How does Chinese medicine diagnose and treat headache?

Headache is one of the most common clinical symptoms whose underlying cause can be difficult to diagnose and treat. This article describes how Chinese medicine uses the nature and location of pain as well as associated symptoms to diagnose and treat the common causes of headaches.

Exterior or interior?

According to Chinese medicine theory, headache has two broad aetiologies: invasion by an exterior pathogen or internal disorder. A headache caused by an exterior pathogen has an acute onset with severe and continuous pain. It can often be accompanied by or follow cold and flu symptoms. Chronic, recurring or slow onset headaches on the other hand are generally due to internal disorders.

Acute and exterior headaches are usually associated with, or worsen after a recent history of infection by bacterial or viral pathogens, the most common being cold and flu. Chinese medicine further differentiates this type of headache according to its nature (wind-cold, wind-heat or wind-dampness) and location of pain.

• A Wind-Cold headache is continuous and aggravated by exposure to cold. The patient typically presents with a white tongue coating, floating and rapid pulse.
• A Wind-Heat headache is severe with a burning sensation. The patient may also be thirsty with a red tongue, yellow tongue coating and tight pulse.
• A Wind-Dampness headache is distending with a heavy sensation. The patient may feel their body or limbs are heavy, feel stuffy in the chest and present with a white and greasy tongue coating and soft pulse.

Which channel is affected?

Having differentiated the nature of the invading pathogen, it is then necessary to determine the location of the pain which indicates the channel that can be treated with acupuncture. The twelve primary acupuncture channels of the body can be divided into six pairs that meet at the head. When an external pathogenic factor invades any part of the body the resulting headache will be localised along the path that the channel runs in the head.

The following sites of pain are significant:

• The bridge of the nose and area between the eyebrows, back of the head (occipital region), nape of the neck and upper back represent the Greater Yang channel.
• The temporal and lateral side of the head indicates the Lesser Yang channel. The pain can be uni or bi-lateral.
• The forehead indicates the Yang Brightness channel.
• A heavy or distending pain around the upper head indicates the Greater Yin channel.
• Pain on the inside of the head radiating to the teeth indicates the Lesser Yin channel.
• Pain at the vertex/top of the head indicates the Terminal Yin channel.

For acute headaches, acupuncture points on the appropriate channels can then be selected according to the nature of the exterior pathogen and affected channel. For example BL-2 and BL-10 are suitable points on the Greater Yang channel for a wind-cold headache with pain between the eyes and a stiff neck. If the headache is accompanied by cold and flu symptoms, other additional points as well as herbal formulas are included in the treatment.

Which internal disorder?

When there is no evidence of exterior invasion, headaches of a chronic or recurring nature are symptoms of an underlying internal disorder, which may have a history of months, years or even decades. Internal disorders are more complicated and may involve one or more organs. Again, the precise pattern of internal disharmony can be ascertained by questioning the nature of the headache. Each of the following “syndromes” represents a unique combination of symptoms recognised by Chinese medicine diagnosis.

• A recurring distending or severe headache, often accompanied by dizziness or vertigo may be due to an Excess Yang syndrome. This type of headache is most commonly associated with stress, anger or other emotional changes and triggers. Its origin may be due to Liver Heat or Liver Yang Uprising which can be determined by further detailed questioning.
• Qi Deficiency headaches are mild and chronic, they may become more severe or triggered by physical fatigue or exercise. Spleen Qi deficiency syndrome is commonly associated with this type of headache.
• A heavy, foggy headache with dizziness may indicate a Dampness and Phlegm syndrome. This may co-exist with Spleen Qi deficiency symptoms such as fatigue, oedema, weight gain, poor appetite and digestive problems.
• Headache with a sharp, stabbing or throbbing pain may be indicative of Blood Stasis. This syndrome may arise from a history of physical trauma or surgery.
• A long-term, dull, empty headache with poor memory may indicate a Kidney Essence Deficiency syndrome especially in elderly patients. This may be accompanied by low back pain, weak knees, sexual or urinary dysfunction.

These are the main types of headache recognised by Chinese medicine diagnosis. Each type of headache may be caused by different underlying syndromes of disharmony which must be differentiated by further questioning of associated symptoms. Through detailed questioning of the nature of all symptoms, a rational diagnosis based on syndrome differentiation can be obtained.  The corresponding acupuncture points and/or herbal medicine formula is then chosen to treat the diagnosed syndrome which is causing the headache.

This is the principle by which Chinese medicine diagnoses and treats many disorders. To an experienced Chinese medicine practitioner, headache is not simply a disease to be cured but an important diagnostic clue which forms part of a holistic diagnosis process.

Acupuncture for the management of chronic headache: a systematic review

This systematic review demonstrated that traditional needling acupuncture is superior to sham acupuncture and pharmacological therapy for chronic headache treatment by improving headache intensity and frequency and increasing the response rate. The authors also found a lower incidence of side effects in the acupuncture group when compared with medications.

• Sun Y, Tong J. Acupuncture for the Management of Chronic Headache: A Systematic Review. Anesthesia & Analgesia. Dec 2008;107(6);2038-2047. [Fulltext]

Cochrane Reviews: Acupuncture for tension-type headache

Acupuncture in primary headache treatment

Abstract: Acupuncture has a long tradition of use for the treatment of many pain conditions, including headache. Its effectiveness has been studied mainly for primary headaches, particularly for migraine and tension-type headache (TTH). Traditional Chinese Medicine (TCM) has two diagnostic frameworks for headaches: meridian diagnoses, based on the location of the pain and on the meridians (or channels) that pass through it; syndrome diagnoses, dependent on external or internal factors and on the characteristics of the pain. The four meridians involved in headache are Shaoyang (TE-GB channels, on the temporal sides of the head); Taiyang (SI-BL channels, occiput); Yangming (LI-ST channels, forehead) and Jueyin (PC-LR channels, vertex). The syndromes may be due to excess or deficit. Very generally, the excess syndromes correspond in the majority of cases to migraine and the deficit syndromes to TTH. Acupuncture is a complex intervention, which is also characterized by a close interaction between patient and therapist. The complicated system of TCM classification of headaches has frequently generated great diversity among the various therapeutic approaches used in the different studies on acupuncture in headache treatment. Despite these differences, the recent Cochrane systematic reviews on acupuncture in migraine and in TTH suggest that acupuncture is an effective and valuable option for patients suffering from migraine or frequent TTH. Moreover, acupuncture seems to be a cost-effective treatment.

• Schiapparelli P, Allais G, Rolando S, Airola G, Borgogno P, Terzi MG, Benedetto C. Acupuncture in primary headache treatment. Neurological Sciences. 2011;32(1);15-18. [Abstract]

References

• Point location image copyright Carole & Cameron Rogers, ‘Point Location and Point Dynamics Manual’, University of Technology, Sydney.