59 Kg. In recent past her pain scale
was aggravating even by routine physical activity and wasoften accompanied by nausea or vomiting, so she
wanted a treatment in Siddha which help her lead a normal life and treat her without medications.

Intervention
The treatment was started on 30th June, 2023; it was planned for 10 days for Cervical stiffness along
with 3-4 sessions of Migraine twice a week. The patient had complaints of severethrobbing pain in right
temporal region, watery eyes associated with nausea and vomiting.Patient was advised to do physio exercise for
1/2 hr and practice yoga includingasanas, pranayama’s, and meditation for one hour to lower her anxiety levles.
With that she followed proper diet and siddha treatment as prescribed.External therapies are really helpful in
this condition and gives a remarkable relief. Hot water fermentation along withsteam inhalation (Vedhu)& nasal
applications (Nasiyam) were been advised to be done twice daily to the patient [18].
In initial week, patient could see difference in her neck stiffness. She could notice that she was able to
sleep well for 8 hours while earlier she could not sleep even for 2-3 hrs without disturbance. Pain in neck
reduced from 9 to 4 in just first week. She also was advised to reduce her medications in a weeks time so that
her dependency on pain killers is reduced and the outcome of siddha therapy can be visualized. On 7 th day of
treatment, the patient underwent the sinus session done by Chief healer who performed the procedure by hand
pressure therapy (Varmam) along with some hard strokes on the cervical region. She initiated by pressurizing
her fingers into nasal cavity and manipulating with fingers. She used different hand pressures like Thadaval and
Amartthal to stimulate "varmam" points at neck and nasal area.The Varmam points that are stimulated to
achieve a therapeutic effect in the treatment of patients diagnosed with Cervical Spondylosis and migraines in
Siddha therapy are mentioned in Table-1.

Table-1: Varmam points and their locations

Varmam point Location Technique
Mudicchu Varmam Prominence corresponding to C7 Manipulate in a clockwise and anticlockwise
vertebra rotation 3 times each and then stretch downwards
along the spine up to the T6

Kakkatai Kalam Supra clavicular fossa on both sides Press the middle three fingers on the
supraclavicular fossa from the posterior aspect of
the patient

Chippi Varmam two fingerbreadths downward from Fix the tip of the three middle fingers; move fingers
the kaichulukki varmam point up and down whilst giving pressure

Kavuli Kalam Web area in between the thumb and Fix the tip of the three fingers; press in a pumping
the index fingers motion 3 times or so

Melmannai Varmam Upper end of the calf muscle Fix the middle finger at the point and press
(posterior aspect) (Simultaneously the patient is asked to flex and
extend the neck)

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 TreatingChronicMigraine with Traditional Siddha therapy- A case study
Manipooraga Adangal (esp for Five fingerbreadths below the Fix the tip of the middle three fingers transversely
gut points) umbilicus on the point; gently press and lift upwards

Sevikutri Kalam Fossa behind the ear lobe Fix the central part of the middle finger; apply
gentle upward pressure to the point (simultaneously
on both sides)

These treatment protocols continued for 10 days along with internal medications in tapering way and
was stopped within 8 days. The patient was able to see changes in the intensity of headache and its duration
even after not taking her medications. Earlier she felt heaviness in frontal portion but after sinus treatment, she
felt relieved. She felt better in breathing and headache intensity was 5 on VAS. She had started going to her
office from 5th day and was now comfortable with sounds though by the evening time, she could feel heaviness
but intensity was less as compared to when she joined. On 9 th day, the chief healer did her Gut session due to
some constipation issues which she was having since 10 years. Studies shows constipation, acidity can be one of
the reason for migraines [19]. For concentration and anxiety, a meditation for 10 mins was been followed. Her
dietary regimen included Alkaline foods with less oil, salt and spice. The diet was pure vegetarian with low-
carbohydrates, and protein-filled diet.
After the 15th session, the patient was asked to come only once a week for next 4 sessions and was
advised to notice all developments in her symptoms. In all next 3 sessions & 1 gut session, she was monitored
for feedback related to her sleep and headaches intensity. At the end of treatment, the symptoms presented by
patient at time of admission like sleeplessness, stiffness in neck, headache remarkably improved. Depending
upon the feedback, X-rays were taken out for pre and post appearance of PNS and cervical region (Fig-1).

Fig-1: Pre and post treatment PNS x-rays

Pre and post treatment Cervical X-rays

III. Results
Significant changes in signs and symptoms were noticed before treatment and after treatment
results. The patient showed no symptoms for vomiting in the gaps; however sometimes she had nausea due to
smell of food. She felt decreased heaviness in frontal head region and no severe migraine attacks. She was able
to sleep for 8-9 hrs without disturbance and was able to do walks for 40 mins. The most important development
was she was not taking any NSAID’s from last 10 days and was able to attend to her office and other family
functions. She was not having any constipation issues after the gut session. On last session, Visual Analog Scale
(VAS) score along with Migraine‑ Induced Disability Assessment Score were determined. VAS score reduced
from 9 (severe) to 2 (mild) and MIDAS score which was 72 (severe) came to 19 (moderate disability). (Table-
2,3)
On 1st and 2nd follow up there was no attacks of migraine in between the course of duration.

Table-2: Symptoms evaluation chart

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 TreatingChronicMigraine with Traditional Siddha therapy- A case study
Symptoms VAS before the treatment VAS after the treatment (0-10)
(0-10)
Headaches 9 2

Neck stiffness 9 0

Neck pain 8 1

Nasal blockage 5 2

Sleeping 9 2

Walking 9 1

Nausea & vomiting 10 2

Photophobia 8 2

Phonophobia 9 3

Working on computers 10 2

Average 9 2

0 = no problem; 1-3 = mild; 4-6 = moderate; 7-8 = fairly severe; 9-10 = severe

Table-3:Evaluation chart to score level of disability (MIDAS)

Question for evaluation Pre-treatment Post-treatment
On how many days in the last three months did you miss work because 10 (Not attending) 1 (No issues now)
your headaches?
How many days in the last three months was your productivity at work 25 4
reduced by half or more because of your headaches?
On how many days in the last three months did you not do household work 10 1
because of your headaches?
How many days in the last three months was your productivity related to 15 2
household work reduced by half of more because of your headaches?
On how many days in the last three months did you miss family, social, or 4 0
leisure activities because of your headaches?
On how many days in the last three months did you have a headache? 20 4
On a scale of 0 to 10, on average, how painful were these headaches? 9 2
VALUE ON AVERAGE >90 (Grade IV) <20 (Grade II)
Score grading:
0 to 5: MIDAS grade I, little or no disability
6 to 10: MIDAS grade II, mild disability
11 to 20: MIDAS grade III, moderate disability
21 or higher: MIDAS grade IV, severe disability

IV. Conclusion
Migraine is an episodic neurovascular disabiling disorder which is closely related toMandai
soolai(severe headache) and is classified under kapa diseases in Siddha. Siddha believes in treating the disease
at its root cause from within by using its unique treatment methods and initiating the Varmam points.These
treatment approaches create a balanced physiology which brings healing to the body and mind. The main reason
for most of the people choosing Siddha is due to its simplicity. Moreover, another foremost reason is due to less
or no side effects when compared to usage of antibiotics. This helps to achieve complete treatment as well as
control of migraine to the patient. This Chronic migraine case shows positive result and improved quality of life
indicating the therapeutic efficacy of Siddha treatment. It has opened new doors for treatment of migraine
through holistic approach where there is no permanent cure for migraine. Siddha therapy can be used as a new
treatment option among practitioners of new era. This would help incutting the expensive medication cost with
positive health benefits thus improved quality of life.

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Corresponding Author: Dr Bhuvanagiri Sathya Sindhuja 51 | Page