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Date:
February 2, 2009
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.
Acupuncture Treatment of Disease 2 Winter 2009
www.CatsTCMNotes.com
Page 1 of 14
Channels
SI, UB
Location
Occiput
Shaoyang
SJ, GB
Temporal
Yangming
LI, ST
Forehead
Jueyin
PC, LV
Vertex
Etiology
Wind
Wind-Cold
Stress
Damp Heat in GB
LV Yang
Yangming disease
i.e., external pathogen
invasion sinus
headache
Irregular diet
Coffee, alcohol, etc.
LV Blood Xu
Cold in LV channel
All-over
headaches
Guiding herbs
Ma Huang
Ge Gen
Qiang Huo
Chai Hu
Huang Qin
Bai Zhi
Shi Gao
Sheng ma
Gao Ben
Xi Xin
Wu Zhu Yu
(Cold in LV ch)
Chuan Xiong*
*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.
Acupuncture Treatment of Disease 2 Winter 2009
www.CatsTCMNotes.com
Page 2 of 14
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
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, windheat 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.
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
Shaoyang Headaches
Yangming Headaches
Jueyin Headaches
GB 20, UB 10, SI 3
Taiyang and SJ 3
Yintang extra point
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.
UB 12 and 13 as well as SJ 17 help to expel wind. Moxa warms the channels and helps expel the
cold.
Migraine
Pian Tou Tong or unilateral head pain
Fluctuation of hormones
Changes in barometric pressure
Chemical sensitivities and pollution
Trauma
Lots more
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.
Acupuncture Treatment of Disease 2 Winter 2009
www.CatsTCMNotes.com
Page 9 of 14
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. Twosided 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.
TCM Mechanism
Note that the mechanism for headaches is very similar: blockage of channels with the same type of
disharmony.
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.
Acupuncture Treatment of Disease 2 Winter 2009
www.CatsTCMNotes.com
Page 11 of 14
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.
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.