Successful Treatment of Recalcitrant Headache - Four cases

Jay L. Glaser, MD*

Lancaster Ayurveda Medical Center, Sterling, MA 01564

Please address correspondence to Dr. Glaser.

Introduction

While headache remains a ubiquitous disorder, in the majority of patients it is mild, infrequent and manageable. Most sufferers find reliable acute therapies and techniques to prevent frequent occurrence (xx). Some patients, however, despite drastic changes in their lifestyle and consultation with both neurologists and alternative practitioners, find that pain is a constant presence in their lives. In 1995, a new approach to the therapy of chronic disease was implemented in several centers in Europe and North America. This paper presents four patients with recalcitrant headache who had exhausted conventional approaches and presenting to one of these centers.

Case 1 - Tension headache

A 51 year-old homemaker, with a history of intermittent headache since menarche, presented to the Chronic Disease Center complaining of exacerbation of her headache since menopause two years previously. She had been experiencing moderately painful bitemporal headache daily with onset in the morning and often lasting until late afternoon, associated with pressure in the frontal area and a band-like tightness across the forehead, not associated with nausea or photophobia. The headaches were different from previous headaches diagnosed as migraine. She had increased her use of ASA-based analgesics containing caffeine and barbiturates. Three weeks before admission she consulted a neurologist who found a normal neurological examination and diagnosed muscle contraction headaches exacerbated by rebound from caffeine dependence. Caffeine and ASA were discontinued, and ibuprofen and bromfenac were prescribed, but the headaches persisted although diminished slightly in intensity.

The patient underwent a 21 day Veda Chronic Disease Program. She received no conventional treatments and was encouraged to reduce her anti-inflammatory medications. By the fourth day of treatment, she had the first pain-free day in several months and had seven days without headache during her admission. The headaches diminished in frequency, intensity, and duration, and were relieved with smaller doses of analgesics. Currently, five years following discharge, she is having less than one mild headache per week, which she can control within 30 minutes using non-pharmacological interventions, including the Transcendental Meditation technique. She requires ibuprofen only rarely.

Case 2 - Migraine

A 57-year-old teacher presented to the Lancaster MAMC with a seventeen year history of common migraine. Her mother and four of six sisters were migraineurs. During the six years before beginning the Veda Chronic Disease Program, her headaches worsened in frequency, duration and intensity. They began to occur monthly, usually around menses (the patient required estrogen replacement for hot flushing), or with eating many different foods, and lasted 24 to 72 hours without remission. During this time, she was incapacitated, often reduced to tears, confining herself in a dark room with nausea and vomiting, and not being able to move without exacerbating the pain. Ergotamine, analgesics, hormonal modifications and anti-inflammatory medications helped minimally.

She underwent a two-week multi-strategy Veda CDP including Veda Takradhara during the first week, and an individualized program of bastis during the second week. During the 27 months since she completed the program, the only severe or prolonged episode of headache occurred during exertion at an altitude 4500 meters and probably represented acute mountain sickness. Migraine-like symptoms still occur approximately monthly but are aborted within one hour by NSAID analgesics or small doses (12.5 mg) of sumatriptan. She attributed a significant part of her improvement to dietary changes she made following the program. Before the program, she had already excluded her usual dietary triggers such as chocolate, cheese, bananas, etc. She stated, "The refinement in my awareness created by the treatments made me conscious of the subtle influences of foods that I hadn't noticed before."

Case 3 - Cluster Headache

A 65 year old retired executive suffered from daily headache that began suddenly at age 27. He had consulted neurologists at several well-known clinics and had been diagnosed to have cluster headache. Recently they were exacerbated by rebound sinus congestion. He described the severity as only 40% of their maximum intensity as a young man when they occurred but monthly, but for several years it had become rare to have a single day in a month without headache. The pain was located between the eyes, accompanied by photophobia and lasted several hours to half a day. They were relieved by hot packs, and somewhat by ASA, acetominophen, caffeine and ergotamine suppositories. Ergotamine, dihydroergotamine, and sumatriptan were helpful for two to six months and then lost their effectiveness.

The patient was treated with an individualized three week program including Veda Takradhara, bastis and herbal preparations. During the second week of treatment he had several periods of consecutive days without headache. During his last week of treatment he had five consecutive days without headache. During the first week of his stay, he described a transformation in his awareness of the headaches that seemed to be an extension of his experience during his twice daily practice of the Transcendental Meditation and TM-Sidhi Program. Previously the headache was such a dominant sensation, that even ordinary thinking was impossible. He began to describe "witnessing" his headaches from a standpoint of settled well-being or "bliss."

At home he remained free of pain for two weeks off all medication. Due to difficulties maintaining the dietary and other lifestyle changes adopted in residence, there was a return to his previous pattern. Twenty months after therapy, the headaches continue but in an attenuated form: they are somewhat less severe, more amenable to medication, and days without pain are more frequent. The pain is more tolerable since the experience of witnessing them continues.

Case 4 - Cervical headache

A 71 year old attorney presented to the Lancaster MAMC with intermittent cervical-occipital pain radiating to the left scapula of eight years duration that had not responded to anti-inflammatory medication, physiotherapy, acupuncture, massage, or chiropractic manipulation. MR imaging showed degenerative disc disease with compression and spurring at C5-C6. The pain had been aggravated four years previously by a motor vehicle accident. He had noticed increase in tinnitus and tic douloureux. MR imaging of the head was negative. The pain was exacerbated by stress and relieved by stretching.

The patient was treated with a two week program consisting of daily Veda Shirobasti followed by an individualized program of basti. (During Veda Shirobasti, a cylindrical apparatus is sealed to the circumference of the skull such that the cranium can be bathed in intensely herbalized sesame oil). He was prescribed herbal preparations to take at home as well as Vedic physiotherapy exercises for the neck. Three months following treatment the pain was less frequent and less intense with disappearance of tinnitus and tic douloureux. Two and a half years following his initial visit, the symptoms continue to be in remission.

Discussion

According to standard understanding of headache, these four cases represent different etiologies with different mechanisms of pain and perhaps involvement of disparate anatomical structures. One might wonder why they would all seem to have derived benefit from a similar program.

First, recent work suggests that the anatomical structures and nociceptors for the three first patients may actually be very similar. Many authors feel that most headache has a migraine-like component (xx).

Second, a majority of headache sufferers report the exacerbation of their condition with stress, no matter what the etiology (xx). Several of the programs utilized in their care (Transcendental Meditation technique, yoga, pranayama breathing exercises, etc.) have well documented to reduce anxiety, stress and even headaches (xx,xx)

Third, the MVAH prescribes therapy for headache, like other disorders, based on the Ayurvedic diagnosis, which could be completely different for several individuals with the conventional diagnosis of common migraine. According to the principles of Vedic medicine, several common etiological factors are at play in the three cases. First, vata dosha represents the abstract quality of movement or transport in the body. In its aggravated state, Vata creates an influence of imbalance in circulation and communication between neural structures. (xx) Second, Vedic medicine recognizes the accumulation of extra- and intracellular residues resulting from inefficient metabolism and digestion as playing a role in most headache. These residues, called ama (Sanskrit for unripe or uncooked), is held to be carried to the site of pain by the aggravated vata. (xx)The procedures of Vedotakradhara (for the cases of intracranial headache) and Vedoshirobasti (for the case of cervical occipital pain) are procedures of choice during the first two weeks of therapy for pacifying the aggravated vata and mobilizing ama for elimination during the week of basti therapy.

The underlying principles of Vedic medicine also state that the human physiology is the expression of the structure of Veda (organizing intelligence in nature) and the Vedic literature derived from Veda (Nader). Disorder is understood as a disruption in the full expression of this intelligence (perhaps finding its biological manifestation in our genetic information) and successful therapy by definition brings this intelligence into function (Charaka xx).

In conclusion, we have identified a means of treatment that has offered relief to numerous individuals with refractory headache. While many patients with headache have sought out these programs, perhaps intuitively feeling that these consciousness-based treatment modalities will be of benefit, we have also noted their utility in other disorders. The benefits and cost-effectiveness of these programs need to be confirmed in wider trials and we encourage other authors to join this ongoing research effort.

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