Headache involves a mild or severe pain in one or more parts of the head such as the back of the neck. It is just a subjective symptom but 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.
Aetiology and Pathology in Chinese Medicine
There are many different patterns and a variety of causes in headache According to TCM theory, headache can be caused by many factors which are usually classified to 2 categories：exogenous factors and internal disorders.
Exogenous factors include pathogenic wind, cold, dampness, etc. In fact, all the above are normal changes of climate in nature ，but if it changes too strongly or too fast over the limitation of self-regulating functions in the human body, that will become a pathogen which might cause some diseases such as headache.
Among them, wind is usually the first pathogenic factor causing headache which is often accompanied by other pathogenic factors, such as cold, heat, dampness, etc. For example, if the headache is caused by wind and cold, it is called ‘wind-cold headache’; if caused by wind and heat, it is then called ‘wind-heat headache’, or if by wind and dampness; it is called ‘wind-dampness headache’, etc.
TCM believes that when wind-cold, or wind–heat, or wind-dampness invade the human body, head in particular, which may cause the unsmooth circulation of qi and blood, even blockage in the meridian, headache will takes place.
So we can say that the blockage of qi and blood in the meridian of the head by invasion of pathogenic wind-cold, wind-heat or wind-dampness is a basic pathogenesis causing headache.
Internal disorders cover many internal pathogenic factors, such as 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, etc.
1. The stagnation of phlegm and dampness in the interior is generally caused by deficiency of spleen-qi or yang. TCM believes that when the spleen becomes dysfunction in transmitting and transporting water and dampness which might be stagnated in the human body acting as an internal pathogenic factor causing some diseases including headache, it is called phlegm-dampness headache.
2. The stagnation of liver-qi is usually resulted from long-term depressed emotional condition or suddenly-strong emotional damage, such as sadness, overwork and other reasons which may cause the disorder of circulation of qi and blood in the meridian in whole body as well as head, and then headache occurs.
3. Hyperactivity of liver-yang is mostly seen in patients with hypertension, generally the patient had deficiency of liver-yin or kidney-yin which can’t restrict the liver-yang, as a result, an imbalance between yin and yang is formed, the yin lacks ability to restrict the excess liver-yang which might reversely go up into the head, so headache comes.
4. Deficiency of qi and blood is a result of many chronic or acute diseases, such as chronic digestive disorder caused by improper foods where the spleen and stomach can’t digest and absorb the food essence for nourishing the whole body; or caused by acute or chronic bleedings during the periods of convalescence or other reasons. All the above might contribute to condition of deficiency in qi and blood which can’t nourish the whole body including the head causing headache.
5. Deficiency of kidney can be caused by many factors, such as genetic factor, excessive sexual intercourse, etc. TCM regards the kidney-qi, including the kidney essence can produce the marrow in the bones; while the brain is filled by the marrow, it is so called ‘the brain is a sea of the marrow’. If the kidney–qi is deficient, the head including the brain can’t get its enough nutrients from kidney-qi-essence and marrow, therefore headache occurs.
6. Blood stasis is caused by many factors, such as long-term stagnation of qi , invasion by cold pathogen, damage to the blood-vessel by heat pathogen, etc. As blood stasis can directly obstruct the circulation of qi and blood in the meridians including the head, so it is also a pathogenic factor causing headache.
From the above analysis on pathogenic factors, we can see that pathogenic factors causing headache mainly act on the circulation of qi and blood in whole body as well as the head, resulting in an unsmooth, blocked and disordered condition in the circulation of qi and blood which could cause headache clinically. Therefore, we can sum up that the blockage in circulation is a basic pathology in most cases with headache.
Differential Diagnosis in Chinese Medicine
TCM has many different methods in diagnosing headaches.
1. Assessing Headache according to the Position
It means that you can determine to which meridian is involved according to the position where the head aches. For example, if headache occurs in the forehead and supra-orbital bone, it indicates the disorder of Yangming Meridian; if headache takes place in both sides of the head, especially in the temples, it means the disease of Shaoyang Meridian; if pain is at the back of the head and neck, the Taiyang Meridian is involved; if pain is at the vertex of the head ,it’s due to the Jueyin Meridian’s diseases, etc. All above are very important for directing us to use herbal and acupuncture therapies clinically.
2. Assessing Headache according to the Nature and Accompanying Symptoms
First, Headache due to Exopathic Factors
Headaches due to exopathic factors generally attack suddenly and last for short time, marked by aching all over the body, chills or fever. And further, if headache is accompanied with stiffness of the neck, aggravated when exposed to wind and cold, it could be diagnosed as Wind-Cold Headache; if headache marked by a preference for coldness, aggravated when exposed to wind and heat, it is a Wind-Heat Headache; if headache accompanied with a feeling of heaviness in the body and head in particular, as if the head were wrapped up, it is a Wind-Dampness Headache, etc.
Second, Headache due to Internal Factors
Those headaches due to internal factors mostly attack slowly, exist for a long time, less severe, and generally take place from time to time.
And further, if head aches as if it were wrapped up tightly with an oppressive sensation in the chest, marked by greasy fur of the tongue, it is a headache due to stagnation of phlegm and dampness in the interior; if headache is accompanied by distension in the chest and hypochondria, it is a headache due to stagnation of liver-qi; if distending pain in the head and eye, it is a headache caused by hyperactivity of liver-yang or flaming up of liver –fire; if headache accompanied with pricking feeling, localized in a certain place, it is a headache caused by blood stasis; if head is of dull pain, worse after overwork, it is a headache due to deficiency of qi ; while if head is a dull headache with dizziness, pale complexion, it is a headache caused by blood deficiency; if hollow headache occurs with aching pain in the loins and knees, it is a headache due to kidney deficiency, etc.
Diagnosis in Western Medicine
In Western medicine, there are 2 types of headaches: primary headaches and secondary headaches.
Primary headaches are not associated with or caused by other diseases, for example, tension headache, migraine and cluster headache, etc.
1. Tension Headache
It is the most common type of primary headaches, as many as 90% adults have had or will have tension headache, and women are more common than men. It often begins in the back of the head and upper neck as a band-like tightness or pressure encircling the head with most intense pain over eye, which is usually mild, not associated with nausea, vomiting or sensitivity to light and sound. There are many effective therapies including acupuncture, herbal medicines and massage for treating tension headache in TCM.
2. Migraine Headache
It is the second most common type of primary headaches, which affects children as well as adults. An estimated 6% of men and up to 18 % of women experience migraine headache. It is usually described as an intense, throbbing or pounding pain that involves one temple or located in the forehead, around eye, or back of head, accompanied by nausea, vomiting, and sensitivity to light and sound. Personally I have rich experiences in treating migraine with acupuncture and herbal medicines.
3. Cluster Headache
It can affect people at any age, mostly between ages 20-40.Men is more common than women. Cluster headache is one of most painful type of headaches, it may last from weeks to months, followed by remission periods when the headache attacks stop completely. The pattern varies from one person to another, but most people have one cluster period a year. During remission, there is no headache for months, even years. I also have some therapies to prevent it re-occurring with herbs and acupuncture.
Secondary headaches are caused by other diseases which may be minor, such as nasosinusitis, glaucoma, otitis media, hypertension and other diseases. Some of them are serious, even life threatening, such as haemorrhage, bacterial meningitis, viral encephalitis, hydrocephalus, head trauma, injuries, brain tumour, ect.
Clinically, many patients suffer from mixed headaches in which tension headache or migraine and some secondary headache trigger each other. Therefore, we should suggest the patients go to hospital for further check up, and then we will decide how to treat the patient with TCM therapies, because some patients with secondary headaches are not convenient for TCM therapies.
Treatments in Chinese Medicine
Basic acupoints: Baihui (Du 20), Taiyang (Extra 1), Hegu (LI4).
1. According to positions of headache
For frontal headache: add Yintang (Extra2), Shangxing (Du23), Neiting (S44).
For temporal headache: add Waiguan (SJ5), Zulinqi (G44).
For parietal headache: add Houxi (SI3), Taichong (Liv 3), Zhiyin (B67).
For occipital headache: add Fengchi (G20), Kunlun (B60)
2. According to syndrome types of headache
Headache due to exopathic factors:
For wind-cold headache: add Fengfu (Du16), Dazhui (Du14);
For wind-heat headache: add Fengchi (D20), Quchi (LI11);
For wind-dampness headache: add Waiguan (SJ5), Sanjiaoshu (B22);
3. Headache due to internal factor:
For headache due to stagnation of phlegm: add Fenglong (S40), Yinlingquan (Sp9);
For stagnation of liver-qi: add Waiguan (SJ5), Yanglingquan (G34);
For hyperactivity of liver-yang: add Taichong (Liv3), Taixi (K3);
For flaming–up of liver-fire: add Xingjian (Liv 2), Ganshu (B18), Qimen (Liv14);
For blood stasis: add Xuehai (Sp10), Xinshu (B15);
For deficiency of qi: add Zusanli (S36), Qihai (Ren6);
For deficiency of blood: add Xuehai (Sp10), Pishu (B20)
For deficiency of kidney: add Taixi (K3), Shenshu (B23).
Of course, we can add more points or change the above points according to patient’s concrete conditions.
We should prescribe different formula for each patient according to syndrome type of headache.
Headaches due to Exopathic Factors
1. Wind-cold headache
Therapeutic principle: dispersing pathogenic wind and cold to relieve the pain.
Prescriptions: Modified Chuan Xiong Cha Tiao San/Decoction
Chuanxiong (Rhizoma Ligustici Chuanxiong) 10g
Qianghuo (Rhizoma seu Radix Notopterygii) 9g
Jingjie (Herba Schizonepetae) 6g
Fangfeng (Radix Ledebouriellae) 9g
Baizhi (Radix Angelica Dahuricae) 9g
Xixin (Herba Asari) 3g
Gancao (Radix Glicyrrhizae) 6g
Preparation and administration: All the above herbs should be soaked in water for 2-3 hours, and then stew the herbs in the water in the pot for 20-30 minutes. Take the tea (decoction) orally, a half in morning, and another half in the evening, continue for 7-10days.
2. Wind-heat headache
Therapeutic principle: dispersing pathogenic wind and clearing up pathogenic heat to relieve the pain.
Prescription: Modified Sang Ju Yin/Decoction
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