Effect of vatakarma kapalbhati on sinus headache

Poornima Ravi; V Venugopal; Deenadayalan Boopalan; Akila Anandhan; Yogapriya Chidambaram; Maheshkumar Kuppusamy

doi:10.4103/jopcs.jopcs_15_22

CASE REPORT

Year : 2023 | Volume : 4 | Issue : 1 | Page : 32-34

Effect of vatakarma kapalbhati on sinus headache

Poornima Ravi¹, V Venugopal², Deenadayalan Boopalan³, Akila Anandhan⁴, Yogapriya Chidambaram³, Maheshkumar Kuppusamy⁴
¹ Yoga and Naturopathy, Government Yoga and Naturopathy Medical College and Hospital, The Tamilnadu Dr.MGR Medical University, Chennai, TamilNadu, India
² Department of Yoga, Government Yoga and Naturopathy Medical College and Hospital, The Tamilnadu Dr.MGR Medical University, Department of Physiology, Chennai, TamilNadu, India
³ Department of Naturopathy, Government Yoga and Naturopathy Medical College and Hospital, The Tamilnadu Dr.MGR Medical University, Department of Acupuncture and Energy Medicine Chennai, TamilNadu, India
⁴ Department of Physiology, Government Yoga and Naturopathy Medical College and Hospital, The Tamilnadu Dr.MGR Medical University, Department of Physiology, Chennai, TamilNadu, India

Date of Submission	07-Jul-2022
Date of Decision	17-Oct-2022
Date of Acceptance	23-Oct-2022
Date of Web Publication	04-Jan-2023

Correspondence Address:
Dr. Maheshkumar Kuppusamy
Department of Physiology, Government Yoga and Naturopathy Medical College and Hospital, The Tamil Nadu Dr. MGR Medical University, Chennai - 600 106, Tamil Nadu
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jopcs.jopcs_15_22

Abstract

Sinusitis is a common inflammatory condition affecting paranasal sinuses encountered by people of all age groups. Vatakarma Kapalbhati is a yogic cleansing technique and pranayama found to be beneficial in sinus headaches. We reported the effect of Vatakarma Kapalbhati on three individual cases with sinus headaches. Three women who had chronic headaches due to paranasal sinusitis were given Vatakarma Kapalbhati as an intervention. Outcome measures such as Pittsburgh Sleep Quality Index (PSQI), Sinonasal Outcome Test-22 (SNOT-22), Headache Impact Test-6 (HIT-6), and Visual Analog Scale (VAS) were used to assess the efficacy of the intervention. Significant improvement in PSQI, SNOT-22, HIT-6, and VAS was found postintervention when compared to the baseline. Vatakarma Kapalbhati could be a potential supportive therapy for the management of sinusitis headaches alongside conventional management.

Keywords: Headache, kapalbhati pranayama, pranayama, sinus headache, sinusitis, yoga

How to cite this article:
Ravi P, Venugopal V, Boopalan D, Anandhan A, Chidambaram Y, Kuppusamy M. Effect of vatakarma kapalbhati on sinus headache. J Prim Care Spec 2023;4:32-4

How to cite this URL:
Ravi P, Venugopal V, Boopalan D, Anandhan A, Chidambaram Y, Kuppusamy M. Effect of vatakarma kapalbhati on sinus headache. J Prim Care Spec [serial online] 2023 [cited 2023 Jun 6];4:32-4. Available from: https://www.jpcsonline.org/text.asp?2023/4/1/32/367062

Introduction

Sinusitis is a common acute or chronic inflammatory condition of a mucus membrane lining the paranasal sinuses.^[1] The etiology of sinusitis could be of infectious or noninfectious origin. Upper respiratory tract infection, allergic rhinitis, immune deficiency, cigarette smoking, deviated nasal septum, and nasal polyps are a few of the potential risk factors.^[2] Sinusitis is characterized by the release of inflammatory mediators and hypersecretion of mucus, which impairs mucociliary function and might result in edema or mucus membrane injury.^[3] Nasal blockage, sneezing, running nose, ear fullness, and ear pain are the common symptoms of sinusitis.^[4],[5]] Sinusitis can be classified as acute, subacute, or chronic based on the duration. The complication of sinusitis includes inflammatory edema, orbital abscess, orbital cellulitis, frontal and maxillary osteomyelitis, epidural abscess, meningitis, and brain abscess.^[6] Corticosteroids, anti-inflammatory drugs, decongestants, antimicrobial, antifungal drugs, and surgery are potential conventional management strategies.^[7]

Yoga is a common and widely used branch of complementary and alternative medicine therapy in recent times. Breathing techniques (pranayama) were found to be beneficial for chronic tension headaches, migraines, and cluster headaches.^[8] Kapalbhati, also known as the "Frontal Brain Cleaning Technique" drains excess mucus from the paranasal cavities.^[9] Few consider Kapalbhati a pranayama and few consider it a kriya. The present case series shows the effect of vatakarama Kapalbhati on three individual patients with sinusitis.

Case Report

Case 1

A 29-year-old female approached for an online consultation with chief complaints of severe headache, ear pain, and pain in her face for the past 6 months. Her computerized tomography report revealed maxillary sinusitis. Her past history revealed systemic lupus erythematous for which she was on medication. After childbirth, her gynecologist advised to discontinue the medication. Investigating her medical history revealed that she had not been on any medication for the previous 8 months. She had disturbed sleep since she had to take care of a toddler, but her appetite and thirst were good. She was obese in Grade 2 (87 kg, 164 cm). On physical examination, there was pallor in the skin and palpebral conjunctiva. There was no icterus, edema, lumps, or cyanosis. She had a biphasic gait. She had no history of allergy, hypertension, coronary artery disease, cerebrovascular disease, hypertension, or tuberculosis. Vatakarma Kapalbhati was given as an intervention from January 2020 to October 2020 for 10 months. The duration was 15 min in the morning and evening preferably between 6.30 and 6.50 a.m. and 6.30–6.50 p.m. No further modifications were made in her lifestyle. Follow-up was conducted in October to check for the reoccurrence of symptoms. As of now, there has been no reoccurrence.

Case 2

A 20-year-old female approached us for online consultation with the complaint of severe headache, sneezing, and dizziness for the past year. During the year 2018, she went to a Siddha doctor and was diagnosed with sinusitis and applied Neerkovai tablets (Siddha medicine) to her forehead, either side of her nose, and also two drops of sukku thailam to her nose. Her headache got aggravated after a head shower, even if her hair is thoroughly dried. She personally admitted that this headache was decapitating her from preparing for the chartered accountant exams. The only remedy that she could do was to sleep at least an hour after the onset of the headache. She attained menarche at the age of 14. Her menstrual history was regular; she had a 3–5-day bleeding phase with 28–30 days of her cycle and experienced no pain or discomfort. She had disturbed sleep, which was due to her exam preparation, good thirst, and good appetite, and her bowel movement was regular. On general physical examination, there was no pallor, icterus, cyanosis, lumps, or edema. She had no allergies, no history of genetic diseases, and not known case of anemia, bronchial asthma, cardiovascular disease, cerebrovascular disease, diabetes mellitus, or tuberculosis. Vatakarama Kapalbhati was given as an intervention from March 2020 to November 2020 for 9 months. The duration was 15 min in the morning and evening preferably between 6.30 and 6.50 a.m. and again between 6.30 and 6.50 p.m. No further lifestyle modifications were advised to her. A telephonic follow-up was conducted in December to check on the reoccurrence of the symptoms. As of now, there has been no reoccurrence.

Case 3

A 29-year-old female approached us for an online consultation with a chief complaint of severe headache. She was diagnosed with paranasal sinusitis at 14 years of age and inhaling eucalyptus oil provided her a certain degree of relief. Even now, she had the habit of inhaling it, which makes her feel better. She attained menarche at the age of 12 years. She gave birth to a healthy boy vaginally during the year 2017. She had a normal menstrual history with 5 days of bleeding in 30 days of the cycle and had slight pain in the lower back region and thighs during menstruation. She was obese in Grade 1 (164 cm, 76 kg). She had no history of allergies, had disturbed sleep, good thirst, and good appetite, and her bowel movements were regular. On general physical examination, there was no pallor, icterus, cyanosis, lumps, or edema. She had no allergies, no history of genetic diseases, and no known cases of anemia, bronchial asthma, cardiovascular disease, cerebrovascular disease, diabetes mellitus, or tuberculosis. Vatakarma Kapalbhati was given as an intervention from May 2020 to December 2020, for 8 months, the duration was 15 min in the morning and evening preferably between 6.30 a.m. and 6.50 a.m. and 6.30–6.50 p.m. Follow-up was conducted in January 2022 to check on the reoccurrence of the symptom. As of now, there has been no reoccurrence.

Intervention procedure

On an empty stomach or 2 h after food, Vatakarma Kapalbhati practice is to be done. The patient sits in a comfortable position and was asked to start the practice with inhalation. Followed by which, the patient is asked to exhale forcefully through both nostrils. Initially, patients were asked to perform 10–20 strokes of exhalation after inhalation, followed by 1 min of rest. Slowly, the strokes of exhalation after deep inhalation were increased to 40–60 strokes, which were also followed by 1 min of rest. Initially, for 7 days, patients were given step-by-step instructions regarding the procedure of practice, and it was not taken into account during the intervention period. The attendance of each participant was recorded individually. Intervention and instruction regarding practice were given only through the online video-based platform Google Meet. Since only three patients were there, it was easy to perform regular follow-up and monitoring as well. All these cases were informed about the intervention and assessment procedure, before the intervention, and written informed consent was obtained for assessment, intervention, and publication from patients and also from their family members.

Outcome measures

Pittsburgh Sleep Quality Index (PSQI) was used to assess the sleep quality of patients, Perceived Stress Scale (PSS) to analyze the stress encountered by the patient, Sinonasal Outcome Test-22 (SNOT-22) to assess the symptoms of sinusitis, Headache Impact Test-6 (HIT-6) to learn about the intensity of the headache and its impact on patient's life, and Visual Analog Scale (VAS) to rate the pain. Baseline data were taken before the beginning of the intervention, and postdata were taken after 7 days of the postintervention period.

Results

The results of the intervention are shown in [Table 1]. PSQI, Perceived Stress Scale (PSS), SNOT-22, HIT-6, and VAS scores improved in Vatakarma Kapalbhati. None of the patients reported any adverse effects during the intervention. Improvement in the quality of sleep was reported by all three patients. The intensity of headache was significantly reduced, and the patients reported that the pain was much more tolerable. Even though cases 1 and 2 had reported that the headache does not affect their quality of life. Case 3 reported that her headache episodes sometimes interrupt her happiness and make her feel annoyed, for her Kapalbhati pranayama helped to overcome the annoying feeling.

Table 1: Details of the outcome variables

Click here to view

Discussion

This was the first case report to document the solitary effect of Vatakarma Kapalbhati on sinus headache. In addition, Vatakarma Kapalbhati, a form of abdominal-respiratory-autonomic exercise, has shown a reduction in weight (observed in case 2) which may be due to rapid abdominal contraction, an increase in overall metabolism, and a decrease in fat deposition.^[10] Reduced stress was also reported which might be due to the inhibitory signal produced by slow-adopting stretch receptors in the lungs, which brings about parasympathetic dominance and alleviates stress.^[11],[12]] Vatakarma Kapalbhati ensures acid-base balance in the body, activates the lungs, brings about better oxygenation, and also improves circulation.^[13] It balances vatta (wind), pitta (bile), and kapha (phlegm) in the body.^[14] Previous studies recommended Vatakarma Kapalbhati pranayama for chronic headaches, allergic rhinitis, sinusitis, and upper respiratory tract infection. It also activates the forebrain, promoting cognitive function.^[15],[16]]

Although the case series shows the effectiveness of Vatakarma Kapalbhati on sinus headaches, the mechanism of action was still unclear. A possible mechanism would be drainage of excess mucous and water from sinus cavities and proper ventilation of the sinuses that may in turn help in nitric oxide production and alleviate inflammation. One major limitation is the lack of control over the confounding variables which might possibly impact during practicing a specific practice at home. We recommend an adequately powered randomized control trial with a larger sample size to confirm the findings of our case series.

Conclusion

Vatakarma Kapalbhati could be used as an effective tool to treat sinus headaches. It also reduces stress and improves sleep quality in patients with paranasal sinusitis. Future randomized controlled trials would help substantiate our observation.

Declaration of patient consent

The authors certify that they have obtained patients consent. The patients have given their consent for their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published, and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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