Course: Acupuncture Treatment of Disease 2 Date: February 2, 2009

Class #: 5 Headache and Migraine

Headache
Tou Tong

Cephalgia is pain of the head. A headache can be an isolated

phenomenon or could be a symptoms of both acute and chronic
diseases. Headaches can be primary (no cause you can pinpoint just
happens) or secondary (a result of something else).

Headaches result from stimulation of, traction of, or pressure on any of

the following pain sensitive structures on the head:
Blood vessels there are a lot of nerve endings on the blood
vessel walls
Cranial nerves
o Trigeminal CN V
o Glossopharyngeal CN IX
o Vagus CN X
Tissues covering the cranium
o Scalp
o Muscles
o Ligaments of head/neck

Some types of headaches in Biomedicine include:

Vascular headaches.
As an example, migraines are often classified as vascular headaches. Vascular headaches are the
result of blood vessels enlarging and compressing an adjacent nerve which causes the headache.

Muscular contraction headaches.

Tension headaches are muscular contraction type headaches. Symptoms include
tightness/stiffness of scalp, neck, shoulder, trapezius, SCM. They can result from emotional
stress, overwork, common cold (wind-cold), and Taiyang diseases (as outlined in the Shang Han
Lun).

Traction or inflammatory headaches.

Sinus headaches are an example of inflammatory headaches. Inflammatory headaches are the
result of pressure in the head increasing and causing pain. Other possible causes (in addition to
sinusitis) can include hemorrhaging in the brain due to stroke, tumors, etc. Be careful not to
mask over possible tumor symptoms.

There are many ways to classify headaches. Another classification method is to classify by extracranial,
the more common and typical type, or by intracranial which is more severe and maybe even fatal. For a
different classification, one used in the biomedical community rather frequently, check out these notes
starting on page 5.

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Treatment is often a combination of pain relievers, anti-inflammatories, inhalers, antibiotics, etc.

Symptoms of a headache when described in biomedical terms include location of pain, nature of pain
and inducing factor.
Throbbing or dull pain?
Nausea? Vomiting?
Blurred vision?
Tender scalp?
Sensitivity to light, odors, and noise?
Yes to these questions can help determine a migraine status.

Types of headaches per TCM Classification

Type Channels Location Etiology Guiding herbs

Taiyang SI, UB Occiput Wind Ma Huang
Wind-Cold Ge Gen
Stress Qiang Huo
Shaoyang SJ, GB Temporal Damp Heat in GB Chai Hu
LV Yang Huang Qin
Yangming LI, ST Forehead Yangming disease Bai Zhi
i.e., external pathogen Shi Gao
invasion sinus Sheng ma
headache
Irregular diet
Coffee, alcohol, etc.
Jueyin PC, LV Vertex LV Blood Xu Gao Ben
Cold in LV channel Xi Xin
Wu Zhu Yu
(Cold in LV ch)
All-over Chuan Xiong*
headaches

*Chuan Xiong is the most basic herb for all types of headachesChuan Xiong Cha Tiao San formula
works for allergic and external invasion headaches. Drink 3-5 grams in powder form with green tea.

TCM Etiology

Five etiologies to know regarding headaches in TCM:

Invasion of external pathogens

o Pressure: wind
o Temperature: cold or heat
o Humidity: dry or damp
You can therefore have headaches with patterns such as wind cold, wind heat, wind damp, wind
dryness, etc.

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 Emotional disorders
o Liver more deficiency related headaches
o Gall Bladder more excess related
Irregular diet
Overconsumption of spicy foods, alcohol, coffee, etc.
Overworking
Consumes yin, leading to an imbalance of yin/yang
Trauma

TCM Mechanism

Blockage of channels in the head

with disorder of Shi (excess) and Xu in the upper and lower parts of the body.

Headaches are a Channel syndrome and 2/3 of them are excess in nature. Channels that flow through or
on the head include:
The 6 regular Yang channels
Ren channel
Du channel
Yin Qiao channel
Yang Qiao channel
Liver
which is a yin organ with yang functions.

TCM Differential Diagnoses and Treatments

Differential diagnoses for headaches are a mix of excess/deficiency and internal/external.

External evils are excess in nature and are the invasion of external pathogens such as wind-cold, wind-
heat and wind-damp.

Internal evils causing headaches can be excess or deficient. Excesses are Liver Yang/Fire, Turbid
Phlegm and Inner Wind, and Blood Stasis. Deficiencies are Blood xu and Kidney xu.

Basic Points to treat Headaches

GB 20 is suitable for headaches of any kind, including migraines. It also expels wind for
headaches of either external wind or internal wind.

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 Du 20 balances Yang Qi. Also good for one-sided headaches, vertex headaches, wind in the
head including that which induces dizziness.
Taiyang extra point treats headaches and migraines in the temporal region (best to combine it
with distal points). Also eliminates wind and heat.
Yintang treats frontal headaches.
LU 7 + LI 4 host/guest combination. Together these also balance the Yang.
o LU 7 is the command point for the head and nape of the neck; addresses headaches, stiff
neck and nape, one-sided headaches.
o LI 4 is the command point for the face and mouth. Good for headaches, one-sided
headaches and whole-head headaches.
UB 10 to treat stiff neck and occipital headaches. Activates and alleviates pain of the Taiyang
channel. Deadman says it addresses pain and heaviness of the head, headache, wind affecting
the head, inability to turn the head due to stiffness in the neck.
SJ 3 activates the SJ channel and alleviates pain. It is used for one-sided headaches and pain
in the temples. The San Jiao channel is closely associated with the Shaoyang channels, so
assists in treating Shaoyang headaches.
SI 3 benefits the occiput, back and neck, activates the channel and alleviates pain. It is
indicated for stiffness and pain with difficulty turning the neck to one side. It is also useful
for bilateral pain and pain in the shoulder and upper back.

Taiyang Headaches GB 20, UB 10, SI 3

Shaoyang Headaches Taiyang and SJ 3
Yangming Headaches Yintang extra point
Jueyin Headaches Du 20, LU 7, LI 4

Generally: For acute headaches acupuncture is better and faster than herbs. If there is a heavy
sensation that goes to the forehead and eye area when needling GB 20 the patients headache
should be greatly relieved after the treatment.

Wind-Cold Invasion Headache

This is an external excess headache caused by invasion of external pathogens. This type of
headache is a Taiyang headache and affects the occiput and below.

UB 12 and 13 as well as SJ 17 help to expel wind. Moxa warms the channels and helps expel the
cold.

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Wind-Heat Invasion Headache
This is an external excess headache caused by invasion of external pathogens. This type of
headache is a Yangming headache affected the forehead region and below.

Wind-Damp Invasion Headache

This is an external excess headache caused by invasion of external pathogens. This type of
headache affects the temporal region or whole head and is a Shaoyang headache.

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Liver Yang Rising and Flaring up of Liver Fire
This is an internal excess headache. It affects either the vertex (LV) or temporal area (GB).

Know these symptoms!

Retention of Turbid Phlegm and Inner Wind

This is an internal excess headache. It is primarily though not exclusively a temporal headache.

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Retention of Blood (Xue) Stasis
This headache is one of internal excess and can be either acute or chronic. Location can be
anywhere on the head.

Blood Deficiency (Xu)

This is an internal deficient headache and is chronic in nature. It is related to anemia, irregular
menstrual cycle with heavy bleeding and post-partum bleeding. Headaches are Jueyin headaches
and may be felt at the vertex or internally.

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Kidney Xu of Essence or Yin
This is an internal deficiency and is associated with a Jueyin headache around Du 15 and Du 16.

Know these symptoms!

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 Migraine
Pian Tou Tong or unilateral head pain

Biomedically, migraines are defined as a biological

disorder of the CNS. The most common type of
migraine is of vascular nature and is due to a rapid
change in the size of blood vessels. Somewhere in the
neighborhood of 25million people suffer from
migraines annually, according to a 1999 study. That
breaks down to 20% of women and 11% of men that
will experience at least one migraine in their lifetimes.
Cost in medical care and productivity loss combined is
more than $17billion per year.

The biomedical mechanism causing migraines is an

insufficiency of serotonin. Serotonin is a
neurotransmitter the equivalent of Wei Qi as the
carrier of Shen and plays a significant role in the
contraction and expansion of blood vessels.

Migraine triggers include:

Bright lights and sunshine Fluctuation of hormones

Diet factors including MSG, Changes in barometric pressure
chocolate, red wine, etc. Chemical sensitivities and pollution
Noises loud or noisy sounds Trauma
Stress Lots more
Various smell triggers

Symptoms:
The following list contains both symptoms and the measures by which one is classified as a migraine
sufferer for biomedical purposes:
Patient has had at least 5 headaches with similar features lasting 4 72 hours per episode.
Headaches are of moderate to severe intensity and last 2 72 hours
Throbbing, pulsating pain
Initially begin as unilateral headaches (typically)
Pain is worse with activity (walking, exercise, esp going up/down stairs, bending over, etc.)
Pain is often accompanied with nausea/vomiting
Sensitivities to:
o Light (photophobia)
o Sound (phonophobia)
o Smells (osmophobia)
Family history of migraines (in TCM this is reflective of a Kidney Essence Xu)
Cyclical pattern tend to recur cyclically

Migraines are classed into two types in the biomedical model: common migraines and classic migraines.

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 Classic migraines have auras, a visual pattern of colors and/or visual disturbances that look
like lines around what the patient sees. Classic migraine sufferers often have early signs that
a migraine is coming on which could be dizziness, mild nausea, etc. Classic migraines are
experienced by 15-40% of migraine patients.
Common migraines come without any early warnings such as the auras. These are far more
common and account for 60-85% of all migraines experienced.

The differences between headaches and migraines.

Though a migraine could be a two-sided headache, for more commonly they are one-sided. Two-
sided headaches would be a sub-category of headaches. Migraines are associated with more
throbbing pain, sensitivity to light, cyclical patterns and are far longer in duration than
headaches. A migraine might last as little as 4 hours or as long as 72 and is often vascular.
Migraines also often have digestive problems and visual disturbances up to and during the
migraine.

Migraines are associated with blood dysfunction, and not just of a deficiency type either.
Dysfunction of blood leads to mental and shen problems as well as memory problems. Wei
(defensive) Qi and Ying (nutritive) Qi are the carriers of Shen. If the blood is blocked or
deficient the Ying Qi also becomes blocked or deficient which leads to Shen disturbance.

Treatment protocols in western medicine prescribe prozac, propranolol, amitriptyline, and

carbamazepine to reduce frequency of episodes. Ergotamine is often prescribed upon the first attack and
sometimes just ibuprofen to relieve pain.

TCM Etiology

There are 4 basic etiologies for migraines in TCM:

1. Invasion of external pathogens
Changes in weather (wind, heat, cold, etc.), sunshine and bright lights, odors and pollution,
noises/sounds/voices are considered external pathogens because they can cause migraines for
those that are susceptible. The 5 sense organs are yang in nature and are therefore easily affected
by Yang messages such as the pathogens listed above. Entry of these pathogens causes a Yang
excess and thus the migraine.

2. Irregular diet
This causes a disharmony of the Middle Jiao (SP/ST) either due to the Liver overacting on the
Spleen or due to weakness of the Spleen/Stomach.

3. Emotional disorder
Related to the Liver which ends at the vertex. The liver plays a strong role in the head and is in
charge of the nervous system.

4. Overworking.
This causes an excess on the head and a deficiency in the lower part of the body.

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TCM Mechanism

Hyperactivity of the 5 sense organs with Excess and Deficient disharmony

between the upper and lower parts of the body.

Note that the mechanism for headaches is very similar: blockage of channels with the same type of
disharmony.

TCM Differential Diagnoses and Treatments

Differntial Diagnoses include both excesses and deficiencies. Deficiencies include Ht and Lv blood xu
and Lv and Kd xu. Excesses include Lv Yang/Fire and disharmony of Lv and MJ.

Basic Points

GB 4, 5, 8
All are indicated for headaches and migraines
GB 14
This is the point at which the Gallbladder channel meets the Yang Wei, SJ, ST, and LI
channels. It can treat headaches in the infraorbital region, forehead, temporal/shaoyang, and
parietal regions as well as in the eye.
GB 20
Indicated for migraines (i.e., one sided headache including migraines due to hypertension).
Deadman says this is the predominant point to treat all diseases of the head, brain and
sensory organs, especially the eyes. Ah! Maybe thats why you aim it at either the same side
or contralateral eyeball when you insert!
GB 41 + SJ 5
o GB 41
For headaches and migraines, occipital pain, vertex pain, eye pain. Because it also
spreads Liver qi, great for vertex headaches, Liver Yang/fire rising. Also as the confluent
point of the Dai Mai, can help balance upper and lower body.
o SJ 5
Classically indicated for temporal, vertex, and frontal headaches as well as Kidney xu
headaches because 1) it expels pathogenic factors and is thus useful for headaches
associated with wind cold, wind heat and wind damp, 2) it is the confluent point of the
Yang Wei vessel which links all Yang channels, 3) it connects with important points for
headaches like GB 13-20, ST8 and Du 16, and 4) thats important because GB and LV
channels are so closely linked. And thats where the migraine thing comes in. SJ 5 treats
migraines arising due to LV disharmony and is often coupled with GB 41 for this very
purpose.

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 DU 20
This is the meeting point for Du, Bladder, Gallbladder, and San Jiao yang channels as well as
the Liver channel. It is the most Yang point in the body and thus regulates Yang. Indicated
for migraines, vertex pain. It is also said to treat sense organ problems.
Yintang
For pain in the forehead
Taiyang
Local point for migraine headaches, especially in the temporal region. Also eye pain.

General rules: you can use gentle energetic body work/touch to help with migraine if the patient can
tolerate it. You must find the specific/exact point however. If one side is too sensitive to be manipulated
or touched, treat the opposite/contralateral side. GB 20 is the best point to treat acute headaches in order
to relieve pain. Use a heavy stimulation here.

Rising of Excessive Liver Yang/Liver Fire

As implied this is an excessbut also can be a deficiency. Males experience this type more than
females, but females may experience this before their periods.

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Disharmony between LV and MJ with rebellious ST Qi
This is an excess. Both men and women experience this. In females, occurs 3-5 days before the
period begins.

Heart and Liver Xue Xu (blood deficiency)

This is a deficiency pattern occurring more in females, especially at the end of menses or if there
is heavy bleeding during menses.

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Liver and Kidney Xu
This is also a deficiency pattern, occurring more in females, especially during menopause.

Know the difference between the different types of headaches and which points to use for each
Know the basic points as a whole too.
Know what the external pathogens for headaches are
Know the differences between Liver fire flaring up and Liver Yang rising
Review and know the Kidney Xu pattern symptoms and treatment
Know the difference between headaches and migraines.

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