Intranasal Vacha Taila Nasya as Add-on Therapy for Postdural Puncture Headache: A Pilot Randomised Controlled Trial

Introduction: Postdural Puncture Headache (PDPH) is a common complication of spinal anaesthesia, typically managed with conservative measures or invasive epidural blood patch. Vacha (Acorus calamus) Taila Nasya, described in Ayurveda for head disorders, offers potential as a safe, non invasive adjunct therapy. Aim: To evaluate the efficacy and safety of Vacha Taila Nasya as an add-on therapy in routine postoperative care for PDPH. Materials and Methods: This single-centre, pilot, randomised controlled trial was conducted at the Inpatient Departments of Shalyatantra and Stree Prasuti, Dr. D. Y. Patil College of Ayurved and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pimpri, Pune, Maharashtra, India over a period of 1 year and 6 months. A total of 40 patients diagnosed with PDPH following spinal anaesthesia were enrolled. Participants were randomised into two groups: Group A (control: routine postoperative care including hydration, bed rest, analgesics, and caffeine as required) and Group B (intervention: routine postoperative care plus Vacha Taila Nasya, 2 drops per nostril, twice daily for 3 days). The study was conducted in an openlabel design; however, outcome assessment was performed by a blinded investigator. The primary outcome was change in Visual Analogue Scale (VAS) pain score. Secondary outcomes included resolution of associated symptoms (neck stiffness, tinnitus, hypoacusis, photophobia, nausea) and incidence of adverse events. Data analysis was carried out using the Mann– Whitney U test with Statistical Package for the Social Sciences (SPSS) software, version 26.0 (IBM Corp., Armonk, NY, USA). Results: Patients in the Vacha Taila Nasya group (Group B) demonstrated significantly greater pain reduction compared to the control group (mean VAS score reduction was 5.6±1.2 in Group B compared to 3.1±1.4 in Group A (p-value=0.004). Associated symptoms such as nausea, neck stiffness, and photophobia also improved significantly (p-value <0.05 for all). No major adverse events were observed; only 2 patients (10%) reported mild nasal irritation, which resolved spontaneously without intervention. Conclusion: Vacha Taila Nasya was safe, feasible, and demonstrated promising efficacy as an adjunct therapy in the management of PDPH. As part of an integrative approach, it may reduce symptom burden, minimise reliance on conventional analgesics, and enhance patient comfort in the postoperative setting. Early adoption in selected cases could provide a simple, non invasive supportive therapy alongside routine care.