INTRODUCTION:

India is endowed with approximately 6000 medicinal plants which have been used traditionally as herbal medicine.¹ Medicinal plants are accepted culturally from centuries² and are useful in cosmetic, agricultural, food and pharmaceutical industry. Since ancient time medicinal herbs are used by peoples of all civilization for curing diseases. Research shows that plant contains active constituents for curing diseases.³ Herbal medicines are effective, less expensive, possess fewer side effects hence considered safe, less likely to cause herbal addiction, therefore considered as good choice for treating diseases as compared to allopathic medicines.^4,5,6,7

Theories of traditional Korean medicine also revealed that herbal medicines helps in controlling physiological action on various organs hence can be used for maintaining good health.⁸At present time several herbal formulations are available in various dosage form like tablets etc⁶ and several pharmaceutical companies are earning income by formulating and marketing herbal preparations.⁹Although to increase the acceptability of medicinal plants there is a crucial need to aware people and to develop belief towards the indigenous system of medicine by establishing its validity in treatment for various diseases.²

Migraine is a multifactorial, spiking brain disorder which is characterized by intermittent attacks of pulsating quality, severe or moderate intensity lasting 4-72 hours. Attacks are mostly associated with vomiting, nausea, phonophobia or photophobia.¹⁰ Migraine headache is a most common brain disorder and is pervasive and spiking in nature.¹¹

Many herbal medicines can be used for curing pain of migraine. Believing and understanding of pain is crucial in influencing the patient’s reaction to the pain therapy provided. Adequate pain management is an enthralling and general requirement in health care. Effective acute pain management helps in improving patient outcomes and increasing satisfaction level of patients.¹²

Historical aspects of migraine¹¹:

Hippocrates:

It is supposed that primary depiction of migraine as an intermittent disorder was seemed in Mesopotamian poems (3,000 Before Christ). Hippocrates described migraine pain as harsh pain in half portion of head which impinged in the head and neck accompanying disturbance of sight.

Celsus:

Celsus acknowledged migraine symptoms as a prolonged feebleness of head, which may persist through out the life and is not perilous in nature. According to Celsus the pain associated with migraine might be of less duration, intense however not mortal; drinking wine, excessive heat or cold may elevate the pain. This pain may be associated with high body temperature and may affect the whole head or some part of it.

Aretaeus:

Aretaeus used the word "heterocrania" (located in half of the skull) to indicate the position of pain associated with migraine. He described migraine pain as a pain that remains in the half of the head and migraine as an illness that appears to be slight but not mild in any way even though it intermits, associated by various enduring symptoms like vomiting of bilious matters, nausea, heaviness of the head, anxiety etc.

Galen:

Galen discriminated common headaches with migraine and used the term "hemicrania to indicate its location. He defined migraine as a throbbing disorder which protracts laterally with longitudinal suture. According to Galen factors like excessive cold or heat can trigger the headache associated with migraine in half portion of the head.

Tissot:

In nineteenth century conceptions associated with migraine instigate to clinch the speedily evolving knowledge of physiology and medicine. Various vascular disorders extending from dilatation of arteries, inflammations or constriction to cerebral congestion were popular notions.

Hughlings Jackson:

Jackson’s annotations about migraine was though fleeting but proved invaluable as he mentioned that the use of hypothesis is a technique of science. Although he differentiated migraine with epilepsy.

Edward Living:

Edward Living encompasses case histories of many patients suffering from migraine in his book. He provided full explanations of migraine associated aura, its protein expressions and determined the links between migraine and epilepsy, vertigo, faints, insomnia, other diseases associated with nervous system.

E. Du Bois Reymond:

He was the first physician to discover that the peripheral passage of a nerve impulse was escorted by the action potential. In his writing he attributed that in migraine the muscular coats in the vessels of affected area of head is the site of tetanus to take place. His elucidation contributes tremendously in the art of descriptive writing at this time.

Gowers:

Gower’s work was published in “Diseases of the Nervous System" provides an up to date explanation of etiology, complications and clinical expressions. Exemplary precision about interpretations and descriptions can be obtained from this chapter.

The Twentieth Century:

In twentieth century writings and research both have developed parallelly. Anomalies in serotonin and prostaglandins were shown in research. Presently flaw in endogenous opioids is considered to be the primary notion. But it remnants enormously challenging to find out the exact cause of migraine as many of the objective irregularities on measurement are noticed only in few patients and usually it was observed that induced attacks are triggered only by any stimulus.

For experimental purposes no suitable animal model is available therefore any constant or valid accompaniment of disorder has not been found.

Pathophysiology:

Pathophysiology of migraine is still not entirely known.

1. Cortical Spreading Depression:

One possible mechanism is cortical spreading depression, a process in which a slow wave of glial and neuronal depolarisation extents through the cerebral cortex which activates trigeminal afferents due to which pain-sensitive meninges gets inflamed which causes migraine.¹⁰

2. Activation of the trigeminovascular system:

Trigeminovascular theory emphases on the relation between intracranial vessels and trigeminal nerves.¹³ Trigeminovascular system stimulation is also thought to be involve in migraines. Sensory neurons from trigeminal ganglion in spine and face innervate the vascular system and dura matter in the cranium. Vasoactive neuropeptides like substance P, neurokinin A and calcitonin gene-related peptide gets discharge when trigeminal ganglion gets stimulated. These neuropeptides lead to inflammation of neurons instigating extravasation of plasma protein, vasodilation (CGRP is a powerful vasodilator) and intensify and prolong the migraine pain.¹⁴

3. Neurogenic inflammation:

Neurogenic inflammation that plays a vital role in migraine pathophysiology occurs due to activation of primary neurons. Various neurotransmitters such as substance P, Calcitonin Gene-Related Peptide and pro-inflammatory neuropeptides gets released due to primary neurons activation. Nitric oxide, Glutamate, and Pituitary adenylate cyclase-activating polypeptide are also involved in inflammatory mechanisms modulation.¹⁵

4. Vascular theory:

Earlier it was considered that migraine is a vascular disorder. According to vascular theory migraine associated pain is action violated and are elevated due to dilatation of meningeal and cerebral arteries.¹⁰ It was extensively assumed that vasoconstriction occurs during aura after which dilatation leads to headache.¹³

Role of serotonin:

It has been observed that there is an about 40% reduction in level of serotonin (neurotransmitter) during headache attack in patients suffering from migraine and intravenous administration of serotonin decreased the headache to a level. Serotonin receptors are found in cranial vessels and trigeminal nerve.⁶ However due to systemic effects of serotonin various side effects are seen hence serotonin is consequently not used practically while serotonin agonists that selectively acts on cerebral blood vessels like sumatriptan were developed.¹³

Clinical features¹¹:

Men have lower risk (6%) of migraine when compared with women (18%). This is usually due to fluctuation in hormones especially estrogen level in women. Migraines usually commence in teenagers or in between the age of 35 to 45 years.

Migraine is of two major subtypes¹⁰:

1. Migraine with aura:

Ephemeral neurological signs that generally accompanied headache are usually associated with this type of migraine. Before some hours or days of headache premonitory phase can be experienced by some patients. Premonitory symptoms comprises of depression, yawning, hypoactivity, hyperactivity, desire for particular foods, fatigue, neck pain or stiffness.

2. Migraine without aura:

In this headache generally accompanied symptoms such as severe or moderate pain in unilateral location, which gets intensified by routine physical work, headache, vomiting, nausea and/or or phonophobia and photophobia.

Diagnosis of migraine¹¹:

Migraine can be diagnosed by performing examination of cranial nerve, orthopedic tests, cranial magnetic resonance imaging and urinalysis.

As stated by International Classification of Headache Syndromes, Migraine can be demarcated as per following criteria.

1. Minimum five attacks out of which at least 1 sustaining criteria B–D.

2. Headache attacks which persists for 4 to 72 hours when treatment is not given or is not treated successfully.

3. Headache embracing any of the two features given below:

a. Pain intensity ranging from moderate to severe

b. Headache in pulsating form

c. Headache located Unilaterally

d. Headache that gets aggravated by daily physical activities (e.g. climbing stairs, walking).

4. Headache is accompanied with any of the given symptoms:

a. Vomiting or Nausea

b. Phonophobia and Photophobia.

Herbal plants used in migraine

1. Coriander¹⁷:

Coriandrum sativum (C. sativum) fruit has been commonly used for treating headache in Persian medicine. Kasmaei et al evaluated C. sativum syrup for its effectiveness in severity, frequency and duration of migraine. Total 68 patients suffering from migraine were arbitrarily divided into control and interference group, each containing 34 patients. Interference group was treated with 500mg dose of sodium valproate and 15ml of Coriander fruit syrup per day for one month while control group was treated with placebo syrup in 15ml dose thrice a day instead of coriander fruit syrup. This study revealed that recurrence, pain and extent of migraine attacks gets reduced with C. sativum fruit.

2. Combination of Viola odorata, Rosa damascena flower and Coriandrum sativum fruit¹⁸:

Study was performed by Kamali et al for determining efficacy of Coriandrum sativum fruits, Rosa damascene flowers and Viola odorata flowers in combined form on duration, frequency and severity of headaches associated with migraine. They performed double blind, placebo-controlled trial by taking 88 patients suffering from migraine. All the patients were randomly allocated to interference (n=44) or placebo group (n=44). To the interference group combination of Coriandrum sativum fruits, Rosa damascene flowers and Viola odorata flowers was given in dose of 500mg capsule thrice a day, 20mg propranolol tablet two times in a day and 500mg of placebo capsules for four weeks was given to control group. From the study it was concluded that combination of these herbal drugs do not show any severe side effects and can be used to improve the condition of migraine patient’s. It helps in improving severity, frequency and extent of headache attacks in migraine.

3. Valerian¹⁹:

One of the plant that is used traditionally for treating migraine is Valeriana officinalis. Mirzaee et al used a randomized, single-blind clinical trial carried out on 84 female patients suffering from migraine headaches. Randomly patients were assigned to case (n=42) and control groups (n=42) and treated during three consecutive phases of 45 days. In initial phase 200mg of sodium valproate in tablet form was given in 200mg dose for two days and 25mg of indomethacin capsule was given in attacks. While 350mg of valerian capsule thrice daily was added to other drugs of case group in second phase and instead of valerian, placebo was given to control group. Lastly, in the third phase both groups were treated similarly as they were treated in first phase. The results indicated that capsule of valerian significantly helps in reducing the duration, regularity and strength of attacks associated with migraine and it can used as an alternative of common medications used in migraine.

4. Feverfew²⁰:

Johnson et al performed a study for evaluating the efficacy of feverfew (Tanacetum pathenium) leaves. Patients who had taken raw feverfew leaves for at least three months every day were enrolled in this study. They performed a placebo controlled trial in which seventeen patients who had taken daily fresh leaves of feverfew as prophylaxis contrary to migraine have participated. Freeze dried feverfew capsules were given to eight patients and placebo was given to remaining nine patients. It was concluded from the study that severity and rate of recurrence of vomiting, nausea and headache was significantly increased in patients who received placebo. In the patients who have taken feverfew capsules no change in severity and rate of recurrence of symptoms were noticed. This shows that when taken prophylactically feverfew can be used to avert migraine attacks.

5. Combination of magnesium, feverfew and coenzyme Q10²¹:

Guilbot et al performed a study to assess the efficiency of the proprietary supplement comprising magnesium, feverfew and coenzyme Q10 in combined form for migraine prophylaxis. For this study adult migraine patients having ≥2 migraine attacks in prior month excluding the patients who have taken overdose of medicines or those who were suffering from chronic migraine were selected in study by general practitioners. Tablet containing feverfew (100mg), magnesium (112.5 mg) and coenzyme Q10 (100mg) was supplemented once daily for 3 months after one-month of baseline phase. From this study it can be concluded that there is decrease in migraine headache during three month of supplementation compared to baseline phase and can be given safely to make life of adult migraine patients better.

6. Butterbur^22,23:

Butterbur root extract is a prospective new treatment for preventing migraine however butterbur plant contains carcinogenic and hepatotoxic pyrrolizidine alkaloids therefore these compounds are removed before preparing it for commercial use.

Lipton et al performed a 3-arm, randomized clinical trial in 245 patients. In this trial butterbur extract was given in 5075mg and 7550mg dose two times per day, placebo was also given twice daily. It was observed from the study that higher dose of butterbur extract was more eﬀective than placebo in diminishing migraine attacks.

An open-label study was conducted for evaluating efficacy of butterbur in 109 adolescents and children revealed that 77% of patients shows at least 50% decrease in frequency of migraine. In all studies, no severe adverse effects of butterbur was noticed.

7. Lavender²⁴:

Through a placebo-controlled trial in humans Rafie et al determined the effectiveness of essential oil of lavender in inhalation form for treating migraine. For this study 47 patients having symptoms of migraine were allotted into case and control group. To the case group lavender essential oil was inhaled for a duration of 15 minutes while liquid paraffin was inhaled to control group for equivalent time duration. Severity of headaches and symptoms associated with headache was observed for 2 h in 30 minute intervals. In case groups out of 129 headache attacks, 92 reacted partially or wholly to lavender oil while out of 68 headache attacks 32 reacted to placebo. This shows that number of patients responding was significantly more in case group in comparison to control group (p = 0.001). This study revealed that lavender essential oil inhalation can be safely use for managing headache associated with migraine.

8. GelStat Migrane²⁵:

Cady RK et al performed a study enrolling 30 patients including both male and female who were suffering from migraine as per IHS diagnostic criteria i.e. migraine is associated with aura or not, < or = 15 headache days per month, 2 to 8 migraines in a month and concluded that when GelStat migraine which is a combination of ginger and feverfew when taken early during mild headache phase can be used as a first line treatment of migraine. 29 evaluable patient finished the study at mild pain. No pain was noticed in 48% patients after 2 hrs of treatment while minor headache was observed in 34% patient and in 29% patient’s recurrence was seen within 24hrs. Gelstat migraine therapy satisfied about 59% of patients. Negligible side effects were noticed which was not serious.

9. Ginger²⁶:

Martins et al evaluated the efficacy of ginger in treating acute type of migraine and concluded that when ginger is given along with non-steroidal anti-inflammatory drugs it helps in treating migraine attack. They performed double-blind placebo-controlled clinical trial by dividing sixty patients in two groups, to these groups 400mg extract of ginger (5% active constituent) or cellulose as placebo was given, along with 100mg dose of ketoprofen given through intravenous route for treating migraine. Less pain and improved functional status was observed after one hour, one and half hour and two hour in ginger treated patients.

10. Feverfew in migrane^27,28:

Pareek et al performed a trial by enrolling seventeen patients who were self-medicated with feverfew for several years before enrolling in study. They divided the patients into two groups. One group containing eight patients were treated with feverfew while placebo was given to other group containing nine patients. It was observed that in the patients taking feverfew the frequency of headaches remains constant and vomiting and nausea were reduced while it was augmented to almost 3-times in patients who switched to placebo in the trial phase. In some patients due to sudden stoppage of feverfew intake enfeebling headaches was also observed. Although statistical analysis has been interrogated in this study. Findings from this study was further confirmed by a placebo-controlled study in patients of migraine.

CONCLUSION:

Migraine is commonly associated with headache. If it is diagnosed in primary stage and treated hastily, transformation of sporadic migraine to chronic migraine can be prohibited and quality of life can be boost up to some extent. Although migraine cannot be cured in any sense but it can be managed. This review revealed that there are many herbal medicines which can be used for managing migraine.

REFERENCES:

1. Goli. Venkateshwarlu, Ragya Eslavath and A. Santhosh et al. Rephanus sativa- An Important Medicinal Plant: A Review of Its Folklore Medicine and Traditional Uses. Asian J. Pharm. Res. 2014; 4(3): 160-161.

2. Suman. Herbs: An alternative approach in Nephroprotection. Research J. Pharmacognosy and Phytochemistry. 2013; 5(1): 15-21.

3. Sandhya S, Vidhya Sravanthi E and David Banji et al. A Review on Medicinal Herbs Used for Acne. Res. J. Topical and Cosmetic Sci. 2011; 2(2): 40-44.

4. Rutuja Sawant, Aloka Baghkar and Sanjukta Jagtap et al. A Review on - Herbs in Anticancer. Asian J. Res. Pharm. Sci. 2018; 8(4):179-184.

5. Archana R Dhole, Vikas R Dhole and Chandrakant S Magdum et al. Herbal Therapy for Urolithiasis: A Brief Review. Research J. Pharmacology and Pharmacodynamics. 2013; 5(1): 06-12.

6. Pawar M.P., Patil N.P. and Baviskar D.T. Anti-diabetic uses of some Common Herbs in Pastoral Region of Dhule District of Maharashtra. Research J. Pharma. Dosage Forms and Tech. 2013; 5(2): 62-64.

7. N Sirisha, M Sreenivasulu and K Sangeeta. A Review on Herbal Diuretics. Research J. Pharm. and Tech. 2011; 4(3): 335-348.

8. Hun-Yong Ha and Wan-Young Yoon. Anti-wrinkle Effects of Mixed Extracts of Three Medicinal Herbs. Research. J. Pharm. and Tech. 2018; 11(7): 3031-3035.

9. Dharmesh Sharma, Deepak Prashar and Sanjay Saklani. Bird’s Eye View on Herbal Treatment of Diabetes. Asian J. Pharm. Res. 2012; 2(1): 01-06.

10. Bhupendra Shah and Dipesh Raj Pandey. Migraine. European Journal of Biomedical and Pharmaceutical sciences. 2017; 4(4): 226-230.

11. JMS Pearce. Historical aspects of migraine. Journal of Neurology, Neurosurgery and Psychiatry. 1986; 49(10): 1097-1103.

12. V. Indra Effective Pain Management to Improve Patient satisfaction – A Review. Int. J. Nur. Edu. and Research. 2019; 7(4): 613-615.

13. Nobuo Araki. Migraine. JMAJ Chronic Headache. 2004; 47(3): 124–129.

14. D. Ruthirago, P. Julayanont, J. Kim. Translational Correlation: Migraine. Conn’s translational Neuroscience, Edited by P. Michael Conn. Academic Press, United States. 2017; 1st Ed: pp. 159-165.

15. M Lukacs, J Tajti and F Fulop et al. Migraine, Neurogenic Inflammation, Drug Development - Pharmacochemical Aspects. Curr Med Chem.2017; 24(33): 3649-3665.

16. Milan Aggarwal, Veena Puri and Sanjeev Puri. Serotonin and CGRP in migraine. Ann Neurosci. 2012; 19(2): 88–94.

17. Hosein Delavar Kasmaei, Zahra Ghorbanifar and Farid Zayeri et al. Effects of Coriandrum sativum syrup on migrane: A Randomized Triple blind placebo-controlled trial. Iranian Red Crescent Medical Journal. 2016; 18(1): e20759.

18. Mohadese Kamali, Rostam Seifadini and Hoda Kamali et al. Efficacy of combination of Viola odorata, Rosa damascena and Coriandrum sativum in prevention of migraine attacks: a randomized, double blind, placebo-controlled clinical trial. Electronic Physician. 2018; 10(3): 6430-6438.

19. Mahmoud Gholamreza Gholamreza Mirzaee, Soleiman Kheiri and Mahboobeh Bahrami. Effect of valerian capsules in patients with migraine attacks treated with sodium valproate: A randomized clinical trial. J Shahrekord Univ Med Sci. 2015; 16(6): 119-126.

20. ES Johnson, NP Kadam and DM Hylands et al. Efficacy of feverfew as prophylactic treatment of migraine. Br Med J (Clin Res Ed). 1985; 291(6495): 569-573.

21. Angèle Guilbot, Marie Bangratz and Samira Ait Abdellah, et al. A combination of coenzyme Q10, feverfew and magnesium for migraine prophylaxis: a prospective observational study. BMC Complement Altern Med. 2017; 17(1): 433. Ye jisme 12 rfrnce likha h vo h

22. Christina Sun-Edelstein and Alexander Mauskop. Foods and Supplements in the Management of Migraine Headaches. Clin J Pain. 2009; 25(5): 446-452.

23. Lipton RB, Gobel H and Einhaupl KM et al. Petsites hybridus root (butterbur) is an eﬀective preventive treatment for migraine. Neurology. 2004; 63(12):2240–2244.

24. Shahram Rafie, Forough Namjoyan and Fereshteh Golfakhrabadi et al. Effect of lavender essential oil as a prophylactic therapy for migrane: A randomized controlled clinical trial. Journal of Herbal Medicine. 2016; 6(1): 18-23.

25. Cady RK, Schreiber CP and Beach ME et al. Gelstat Migraine (sublingually administered feverfew and ginger compound) for acute treatment of migraine when administered during the mild pain phase. Med Sci Monit. 2005; 11(9): PI65-9.

26. Martins LB, Rodrigues AMDS and Rodrigues DF et al. Double-blind placebo-controlled randomized clinical trial of ginger (Zingiber officinale Rosc.) addition in migraine acute treatment. Cephalalgia. 2019; 39(1): 68-76.

27. Anil Pareek, Manish Suthar and Garvendra S. Rathore et al. Feverfew (Tanacetum parthenium L.): A systematic review. Pharmacogn Rev. 2011; 5(9): 103–110.

28. Murphy JJ, Heptinstall S and Mitchell JL. Randomised double-blind placebo-controlled trial of feverfew in migraine prevention. Lancet. 1988; 2(8604):189–192.

Received on 23.03.2020 Modified on 20.04.2020

Asian J. Res. Pharm. Sci. 2020; 10(3):189-194.

DOI: 10.5958/2231-5659.2020.00036.3