Migraine and Headache problems affect eight million people in the UK alone. That's 12% of us. It's a worldwide problem, more common than asthma, diabetes and epilepsy combined. What does Chinese medicine have to say about it?
Although they can be very severe, incapacitating people for days on end, migraines are still just one form of headache, and headaches have many causes in Chinese medicine.
Your head is where, in Chinese medicine, your Yang energies concentrate and collect. All your Yang channels meet here, and if clear Yang energy ascends properly, you will have good hearing, good vision, a good sense of smell and good taste-buds. You will also be able to think clearly.
Too much Yang, however, can makes your head feel like bursting!
Conversely, when Yin forms of energy, such as phlegm, catarrh, mucus and coldness, get stuck in the head, you feel confused, heavy-headed and slow.
However, your head itself and its contents (eg your brain) are said to be 'ruled' by your Kidneys (capital 'K' denotes the Kidney Zangfu or energy organ). Kidney deficiency causes many long-term deep-seated problems.
From the above alone, you will understand that in Chinese medicine migraine and headache problems arise from :
Internal means the problem arose from something already there, although it may have been prompted by something from outside.
External means, in Chinese medicine, the environment and weather are seen as the cause - although there would have had to be susceptibility to it before External factors take hold.
Too much Yang pushing up and collecting in your head can come from various internal problems:
Too much Yin in the head?
So-called external conditions causing migraine and headache arise from the weather, the climate and sudden changes in temperature or conditions that we cannot adjust to fast enough.
These include, for some people, air-conditioning and central heating, (together with the dust and other allergens they may carry) when the body is hit by a sudden change in ambient temperature.
Usually there is a 'wind' as well. This 'wind' could come about from driving with the window open in summer, enjoying the breeze into the car as you speed along. For some people, this is enough to set off a headache.
Incidentally, it may go further than mere migraine or headache! I have seen many patients who got facial paralysis (Bell's Palsy) from exposure to the weather or the wind.
Where you feel the migraine and headache says a lot about which acupuncture channels are affected.
For any kind of treatment in Chinese medicine, the channel (or meridian) where the pain occurs, or along which it travels, makes an enormous difference to the treatment outcome.
All the Yang channels (ie Small Intestine, Bladder, Three Heater, Gallbladder, Stomach and Large Intestine meridians) pass over and through the head, plus the Liver and Kidney channels, which come up inside it.
Other zang-fu reach up to the head internally, such as the Heart which has a strong kinship with the tongue, and the Lungs which go to the throat, for instance. But these are less common in headache, let alone migraine.
Forehead or Frontal Pain
This area is crossed by the Stomach and Gallbladder channels. Pain here often comes from Stomach Qi problems (eg Stomach Heat) or Blood deficiency, perhaps from weak Stomach Qi or from an inadequate diet or from poor eating habits.
Occiput Pain Area
Lesser Yang: Gallbladder and Three-Heater areas
These migraine and headache pain areas beside the eyes, or on the side of the head above and to the front of the ears, are crossed by the Gallbladder and Three-Heater channels, which account for most problems here.
Liver Yang Rising pain area
The side of the head shown relates usually to the Liver Yang rising pain syndrome.
This is probably the most common area for migraine. It affects one side of the head usually, and often derives from some deficiency in either Liver Yin or Liver Blood, and/or sometimes Kidney Yin or Yang.
Liver Blood Deficiency
For pain at the Vertex, the cause is usually Liver Blood deficiency. This sometimes comes with dizziness and visual problems
Pain behind the eyes
Pain and problems behind or within the eyes come usually, in fact nearly always, from either Liver Blood deficiency (dull ache including loss of vision) or from the throbbing, even numbing pain of Liver Yang ascending.
The location tells you which channels or meridians are affected.
The symptoms tell you which syndrome is involved.
In migraine, syndromes are mostly what are called 'full' rather than 'empty'. As sufferers grow older, they tend also to get deficiency syndromes as well. After some years, there can be quite a mix.
What about headache?
The earlier in the day and the more acute, the more likely it is to be from 'fullness' or 'excess'.
The more suddenly it comes, the more likely it is to be from Wind.
If it improves from exercise and good sex, it's probably from Qi stagnation. Read more about this interesting syndrome in my book.
See the letter below for a summary of 'orthodox' treatments but in terms of treatment using Chinese medicine, the following are frequently used by practitioners:
For research on using acupuncture for migraine and headache click here.
You may also be interested in the following, a copy of a letter sent to the editor of the Journal of the American Medical Association which had
"carried an article on the prevention of migraine. Although this was billed as being a summary of information about treatment options that are endorsed by the US government this didn't appear to be true, and moreover acupuncture was missing.
Acupuncture is one of the very best treatments for preventing migraines, and is even recommended by NICE for use in the NHS, so we thought that it was worth writing a letter to the editor. In the event, they chose not to publish it but we reproduce it below, to give you an idea of the various arguments and to encourage others to take up their pens when they think there is a case to answer."
"We read your article on the prevention of migraines with great interest but couldn’t tease out how the authors chose which treatments to include (see reference 1, below).
The review mentions pharmaceutical, nutraceutical and physical approaches, both FDA approved and off-label, effective and ineffective, but fails to mention acupuncture, which has stronger evidence than most of those recommended.
It would have been logical to consider only FDA-approved or guideline-endorsed interventions but most of those mentioned don’t meet these criteria: most beta blockers, the antidepressants, ACE inhibitors, NSAIDs, statins, and supplements are not FDA-approved for migraine prevention and constitute off-label prescribing.
By contrast, the FDA now recommends that doctors learn about acupuncture as a safe and effective pain treatment in order to reduce prescribing of opioids (see reference 2 below) and acupuncture is recommended in the NICE clinical guidelines for the prevention of migraine.
The only drugs recommended are topiramate, propanolol and gabapentin (reference 3).
The vast majority of treatments mentioned are poorly tolerated and frequently discontinued due to unpalatable side-effects. Many are not considered safe during pregnancy.
Acupuncture is considered a very safe treatment. Some of the included treatments have only the flimsiest of evidence supporting a recommendation, for example the combination of simvastatin plus vitamin D.
On the other hand, the most recent Cochrane systematic review of acupuncture for migraine prophylaxis includes 4,985 participants in 25 randomised controlled trials, firmly placing it amongst the most well studied treatments.
Finally, one could have focused on effectiveness or efficacy, the logical choice for educating clinicians on how best to help their patients. But some treatments mentioned have zero evidence of efficacy, for example nortriptyline (reference 4).
In stark contrast, strong peer-reviewed evidence supports the use of acupuncture as effective, efficacious and safe for migraine prophylaxis.
In the most recent Cochrane review acupuncture is superior to no acupuncture (acute treatment only or routine care) and even to the diluted dose of acupuncture that masquerades as placebo (see reference 5).
Of most clinical interest, though, is that acupuncture was more effective than prophylactic drugs (metoprolol, flunarizine and others), and with fewer adverse events.
In summary, a review of treatments for migraine prophylaxis that fails to mention one of the best-studied, most effective and best-tolerated does a great disservice to patients by misinforming clinicians.
If there was a valid reason for this omission, we would be interested to hear it.
Mark Bovey (Research Manager, British Acupuncture Council )
Mel Hopper Koppelman (Director of Evidence Based Acupuncture)
1. Abramowicz M, Zuccotti G, Pflomm J-M, eds. Prevention of Migraine. JAMA. 2017;317(21):2230- 2231. doi:10.1001/jama.2017.1680.
2. FDA. FDA Education Blueprint for Health Care Providers Involved in the Management or Support of Patients with Pain. 2017:1-10. https://www.fda.gov/Drugs/NewsEvents/ucm553931.htm.
3. NICE National Institute for Health and Care Excellence. CG150. Headaches in Over 12s: Diagnosis and Management. NICE; 2012. https://www.nice.org.uk/guidance/cg150.
4. Domingues RB, Silva ALPD, Domingues SA, Aquino CCH, Kuster GW. A double-blind randomized controlled trial of low doses of propranolol, nortriptyline, and the combination of propranolol and nortriptyline for the preventive treatment of migraine. Arq Neuropsiquiatr. 2009;67(4):973-977.
5. Linde K, Allais G, Brinkhaus B, et al. Acupuncture for the Prevention of Episodic Migraine. (Linde K, ed.). Chichester, UK: John Wiley & Sons, Ltd; 2016. doi:10.1002/14651858.CD001218.pub3."
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