Suryavarta Shiroroga – Causes, Symptoms, Treatment

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

Suryavarta is a type of headache, with a relationship to course of Sun movement. Here, intensity of headache increases with that of the Sun and reaches peak by noon.

Introduction

Suryavarta – according to the course and movement of the Sun
Shiroroga – disease of the head / headache
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Other names – Suryapavarta, Bhaskaravarta

Main symptom

Headache typically starts along with the sunrise. The pain is usually mild in nature.
The headache gradually increases along with the intensity and movement of the sun, towards the afternoon.

The pain is concentrated in the eyes and along the eyebrows and is severe in nature. The intensity of headache is severe in the noon when the intensity of the heat of sun is optimum.
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The severity of the headache reduces post-noon, as the intensity of the heat of the sun reduces towards evening. The headache too reduces towards evening and becomes mild by evening.

The patient is sometimes comforted with cold remedies and measures and at some other times he is comforted with hot remedies and measures.

This condition caused by simultaneous vitiation of all three doshas and is said to be dreadful in nature and is called Bhaskaravarta / Suryavarta.
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Pathogenesis

Pathogenesis of Suryavarta according to various references, Reasons for waxing and waning of pain

1. Master Srikantadatta, in his Madhukosha commentary on Madhava Nidana tells that it is the nature of the disease.

2. Master Nimi gives a valid explanation for this behavior of the disease. According to him, since night is cold in nature and is enriched with tama quality, kapha gets accumulated in the channels of the body and head overnight. This causes blocks in the channels of the body. When the channels get blocked, the easy movement of vata is hampered and as a result, vata gets aggravated. This leads to the onset of headache, early in the morning, with sunrise, and intensifies towards mid-noon.
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At noon, due to the intensity of heat of the Sun, the kapha which has accumulated and got consolidated in the channels of the body gets melted, just as the ice melts due to the heat of the sun. This releases the obstruction of vata. The vata starts getting settled in its place and thus the relief from headache sets in and the person starts feeling better. By evening the entire kapha which had accumulated and blocked the channels will have melted completely. This would have released the obstruction of vata entirely. The vata would get settled down and there is total relief from the headache. The same cycle would keep repeating in the patient until the condition is taken into control by suitable interventions and measures.

3. According to Master Dridhabala, due to the heat of the sun, the mastulunga i.e. brain keeps getting melted which causes this nature of pain in relation to the sun’s heat. Towards the mid-noon as the intensity of the heat of the sun keeps increasing, the melting of the brain too takes place with the same intensity.

At mid-noon, the melting of brain will take place with great intensity and the headache too becomes severe and intolerable. Post-noon when the intensity of the heat of the sun drops the intensity of the melting of brain stops and the headache starts deteriorating.
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We should not take the explanation of Dridabala in true sense because the brain doesn’t melt and solidify once again. Just as the ice melts on getting exposed to the heat of the sun and gets consolidated when the heat reduces and it is exposed to coldness, the explanation of master Dridabala too should be taken in this sense.

4. Master Charaka too has given the same reasons for the intensity of the headache increasing and decreasing with the course of the sun. In fact Dridabala has magnified the version of master Charaka and has detailed the explanation as above.
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‘At sunrise, due to the heat of the sun, gradual liquefaction takes place in the brain. Due to continued liquefaction, the headache gradually increases towards mid-noon as the day graduates. Towards the end of the day i.e. evening the liquefied things consolidate in the brain and the headache decreases’.

Probably master Charaka and Dridabala mean to explain the liquefaction and consolidation of kapha in the brain but haven’t mentioned the word kapha. We should remember that head is one of the predominant sites of kapha.

Sanskrit Shloka

Doshas in Suryavarta

The dosha games in suryavarta headache
According to master Madhava, this condition is caused by simultaneous vitiation of all three doshas.

Master Sushruta’s explanation that the headache sometimes reduces with cold comforts and sometimes with hot comforts, points out towards the disease being caused by predominant vitiation of pitta and vata. When pitta dominates in the pathogenesis, it gets relieved by cold measures and when vata dominates, it gets relieved by hot comforts.

We can conclude that suryavata is a vata-pittolbana sannipata i.e. caused by all three doshas but with predominance of vata and pitta.
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But how does the headache get reduced in the evening time when vata is predominant and why is the pain mild at the beginning and end of the day? This is because, even among vata and pitta, the pitta vitiation is severe. Therefore the pain subsides during evening, when vata is predominant.

If so, the logic of using powders like pitta increasing herbs like roots of long pepper, Acorus calamus, roots of Albizia lebbeck for nasal instillation to relieve headache needs to be explained. The answer is that these herbs act on the disease but not on the doshas i.e. they are disease specific remedies and hence relieve the headache immaterial of the predominant dosha.

Another explanation – since vata and pitta are cold and heat predominant doshas, they get obstructed when the channels of the body constrict as the intensity of the sun increases towards mid-day. As a result, the obstructed vata and pitta cause headache. The channels of the body open up as the sun sets towards the evening. As a result the vata and pitta too subside since there is no obstruction in the channels. As a result the pain subsides towards evening.
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Master Vagbhata clearly explains that suryavarta is tridosha disease caused by predominant involvement of pitta with association of vata.

According to him – ‘The vayu on getting the association of pitta will cause pain in the eyes, above the eyebrows, forehead and temples which constantly increases. The pain especially increases when the patient is on empty stomach and doesn’t eat anything. This is a highly unpredictable condition which sometimes gets reduced with cold measures and sometimes with hot comforts. This is called suryavarta’.

According to master Charaka, Suryavarta is caused by contaminated vata and blood tissue. He has also mentioned forcible withholding of body urges, indigestion and contamination of tissues of the brain in the causation.

Causes of Suryavarta

Compiling from all the above said references, the causes of suryavarta headache can be enumerated as –

Symptoms of Suryavarta

With the help of all the above said references, we can enlist the symptoms of suryavarta as below –

  • Severe headache which waxes and wanes from morning to evening following the course and intensity of the Sun
  • The headache is mild to moderate during the early part of the morning and evening but is severe and intolerable at mid-noon
  • Pain in the eyes, eyebrows, region above eyebrows, forehead and temple
  • Pain intensifies towards noon following the course of the sun and reduces towards evening and gets relieved at sunset
  • Sometimes relived by cold comforts and sometimes by hot comforts
  • Pain increases on empty stomach and during indigestion
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Modern correlation

Suryavarta has often been compared to chronic rhinitis and its complications. Many experts have closely compared it with various forms of sinusitis. It is said to be caused by various kinds of infections like those caused by B. Influenza, M. Catarrhalis, Staphylococcus etc. Ascending infection from nose, teeth or throat are said to be causal. The symptoms depend on the seat of infection and on which sinuses are infected and inflamed. The pattern of headache almost resembles that of suryavarta.
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Suryavarta Viparyaya

Suryavarta Viparyaya – a variant of Suryavarta headache

Master Nimi / Videha have described yet another condition, a variant of suryavarta called Suryavarta Viparyaya. This condition also follows the course of the Sun. Viparyaya means opposite. Actually, going by the name of the disease, in this condition the sequence of events and symptoms should be exactly opposite to those in suryavarta. But we do not see many differences in the manifestation of this variant except its name and few differences. The differences are –

In Suryavarta, pitta is predominantly vitiated and vata is associated. In Suryavarta viparyaya, vata is predominantly vitiated while pitta is associated.

As in Suryavarta, the headache becomes severe in this condition too, due to the predominant increase of pitta. We do not have a clear explanation so as to what happens to the headache in the morning time in suryavarta viparyaya.

By evening, vata naturally increases and as a result pitta gets subsided leading to reduction of headache in suryavarta viparyaya. In suryavarta too the headache reduces towards the end of the day.

While Suryavarta is a condition caused vitiation of all three doshas, Suryavarta Viparyaya is caused by vitiation of dual doshas i.e. vata and pitta.

We can find a dwandwaja suryavarta i.e. suryavarta caused by dual vitiation of doshas in Gadanigraha treatise wherein the headache starts after sunset, remains all through the night and gets subsided at sunrise.
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Treatment

Line of treatment

Treatment Principles of Suryavarta headache –

In suryavarta headache nasal medication / errhines and other treatments should be done. Other treatments may include other purification treatments like purgation etc according to the condition of the disease and predominant dosha involved. But here the author has specifically put errhines at the top of the treatments. Even in clinical practice, all sorts of headaches respond to errhines, especially suryavarta headache. The meat soup of animals living in desert like lands should be served for food. Other than this sweets prepared with milk and rice and other sweetened foods should be served. Ghee added to hot milk too shall be served.
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Regular consumption of ghee and milk – It is important that in suryavarta headache one should take care that he should not keep his stomach empty for more time, especially in the morning. This is because headache increases on empty stomach. Early in the morning one should make a habit of consuming ghee, milk or sweets prepared with milk. Sweet dishes prepared with milk using rice should be consumed.

The patient should be asked to finish his morning rituals even before sunrise and served with delicacies prepared in ghee or milk base and also sweetened foods. Those who have severe pain shall consume fresh jalebis dipped in milk to their capacity. Alternatively thick syrup prepared from jaggery should be given mixed with ghee in good quantity. Drinking fresh sugarcane juice also gives relief from headache.

Therapeutic purgation – Virechana is beneficial in high pitta and vata conditions. In this headache too pitta and vata are severely aggravated. Therefore purgation should be given to expel the vitiated doshas.

Bloodletting – Bloodletting will relieve the pressure caused by congested blood and relieves headache related to suryavarta.

Nasal medication

Nasal medication / errhines –

Below mentioned medicines are used as errhines for relieving headache in suryavarta –

Poultices

The meat of animals and birds living in desert regions should be prepared and tied in poultice. This should be used to provide heat / sudation to the head. Similarly poultices containing thick gruel prepared in ghee too should be used for sudation over the head to relieve the pain.

Medicinal pastes

Seeds of sunflower should be ground in the juice of sunflower and the resultant paste should be applied over the head in headache of suryavarta.
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Oral medicines

Niargim tablet,
Shirashuladi Vajra Rasa
Rasnadi kashayam tablet
Trishun tablet
Sheetaprabha gulika
Migrakot oil, tablet
Rasnadi Guggulu
Varanadi Ghrita,
Varanadi Kashaya
Brahmi ghrita
Saraswatarishta
Bramhi vati
Pathyadi Kada,
Pathyaksha Dhatryadi kashaya etc.

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