Headache


 

Etiology

Headache, also referred to as “cephalalgia” is a condition characterized by pain that can occur anywhere in the head or neck. It is a symptom that can be caused by numerous conditions of both the head and neck. A Headache can be primary, where there is no underlying condition (IE Migraines) or can be secondary, in which it is cause by another condition. Many of these conditions are benign, but some may be serious. Because of this, all new, or changed headaches require the attention of a medical professional. Some of the main causes of Headaches include: 

o        Cervical Strain or Sprain   

o        Bulging or “slipped” disc in cervical spine

o        Vascular Issues in the neck (another type of headache: Migraine) 

o        Ear Infections

o        Nerve pain secondary to many problems such as Shingles or Trigeminal Neuralgia.

o        Sinus congestion or infection 

o        Problems or inflammation of eyes or optic nerve.  

o        Meningitis

o        Brain bleeds (and other more serious conditions)

o        Hormone Changes (hyperthyroidism or estrogen)





Clinical Features

Headaches can affect (and appear) in any region of the head or neck. There are many “types” of headaches based on location, and cause. First, when discussing any headache, we need to rule out the “Red Flags”:

o          Systemic symptoms (IE fever or recent weight loss)

o          Systemic disease (IE history of HIV infection, or other malignancy)

o          Neurologic symptoms or signs (IE loss of motor control or speech)

o          Onset sudden (also known as a “thunderclap” headache)

o          Onset after 40 years of age

o          Previous headache history (IE is this the first, the worst, or a different headache)




The above “Red Flags” must first be ruled out. If a red flag is suspected, the patient must see a physician as soon as possible because the headache could be a sign of something serious (meningitis, tumor, brain bleed, etc.) going in in the body that require further testing. 




If the red flags are ruled out, then we can proceed to explore the other causes of headaches, of which there are four “Main” types:

o         Migraine – A vascular headache that can have many triggers and forms. Types of migraine include: With or Without Aura, Ocular Migraine, Hemiplegic Migraine, Chronic, and Intractable. A Migraine can be moderate to severe, can last a few hours to a few days, can occur several times per month or year (usually secondary to a “trigger” like a food, stress, hormonal, etc.). It can be bi or unilateral, and often occurs as a “pulsing” or “throbbing” type of pain. Many people will experience sensory sensitivity, especially photosensitivity, and can also experience nausea with or without vomiting. A Migraine can also come in combination with tension headaches.

o        Tension – A mild to moderate type of headache from tight muscles in the head and neck. This is the most common form of headache, and usually lasts from 30 minutes to many hours. It is usually described as dull and achy, although can be severe, and is located across the vertex of the head, like a “tight towel wrapped around the head”. There is no aura, no nausea or vomiting, although there can be photosensitivity and noise sensitivity. 

o          Cluster – A moderate to severe headache that occurs in “clusters” over a short period of time, can be reoccurring. This type of headache can appear multiple times per day over a period of months. It is usually unilateral, focused at or behind one eye or in one of the temples. Pain is usually described as sharp, or stabbing, and can be accompanied by runny nose and tears on the affected side. 

o        “New” Daily Persistent – A diagnosis given after ruling out other forms of headaches. A persistent pain (lasting more than 4 hours) that occurs, usually, within a period of one to three months. Often, this type of headaches is made worse with regular use of OTC medications like acetaminophen or NSAIDS. 






Diagnosis

Traditional Chinese Medicine differentiates Headache symptoms into eight types:

o         Wind Cold Headache – Sudden onset, with stiff neck, aversion to wind and cold, sneezing stuffy nose, lack of thirst, and cough. We observe a tongue with thin white coating and a floating, tight pulse. This type of headache often occurs with the early stages of an upper respiratory infection. 

o         Wind Heat Headache – “Splitting Headache” with a feeling of distention. Occurs with fever, aversion to wind, red face and/or eyes, a sore throat, and thirst with a desire for cold drinks. We observe a red tongue, especially the tip, with a thin yellow coating, and a floating, rapid pulse. This type of headache often occurs with a viral infection, like the flu. 

o         Wind Damp – This is a tension type headache, characterized by a feeling of head “wrapped in a cloth” with heaviness. Can also experience an aversion to wind, chest and epigastrium oppression, poor appetite, inability to concentrate, and loose stools. We observe a tongue with white and sticky coating, and a soft or slippery pulse. 

o         Hyperactive Liver Yang – An “intense” headache, especially on the top of the head, or all over. Occurs with dizziness, mental restlessness, a propensity to be angry, poor sleep, hypochondriac region pain, a red face, bitter taste in mouth, blurred vision and/or eye strain and red eyes. We observe a red tongue with yellow coating and a wiry pulse. This type of headache is usually secondary to high blood pressure. 

o         Kidney Deficiency – This headache is characterized with an “empty feeling” in the head. Can have dizziness, a feeling of “apathy” or fatigue, ringing in the ears, insomnia, poor memory, leukorrhea or nocturnal emissions, and a sore or weak back. We observe a red tongue with little to no coating, and a thin, weak pulse, sometimes rapid. This type of headache usually occurs in elderly, or those with long standing, chronic illness, or those with hormonal diseases. 

o         Qi and Blood Deficiency – Headache which is worse with overexertion. Often occurs with dizziness, fatigue, poor appetite, heart palpitations, and a pale complexion. We observe a pale tongue with thin, white coating, and a thin, weak pulse. This type of headache is often observed with hypothyroidism, anemia, and eating disorders (causing malnutrition). 

o         Turbid Phlegm – Headache characterized as a feeling of heaviness or fogginess in brain. Often described as a feeling like when you turn your head quickly, it feels like your brain takes a moment to “catch up” to head. Can be accompanied by fullness in chest and epigastrium, vomiting or spitting of mucus, fatigue, and poor appetite. We observe a tongue with a thick and sticky white coating, and a slippery pulse. This type of headache differs from a “wind damp” type in that it is a more “internal” disorder. (IE as opposed to a simple URI, it could be bronchitis, pneumonia, or a chronic lung or upper respiratory problem. 

o         Blood Stasis – A chronic, intense, fixed headache that is sharp in quality, and worse at night. Can occur with hypochondriac region pain, painful period with dark clots, and other clotting or circulation problems in the body. We observe a purple tongue with bleeding or bruised spots, and a thin, choppy pulse. This type of headache often occurs secondary to previous head traumas, or with systemic vascular diseases. 




Treatment of Headache

Treatment of headache requires restoration of circulation to the head and neck to ensure proper function of the tissues. We relax the muscles of the head and neck, and help blood to enrich the tissues. If toxins are present, we must also help the body to rid of those toxins, and address any underlying conditions. Common point prescriptions for headache include: LI 11, 4, 3, 2, Lu 7, 10, Ht 3, GB 39, 42, and Liv 2, 3. These points would be in combination with points addressing the underlying conditions (IE we would use points like Liv 8 to nourish blood when the underlying condition was blood deficiency). We then utilize herbs for detox, circulation, and for treatment of the underlying conditions:

o         Wind Cold Headache – Chuan Xiong Cha Tiao San, Qing Bi Tang, Bai Zhi. 

o         Wind Heat Headache – Chuan Xiong Cha Tiao San, Yin Qiao San, Bai Zhi, Xi Xin.

o         Wind Damp – Chuan Xiong Cha Tiao San, Qiang Huo, Yu Ping Feng San, Bai Zhi

o         Hyperactive Liver Yang – Chuan Xiong Cha Tian San, Long Dan Xie Gan Tang, Tian Ma Gou Teng Yin, Yan Hu Suo, Ye Jiao Teng. 

o         Kidney Deficiency – Jin Gui Shen Qi Wan, Zhi Bai Di Huang Wan, You Gui Wan, Zuo Gui Wan, Bai Zhi, Xi Xin (if tolerated), Yan Hu Suo. 

o         Qi and Blood Deficiency – Bu Yang Huan Wu Tang, Dang Gui Shao Yao Tang, Chuan Xiong Cha Tiao San, Yan Hu Suo. 

o         Turbid Phlegm – Qing Qi Hua Tang Wan, Qing Zao Jui Fei Tang, Chuan Xiong Cha Tiao San, Pu Ji Xiao Du Yin, Bai Zhi, Xi Xin. 

o         Blood Stasis – These cases need close attention and care, herbs can very a lot according to signs and symptoms, and medications that these            patients might be on, some herbs might include (with caution): Bu Yang Huan Wu Tang, Si Ni Tang, Mao Dong Qing, Liu Ji Nu, Chi Shao, Dan              Shen, Zhi Chuan Wu, Bai Zhi, Xi Xin. 

Headaches, especially new or changed headaches, can be a sign of something more serious going on, and longstanding or chronic headaches can be a large source of stress in people’s lives. Don’t wait any longer, come in and get evaluated today to see if Chinese Medicine can help reduce or eliminate your Headaches!

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