Efficacy of Nutūl-i-Ḥār (Hot Irrigation), a Polyherbal Unani Formulation, in the Treatment of Shaqīqa-i-Muzmin (Chronic Migraine): An Open Single-Arm Exploratory Clinical Trial
Abstract
Shaqīqa-i-Muzmin (chronic migraine) is a type of migraine that is usually caused by cold humours (bārid akhlāṭ), specifically by phlegm (balgham) and to lesser extent by black bile (sauda). The aim of this study was to evaluate the effect of Nutul-i-Ḥār (hot irrigation) in the treatment of chronic migraine. Nutul (irrigation) therapy is widely and successfully used in diseases of head as described in Unānī system of medicine. This open, single-arm, exploratory clinical study was conducted in 30 patients of chronic migraine selected by convenient sampling method. One litre decoction prepared with 12 g each of Astragalus hamosus L. (Iklilul malik), Matricaria chamomilla L. (Babuna), Artemisia absinthium L. (Afsanteen), Origanum vulgare L. (Marznjosh) and Trigonella foenum graecum L. (Hulba) was poured over painful side of head for 45 minutes on every alternate day for a period of 30 days (15 sittings). The patients, thereafter, were followed untill 90th day of the study for various outcome measures comprising headache intensity, headache frequency, Migraine Disability Assessment Scale (MIDAS), and rescue medication. The reduction in headache frequency, MIDAS score and use of rescue medication was significant (p < 0.001) after the treatment. Reduction in headache intensity at 30th day, 60th day and 90th day was significant as compared with baseline values (p < 0.001) but not statistically significant at 90th day with respect to 60th day (p > 0.05). Statistical analysis was done using parametric (paired t-test) and non-parametric tests (Wilcoxan sign ranked test, Freidman with Dunn’s multiple comparison tests). Hot irrigation with medicated decoction was found effective in the treatment of chronic migraine.
Larus SG. Migraine, Blood Pressure and Inflammation in Relation to Cardiovascular Disease and Mortality [PhD Thesis]. University of Iceland, 2010.
Pearce JM. Historical aspects of migraine. J Neurol Neurosurg Psychiatry 1986; 49:1097-1103.
Tabri M. Moalajat-e-Buqratiya. Vol 1. Central Council for Research in Unani Medicine. New Delhi 1995; pp 284-290.
Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, et al. Harrison’s Principles of Internal Medicine. 18th ed. Vol 1. The McGraw Hill Companies. USA 2012; pp 114-128.
Khan A. Ikseer-e-Azam. (Urdu translation by M Kabeeruddin). Idara-Kitab-ush-Shifa. New Delhi 2011 p 11.
Arzani A. Tib-e-Akbar. (Urdu translation by HM Hussain). Deoband. Faisal Publications. YNM; pp 20-21.
Zohar I. Kitab ul Taiseer. Central Council for Research in Unani Medicine. New Delhi 1986; pp 77-78.
Razi Z. Kitab Al Hawi. Vol 1. Central Council for Research in Unani Medicine. New Delhi 1997; pp 192-198.
Ibne Sina. Al Qanoon Fil Tib (urdu translation by Hkm GH Kintoori). Part 1. New Delhi: Aijaz Publishing House; 2010.
Tabri R. Firdous-ul-Hikmat. Idara-Kitab-ush-Shifa. New Delhi 2010; pp 155-156.
Majoosi A. Kamil-us-Sana. (Urdu translation by G H Kantoori). Vol 2. Central Council for Research in Unani Medicine. New Delhi 2010; pp 544-545.
World Health Organization. The World Health Report 2001. Geneva: WHO; 2001.
Extrapolation Statistics on Prevalence Rate of Migraine to Countries and Regions 2012. Available from: http://www.rightdiagnosis.com/m/migraine/statscountry.
Renjith V, Pai M, Castelino F, Pai A, George A. Clinical profile and functional disability of patients with migraine. J Neurosci Rural Pract 2016;7:250-256.
Kulkarni GB, Rao GN, Gururaj G, Stovner LJ, Steiner TJ. Headache disorders and public ill-health in India: Prevalence estimates in Karnataka State. J Headache Pain 2015;16:67.
Atif M, Hussain S, Sarwar MR, Saqib A. A review indicating the migraine headache as a prevalent neurological disorder: Still under-estimated, under-recognized, underdiagnosed and under-treated. J Pharm Pract Community Med 2017;3:3-11.
Manack AN, Buse DC, Lipton RB. Chronic migraine: epidemiology and disease burden. Curr Pain Headache Rep 2011;15:70-78.
Gururaj GK, Kulkarni GB, Rao GN, Subbakrishna DK, Stovner LJ, et al. Prevalence and socio demographic correlates of primary headache disorders: results of a population based survey from bangalore, india. Indian J Public Health 2014;58:241-248.
Jurjani AH. Zakheera Khawarzam Shahi. (Urdu translation by Hadi Hussain Khan). Vol 6. Idara-Kitab-ush-Shifa. New Delhi 2010; pp 105-106.
Baghdadi H. Mukhtarat Fil Tib. Vol 3. Central Council for Research in Unani Medicine. New Delhi 2004; pp 19-20.
Nikhat S, Fazil M. An analytical review on nutool (irrigation) therapy. J Drug Deliv Ther 2015;5:1-4.
Nayab M, Kouser H, Ansari AN. Tanqiya wa tadeel (evacuation and rejuvenation): the unani concept as evolutionary basis for conventional stroke management. J Drug Deliv Ther 2021;11:195-200.
Kouser H, Khan F, Tehseen A, Nayab M, Ansari AN, Understanding the concept of Purgation (Ishal) in Unani Medicine: A Review, J Drug Deliv Ther 2021;11:241-246.
Khare CP, Indian Medicinal Plants an Illustrated Dictionary Springer Science, Business Media. LLC 2007.
Kazrooni SA. Al Mughni Fil TibMaroofba Al Sadeedi. Munshi Naval Kishor. Lucknow 1311; pp 18-19.
Ibn Nafees. Ilmul Advia Nafeesi Ma Zamima (Urdu). Aijaz Publishing. New Delhi 2007; pp 70-72.
Ghani N. Khazain ul Advia. Idara Kitab ush Shifa. New Delhi 2001.
Khan MA. Moheete Azam. Vol. I. Matba Nizami. Kanpur 1885; p 144.
Lubhaya R. Bayanul Advia. Vol.I. Goswami Pharmacy. Gali Qasim Jaan. New Delhi 1984.
Kabiruddin. Makhzanul Mufradat al Maroof Khawas ul Advia. Aijaz Publishing House. New Delhi 2001.
Hakeem MA. Bustan Al Mufradat (Musawwar Edition). IdaraKitabus-shifa. New Delhi 2002
Betar I. Al Jame ul Mufradat al Advia wa al Aghziya (Urdu translation Ziauddin Abdulla bin Ahmad Undlasi). Vol. 1. Central Council for Research in Unani Medicine. New Delhi 1998.
Razi Z. Kitab Al Hawi. Vol. X. Central Council for Research in Unani Medicine. New Delhi 1997.
Khan MM. Tohfatul Momineen. Matba Nawal Kishore. Lucknow 1846.
Attar Z. Ikhtiyarat-i-Badiyee. Matba Munshi Nawal Kishore. Lucknow 1888.
Miraj S, Alesaeidi S. A systematic review study of therapeutic effects of matricaria recuitta chamomile (chamomile). Electron Physician 2016;8:3024-3031.
Nayab M, Khan F, Ansari AN, Khan TN, Itrat M, Nutūl as an effective and time tested regimenal modality in unani system of medicine – an overview. J Drug Deliv Ther 2021;11:132-137.
Khan S, Nayab M, Ansari RA. Effect of nutool with roghan-e-banafsha in sahar (primary insomnia). Int J Res Anal Rev 2019;6:1271-1281.
Azam R, Nisar S, Jabeen A, Jilani S, Jahangir U, et al. Nutool therapy (irrigation) and its practical applications in unani system of medicine. World J Pharm Res 2016;5:599-607.
Azam R, Mushtaq S, Fassihuzaman A. Jabeen Z, Zaidi S. Nutool (irrigation) - an effective mode of treatment in ilaj bit tadbeer (regimenal therapy). Indo Am J Pharm Res 2014;4:5787-5791.
Mooventhan A, Nivethitha L. Scientific evidence-based effects of hydrotherapy on various systems of the body. N Am J Med Sci 2014;6:199-209.
Perini R, Veicsteinas A. Heart rate variability and autonomic activity at rest and during exercise in various physiological conditions. Eur J Appl Physiol 2003;90:317-325.
Nishimura M, Onodera S. Effects of water temperature on cardiac autonomic nervous system modulation during supine floating. J Gravit Physiol 2001;8:65-66.
Hollanda L, Monteiro L, Melo AS. Botulinum toxin type A for cephalic cutaneous allodynia in chronic migraine: a randomized, double-blinded, placebo-controlled trial. Neurology Int 2014;6:70-73.
Suresh KP, Chandrashekara S. Sample size estimation and power analysis for clinical research studies. J Hum Reprod Sci 2012;5:7-13.
Lipton RB, Stewart WF, Sawyer J, Edmeads JG. Clinical utility of an instrument assessing migraine disability: The migraine disability assessment (MIDAS) questionnaire. Headache 2001;41:854-861.
Bigal ME, Rapoport AM, Lipton RB, Tepper SJ, Sheftell FD. Assessment of migrainedisability using the migraine disability assessment (MIDAS) questionnaire: a comparison of chronic migraine with episodic migraine. Headache 2003;43:336-342.
Ruscheweyh R, Müller M, Blum B, Straube A. Correlation of headache frequency and psychosocial impairment in migraine: A cross-sectional study. Headache 2014;54:861-871.
Blumenfeld AM, Bloudek LM, Becker WJ, Buse DC, Varon SF, et al. Patterns of use and reasons for discontinuation of prophylactic medications for episodic migraine and chronic migraine: results from the second international burden of migraine study (IBMS-II). Headache 2013;53:644-655.
Razi Z. Kitab ul Faqir. Vol 1. Part 1. Central Council for Research in Unani Medicine. New Delhi 2005; pp 71-72.
Sharafzadeh S, Alizadeh O. German and roman chamomile. J App Pharm Sci 2011;1:1-5.
Srivastava JK, Shankar E, Gupta S. Chamomile: A herbal medicine of the past with bright future. Mol Med Rep 2010;3:895-901.
Shojaii A, Motaghinejad M, Norouzi S, Motevalian M. Evaluation of anti-inflammatory and analgesic activity of the extract and fractions of astragalus hamosus in animal models. Iran J Pharm Res 2015;14:263-269.
Amrollahi H, Nazari H, Parvini S, Nazari N, Mohammadi A. Anti-inflammatory and analgesic activities of Artemisia absinthium and chemical composition of its essential oil. Int J Pharm Sci Rev Res 2014;24:237-244.
Vyas S, Agrawal RP, Solanki P, Trivedi P. Analgesic and anti-inflammatory activities of trigonella foenum-graecum (seed) extract. Acta Pol Pharm 2008;65:473-476.
Raveendran S, Rajadnya V, Kothari R, Tilak AV, Das S, et al. A study to evaluate the analgesic activity of origanum vulgare in mice using tail flick method. Int J Basic Clin Pharmacol 2019;8(10):2254-2257.
Afarineshe Khaki MR, Pahlavan Y, Sepehri G, Sheibani V, Pahlavan B. Antinociceptive effect of aqueous extract of origanum vulgare l. in male rats: possible involvement of the GABAergic system. Iran J Pharm Res 2013;12:407-413.
Uebaba K, Xu FH, Tagawa M, Asakura R, Itou T, et al. Using a healing robot for the scientific study of shirodhara. altered states of consciousness and decreased anxiety through indian dripping oil treatments. IEEE Eng Med Biol Mag 2005;24:69-78.
Uebaba K, Xu FH, Ogawa H, Tatsuse T, Wang BH, et al. Psychoneuroimmunologic effects of ayurvedic oil-dripping treatment. J Altern Complement Mede 2008;14: 1189–1198.
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Issue | Vol 6, No 4, 2021 | |
Section | Research Article(s) | |
DOI | https://doi.org/10.18502/tim.v6i4.8271 | |
Keywords | ||
Unani medicine Therapeutic irrigation Hydrotherapy Classical migraine |
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