Kshayaja and krimija Shiroroga – Causes, Symptoms, Treatment

By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S

Kshayaja Shiroroga is a disorder of the head caused by depletion of blood due to injury and muscle fat, kapha (and vata according to some references) located in the head leading to the deterioration of their functions and support and subsequent manifestation of headache.
Read – Migraine – Ayurvedic treatment, Herbs, Home Remedies

Kshayaja Shiroroga is thus a kind of ‘disease of the head’ / ‘headache’ caused by injury / trauma leading to depletion of blood and muscle fat and kapha in the head. (Some authors have mentioned deterioration of vata too)

It is also called as Kshayaja Shirashula / Kshayaja Shirobhitapa.
Read – Tension Headache Ayurvedic Treatment, Remedies, Tips, Herbs

Kshayaj Shirorog

Meaning and definition of Kshayaja Shiroroga
When a person has headache caused due to the trauma caused due to depletion of blood, muscle fat and kapha in the head and has severe, intolerable headache which is difficult to treat and also gets worsened on administration of sudation, emesis, medicated smoking, errhines and bloodletting, the person is said to be suffering from kshayaja headache.
Read – Headache Caused By Vata Dosha – Causes, Symptoms, Treatment

Causes and Pathogenesis of Kshayaja Shiroroga
The general causes and pathogenesis explained in the context of all Shirorogas is also applicable to Kshayaja Shiroroga.

Specific Causes of the kshayaja headache included –

  • Depletion of vasa (muscle fat) – in the head (according to master Gadadhara, the term vasa also represents the fatty part of the body which also includes fat, bone marrow, semen and the matrix of brain)
  • Depletion of kapha in the head
  • Injury which leads to depletion of blood tissue or impairs blood circulation in the head
  • Depletion of vata in the head (according to some references)
  • Stree prasanga – excessive indulgence in sex (master Chakshushya)
  • Abhighatat – due to injury (master Chakshushya)
  • Deha karmana – due to excessive physical activities (master Chakshushya)
    Read – How To Get Rid Of Headache? 20 Things That You Should Avoid

Pathogenesis


The blood and muscle fat tissues in the head including kapha dosha in the head get depleted. As a result there is deterioration in their normal functions. The support the head, brain, nerves and sense organs get from these elements is also depleted. These events lead to manifestation of severe and intolerable pain in the head. This condition is difficult to treat and is called as kshayaja headache.

Controversies surrounding the explanation of aetiology and pathogenesis of kshayaja headache – a debate!
Controversies surrounding kshayaja headache are due to ‘vata depletion’ mentioned by some authors as cause of kshayaja headache.

Among the key elements taking part in the pathogenesis and manifestation of kshayaja headache, the blood and muscle fat are the tissues scattered all through the body, including the head. Head is one of the important organs in the body where kapha is located.
Since vata is mentioned by some authors, Prana Vata and Udana Vata are the types of vata which are related to the head can be considered. Hence, the depletion of all these elements may consequentially lead to loss of their functions and lead to severe intolerable headache constituting kshayaja headache. Here, the decrease of vata as explained by some authors is a debatable point.
Read – Vata Kshaya Lakshana: Symptoms Of Decrease Of Vata Dosha

How can vata decrease cause pain?


Generally any type of pain, including the headache is attributed to abnormal increase of vata whereas vata decrease cannot produce headache. But in the pathogenesis of kshayaja headache, it is clearly mentioned that among all the elements which undergo depletion, vata too undergoes depletion. Also, vata and kapha are inversely proportional. If kapha increases, vata decreases and when vata increases, kapha decreases. Here, in kshayaja headache, we see depletion of both doshas.

In the Madhukosha commentary, the answer for this aspect is cleverly given. The author tells that headache occurs in spite of vata decrease because of the ‘vyadhi swabhava’ i.e. ‘nature of the disease’ or ‘basic behaviour and presentation of the disease’.
Read – Kapha Decrease Symptoms, Analysis, Treatment

When the doshas decrease, the functions of those doshas deteriorate. Logically the decrease in doshas cannot cause severe pain, if it cannot be accepted as happening due to ‘nature of disease’. Thus, we get a doubt if decreased vata can really cause pain? It is easy to rub off that question by telling ‘might not, but it happens due to the nature of the disease’.

Another aspect from where we need to look at this is that, if vata decreases, kapha should decrease since both can’t increase simultaneously. When kapha increases following vata decrease, it will obviously cause kaphaja headache. When this happens, one cannot implement the treatment strategies of kshayaja headache. In treatment of kshayaja headache, it has been mentioned that vata mitigating ghee processed with sweet tasting herbs shall be used for drinking and errhine.
Read – Ayurvedic Description of Ghee – Ghritam

These medicines, no doubt decrease vata, but also increase kapha because they are kapha increasing in nature, including the sweet herbs and ghee. Also, we would get a doubt so as to why vata mitigating ghee is needed if vata has already decreased? The answer is the same. Vata mitigating sweet tasting ghee is used to mitigate and cure kshayaja headache, to combat the nature of the disease, not to address vata.

The version which matters

Master Sushruta has mentioned kshata i.e. injury which indirectly points towards blood loss as causative of kshayaja headache. So, inclusion of vata kshaya is out of equation.

Some other authors like Master Gayi etc have not accepted the ‘asruk, vasa, shleshma sameerana sankshayena’ i.e. ‘depletion of blood, muscle fat, kapha and vata’ version.
Read – Medo Dhatu: Fat Tissue, As Explained In Ayurveda

They have replaced it with ‘vasa balasa kshaya sambhavanam / vasa balasa kshata sambhavanam’ version i.e.

  • ‘kshayaja headache is caused due to the decrease of muscle fat and kapha (blood and vata not mentioned)’ or
  • ‘kshayaja headache is caused due to decrease of muscle fat, kapha and injury (injury might include blood loss, vata not mentioned).

    In these two versions, decrease of vata has not been mentioned.

Master Dalhana, the commentator of Sushruta Samhita too has accepted the ‘depletion of muscle fat, kapha and injury i.e. loss of blood’ as the chief cause leading to the pathogenesis and manifestation of kshayaja headache.
Read – Vata Increase Caused Due to Tissue Depletion: Dhatu kshaya

Why does the kshayaja headache increase by sudation and other therapies?
Sudation, emesis, herbal smoking and strong errhines reduce the kapha in the body and also in the brain by the virtue of their kapha expelling action. This is not intended in treating this type of headache in which there is already decrease of kapha. Strong medicated smoke also depletes the brain tissues and causes their damage. By bloodletting and venesection, the blood tissues are depleted. Thus, these treatments cause increase in kshayaja headache and thus not intended to be administered.

Symptoms of Kshayaja Headache

  • Ugra rujo atimatram – severe, constant and unbearable headache
  • Bhramati – giddiness
    Read – Dizziness: Causes, Symptoms, Ayurvedic Remedies, Treatment
  • Tudhyate – pricking / throbbing pain in the head
  • Numbness in the head
  • Vibhranta netrata – feel of discomfort in the head / confused or bewildered eyes
  • Fainting, unconsciousness
  • Gatra avasada – weakness of the body parts,
  • Kshipram sanjayate – the headache occurs suddenly without any reason
  • Samswedana, chardana, dhuma, nasyaih asruk vimokshai cha vivruddhimeti – the headache increases and becomes severe on administration of sudation, emesis, medicated smoking, nasal medication and bloodletting therapies
  • Vata pittatmakam lingam – symptoms of vata and pitta increase in head (and also in the entire body)
    Read – How To Balance Pitta Vata Dosha? 6 Points To Consider

Modern correlation


By seeing the signs and symptoms of kshyaja headache, it can be classified under the umbrella of ‘constitutional or systemic headache’. These types of headaches occur due to the effect of some other major disease or imbalance in some other part of the body or afflictions of other organs.

These headaches can also occur in long standing diseases which have confined the patient to long term bed rest and also chronic diseases which cause excessive depletion of blood, fat and supportive tissues, most of which falls under kapha category.
Read – Blood Formation, Causes of Impurity, Diseases, Treatment – Charaka Sutra 24

These headaches are also caused due to ‘cerebral anemia’ which occurs due to many disorders which lead to the causation of anemia in the body, which includes the below mentioned conditions –

Ayurvedic treatment for Kshayaja Headaches

Principles and measures of treating Kshayaja Headaches
All remedies, comforts, therapies, food and lifestyle changes in the management of kshayaja headache are oriented towards balancing the tissues which have deteriorated and also to balance the doshas.

Brimhana – muscle bulk promoting therapies / strengthening treatments
Snehapana / ghritapana – drinking of medicated fats
Vataghna madhura ghrita nasya – nasal medication using ghee processed and prepared with vata alleviating herbs which are predominantly sweet tasting herbs
Ksheerapishta vataghna avapidana nasya – vata alleviating herbs are ground in milk and squeezed into the nostrils as drops to alleviate pain of kshayaja headache (readNasya Karma Procedure, Types, Benefits, Contra Indications)
Guda ghrita – combination of ghee and jaggery is given to eat. Foods and delicacies prepared from ghee and jaggery are encouraged to be eaten by the patient suffering from kshayaja headache.
Sudation – administered with sesame macerated with milk and herbs of jeevaniya group of medicines.
Kshaya kasapha ghrita – medicated ghee preparations mentioned in the context of kshayaja cough (the ghee which mitigate cough caused by depletion of tissues) shall be used in kshayaja headache also.

Rasa dravya – herbo-mineral preparations T
These are used individually or together skilfully, given with ghee or Chyavanprash. Milk shall be given as after drink.
Read – Chyawanprash Uses, Dose, How To Take, Ingredients, Side Effects

  • Danti bhasma
  • Mahalakshmi vilas ras
  • Abhraka bhasma
  • Kanchanabhra
  • Muktapishti
  • Vasanta malati
  • Pravala bhasma etc

Krimija Shiroroga

Krimaja Shiroroga is caused by worms / germs.

Krumija – caused by microorganisms
Shiroroga – disease of the head / headache
Krimija Shiroroga is thus a kind of ‘disease of the head’ / ‘headache’ caused by worm infestation or infection. It is also called as Krimija Shirashula / Krimija Shirobhitapa.
Read – Headache Caused By Vata Dosha – Causes, Symptoms, Treatment

Meaning and definition of Krimija Shiroroga
When a person has headache in which the person feels severe throbbing sensation and pulsating pain within the bones of the head, feels as if something is eating off his brain or the membranes within the head, and discharges pus mixed fluids from his nose, the person is said to be suffering from headache caused by worm infestation. This condition is very dreadful.
Read – Migraine – Ayurvedic treatment, Herbs, Home Remedies

Causes of Krimija Shiroroga


General causes and pathogenesis explained in the context of all Shirorogas is also applicable to Krimija Shiroroga.

Specific causes of Krimija headache

  • Sankeerna bhojana – consumption in excess / regularly of impure and adulterated foods / abnormal combinations of food / undercooked or uncooked foods
  • Excessive consumption of sesame seeds in food or sesame seed preparations
  • Excessive consumption of milk
  • Excessive consumption of jaggery / molasses
  • Ajeerna – having long standing indigestion / foods which cause indigestion
  • Puti bhojana – eating foods which are foul smelling and putrid in nature, carried over foods / contaminated and stored foods
    Read – Tension Headache Ayurvedic Treatment, Remedies, Tips, Herbs

Pathogenesis and symptoms of krimija headache  

1. Pathogenesis and symptoms of worm induced headache as explained by master Vagbhata –

When a person regularly consumes excessive foods which are formed by incompatible and unwholesome mixtures of foods, stale, foul smelling and putrid foods, impure and adulterated foods, the kledabhava i.e. moistness increases to abnormal levels in the head. This moistness abnormally happens in the blood and muscles of the head.

Following the increased dampness in the head, all the three doshas in the head get vitiated and create a condition of sannipata i.e. head afflicted by all vitiated doshas.

This increased dampness and consequent increase of doshas to pathological proportions creates a suitable environment for the manifestation of krimis i.e. worms / microorganisms. These worms start consuming the circulating blood in the vessels of the brain.
Read – How To Get Rid Of Headache? 20 Things That You Should Avoid

Symptoms

  • Ghorah vedana – Severe pain in the head.
  • Chittavibhramsha – Perturbation of mind and senses
  • Fever
  • Cough
  • Bala kshayah – This will consequentially cause loss of strength and weakness
  • Roukshya – The worms continue feeding on the blood and flesh which will cause dryness in the head / brain.
  • Shopha – This will further lead to swelling of head / brain.
  • Vyadha – pricking pain in the head
  • Chcheda – cutting pain in the head
  • Daha – burning sensation in the head
  • Sphutana – pulsating / blasting pain in the head
  • Kapala, talu shiraso kandu – itching sensation in the head, scalp and palate.
  • Putitah tamra achcha singhanakah – Bleeding occurs from the nose and blood will have foul smell. The discharges are coppery clear in appearance.
  • Kapala, talu, nasa, shiraso shosha – Person suffers from dryness of head, palate, nose and head.
  • Pralimaka – Person tries to open his eyes with difficult and finds it hard.
  • Karnanada – abnormal sounds in the ear (tinnitus)

This condition is called krimija headache and is a dangerous condition.
Read – Tinnitus Causes, Ayurvedic Treatment, Herbs, Lifestyle Tips

2. Pathogenesis of worm induced headache as explained by master Charaka –
Due to excessive consumption of sesame, milk, jaggery, indigestion and impure and adulterated foods, excessive moistness develops in the blood, muscles and kapha located in the head of a person in whom already the doshas have exacerbated. This moistness leads to decay of these tissues and provides an ideal environment for the development of microbes / worms. Worms are also said to manifest in the head of a person who have done more sins. Manifestation of the germs will lead to many dreadful symptoms. This condition / headache is called krimija headache.
Read – Nose Bleed: Ayurvedic Understanding, Treatment

Symptoms (Sushruta and Charaka) –

  • Nistudhyate yasya shiro atimatram – severe throbbing pain in the head
  • Sambhakshyamanam – person feels as if his brain / layers and coverings of his brain are being eaten by something
  • Sphuarana – pulsating feel / pain in the head
  • Ghraanaat gachchet salilam sa puyam – there are watery discharges from the nose mixed with pus and infected material
  • Vyadha – pricking pain in the head
  • Cheda – splitting pain in the head
  • Ruja – severe headache
  • Kandu – itching in the head
  • Shopha – swelling in the head
  • Dourgandhya – foul smell
    Read – Anosmia: Ayurvedic Treatment And Home Remedies

Modern correlation – Krimija Shiroroga



From the modern point of view, Krimija Shiroroga appears like a headache caused by infection of worm / germ infestation of head and tissues therein. This can happen by direct or indirect impact of the germs present in the body, brain or circulation.

We can analyze the germs / worms causing this type of headache from two perspectives –

1. The worms and microorganisms that are not visible
This occurs when there are plenty of pathological worms in the abdomen which are responsible for causation of reflex headache. These include roundworms, hookworms, tapeworms etc. Here, the headache is secondary and an impact of the worms elsewhere in the body and are actually not present in the head. But the headache is not as severe as explained in the Ayurvedic texts. In this type of reflex headache, the pains of the sort of pricking, piercing, tearing etc, the discharge of pus or blood from nose and feel of the brain being eaten by something are not experienced. The pain will be on mild to moderate scale.

There is another possibility in these cases. The microorganisms and tiny worms like Taenia solium, Taenia echinococcus, cysti, circus or hydatid may reach the brain through circulation. When this happens, the headache is of severe type. These worms cause blockage of the blood vessels supplying the brain and cause ischemia. This results in loss of blood supply to the brain and cause severe headache.
Read – Atrophic Rhinitis: Ayurvedic Treatment, Home Remedies, Herbs, Medicines

2. The worms and microorganisms that are visible – When there is severe headache as explained in Ayurvedic texts and also when the worms are expelled from the nose, being clearly visible, one should consider this as ‘secondary infection in sinusitis’.

Another way of occurrence of such headaches is due to the presence of worms in the gut. These worms cause secondary anemia which leads to deficit blood supply to the brain and cause headache.
Read – 6 Simple Home Remedies To Stop Runny Nose

Ayurvedic treatment for Krimija Headaches

Principles and medications for treating Krimija Headaches
In Krimija headaches, all attempts to pull out and expel the worms located in the head, through the nose should be done. At the same time, all measures including the worm-destroying medicines, food and drinks should be arranged.

Shonita Nasya – When the patient complains that his brain is being eaten by the worms, immediately nasal drops should be instilled using blood. When the blood drops are instilled into the nostrils, the worms in the head get intoxicated by the blood and start roaming around in confusion all through the head and reach the nostrils. These worms should now be removed or brushed off using kurchika i.e. brushes.
Read – Tested Remedies For Eye, Ear, Nose, Throat Problems: Ramdas Pai

Murdha virechana – head cleansing errhines should be given to eliminate the worms from the head. For this, strong acting powders of herbs like Embelia ribes, Achyranthus aspera, drumstick etc which are capable of purging the head are used as snuff and blown into the nose. These powders will expel the worms from the nose.

Krimighna avapidana – The worm-destroying herbs have to be grinded with urine of cow or goat, mixed with powders of herbs like Trikatu (long pepper, black pepper and ginger), holy basil, drumstick etc and squeezed into the nostrils of the patient suffering from krimija headache.
Read – Trikatu Churna Benefits, Dose, Remedies, Side Effects

Vidangadi taila nasya – sesame oil prepared with cow urine mixed with the paste of Embelia ribes, alkali, Baliospermum montanum and asafetida is used as nasal drops.
Read – Vidanga – Embelia ribes Benefits, Usage, Dose, Side Effects

Puti matsya dhuma – the patient suffering from krimija headache should be encouraged to inhale the smoke coming from burning rotten fishes.

Raktaja Pratishyaya chikitsa – all treatments and measures which are advised in the treatment of rhinitis caused by vitiated blood are adopted in Krimija headache also.
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