OJAI, CA—Ayurvedic medicine, a system of healing that originated thousands of years ago in India, is a complementary approach to headache care that can be used in conjunction with the allopathic approach to improve patient outcomes, said Dr. Trupti Gokani, MD, at the Fifth Annual Winter Conference of the Headache Cooperative of the Pacific.
Dr. Gokani, Founder and Director of the North Shore Headache Clinic in Highland Park, Illinois, practices Western Integrative Medicine, which combines allopathic medicine with complementary models such as Ayurveda. The allopathic, Western approach addresses patients’ migraines by focusing on specific symptoms and medications to alleviate attacks, while Ayurveda regards symptoms as manifestations of an imbalanced system. Ayurvedic practitioners seek to restore balance to patients’ systems through dietary adjustments, lifestyle changes, and knowledge of the patient’s mind–body state.
Although many allopathic practitioners may be skeptical of the efficacy of Ayurveda’s system-based approach to treating the complex symptomatology of migraines, Dr. Gokani has observed firsthand the benefits of practicing Ayurveda in combination with allopathic methods. “I’ve been doing this for many years now,” said Dr. Gokani. “What we call these simple approaches … can actually make a pretty big difference in terms of responsiveness to medications, injectables, and abortives."
A Balancing Act
According to the Ayurvedic system, patients’ physical and mental characteristics can be understood in the context of three mind–body types, called doshas—vata, pitta, and kapha. Each dosha corresponds with different digestive capabilities, mind types, body physiques, and headache presentations. Ayurvedic practitioners seek to understand a person’s most prominent dosha and how that dosha appears in the balanced state versus the imbalanced state. “Disease occurs when individuals become imbalanced with their dosha,” Dr. Gokani told Neurology Reviews.
Because Ayurveda regards disease symptoms as “a magnification of the system being imbalanced,” practitioners must ask themselves what they can do to strengthen the system so that the symptom does not occur, said Dr. Gokani.
To restore balance, Ayurvedic practitioners recommend treatment that considers each patient’s dosha. Interventions may include the use of dosha-specific herbal remedies as well as changes to bed times and diet. For example, patients with the excitable vata dosha may become imbalanced after eating cold foods or traveling to cold environments, while patients with an imbalanced pitta dosha, which is linked to the fire state and thus can lead to inflammation, may experience migraines after trips to hot places, eating hot foods, or drinking too much alcohol, said Dr. Gokani. Those with a kapha dosha are prone to congestion and could benefit from avoiding damp environments and heavy, creamy foods that upset digestion.
Digestion and Migraine
Digestive issues are common among patients with migraine, as research shows that approximately half of patients with migraine have reflux symptoms, and 22% have gastroesophageal reflux disease (GERD). “Digestion is the key to health in Ayurveda,” said Dr. Gokani. “The gut and the brain are linked.”
From an Ayurvedic perspective, reflux may result from too much pitta heat, or inflammation, in the digestive tract, said Dr. Gokani. She noted that Ayurvedic practitioners can recommend diets based on the characteristics of each dosha.
Modifying patient diets based on food allergies and intolerances may reduce migraine occurrence as well. “Seventy-five percent of migraine patients are allergic to five or more foods,” said Dr. Gokani. Among 500 patients Dr. Gokani studied at her clinic, 44% had moderate to high allergic reactions after consuming dairy products, 41% had such reactions after consuming eggs, 35% after consuming wheat, and 27% after consuming fruit.
“Treating digestion first actually improves neurologic well-being,” said Dr. Gokani, adding that most neurologists do not take that approach.
Informing Allopathic Treatment
Dr. Gokani noted that integrating the allopathic and Ayurvedic models can be challenging for medical professionals, especially during short treatment sessions, but she believes that the benefits of practicing both techniques are substantial. “We need to understand why [patients] are having the pain.… You can use Ayurveda as a systems-based treatment approach to understand the why and to decrease the overall number of headaches, and then use the traditional approaches to help reduce the symptoms at hand.”
The Ayurvedic model can aid decisions about which traditional agents will work best for symptom reduction, she explained. An anxious patient with the vata dosha might respond well to a benzodiazepine, while a pitta patient, with a headache behind the eyes, might respond best to onabotulinumtoxinA. Persons experiencing congestion from an imbalanced kapha dosha may have success with fexofenadine, said Dr. Gokani. Furthermore, patients may respond better to these traditional medications once their systems are more in balance.