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TCM Pain Management

Headaches and Migraines

 

Nearly everyone will suffer a headache at some point in time. Headache and migraine can impact every aspect of the life and they are one of the most common physical complaints that prompt people to treat themselves or seek professional assistance. Acupuncture can offer powerful relief without the side effects which prescription and over-the-counter drugs can cause. Acupuncture and Chinese Herbal Medicine have been used to relieve headaches and migraines as well as their underlying causes.

 

  • Headache / Migraine
  • Headache / Migraine in TCM
  • TCM Treatment
  • Articles

A headache is defined as a pain or discomfort in the head, scalp, or upper neck. It is one of the most common locations of pain in the body. According to the National Headache Foundation, over 45 million Americans suffer from chronic headaches and 28 million of these suffering from migraines.

 

  • Cause
  • Classification
  • Diagnosis
  • Treatment
  • References

The most common headaches are likely caused by tight muscles in your shoulders, neck, scalp, and jaw. Headaches may result from any number of factors including: vascular problems; withdrawal from certain medications; stress, depression, or anxiety; overworking, not getting enough sleep, missing meals; and injury.

There are over 200 types of headache, and the causes range from harmless to life-threatening. In 2007, the International Headache Society agreed upon an updated classification system for headache in order to help the health care practitioners to diagnose the specific type of headache and to provide better and more effective treatment.

Headache

 

  • Tension Headaches
  • Migraine Headaches
  • Cluster Headaches
  • Secondary Headaches

Tension headaches are one of the most common forms of primary headaches. They may occur at any age, but are most common in adults and adolescents. Up to 90% of adults have had or will have tension headaches. Tension headaches occur more commonly among women than men.

Tension headaches occur when neck and scalp muscles become tense, or contract. The muscle contractions can be a response to stress, depression, a head injury, or anxiety. Any activity that causes the head to be held in one position for a long time without moving can cause a tension headache. Such activities include typing or other computer work, fine work with the hands, and using a microscope. Sleeping in a cold room or sleeping with the neck in an abnormal position may also trigger a tension headache. Other triggers of tension headaches include: alcohol use, caffeine (too much or withdrawal), colds and flu, dental problems such as jaw clenching or teeth grinding, eye strain, excessive smoking, fatigue, nasal congestion, overexertion, and sinus infection. Tension headaches are not associated with structural changes in the brain.

Tension headaches tend to be mild (not disabling) and bilateral (affecting both sides of the head). They often start at the back of the head and spread forward. The pain may feel dull or squeezing, like a tight band or vise on the head. The pain is typically worse in the scalp, temples, or back of the neck, and the shoulders, neck, or jaw may feel tight and sore. The pain is usually persistent, but it does not get worse with activity. There may be difficulty sleeping. Tension headaches usually do not cause nausea, vomiting, or sensitivity to light and sound.

The pain may occur as an isolated event, constantly, or daily. The pain may last for 30 minutes to 7 days. The pain allows most people to function normally, despite the headache.

Migraine headaches are the second most common type of primary headache. An estimated 28 million people in the United States (about 12% of the population) will experience a migraine headache. Migraine headaches affect children as well as adults. Before puberty, boys and girls are affected equally by migraine headaches, but after puberty, more women than men are affected. It is estimated that 6% of men and up to 18% of women will experience a migraine headache in their lifetime.

The underlying cause of migraine is unknown. However, medical experts believe that a migraine is caused by abnormal brain activity, which is triggered by stress, certain foods, environmental factors, or something else. Migraine attacks may be triggered by: alcohol; allergic reactions; bright lights; certain odors or perfumes; changes in hormone levels which can occur during a woman's menstrual cycle or with the use of birth control pills; changes in sleep patterns; exercise; loud noises; missed meals; physical or emotional stress; or smoking or exposure to smoke. Certain foods and preservatives in foods may trigger migraines in some people. Food-related triggers may include: any processed, fermented, pickled, or marinated foods; baked goods; chocolate; dairy products; foods containing monosodium glutamate (MSG); foods containing tyramine, which includes red wine, aged cheese, smoked fish, chicken livers, figs, and certain beans; fruits such as avocado, banana, citrus fruit; meats containing nitrates like bacon, hot dogs, salami, cured meats; nuts; onions; or peanut butter. True migraine headaches are not a result of a brain tumor or other serious medical problem. However, only an experienced health care provider can determine whether your symptoms are due to a migraine or another condition.

Migraine headaches are typically severe headaches that usually occur with other symptoms such as nausea, vomiting, cold hands or feet, and sensitivity to light and sound. The pain may be felt behind the eye or in the back of the head and neck. For many patients, the headaches start on the same side each time. The pain may be described as throbbing, pounding, or pulsating. It tends to begin on one side of the head, although it may spread to both sides. A typical attack lasts between 4 and 72 hours.

An estimated 40-60% of migraine attacks are preceded by premonitory (warning) symptoms lasting hours to days. The symptoms may include: altered mood, irritability, depression or euphoria, fatigue, yawning, excessive sleepiness, craving for sweet or salty foods, stiff muscles (especially in the neck), dizziness, hot ears, constipation or diarrhea, increased or decreased urination, and other visceral symptoms.

An estimated 20-30% of migraine headaches are associated with an "aura" (a group of warning symptoms that start before your headache). Usually, the aura precedes the headache, although occasionally it may occur simultaneously with the headache. The most common auras are visual disturbances such as unformed flashes of white and/or black, brightly colored lights in a zigzag pattern, blurred or shimmering or cloudy vision, or a blind spot (scotoma) in the visual field. Other symptoms of the aura include auditory, gustatory or olfactory hallucinations, temporary dysphasia, vertigo, tingling or numbness of the face and extremities, and hypersensitivity to touch.

For approximately 24 hours after a migraine attack, the migraine sufferer may feel drained of energy and may experience a low-grade headache along with sensitivity to light and sound. Some patient may have cognitive difficulties, gastrointestinal symptoms, mood changes, and weakness.

Cluster headaches are a fairly common form of chronic, repeated headaches. They are more common in men than women. The headaches can occur at any age but are most common in adolescence and middle age. They tend to run in families.

The cause of cluster headaches is uncertain, but they appear to be related to the body's sudden release of histamine or serotonin. Cluster headaches can be triggered by: alcohol and cigarette smoking; high altitudes (trekking, air travel); exertion; bright light (including sunlight); heat (hot weather, hot baths); foods high in nitrites (such as bacon and preserved meats); certain medications (for example, nitroglycerin, used for heart disease); cocaine; and changes in sleep patterns.

Cluster headaches are headaches that come in groups (clusters) lasting weeks or months, separated by pain-free periods of months or years. Attacks tend to occur at about the same time every day and often awaken the patient at night from a sound sleep. Each episode of pain lasts from 30 to 90 minutes.

The pain occurs on one side of the head, usually in, behind, and around one eye. The pain may be described as burning, sharp, or steady. Other symptoms of cluster headache include: swelling under or around the eye (may affect both eyes), excessive tearing, red eye, runny nose or one-sided stuffy nose (same side as the head pain), and red and flushed face. Unlike patients with migraine headaches, patients with cluster headaches tend to be restless. They often pace the floor, bang their heads against a wall, and can be driven to desperate measures.

Secondary headaches are headaches due to an underlying disease or injury that needs to be diagnosed and treated. There are numerous causes of secondary headache, and some are potentially life-threatening and deadly.

The diseases may cause secondary headaches include: head and neck trauma; blood vessel problems in the head and neck such as stroke or transient ischemic attack (TIA); non-blood vessel problems of the brain such as brain tumors or seizures; medications and drugs (including withdrawal from those drugs); infection such as meningitis, encephalitis, HIV/AIDS, pneumonia or influenza; changes in the body's environment including hypertension, dehydration and hypothyroidism; problems with the eyes, ears, nose throat, teeth and neck; and psychiatric disorders.

The health care provider can diagnosis the type of headache by asking questions about the symptoms and medical history and performing an examination of the head, eyes, ears, nose, throat, neck, and nervous system.

Diagnostic tests, such as head CT scan, head MRI, sinus x-rays, temporal artery biopsy or lumbar puncture, may be performed to rule out other causes for the headaches.

Not all headaches require medical attention, and most respond with simple analgesia (painkillers) such as paracetamol/acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs), like aspirin, ibuprofen, or diclofenac. If over-the-counter remedies do not control your pain, prescription medications such as Dihydroergotamine, Ergotamine, Ergotamine with caffeine (Cafergot), or Isometheptene (Midrin) can be used. Sometimes medications to relieve nausea and vomiting are helpful for other migraine symptoms.

Preventive treatment may be used to reduce the frequency, severity, and duration of headaches. This type of treatment involves taking prescribe medication on a daily basis for at least 3 months and in some cases, for over 6 months. The medication used in preventive treatment is normally chosen based on the other conditions that the patient is suffering from. Generally, medication in preventive treatment starts at the minimum dosage which increases gradually until the pain is relieved and the goal achieved or until side effects appear.

Acupuncture has been found to be beneficial in chronic headaches of both tension type and migraine type. You may relieve a headache by resting with your eyes closed and head supported. Relaxation techniques can help. A massage or heat applied to the back of the upper neck can help relieve tension headaches. Psychological treatments are usually considered in comorbid patients or in those who are unresponsive to the medication.

 

Prevention

In recurrent unexplained headaches keeping a 'headache diary' with entries on type of headache, associated symptoms, precipitating and aggravating factors may be helpful. This may reveal specific patterns, such as an association with medication, menstruation or absenteeism or with certain foods.

The following healthy habits can lessen stress and reduce your chance of getting headaches:

  • Avoiding smoking
  • Avoiding alcohol
  • Avoiding artificial sweeteners and other known food-related triggers
  • Getting enough sleep
  • Eating a healthy diet
  • Exercising regularly
  • Learning proper posture
  • Learning to relax using meditation, deep breathing, yoga, or other techniques
  • Stretching your neck and upper body, especially if your work involves typing or using a computer
  • Wearing proper eyeglasses, if needed

 

When to Contact a Medical Professional

Call for an appointment with your health care provider if the headache patterns or pain change; if headaches do not respond to treatment; if headaches disturb sleep; or if you have side effects from medication, including irregular heartbeat, pale or blue skin, extreme sleepiness, persistent cough, depression, fatigue, nausea, vomiting, diarrhea, constipation, stomach pain, cramps, dry mouth, or extreme thirst.

Call 911 if the headaches headache starts very suddenly; if you are experiencing "the worst headache of your life"; if the headaches are more severe when lying down; or if you have speech, vision, or movement problems or loss of balance.

Headache, in Wikipedia

Headache, in MedicineNet

Headache, in MayoClinic

Tension headache, in MayoClinic

Migraine, in MayoClinic

Cluster headache, in MayoClinic

 

In Chinese medicine, headaches and migraines can be caused by a variety of imbalances. In the simplest terms, this imbalance can be characterized as too much or too little of a particular energy/substance. In clinical practice, both an excess and a deficiency can and do frequently co-exist. If a substance is either excess or deficient, this disrupts the flow of Qi (vital energy of the body) and creates pain.

 

  • Etiology
  • Pathology
  • Pattern Differentiation
  • External pathogensInvasion by external pathogens is a common cause of acute, usually self limiting headaches. Wind, cold, damp and heat, either singly or in combination may be involved. Tai Yang channels of the back of the neck are most commonly targeted as they are the most exposed to the environment and the first point of contact between the pathogen and the host. In some cases, these headaches will be accompanied by exterior signs and symptoms, but occasionally the headache may appear before the onset of other symptoms. Each pathogen produces a characteristic type of disruption to the distribution of Qi and blood through the superficial tissues of the head and neck by the pathogen.
  • Emotional factorsEmotions are significant contributors to both acute and chronic headaches. Unexpressed frustration, anger, worry or other internalized emotion causes Qi stagnation which leads directly to the common tension headaches that afflict a large proportion of humanity. Chronic Qi stagnation also contributes to the chronic muscle tension in the upper back and neck that leads to the development of trigger points. Some emotional states may weaken the Spleen and Lungs and lead to Qi deficiency. Worry, obsessive thinking or rumination deplete Spleen Qi or cause Liver Spleen disharmony. Grief, prolonged sadness or bereavement can weaken the Lungs and deplete Lung Qi. Weak Lung Qi loses the ability to restrain the Liver through the controlling cycle (mental controlling wood) which encourages both Qi constraint and the chaotic ascent of Qi.
  • DietThe diet is a common contributor to headaches. Insufficient food or lack of protein can lead to Qi and blood deficiency. Foods or dietary habits that weaken the Spleen, such as raw and cold foods, and restrictive or rigid diets, can lead to Qi and blood deficiency and the generation of damp and phlegm. An excess of sweet, oily, rich food and dairy products directly introduces phlegm damp into the body. Some medications weaken the Spleen, deplete Spleen Yang Qi, or create damp and phlegm when used inappropriately. These include heat clearing herbs, hypoglycemic agents, antihypertensive drugs, laxatives and antibiotics. Excessive reliance on analgesics and damage Stomach and Liver Yin.
    Over consumption of heating foods, in particular red wine and spirits, chocolate, coffee, shellfishes, chilies, cheese and some spices can heat the Stomach, Liver and Gallbladder, leading to heat or fire patterns.
    A common and often overlooked cause of headaches is dehydration. This is seen in those who do manual or outdoor work, as well as those who work in hot environments or in the desiccating environment of air conditioned buildings.
  • OverworkWorking excessively long hours or laboring to the point of exhaustion depletes Spleen and Kidney Yang Qi. Insufficient sleep depletes Heart and Kidney Yin. Headaches are quite common in people who expend lots of mental energy while being largely sedentary, a frequent finding in students, academics and office workers. This is due to the combined effects of Qi and blood deficiency, the creation of damp as a result of Qi deficiency, and the postural stresses associated with working long hours or working at night, depletes Liver blood.
  • ConstitutionChronic headaches can be associated with constitutional or inherited imbalances. Migraine headaches often run in families, and many patients report a history of headaches that start from a young age. This may involve aspects of Kidney essence deficiency and subsequent Yin deficiency causing ascendant Yang, or inherited tendency to phlegm damp, Qi and blood deficiency, or Qi stagnation.
  • TraumaA fall or blow to the head is a common cause of blood stasis type headaches. The headaches may not necessarily appear immediately following the trauma, but can occur months or years later, initiated by another illness or a decline in general health and circulation.

There are two mechanisms of headache production, those associated with deficiency and those associated with excess. These two types produce quite different types of headaches.

The excess types of headache are more severe, and can be debilitating. They are caused by obstruction to the circulation of Qi and blood by a pathogen. The nature of the obstructing pathogen has a direct bearing on the quality of the pain. The more substantial the obstruction, the more intense the headache.

The deficiency types of headache are due to insufficient Qi, blood, Yin or Yang reaching the head. They are mild to moderate and dull, and are associated with mental and physical fatigue. Mixed deficiency and excess headaches are common, with some patients experiencing both at the same time, or sequentially. A common example is the persistent dull headache of Yin and blood deficiency which occasionally yields to the intense and splitting headache of ascendant Yang.

  • External Invasion
    • Wind-coldWind-cold headaches are due to exposure to wind and cold, as may occur for example, from getting chilled as the weather changes, sleeping in a draught or having air conditioning blowing on the head and neck area. The wind-cold penetrates into the Tai Yang channels, constricting and obstructing the circulation of Qi and blood, resulting in pain. Wind-cold type headaches are most commonly associated with the common cold, influenza or upper respiratory infection, but may also be diagnosed as a migraine headache or trigeminal neuralgia. Migraine type headaches and facial pain may be of a wind-cold type, especially those triggered by exposure to wind or sudden changes of temperature.
    • Wind-heatWind-heat headache is caused by invasion of wind and heat. Win-heat, being a purely Yang pathogen, tends to rise and expand affecting the forehead or the whole head. Wind-heat headaches may be associated with the common cold, influenza, tonsillitis, acute bronchitis and other upper respiratory tract infection, and the early stage of measles, mumps, encephalitis or meningitis.
    • Wind-dampWind-damp headaches may be acute, or chronic and recurrent. Damp can quickly gain access to the body on the back of wind via the Tai Yang channels when the pores are open and the patient sweating, or gradually by prolonged exposure to damp or humid conditions or contact with water. Once in the body, damp has an affinity for the Spleen and muscles, and blocks Qi and blood flow through the muscles. The blockage of Qi and blood flow in the muscles, compounded by obstruction of the Qi dynamic and accumulation of damp in the head lead to the heaviness and dull ache in the head and muscles. Acute wind-damp headaches may be diagnosed as common cold, influenza, stomach flu, viral gastroenteritis or rheumatic fever.
    • Summer heatSummer heat is an acute disorder that occurs during hot weather. There are two main variations. In the first, prolonged exposure to direct sun or a hot environment can lead to a type of heatstroke, where the body is unable to cool itself sufficiently and overheats producing an elevated body temperature and dehydration. The second type is due to an invasion of a summer heat pathogen. This is similar to a damp heat invasion, with the heat component considerably stronger than the damp in this case. Summer heat headaches may be diagnosed as acute gastroenteritis, food poisoning, gastric flu, influenza, acute colitis or heatstroke.
  • Liver Qi StagnationLiver Qi stagnation is a common type of headache, typically associated with stress and emotional tension. Liver Qi stagnation headache often manifests as the classical tension headache, however depending on complicating factors, it may be migrainous in nature, with a premonition or aura. The more heat, the more tendency to migraine type headaches; the more blood deficiency, the more tendency to dull and persistent headaches. Liver Qi stagnation is a common type of stress induced headache, and the precursor to a variety of other more severe and persistent headaches.
  • Liver FireLiver fire headaches are usually a complication of prolonged Qi stagnation, in combination with alcohol, coffee, or other heating and stimulation substances. Liver fire headaches usually occur as an acute exacerbation of a more persistent or background headache of a Qi stagnation type. When recurrent or persistent, the heat depletes Liver Yin and can evolve into Yin deficiency with Liver Yang rising. Headaches of Liver fire type may be diagnosed as migraine, cluster headache, alcohol or substance abuse headache, cholecystitis, hypertension or referred pain from myofascial trigger points.
  • Liver Yang Rising with Yin DeficiencyHeadaches from Liver Yang rising car caused by an imbalance in the distribution of Yin and Yang. Too much Yang Qi ends up in the head can happen as the result of a sudden explosion of stagnant Qi, or more commonly because Yin and/or blood are insufficient to anchor Yang and provide a counterweight to its active and rising nature. When the anchoring Yin reaches a critical point of deficiency, the Yang loses its moorings, becomes excessively mobile and rises to the head. When ascendant Yang reaches a certain level of chaotic intensity, it is redefined as wind. The greater the deficiency of Yin, the more likely and more vigorous the Yang is to slip its moorings and ascend to the head. Headaches of Liver Yang rising type may be associated with hypertension, migraine, or cluster headaches, temporal arteritis, transient ischemic attacks, arteriosclerosis or referred pain from myofascial trigger points.
  • Cold Affecting the Liver and StomachThe headache associated with cold in the Liver and Stomach is due to counterflow of Yang Qi through the Jue Yin channels brought about by blockage of the Qi dynamics by cold. The cold is the product of disharmony between the Liver and Stomach and a cold diet which weakens Spleen Yang Qi. The cold accumulates in the body and blocks the Qi dynamic. The obstructed Qi counterflows to the head through the Liver channel ending at the vertex. This pattern is also known as cold encroaching on the Jue Yin channels. Headaches of the Liver and Stomach cold type may be diagnosed as migraine, neurogenic or hormonal headache.
  • Phlegm DampHeadache and head distension associated with phlegm damp is a chronic and recurrent problem. Phlegm damp headaches can be severe and may be episodic, with headaches occurring in clusters interspersed with variable periods of remission. The sporadic nature of the headaches is due to the alternate congealing and dispersal of phlegm damp in response to changes in the diet and emotions, or exposure to strong dispersing substances like perfume and gasoline. Phlegm damp headaches are often complicated by Spleen Qi deficiency, and occasionally by ascendant Liver Yang or wind. Phlegm damp headaches can appear similar to those due to wind damp. Headaches of a phlegm damp type may be diagnosed as chronic headache, cerebral atherosclerosis, hypoglycemia, Meniere's disease or hypertension.
  • Blood StasisHeadaches due to blood stasis may be acute or chronic. When acute, there will be a history of head trauma or concussion; when chronic, there is often a long history of constrained Liver Qi, chronic heat or cold, or various deficiency states. Stasis of the blood obstructs the free movement of Qi and blood in the network vessels or the head, causing rather intense focal pain. Blood stasis is a common type of headache, and depending on the etiology, may not always display the classic signs and symptoms of blood stasis. The diagnosis of blood stagnation should be considered when other approaches have failed, or when there are chronic headaches without indications of other pathology. Headache of a blood stasis type may be associated with head injury, post traumatic stress disorder, post concussion syndrome, tumors, chronic depression, cluster headaches, chronic migraines or referred pain from myofascial trigger points.
  • Stomach HeatStomach heat headaches have a strong relationship to diet, and are triggered by foods such as chocolate, cheese, chilies, coffee, shellfish and red wine, or simply overeating. Most patients subject to headaches of this type have evidence of low grade heat in the Stomach in between headaches, causing chronic indigestion and heartburn. Prolonged Stomach heat can lead to damage of Stomach and Liver Yin. Headaches of a Stomach heat type may be diagnosed as food related headache or migraine, food allergy, food intolerance or trigeminal neuralgia.
  • Stomach and Gallbladder DisharmonyStomach and Gallbladder disharmony is a pattern associated with persistent low grade heat and/or phlegm in the Gallbladder, usually from the diet or prolonged Qi stagnation. The irritated Gallbladder, when inflamed by stress or fatty foods, invades the Stomach via the controlling cycle, and causes Stomach and Gallbladder Qi to counterflow upwards to the head. Headache of this type may be diagnosed as migraine, cholecystitis or gallstone.
  • Qi DeficiencyHeadache associated with Qi deficiency is due to a failure of Qi (and blood not being lead) to the head. The deficiency may affect the Spleen and Stomach, Lungs and/or Heart, and can be complicated by blood deficiency, blood stasis or Yang deficiency. Qi and blood deficiency are often seen together, but each causes a distinct type of headache, with predictable complication, and can be distinguished when independent. Qi deficiency headaches may be diagnosed as hypoglycemic episodes, diabetes, mental and physical exhaustion, burn out, poor muscle tone and postural weakness.
  • Blood DeficiencyBlood deficiency headaches are common, and due to failure of blood to reach the head, or failure of the weakened blood to anchor Yang securely. These headaches are more frequent in women of reproductive age, and in general are more severe than those associated with Qi deficiency. Blood deficiency headaches are often complicated by Liver Qi stagnation and may be sporadically compounded by Yang rising. Headaches due to blood deficiency may be diagnosed as anemia from nutritional deficiency, low iron stores, chronic blood loss, menstrual or hormonal headaches, myofascial trigger points or tension headaches.
  • Kidney DeficiencyKidney deficiency headaches can be divided into two main types: Yin deficiency and Yang deficiency. Various combination of Yin and Yang deficiency also occurs. The mechanism of each is different. In the Yin deficiency pattern, the headache is due to two factors: deficiency of the brain and the rising of heat and ascendant Yang that is created by the deficiency. Yang deficiency headache is due to a failure of Yang Qi to reach the head and the constricting effects of cold on the circulation of Qi and blood. Kidney Yin deficiency headaches may be diagnosed as migraine or cluster headache, temporal arteritis or hormonal headache. Kidney Yang deficiency headache may be diagnosed as hypothyroidism, Addison's disease, hormonal headache, cervical osteoarthritis or uremia.

 

Headache and Migraine

Traditional Chinese Medicine does not recognize migraines and recurring headaches as one particular syndrome. Instead, it aims to treat the specific symptoms that are unique to each individual using a variety of techniques such as acupuncture, Chinese herbs, Tui Na massage, and energetic exercises to restore imbalances found in the body. Examining the specific triggers, characteristics and location of the headaches, and the person's constitution and medical history allows treatment that is tailored to the individual. A comprehensive treatment plan based on the Chinese medical diagnosis ensures that both the root (underlying cause) and the manifestation (headache pain) are addressed.

Treatment of the acute headache aims at immediate relief with the use of acupuncture to disperse stagnation, dispel wind and so forth, or with swift acting herbal formulas. Between episodes the treatment focuses on the underlying condition. As a general rule, headaches due to deficiency (in particular blood and Yin deficiency) respond best to herbal therapy, while the Liver patterns respond well to regular acupuncture and Tui Na massage. Blood stasis patterns can do well with acupuncture, but will often need herbs to obtain a sustained result. Headaches due to external pathogens usually respond quickly to both herbs and acupuncture.

 

  • Acupuncture
  • Chinese Herbal Medicine
  • Manual Therapy

Acupuncture points are selected on the basis of the pattern involved and the location of the headache. During a headache, the main points will be selected from those that influence the location of the headache. In between headaches, points are selected primarily on the basis of the diagnostic pattern. Acupuncture points can also be selected on the basis of their specific effects on headache.

The length, number and frequency of treatments will vary. Typical treatments last from 5 to 30 minutes, with the patient being treated 1 to 5 times a week. Some symptoms are relieved after the first treatment, while more severe or chronic ailments often require multiple treatments.

The greatest advantage of acupuncture over Western medicine is that it is virtually harmless. Some medications can have serious side effects and can (in some instances) actually lead to patients experiencing rebound headaches. Unlike synthetic drugs, acupuncture has virtually no side effects, and the procedures for treating headaches are much less invasive with acupuncture than with surgery.

In a randomized controlled trial study in 2004 evaluated the effect of acupuncture on 401 patients with chronic headache. The study suggests that acupuncture leads to persisting clinically relevant benefits for primary care patients with chronic headache, particularly migraine. The researchers also concluded that acupuncture is relatively cost-effective compared with a number of other interventions provided by the NHS.

In a Cochrane review published in 2009, the researchers focused on the effect of acupuncture for tension headaches by evaluating 11 studies that investigated 2,317 participants. The authors concluded that acupuncture could be a valuable non-pharmacological tool in patients with frequent episodic or chronic tension-type headaches.

In another Cochrane review published in 2009, the researchers examined acupuncture for migraine treatment and reviewed 22 trials with 4,419 total participants who had received a migraine pain diagnosis with or without aura. The researchers found that acupuncture provides additional benefit to treatment of acute migraine attacks or to routine care.

Chinese herbs are often used to enhance the effect of acupuncture on treating headaches and migraines. Herbal formulas are prescribed for each patient based on information about specific triggers, aggravating and alleviating factors, and overall health. The individual Chinese herbs most commonly used in the herbal formulas for headaches and migraines are:

  • Chuan Xiong (Chuanxiong Rhizoma)Chuan Xiong activates Qi and blood, dispels wind. It is the premier herb for headaches and can be used for all excess types of headache. For severe headaches, it is often combined with Bai Shao (Paeoniae Radix alba) and Nui Xi (Achyranthis bidentatae Radix) to prevent excessive dispersal of Qi and blood. For blood stasis headaches, it is often used with Dang Gui (Angelicae sinensis Radix) to enhance its blood activating effects while preventing excessive dispersal of Yin and blood.
  • Bai Zhi (Angelicae dahuricae Radix)Bai Zhi dispels wind cold and stops pain. It is commonly used for frontal and temporal headaches, facial pain and toothache from wind cold, wind heat or phlegm damp. It is especially good when there is sinus congestion.
  • Cang Er Zi (Xanthii Fructus)Cang Er Zi dispels wind and stops pain. It is good for frontal headaches, especially those associated with sinus congestion.
  • Gao Ben (Ligustici Rhizoma)Gao Ben dispels wind cold damp. It is often used for occipital and vertical headaches and headache from external invasion.
  • Qiang Huo (Notopterygii Rhizoma)Qiang Huo dispels wind cold damp and stops pain. It is usually used for occipital headaches from external invasion or protracted wind damp in the Tai Yang channels.
  • Ge Gen (Puerariae Radix)Ge Gen eases the muscles and dispels wind. It is for neck and occipital pain from a variety of causes, including external pathogens, ascendant Yang and Qi stagnation.
  • Man Jing Zi (Vitivis Fructus)Man Jing Zi dispels wind damp heat and targets the face and eyes. It is often used for frontal and temporal headache and eye pain from wind heat and Liver heat patterns.
  • Ju Hua (Chrysanthemi Flos)Ju Hua dispels wind heat and calms the Liver. It is for wind heat and ascendant Yang type headaches; it targets the eyes, forehead and temporal area.
  • Chai Hu (Bupleuri Radix)Chai Hu dispels wind heat, harmonizes Shao Yang, dredges the Liver and alleviates Qi stagnation. It is commonly used for temporal and vertex headaches from Qi stagnation, ascendant Yang, Gallbladder and Stomach disharmony and wind heat.
  • Sheng Ma (Cimicifugae Rhizoma)Sheng Ma clears heat and used for frontal headaches from Stomach heat and Qi deficiency headaches.
  • Tian Ma (Gastrodiae Rhizoma)Tian Ma extinguishes wind, alleviates spasm and stops pain. It is an important herb for temporal, vertex and entire cranium headache from ascendant Yang and phlegm damp.
  • Gou Teng (Unicariae Ramulus cum Uncis)Gou Teng extinguishes wind, alleviates spasm, calms the Liver and clears heat. It is commonly used for temporal and vertex headaches from Liver heat and wind. It is good when there is spasm and tension in the neck.
  • Bai Ji Li (Tribuli Fructus)Bai Ji Li dispels wind, dredges the Liver, and activates Qi and blood. It is for temporal headaches from Liver Qi stasis and ascendant Yang, especially when there is dizziness and redness or pain in the eyes.
  • Ci Shi (Magnetitum)Ci Shi subdues ascendant Liver Yang and used for headache from Liver Yin deficiency with Liver Yang rising.
  • Shi Jue Ming (Haliotidis Concha)Shi Jue Ming calms the Liver and restrains Yang. It is often used from temporal and vertex headache from ascendant Yang. It is good when there is visual disturbances and aura.
  • Wu Gong (Scolopendra) and Quan Xie (Scorpio)Wu Gong and Quan Xie extinguish wind, alleviate spasms and stop pain. They are used together for relatively severe, stubborn or neuralgic pain.
  • Di Long (Lumbricus)Di Long frees the channels and network vessels. It is often used for stubborn headache and loss of function from blood stasis.
  • Bai Fu Zi (Typjonii Rhizoma)Bai Fu Zi dispels wind phlegm and stops pain. It is a strong dispersing and slightly toxic herb used for stubborn headaches and facial pain associated with phlegm or blood stasis.

As a general rule, headaches due to deficiency (in particular blood and Yin deficiency) respond best to herbal therapy. Herbs are often used for blood stasis type in order to obtain a sustained result. Headaches due to external pathogens usually respond quickly to both herbs and acupuncture.

Tui Na massage and passive mobilization of the neck and upper back are helpful for alleviating muscular tension and deactivating trigger points. Strong massage is most suitable for the excess patterns. Patients with blood or Yin deficiency patterns should be treated gently, as deep massage can irritate the muscles, aggravate tension, and worsen the headache.

Biomechanical and ergonomic factors need to be addressed. Sleeping position, pillow height, computer keyboard and screen placement, office furniture and couch design are frequent factors in chronic headaches, regardless of the systemic pathology also present. An assessment of one's posture allows the effective use of appropriate stretches and exercises to address contributing musculoskeletal factors.

 

 

 

 
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