Headache and Migraines
According to TCM theory headaches have many different patterns and can be caused by a variety of factors. These causes are classified into 2 categories: exogenous factors and internal disorders. Headaches can be induced by various acute or chronic diseases, including migraine, tension headache, trifacial neuralgia, nasosinusitis, otitis media, cervical spondylopathy, hypertension, etc. Traditional Chinese medicine (TCM) has rich experiences in treating headaches caused by different reasons.
External pathogenic factors are wind, cold, dampness, and heat.
The basic pathogenesis causing headache is the blockage of qi and blood in the meridian of the head by invasion of pathogenic wind-cold, wind-heat or wind-dampness. The exterior invasion of wind-cold, or wind–heat, or wind-dampness prevents the Qi and blood to flow freely in the channels and collaterals blocking the meridian and this is when a headache occurs. The meridians that reach the head are the Gall Bladder and San Jiao channels of the foot/hand Shaoyang, Large Intestine and Stomach channels of the hand/foot Yangming, and Urinary bladder and Small intestine channel of the foot/hand Taiyang; and the Du channel.
Internal disorders: Headache
Internal pathogenic factors are dysfunctions of the Zang Fu (solid and hollow) organs and leads to stagnation of phlegm and dampness in the interior, the stagnation of liver-qi, hyper-activity of liver-yang, deficiency of qi and blood, deficiency of kidney-qi, and blood stasis. The basic pathology for headache either external or internal is the dysfunctional (unsmooth, blocked and disordered) circulation of qi and blood in the head and the whole body.
For clinical purposes the International Headache Society (IHS) divides headaches into 2 broad categories: primary headaches and secondary headaches.
Primary headaches, which are headaches with no organic or structural etiology, include: vascular (migraine) headache, trigeminal autonomic cephalalgias headache: pain in the head caused by dilation of cerebral arteries or muscle contractions or a reaction to drugs (which includes cluster headache), tension headache, and other secondary headaches examples include: hemicrania continua is a persistent unilateral headache that responds to indomethacin. Hemicrania continua is considered a primary headache disorder, meaning that it’s not caused by another condition, new daily persistent headache, exertional headache, hypnic headache a headache that induces sleep, thunderclap headache is a headache that is severe and sudden like a thunderclap it may be the result of bleeding in the head a sign of a medical emergency, immediate medical attention must be considered.
Secondary headaches are those due to an underlying structural or organic disease that include: Head trauma, cardiovascular disorders, substance abuses, medication side effects, metabolic disorders, ear, nose, eye, neck, cranium disorders, cranial neuralgias, hypertension, and psychiatric disorders. Disorders in respiration can also be classified here since inadequate breathing and breath holding prevent the free flow of cerebrospinal fluid (CSF) circulation. The different type headaches are defined by the channel affected and the pathology present.
The primary exterior pathogen is WIND. Think of wind in the context of the environment, it moves rapidly upward swiftly, wind stirs up things, and it is the primary way in which other external pathogenic factors enters the body.
Exterior factors are: Wind-Cold, Wind-Heat, and Wind-dampness. These all obstruct the free flow of yang Qi, and blood in the head.
Interior factors are caused by disorders of the Spleen (accumulation of phlegm/damp), Liver (liver fire or deficiency fire stirring upwards), and Kidney (essence deficiency due to malnourishment).
Diagnosis is made by eliciting relevant symptoms i.e., stabbing pain is a blood stasis headache, an empty type headache is due to kidney essence deficiency, a phlegm/damp type headache feels like a heavy wet towel covering the head. These are just a few examples.
Diagnosis is also made by identifying the channel(s) affected. Examples are a Taiyang headache originates at the back of the head and down the neck, Jueyin headache affects the eyes and the top of the head.
Exterior type headaches come on suddenly is severe and has pain that is sharp, throbbing, burning, distending, is heavy and constant. Interior derived headaches are gradual, mild, with pain that is dull, empty feeling, lingering, worse with activity, and intermittent.
As with all pain in the body if there is a blockage to the free flow of qi and blood pain will ensue. Treatment principles are to clear the external pathogen and tonify (strengthen) the internal deficiency. Acupuncture and Chinese herbal medicine is effective to achieve a favorable outcome.
Common causes of headache include:
- Sinus disease
- Dental issue
- TMJ or TMD
- Pathology of the ears
- Muscular injuries
- Cervical spine issues
- Emotional stress
- Eye strain
- Trigeminal neuralgia
- Head injury
Clinical Manual of Oriental Medicine. 2nd Edition by Dr. John Chen PharmD
Essentials of Chinese Medicine Internal Medicine By Anshen Shi ©2003
Biomedicine A Textbook for Practitioners of Acupuncture & Oriental Medicine By Bruce H. Robinson, MD ©2007
Medicine Edited by Allen R. Myers – 4th Edition ©2001 Lippincott Williams & Wilkins The National medical series for independent study