By Jiang Liu, Diplomate of Oriental Medicine
AR Licensed Acupuncturist and Herbalist
Acupuncture & Chinese Medicine Clinic
2024 Arkansas Valley Dr., Suite 402
Little Rock, AR 72212
Headache is pain or discomfort that occurs in one or more areas of the head, face, mouth, or neck. Headache can be chronic, recurrent, or occasional. The pain can be mild or severe enough to disrupt daily activities. There are many different types of headaches. The following are three major categories of headaches:
1. Primary headaches: they account for about 90% of all headaches. There are three major types of primary headache: migraine, tension-type headache and cluster headache:
- Tension headaches are the most common type of primary headache; as many as 90% of adults have had or will have tension headaches. their cause is not known. The most likely cause is contraction of the muscles that cover the skull. When the muscles covering the skull are stressed, they may spasm and cause pain.
- 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 migraine headaches. See Migraine in this web site.
- Cluster headaches are a rare type of primary headache, affecting 0.1% of the population. The cause of cluster headaches is uncertain. It may be that certain parts of the brain begin to malfunction for an unknown reason. The hypothalamus is responsible for the body’s biologic clock and may be the part of the brain that is the source for the headaches.
2. Secondary headaches: caused by underlying conditions such as head and neck traumas, cranial or cervical vascular disorders, substance or its withdrawal, infection, disorders of homeostasis, disorder of cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cranial structures, psychiatric disorders.
3. Cranial neuralgias: a group of headaches caused by nerve inflammation in the head and upper neck. Facial pain and a variety of other causes for headache are included in this category.
For the secondary and cranial neuralgic headache, treatment should go to underlying diseases. For the primary headaches, over the counter medicine and prescription could be used:
- Tension headaches: over-the-counter (OTC) analgesics: acetaminophen (Tylenol) and non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and non-aspirin (ibuprofen-Advil, Nuprin, Motrin IB, Medipren; and naproxen –Aleve).
- Migraine headaches: OTC analgesics: acetaminophen (Tylenol) and non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and non-aspirin (ibuprofen-Advil, Nuprin, Motrin IB, Medipren; and naproxen –Aleve). Narcotics and butalbital-containing medications, dihydroergotamine, prochlorperazine and valproate may be used in severe cases.
- Cluster headaches: Cluster headaches may be very difficult to treat and treatment options may include oxygen treatment, corticosteriods, calcium channel blocking agent, antiepileptic drugs, intranasal applications such as Lidocaine, ergotamine agents, sumatriptan (Imitrex). For those who do not respond to the medications, surgery may be recommenced.
Chinese medicine such as acupuncture and Chinese herbs has been applied to headaches from the earliest beginnings of Chinese medicine. Acupuncture, as well as Chinese herbals is effective for tension headaches, migraine headaches, cluster headaches, post-traumatic headaches, and disease-related headaches that might be due to sinus problems, high blood pressure or sleeping disorders. Some OTC medications and prescription medicine can have serious side effects. Unlike synthetic drugs, the greatest advantage of Chinese medicine is that it is natural and has virtually no side effects. Since the chronic nature of headaches and side effects of synthetic chemical medicine, more and more headache sufferers are seeking acupuncture or herbal medicine for the cure.
Various clinical studies on effectiveness of acupuncture have been performed. Even though standardized accupoint protocol was used instead of using individualized accupoints that is the beauty of Chinese medicine, the results show the effectiveness of acupuncture on different kind of headaches. The following are a few of those studies.
- Acupuncture for tension-type headache (Linde K et al. Explore (NY). 5(6):356-8, 2009). BACKGROUND: Acupuncture is often used for tension-type headache prophylaxis but its effectiveness is still controversial. This review investigated whether acupuncture is a) more effective than no prophylactic treatment/routine care only; b) more effective than ‘sham’ (placebo) acupuncture; and c) as effective as other interventions in reducing headache frequency in patients with episodic or chronic tension-type headache. This review included eleven trials with 2317 participants. Two large trials compared acupuncture to treatment of acute headaches or routine care only. Both found statistically significant and clinically relevant short-term (up to 3 months) benefits of acupuncture over control for response, number of headache days and pain intensity. Six trials compared acupuncture with a sham acupuncture intervention, and five of the six provided data for meta-analyses. Small but statistically significant benefits of acupuncture over sham were found for response as well as for several other outcomes. Three of the four trials comparing acupuncture with physiotherapy, massage or relaxation had important methodological or reporting shortcomings. AUTHORS’ CONCLUSIONS: acupuncture could be a valuable non-pharmacological tool in patients with frequent episodic or chronic tension-type headaches.
- Use of acupuncture in the therapy of chronic daily headache (Naprienko MV et al. Zh Nevrol Psikhiatr Im S S Korsakova. 103:40-4, 2003). To determine efficacy of acupuncture (AC) in combined treatment of chronic daily headache (CDHA), 90 patients with this disorder were studied, using clinico-neurologic tests. Severity of patient’s state was evaluated with Clinical Global Impression (CGI) scale, including scoring of disease severity, global evaluation of the post treatment state dynamics and the index of therapeutic efficacy. Headache intensity was assessed with VAS. A state of functional activity of nociceptive and antinociceptive systems was studied, using nociceptive flexor reflex (NFR). For treatment, the patients were randomly divided into two clinically matched groups: group 1 received combined drug therapy, group 2–combined drug therapy and additional acupuncture course. The results revealed high efficacy of AC combined with drug therapy for CDHA treatment. Most efficient was use of AC in patients with significantly reduced activity of antinociceptive systems and presence of drug abuse allowing to reduce analeptics withdrawal time. Besides, more pronounced clinical effect of AC was obtained in patients with transformed migraine.
Etiology & clinical manifestations
In Chinese medicine, headaches are caused by multiple factors and the following are the common ones:
- External factors
Wind-cold: due to the invasion of wind and cold evil that disturbs the vertex of body, the meridians are clotted and stagnated. Symptoms and signs: headache involved in neck and upper back, tightness or aversion wind and cold, no thirsty. Thin tongue coat and superficial, tight pulse.
Wind-hot: due to invasion of wind and heat to vertex of the body, the meridians are disharmonized. Symptoms and signs: distensive headache, fever, aversion to cold, red face and red eye, thirsty with desire of water and constipation. Red tongue tip, thin yellow tongue coat, and superficial, fast pulse.
Wind-damp: invasion of wind and damp into vertex of body. Symptoms and signs: tight headaches, heavy extremities, tight chest, poor appetite, and loose stools. Greasy, white tongue coat and lingering pulse.
- Internal factors
Blood deficiency: qi and blood can not go up due to their deficiency, resulting in poor nourishment of meridians. Symptoms and signs: light headache with occasional dizziness, palpitation, insomnia, poor complexion, low spirit and tiredness. Light-colored tongue with thin, white coat and thin, weak pulse.
Blood stasis: blood stasis leads to obstruction and stagnation of meridians, which results in headache. Symptoms and signs: long, lasting headaches and could not be cured, stabbing pain, always localized in one area, may have the history of head trauma. Dark, purple tongue with or without petechia or ecchymosis; thin, white coat, and thin, lingering pulse.
Liver-yang ascending: liver lost harmony that leads to qi stagnation. qi stagnation become fire, which make yang dominant and wind moved up. Symptoms and signs: dizziness and distensive headache, much severer in bilateral head, anxiety and easy to get angry, poor sleep, bitter mouth, red face, bilateral flank pain. Red tongue with yellow coat and taut, fast pulse.
Kidney deficiency: deficiency of kidney essence and marrow result in brain dysfunction. Symptoms and signs: headache with empty feeling, dizziness with tinnitus, sore low back and knees without strength, low sprit and tiredness, spermatorrhoea or morbid leucorrhoea. Red tongue with scanty coat and thin, weak pulse.
Phlegm stasis: spleen could not perform normal function so that phlegm is stagnated, eventually ascending to the head and causing headache. Symptoms and signs: dizziness and headache, full and distensive feeling of chest, poor appetite, vomit. White, greasy tongue coat and slippery or taut slipper pulse.
Principle of treatment
- External factors
Wind-cold: dispel wind and cold, and stop the pain
Wind-hot: dispel wind, decrease heat and pacify meridians
Wind-damp: dispel wind, overcome damp and smooth the meridians
- Internal factors
Blood deficiency: tonify blood, nourish yin, harmonize meridians and suppress pain
Blood stasis: activate blood, dissolve blood stasis and smooth meridians
Liver-yang ascending: pacify liver, reduce yang and extinguish wind
Kidney deficiency: tonify yin, nourish kidney, supply essence and stimulate marrow production
Phlegm stasis: strengthen spleen, neutralize phlegm damp, dissolve phlegm and descend ascended phlegm
Chinese medicine practitioners treat headache patients according to patient’s initial cause, symptoms and signs, presentation of pulse and tongue. Acupuncture, herbal medicine and some other Chinese medicine modalities can be used alone, or combined, which depend on individual situation. Acupuncture, twice a week for 4 weeks, is a common practice. And herbal medicine, twice a day for 10 days, is often used in clinic practice. Responses to acupuncture or herbal medicine are different, so treatment course and modalities used are different.