Migraine and Headache

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?

A Kind of Headache

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.

There are some forms of severe headache for which you should get urgent medical attention, whether or not you also decide to consult Chinese medicine. Click here.

The Head

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.

What about the Chinese idea of 'Blood' for Migraine and Headache?

Also, your Blood (capital B) must flow smoothly through your head. As with orthodox medicine, Blood is a big subject in Chinese medicine. That link to Blood tells you more about the ideas behind it.

Too much or Too Little

From the above alone, you will understand that in Chinese medicine migraine and headache problems arise from :

Internal and External Causes

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.

Internal Reasons for Migraine and Headache

Too much Yang pushing up and collecting in your head can come from various internal problems:

  • Wind - especially Liver Wind. This is like an internal tempest that sweeps upwards inside you. Wind-caused problems can happen very fast. They arise because your Liver energy isn't secure or stable. They are so bad that in some people they cause symptoms that Western medicine describes as 'stroke'.
  • Liver Fire. This is heating and drying. It inflames tissues, causing red eyes and rashes, tinnitus and often affects people who easily become irascible. It strongly affects the temples and there may be dizziness. This causes severe forms of migraine and headache: more likely headache than migraine, however.
  • Liver Yang rising. Mostly this has pain at the temples, also affects the vision and the ears, and is often caused by stress or internal emotional tensions (these often produce Liver Qi stagnation, listed next). Often there is a deficiency of Kidney Qi too. Very common in migraine and headache.
  • Liver Qi stagnation. This affects every man, woman and child in the world from time to time. It's such a big subject that I've written a book about it, see below. What often helps this condition, at least in the short term, is exercise.
  • Stomach Heat and Stomach Damp-Heat. This doesn't usually directly affect your head, but it produces pain in your face, often from mucus in the sinus cavities or in your nose. It can sometime accompany other forms of migraine and headache. What you eat and how you eat it strongly affect whether you get Stomach Heat, so this syndrome (together with several kinds of Blood deficiency) brings in the food sensitivity issue.

Too much Yin in the head?

  • Cold, stuck in the Liver channel: this produces a kind of solid, clamped, sensation in the head, but its main symptoms are usually felt in the abdomen with feelings of constriction, and a sensation of coldness not merely there but also in the hands and feet. Often you feel better for warmth. Sometimes you feel nauseous but if anything comes up, it's clear liquid. Uncommon in  migraine, but not very uncommon in headache.
  • Damp. This can be a real problem, causing heaviness and slowness but not so much migraines, on its own.
  • Phlegm. This causes dizziness, and often there is real actual phlegm in the sinuses or nose or throat, or even heard as crackling in the ears. There are various kinds of phlegm, eg phlegm affecting the Heart. When you get Wind-Phlegm,  dizziness can be severe and sudden.
  • Blood Stasis or 'Stagnation'. Blood 'stuck' or stagnating in the head is common in various forms of severe headache, and can occur in migraine.

Deficiency conditions

  • Qi deficiency. This kind of headache is usually mild and much better for rest. It's the kind of headache when you like rubbing your head, or closing your eyes, or stopping work. Much better after a good sleep, or even a doze.
  • Blood deficiency. There are various kinds of Blood deficiency, for example see Liver Blood deficiency. This type can certainly appear with migraine.
  • Kidney deficiency. This goes beyond mere Qi deficiency, and usually arises after a longish period of overdoing it - by which I mean over-working or trying to do too much for your constitution. It also gradually starts happening as you grow older. Commonly there is backache, tinnitus and knee pain as part of the ongoing picture. The pain in the head is usually at the base of the skull, which is not where most people get migraine or headache pains first. However, it can occur in people who also have Liver Yang rising.

External Conditions

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.

  • Wind, hot and cold: read more by clicking on the link.
  • Damp and Wind. Much sneezing and shivering with signs of weakness, heaviness and swelling in the face. Not so likely to cause migraine, but damp itself can so load your system that it becomes prone to various forms of migraine and headache.

Location of Migraine and Headache

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.

So migraine and headache problems have to be looked at from not just the location of the pain but also the syndrome concerned, interior or exterior as it may be.

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
Kidney and Bladder

Pain here is on the Bladder channel but this area is reached by the Kidney channel too, so if the pain is severe it is usually from exterior Wind-Cold. If more like a deep ache it comes from Kidney deficiency.

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.

What about Pain in the Whole of your Head?

Two possibilities here: either all the (Yang) channels are disrupted by the invasion of Wind-Heat or, if the pain is more like a deep ache, it will probably be from Kidney deficiency.

Putting Migraine and Headache together

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.

The more of an ache it is, better for rest, the more likely it is to be a deficient-type headache, such as Qi deficiency or Kidney deficiency.

If it improves from exercise and good sex, it's probably from Qi stagnation. Read more about this interesting syndrome in my book.

Bottom Line on Migraine and Headache?

  • Migraines are mostly Liver Yang
  • Headaches can be from a variety of causes and syndromes

Treatments for Migraine and Headache

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:

Research

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."

The Clinical Review on the “Prevention of Migraine”: Acupuncture is Conspicuous by its Inexplicable Absence

"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)

References

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."



www.acupuncture-org.uk

Booking Consultations with Jonathan Clogstoun-Willmott

Click here to see when Jonathan is available, or to BOOK your appointment online. 

Alternatively, ring him on 07950 012501 or freephone (only free to telephone within the UK) 0800 298 7015.


If you live in the Edinburgh area of Scotland where the author of this site works, click Edinburgh Acupuncturist. If you live further afield, click BAcC.

Click to return from Migraine to home page.


Jonathan Clogstoun-Willmott Books

All the books in the 'Chinese Medicine in English' series should be fully accessible on Kindles and Kindle apps. (Or you can buy the softback print editions, of course.)

('Western Astrology and Chinese Medicine' published 1986, was never available in a Kindle version.)

Request! Please!

If, having read one of my books you can write a review - preferably positive - that would help others decide whether to read it.

You can put your review on Amazon or, on this site, here.

And if you think it was terrible?

Well, let me know so I can improve it for the next person. (Ideally let me know before cursing it in public!)

Here are some of the books I (Jonathan) have written.

Subscribers to Kindle Unlimited can borrow the first four for 'free'.

Qi Stagnation - Signs of Stress

Yin Deficiency - Burnout and Exhaustion

Yang Deficiency - Get Your Fire Burning Again!

Yuck! Phlegm! How to Clear Your Phlegm ...

Western Astrology and Chinese Medicine



Published 1986 and, amazingly, still selling. Western Astrology and Chinese Medicine was apparently used back then by at least one acupuncture college to help students understand Chinese medicine!

Six Reviews so far for Yuck Phlegm. (Despite the lurid cover, it explains the five main types of phlegm and what works best for each type. I hope it's easy to read and will be much more useful than all the websites on the subject.)

Return from Migraine and Headache problems to our Home Page.


Didn't find what you were looking for? Use this search feature:


Click Here for Acupuncture Points on Facebook!