JOURNAL OF CHINESE MEDICINE NUMBER 35 JANUARY 1991

THE TREATMENT OF
HEADACHE AND MIGRAINE
BY ACUPUNCTURE
RICHARD BLACKWELL

H
eadache and migraine are among the most com- These are by definition Shi conditions, hence the inten-
mon conditions presenting for acupuncture sity of the pain. The pain is described as tight, pounding,
treatment, and the practitioner must be able to burning, distending, or heavy and continues without
make a clear differentiation, both in order to administer interruption throughout the attack.
the most effective treatment and also in order to give the Aetiology: Headaches due to external pathogenic fac-
most pertinent advice to the patient. tors are often due to i. exposure to wind, either by being
Historically, two different approaches can be discerned in an exposed position outdoors or sleeping in a draught,
in the differentiation of syndromes for headache. The ii. sudden changes in the weather, iii. inadequate care
first and earliest of these approaches originates from the about exposure to external factors, e.g. sudden tempera-
Nei Jing, and differentiates according to which channel ture changes on leaving heated buildings in light cloth-
of the head corresponds to the location of the pain. This ing, or going out in Winter with wet hair immediately
is a form of differentiation according to the Jingluo, and after a hot shower (which opens up the pores). These
it is therefore most useful in the treatment of acute causes are often aggravated by a weakening of Zheng Qi
headaches caused by external pathogenic factors. The due to lack of adequate rest, poor diet etc.
channel differentiation does also have value in cases of
chronically recurring headaches, which are due to injury 1. WIND-COLD
to the Zangfu, but in these cases the differentiation of the Clinical manifestations:
affected channel amounts to a description of the Biao - headache of sudden onset
(the manifestation) only. In order to differentiate the Ben - pain and tightness connects to the neck and upper back
(the root), we have to turn to the second approach, which - pain is especially intense on exposure to wind
differentiates according to the underlying syndrome. - aversion to wind and cold, often with a liking for
This approach is found, for example, in the early Ming wrapping up the head
dynasty text Dong Yuan Shi Shu (‘Ten Works of - no thirst
Dongyuan’). Tongue: thin white coating
Pulse: floating
TREATING THE BEN (THE ROOT) Pathology: The head is where all the Yang channels
meet, and Wind affects the upper part of the body first.
Successful treatment of headaches relies on the effective The channels of the head are invaded by Wind and Cold,
identification and treatment of both Ben and Biao, the which obstruct the circulation of Qi and Blood. The
affected Zangfu and Channels. We deal first with Ben. Taiyang channel (Bladder and Small Intestine) is the
Points given in this section are for the underlying condi- most exterior and therefore usually the first to be at-
tion and should be combined with points given in Sec- tacked by Wind-Cold, hence the radiation to the neck
tion 2 to treat the channels (Biao). Between headaches, and upper back.
treatment should concentrate more on Ben, but the af-
fected channels can still be treated to maintain the flow Treatment: Expel Wind and disperse Cold, using such
of Qi and Blood. points as:
Hegu L.I.-4
HEADACHES DUE TO EXTERNAL Fengchi GB-20
AFFECTION Differentiation According to the Fengmen BL-12
Lieque LU-7
Pathogenic Factor
Waiguan SJ-5
These headaches are primarily caused by invasion of Fengfu DU-16
Wind, which may be combined with Cold, Heat or If pain extends to the upper back: Jianjing GB-21
Damp. The onset is relatively acute and the level of pain
2. WIND-HEAT
relatively intense. These headaches are usually a once-
only event, and they are generally clearly related either Clinical manifestations:
to exposure to extreme weather conditions, or to an - headache with a distending sensation
attack of influenza or common cold. However, chronic - possibly splitting headache
cases do occur in which the pathogenic factor is retained - fever and aversion to wind
in the channels, resulting in a kind of Bi syndrome - red face and eyes
affecting the head. - thirst with desire to drink

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- constipation nausea, dizziness, numbness of the head, sensitivity to

- dark urine wind and shivering. The pain may affect the whole head
Tongue: red with thin yellow coating after beginning unilaterally. There are usually no symp-
Pulse: floating and rapid toms between attacks.
Pathology: Heat flares upwards, carrying Wind with it, In the treatment of these headaches one employs the
and obstructs the Luo channels where the Yang expan- same selection of points, but needling by even method
sive nature of Heat produces a distending or splitting will usually be more applicable than reducing tech-
headache. nique, since the retention of the pathogenic factor im-
plies some deficiency of the Zheng Qi.
Treatment: Expel Wind and clear Heat, using such points
as: HEADACHES DUE TO INTERNAL
Hegu L.I.-4 DISHARMONY Differentiation according
Quchi L.I.-11 to the Zangfu
Dazhui DU-14 These headaches are chronic and characterised by gradual
Fengchi GB-20 onset. That is to say, the patient has been suffering from
Waiguan SJ-5 recurring bouts of headache for some time, and usually
Fengmen BL-12 has a history beginning with mild headaches which
Fengfu DU-16 gradually become increasingly severe. The pain comes
Taiyang (Extra) [bleed] and goes, and between attacks the patient may feel quite
3. WIND-DAMP healthy.
Two of the possible syndromes (Qi and Blood Xu, and
Clinical manifestations:
KID-Xu) are pure Xu syndromes with no Shi element.
- headache with a feeling of the head being heavily
These Xu types of headache are relatively mild, with dull
wrapped
background pain that drags on and is worse for fatigue.
- limbs feel weak and heavy
Because the headache is fairly mild, patients with these
- dizziness
syndromes rarely present with headache as their main
- drowsiness
complaint, but may present with symptoms such as
- no appetite
fatigue or general malaise, in which case analysis of the
- oppression in the chest
headache will help with the differentiation.
- difficult urination
The other syndromes are either purely Shi, or involve a
- maybe watery stools
Shi element. The presence of an excess (of Fire, Yang Qi,
Tongue: white greasy coating
Phlegm or Stagnant Blood) can create severe pain due to
Pulse: slippery or weak-floating
obstruction of the Qi in the channels. The headache may
Pathology: Wind-Damp obstructs the channels of the have a throbbing character, caused by a build up of
head and prevents the clear Yang Qi from ascending, obstruction in the channel which is then relieved as the
producing a wrapped or heavy sensation and dizziness Qi flows through, followed by another build up. Alter-
and drowsiness. natively, the patient may report a bursting or tight
Treatment: expel Wind and resolve Damp, using such headache. The severity of these headaches often brings
points as: sufferers to us for treatment, and acupuncture has a well-
Hegu L.I.-4 deserved reputation for achieving effective results. The
Lieque LU-7 Liver syndromes are particularly common, especially in
Fenglong ST-40 cases of migraine where the severity and unilateral
Sanyinjiao SP-6 location of the pain, when supported by other signs,
Yinlingquan SP-9 naturally point to a Liver/Gall Bladder pathology.
Zhongwan REN-12
1. LIVER FIRE HEADACHE
Touwei ST-8
Baihui DU-20 Clinical manifestations:
Fengchi GB-20 - headache which is intense and throbbing, often in the
Waiguan SJ-5 temple or eye
- the headache is often unilateral
Comment on headaches due to external affection: A - irritability and outbursts of anger
good strategy here is to choose one or two distal points - tinnitus
to expel the pathogenic factor, plus one or two points of - dizziness
the head or neck. It is important also to treat the affected - red face and eyes
channel (see ‘Treating the Biao’ below). One can often - bitter taste
choose points which will combine the functions of expel- - dream-disturbed sleep
ling the pathogenic factor and clearing the affected chan- - constipation
nel, e.g. one could use Hegu L.I.-4 for frontal headache - dark urine
due to Wind-Heat, or Fengchi GB-20 for temporal head- Tongue: red, dry, with yellow coating; sides may be even
ache due to Wind-Cold. redder
Headaches due to external affection which become Pulse: full, wiry and rapid
chronic: When the pathogenic factor is retained in the If Liver-Qi invades the Stomach there will be:
channels over a long period of time, the major identify- - nausea
ing symptom is that of a chronic recurring headache - vomiting
which is induced by weather changes. Other symptoms - no appetite
are varied and can include eye pain, nasal discharge,

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If Liver-Fire generates Stomach-Fire there will be: If Liver-Yin-Xu predominates:

- foul breath Clinical manifestations are the same as Liver-Blood-Xu
- sore painful mouth, gums or tongue with the addition of dry eyes.
- vomiting Tongue: red, no coating
- thirst Pulse: thin, wiry and rapid, or floating-empty
Aetiology: Emotional disharmony, usually involving If there is Liver and Kidney Yin-Xu:
repressed anger, leads to Liver-Qi stagnation, and the - dry eyes
internal pressure of the Qi stagnation then generates - sallow complexion, malar flush
Fire. Foods which are Hot in energetic nature can further - numbness of the limbs
aggravate Liver-Fire. - blurred vision
Pathology: Qi stagnation transforms to Fire which “rav- - night sweats
ages the clear orifices above and induces headache”. The - heat in the palms and soles
periodicity of the headaches is due to the underlying - heat sensation in the face
Liver-Qi stagnation, which is relieved when the Qi is - sore lower back
vented to the head as Fire and takes some time to - constipation
accumulate again. Tongue: red, no coating, mirror-like or cracked
Pulse: thin and rapid, or floating-empty
Treatment: soothe the Liver, clear Fire, using such points
as: The type of headache in which Liver-Blood-Xu predomi-
Xingjian LIV-2 nates is seen mostly in women, whilst the Yin-Xu types
Taichong LIV-3 occur with similar frequency in both sexes.
Fengchi GB-20 Another variation of the Liver-Yang Rising headache is
Taiyang (Extra) that in which the deficiency is relatively slight, but there
Xiaxi GB-43 is pronounced Liver-Qi stagnation:
Qiuxu GB-40 - headache is usually temporal
If there is also Stomach-Fire or if Liver-Qi invades the - headache may be unilateral or bilateral
Stomach: - may extend to neck and shoulders (Gall Bladder
Xiangu ST-43 channel)
Neiting ST-44 - tight, throbbing or distending pain
Neiguan P-6 - hypochondriac pain
- belching
Comment: Headaches due to Liver-Fire are fairly com-
- constipation
mon. Because this is a Shi condition, it tends to occur in
- cold limbs
young adults, and particularly in young men. If the
- headache may be induced by stress, frustration etc.
disharmony continues for many years, the excess Fire
- in women headache may precede menses, accompa-
may begin to damage the Yin and the condition will then
nied
evolve into Liver-Yang Rising.
by breast distention, irritability etc.
2. LIVER-YANG RISING HEADACHE Tongue: pale, or pale-red, maybe slightly purple or with
Clinical manifestations: small purple dots on the sides
- headache, often temporal or in or above an eye Pulse: wiry
- headache often unilateral, may be throbbing in nature Note that the typical tongue in this case is pale, reflecting
- dizziness the slight Blood deficiency which usually underlies these
- tinnitus Liver-Qi stagnation headaches, and indeed aggravates
- tension and restlessness the stagnation since there is insufficient blood to ‘soften
- irritability, quick temper the Liver’. The cold limbs in this case are due to Stagnant
- disturbed and restless sleep Qi trapping the body’s Yang Qi in the interior.
- dry mouth and throat
Additionally, it is not uncommon to see combinations of
- protracted severe headache may be accompanied by
Liver-Yang Rising with other syndromes:
the appearance of blue veins on the temple or forehead
Tongue: may be generally red, may be red with espe- If combined with Liver invading the Stomach there will
cially red sides, or may be pale or pale-red with red sides. be:
Pulse: wiry - nausea, vomiting
- no appetite
Liver-Yang Rising by definition involves deficiency of
This is of course a common complication.
Liver-Blood or Liver-Yin, often combined with Kidney-
Yin-Xu. The clinical picture varies considerably depend- If combined with Spleen and Stomach Yang-Xu, the
ing on which of these deficiencies is predominant. Note Liver will easily invade these organs and there will be:
particularly the contrast in pulse and tongue signs: - severe headache
- fatigue
If Liver-Blood-Xu predominates:
- feeling very chilled
- numbness of the limbs
- nausea and/or diarrhoea
- blurred vision
- dancing sparks and flashes of light in the eyes If there is also Liver-Wind, there may be numbness of the
- photophobia tongue or the head. Whilst this obviously indicates a
- sallow complexion more severe syndrome, if the numbness only occurs in
Tongue: pale, especially at the sides the context of headache, it is not particularly serious.
Pulse: choppy or thin Pathology: Deficiency of Liver-Yin or Blood leads to a

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relative excess of Liver-Yang. This unbalanced Yang Qi Cases with pronounced deficiency may need 20 to 30
easily rises to the head where it may cause blockage of treatments.
any of a number of channels, and hence headache. Notes on Liver-Fire and Liver Yang Rising headaches:
Opinions vary as to the other features of the pathologi- i. It may also be appropriate to consider other points to
cal process, but according to some authorities there is, in treat underlying Liver-Qi stagnation and calm the Shen,
addition to this relative excess of Yang, an implicit eg:
element of Qi stagnation which generates a kind of
Taichong LIV-3
internal pressure. This pressure builds up until the Liver-
Hegu L.I.-4
Qi rebels upwards and encourages the Liver-Yang to
Neiguan P-6
rise, generating symptoms of headache, dizziness, tinni-
Daling P-7
tus etc. The stagnation having been relieved, there is
Shenmen HE-7
then a period of quiescence during which the symptoms
disappear, until the stagnation builds up once more and ii. These types of headaches often occur pre-menstrually
the Liver-Qi again rebels upwards. in women. One of the features of the menstrual cycle is
More severe forms of Liver-Yang Rising are some- that prior to ovulation the Yin of the body is increasing
times seen in which the Yin-Yang imbalance is more as Blood is replenished, whilst after ovulation, up until
severe and the headache fluctuates but is present almost the start of menses, the Yang of the body is increasing.
continuously. In these cases, accompanying symptoms This increase in Yang aggravates any tendency to Liver-
such as tinnitus and dizziness also tend to fluctuate but Yang Rising or Liver-Fire. The general treatment strat-
be ever-present. egy should be as above. In addition, the point combina-
tion Zulinqi GB-41 and Waiguan SJ-5 is particularly
Aetiology:
effective for headache related to the menstrual cycle
i. The major cause, nearly always present, is chronic
(these points activate the Extraordinary channels Dai
emotional problems, especially when involving anger,
Mai and Yang Wei Mai).
frustration or resentment. These emotions lead to Liver-
iii. Nervous tension is a common trigger for these head-
Qi stagnation which generates Liver-Fire. Over a long
aches, but note that sometimes it is only when the person
period of time the Fire depletes Liver and Kidney Yin,
begins to relax that the pent-up Qi can finally be released
resulting in Liver-Yang Rising.
by venting up to the head - this is one cause of the
ii. An inadequate diet and/or Spleen-Qi-Xu may lead to
notorious week-end headache.
Liver-Blood-Xu.
iii. Severe haemorrhage may deplete Liver-Blood, e.g. 3. PHLEGM-DAMP HEADACHE
chronic menorrhagia or haemorrhage during childbirth. Clinical manifestations:
iv. Chronic fearful anxiety, a rushed, stressful and exces- - headache with a confused and swimming sensation in
sively busy lifestyle, excessive sex, constitutional weak- the head
ness, or chronic disease can all deplete Kidney-Yin which - fullness and oppression of the chest and epigastrium
then fails to nourish Liver-Yin. - nausea
Treatment: soothe the Liver, subdue Liver-Yang, tonify - vomiting phlegmy saliva
Yin, using such points as: Tongue: white greasy coating
Taichong LIV-3 Pulse: slippery and wiry, or slippery
Waiguan SJ-5 If Phlegm-Damp transforms to Phlegm-Heat:
Fengchi GB-20 - bitter taste
Taiyang (Extra) - irregular bowel movement
Baihui DU-20 Tongue: yellow greasy coating
Zulinqi GB-41 Aetiology: irregular and unbalanced eating and drink-
Xiaxi GB-43 ing, or excessive fatty and sweet foods, weaken the
Yangfu GB-38 Spleen leading to internal generation of Phlegm-Damp.
Taixi KID-3 The Phlegm-Damp then obstructs the ascent of the clear
Sanyinjiao SP-6 Yang to the head.
Ququan LIV-8
Pathology: failure of the Spleen function of transforma-
Yongquan KID-1
tion and transportation leads to turbid phlegm obstruct-
For nausea and vomiting: Zhongwan REN-12, Neiguan ing the Middle and clouding the orifices above, so that
P-6. the channels are obstructed and blocked and the clear
For photophobia and visual disturbance:Taiyang (Ex- Yang does not ascend.
tra).
Treatment: transform Phlegm, stop vomiting, using such
For tight neck and shoulders: Jianjing GB-21.
points as:
Comment: Of those patients presenting with headache
Fenglong ST-40
or migraine as their main complaint, fully 80% will have
Sanyinjiao SP-6
one of the varieties of Liver-Yang Rising. The prognosis
Zhongwan REN-12
is generally very good and the symptoms often clear
Pishu BL-20
after a course of ten treatments. However a more lasting
Zusanli ST-36
benefit will be achieved when the underlying deficiency
Baihui DU-20
is correctly identified and treated and when the aetiol-
Yintang (Extra)
ogy is clarified and the patient makes appropriate changes
Sishencong (Extra)
in their lifestyle (consider exercise, relaxation and diet).
Neiguan P-6
Gongsun SP-4

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For Phlegm-Heat add: - spermatorrhoea or leucorrhoea

Quchi L.I.-11 - tinnitus
- insomnia
Neiting ST-44
Tongue: red with no coating
Comment: this is a fairly common cause of headache. Pulse: thin and forceless
However, in my experience this syndrome occurs more
If Kidney-Yang-Xu:
often in combination with Liver-Yang-Rising than it
- dread of cold
does alone. In this case the upward movement of the
- white face
Yang Qi carries the Phlegm-Damp with it to the head.
- lack of warmth in the four limbs
When the headache is due to Phlegm-Damp alone it may
Tongue: pale
be periodic or continuous (often worse in the morning).
Pulse: deep and thin
When there is also Liver-Yang-Rising, the headaches are
characteristically periodic. Aetiology and Pathology:
Because of the stubborn nature of this pathogenic i. Kidney-Yin-Xu: constitutional deficiency, or long-
factor, the involvement of Phlegm-Damp should always standing depletion of Jing, creates emptiness of the brain
be considered in cases of chronic and intractable head- and Marrow, and hence headache occurs.
ache, even when the symptoms and signs are not as ii. Kidney-Yang-Xu: damage to the Yin leads to weaken-
clear-cut as those given above. ing of the Yang, the clear Yang does not unfold, and
hence headache occurs.
4. QI AND BLOOD XU
Treatment: nourish Kidney-Yin (and Yang if necessary),
Clinical manifestations: tonify Kidneys. Points to consider:
- headache worse for over-exertion and better for lying
Taixi KID-3
down
Zhaohai KID-6
- headache may affect the whole head
Guanyuan REN-4
- often mild headache with pronounced dizziness
Shenshu BL-23
- pain is dull, empty and prolonged
Baihui DU-20
- pain may begin at the eyebrows and radiate to the
Lieque LU-7 in combination with Zhaohai KID-6
vertex
Fuliu KID-7
- mental weariness and lack of physical strength
Mingmen DU-4
- heart flutters and palpitations
Yongquan KID-1
- poor appetite
Xuanzhong GB-39
- shiny white or sallow face
Shenmai BL-62
Tongue: pale with thin coating
Zusanli ST-36
Pulse: thin, empty, weak, forceless
Aetiology: over-exercise and over-work, deficiency af- 6. STAGNANT BLOOD HEADACHE
ter illness or childbirth, haemorrhage, poor diet. Clinical manifestations:
Pathology: Qi and Blood are deficient and so unable to - long-standing and continuous headache
“blossom upwards into the channels and collaterals of - site of pain fixed and unmoving
the brain and Marrow”, hence there is headache due to - pain is drilling, piercing, stabbing, sharp or pricking
lack of nourishment of the channels and organs of the - there may be a history of injury to the head
head. - pain may be worse at night
Tongue: purple
Treatment: tonify and nourish Qi and Blood, using such
Pulse: thin, or thin and choppy
points as:
Aetiology and Pathology: physical injury or chronic
Ganshu BL-18
disease cause stagnation, which spreads to the collaterals.
Pishu BL-20
Shenshu BL-23 Treatment: move the Blood, transform stagnation, using
Geshu BL-17 such points as:
Zusanli ST-36 Ahshi points
Sanyinjiao SP-6 Local and distal channel points
Guanyuan REN-4 Geshu BL-17
Qihai REN-6 Qihai REN-6
Neiguan P-6 Xuehai SP-10
Ququan LIV-8 Sanyinjiao SP-6
Taichong LIV-3 Comment: although this type of headache is usually
Baihui DU-20 caused by traumatic injury, note that it can also arise as
5. KIDNEY-XU HEADACHE a consequence of prolonged disease, and especially as a
consequence of chronic headache due to any of the above
Clinical manifestations:
syndromes. This syndrome should therefore be consid-
- headache with a vacuous sensation, usually in con
ered in all cases of intractable headache where the nature
junction with dizziness
of the pain suggests Blood Stagnation.
- headache may be at occiput or at vertex (if also Liver-
Blood-Xu), or may affect whole head Migraine headache
- pain may be felt inside the head Clinical manifestations:
- aching and sore lower back - unilateral headache which erupts violently and
- mental weariness and lack of physical strength suddenly

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- very intense pain Points to consider to treat the channels:

- pain affects the temple, forehead or eye and may spread Taiyang channels: Kunlun BL-60, Houxi SI-3, Houding
to the whole head DU-19, Tianzhu BL-10, Fengfu DU-16, Dazhui DU-14,
- pain is drilling, throbbing or stabbing Dashu BL-11.
- pain may radiate to the eyes or teeth
Yangming channels: Hegu L.I.-4, Neiting ST-44, Shangxing
- there may be nausea and vomiting
DU-23, Touwei ST-8, Yintang (Extra), Yangbai GB-14
- maybe photophobia and red eyes
needled through to Yuyao (Extra), Zusanli ST-36.
- maybe clear nasal discharge
- usually no symptoms between attacks Shaoyang channels: Zulinqi GB-41, Waiguan SJ-5, Fengchi
- attacks may be preceded by blurred vision or visual GB-20, Taiyang (Extra), Xuanlu GB-5, Xuanli GB-6,
disturbance or by a sensation of heat in the face Shuaigu GB-8, Tianchong GB-9, Yangbai GB-14 needled
through to Yuyao (Extra), Zhongzhu SJ-3. Zulinqi GB-41
Pathology: migraine is generally caused by Liver-Yang
and Waiguan SJ-5 are often used together because of
or Liver-Fire ravaging upwards. There may also be
their additional action on the Extraordinary channels
elements of Phlegm, Stagnant Blood or pathogenic factor
Dai Mai and Yang Wei Mai.
retained.
Jueyin channels: Taichong LIV-3, Baihui DU-20, Tongtian
Treatment: treat according to the above differentiation.
BL-7, Sishencong (Extra), Xingjian LIV-2, Zhiyin BL-67,
Fengchi GB-2, Houxi SI-3.
TREATING THE BIAO Eye and eyebrow: Zanzhu BL-2.
To treat headaches successfully it is essential to identify
and treat the affected channels as well as the underlying OTHER PRINCIPLES OF
Zangfu pathology. The relationship of the site of the DIFFERENTIATION
headache to the channels is as follows:
Occiput and back of head, radiating down to the neck and The following principles, although not perfectly reliable,
upper back: Taiyang (Bladder and Small Intestine). may give additional useful information:
Forehead, sometimes the eyebrows: Yangming (Stomach Effect of time of day
and Large Intestine). Worse in the morning:
Side of head (parietal and temporal regions), may radiate to the Xu type: Qi and Blood Xu. This type usually worsens
ear: Shaoyang (Gall Bladder and Sanjiao). through the morning, but if the patient is very deficient
Vertex, sometimes the eyes and eyebrows: Jueyin (Liver and it may come on immediately on rising.
Pericardium). Shi type: stagnation of Liver-Qi or Phlegm-Dampness.
The Qi stagnation type is aggravated because the circu-
In addition to the above, experience suggests that unilat-
lation of Qi slows down when the patient rests - in this
eral frontal headaches in the region of Yangbai GB-14
case the headache may be brought on by over-sleeping.
should be attributed to Shaoyang. Shaoyang headaches
Phlegm-Dampness also stagnates with inactivity, and it
can also radiate to the neck and shoulders (Gall Bladder
flows more easily to the head in the lying position.
channel). However, bilateral frontal headaches definitely
Patients with Phlegm-Damp often have a very heavy
belong to the Yangming channels, and they are often
and stuffy head in the morning, with swelling around
associated with sinus problems.
the eyes, and maybe with production of mucus.
In the case of headaches due to external pathogenic
factors, it is clear that any channels of the head can be Worse in the afternoon:
invaded by any of the factors. However it is said that Because this is the Yang time of day, it is the time when
Wind-Cold attacks the Taiyang channels most readily, headaches due to Full or Empty Heat may be at their
and I would suggest in addition that Wind-Heat readily worst. Possible syndromes are Liver-Fire, Liver-Yang
affects the Shaoyang, whilst Wind-Damp favours the Rising, and Kidney-Yin-Xu. Headaches involving Liver-
Yangming or the whole head. Qi stagnation can also worsen in the afternoon as the
In the case of headaches due to disharmony of the events of the day cause the person to become increas-
Zangfu, the relationship of the affected Zangfu and the ingly tense.
affected channel is often straightforward, but is some- Worse in the evening:
times less obvious. Liver-Yang Rising commonly affects These headaches are usually due to deficiency - espe-
the paired Gall Bladder channel (Shaoyang), but as the cially the Kidney-Xu and Qi and Blood Xu types, though
headache progresses it may spread throughout the this pattern does also occur in the Liver-Yang Rising
collaterals of the head to affect the entire head. Less type. The headache becomes worse as the patient’s ener-
commonly, Liver-Yang Rising can affect the Liver chan- gies become increasingly depleted. Headaches involv-
nel directly, producing headache at the vertex (Jueyin). ing Liver-Qi stagnation can also worsen in the evening as
Alternatively, the excess Liver-Yang may invade the the person becomes increasingly tense.
Stomach and Large Intestine channels to produce a Effect of weather
frontal headache (Yangming). Phlegm-Damp commonly
Worse in heat: retained Wind-Heat, Liver-Fire or Kidney-
involves the entire head, but may restrict itself to the
Yin-Xu.
Stomach and Large Intestine channels to produce a
Yangming headache. Finally, occipital headaches can be Worse in cold: retained Wind-Cold, Kidney-Yang-Xu or
due to Empty Heat from Kidney-Yin-Xu affecting the Blood Stagnation.
Bladder channel (Taiyang), but it is also possible to see Worse in damp: retained Wind-Damp or internal Phlegm-
occipital headaches where the local portion of the Gall Damp.
Bladder channel is affected by Liver-Yang Rising.

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Worse for change in the weather: retained external patho- Chocolate also generates Damp-Heat. The Heat affects
genic factor, or may be Liver-Qi stagnation. the Liver and Stomach, the Damp affects the Spleen.
Effect of menses Dairy products generate Damp and Phlegm and they
should be avoided or consumed in small amounts by any
Worse before menses: stagnation of Qi.
patient with Phlegm-Damp involvement in their head-
Worse during menses: stagnation of Blood.
aches. Note also that these foods will sometimes trigger
Worse after menses: Blood-Xu.
the Liver types of headache, because the extra Damp
Effect of exertion they generate further obstructs the Qi, aggravating the
In principle, headaches which are worse for or triggered Liver-Qi stagnation.
by exertion are due to Qi or Blood Xu, while those which Citrus fruits are generally Cold and weaken the Spleen,
are improved by exertion are due to Liver-Qi stagnation. and thus can generate Damp-Phlegm. The extra Damp-
However, whilst exercise and movement undoubtedly ness may then aggravate any Liver-Qi stagnation. Some
are generally beneficial to Qi stagnation, if there is al- doctors also believe that citrus fruits can aggravate Liver-
ready a great deal of stagnation then exercise may move Qi stagnation directly, and others that oranges deplete
and release the Qi too suddenly, with the consequence Liver-Yin.
that the excess vents up to the head. This can either Tea and coffee have a dispersing effect on the Qi, like
trigger a new headache or exacerbate an existing one. alcohol, and can trigger Liver-Fire or Yang Rising. Cof-
Effect of massage fee also depletes Yin and Blood.
Red meats and fried foods are Hot and Damp and can
Xu types of headache are improved by pressure and by aggravate Liver-Fire or Yang Rising.
massage, which summons Qi and Blood to the area. Shi Spices are Hot and aggravate Liver or Stomach Fire. They
headaches are more painful for pressure and therefore move stagnant Qi and can induce Stagnant Qi to rebel
massage does hurt in these cases. However, despite the upwards, triggering headache. Spices also tend to de-
extra pain at the beginning, the massage will then have plete Yin and Blood.
a dispersing effect on the Excess and ultimately will help Sugar depletes the Spleen and generates Damp and
to ease the headache. should be avoided in cases with Phlegm-Damp.

TREATMENT STRATEGY OTHER TYPES OF HEADACHE

Choose a combination of points which addresses both Headache due to eye disorders: treat the Ben, which may be
Ben and Biao. During an attack of headache, first punc- external pathogenic factors, Liver-Yang, Liver-Fire, or
ture distal points only. If the pain is not relieved after 5- Kidney and Liver Yin-Xu. Add local points such as:
10 minutes add local points. Between attacks it is often Zanzhu BL-2, Jingming BL-1, Taiyang (Extra), Chengqi
sufficient to use distal points only, but it can be helpful ST-1, Fengchi GB-20, Tongziliao GB-1, Sizhukong SJ-23.
to add local or adjacent points to maintain a good flow of Guangming GB-37 can also be added.
Qi and Blood in the channels of the head. Headache due to rhinitis, sinusitis etc.: treat the Ben, which
If the syndrome is Shi: during a headache apply reducing may involve external pathogenic factors, Lung Phlegm-
technique to the distal points and apply even technique Damp, Lung Phlegm-Heat, Liver Fire, or Liver Yang.
to local points if they are used. The same needle tech- Add local points such as Yingxiang L.I.-20, Shangxing
nique should be applied between attacks of headache. DU-23, Hegu L.I.-4, Tongtian BL-7.
If the syndrome is Shi and Xu combined: during a headache Headache from too much sunlight: reduce Guangming GB-
one should concentrate on the Shi element by selecting 37 and Zhongzhu SJ-3.
distal points to reduce the excess and applying reducing WARNING
technique to them. If local points are used during a In terms of Western medicine, the vast majority of head-
headache, apply even technique. Between attacks one aches are due to functional disorders without any major
should select some points reinforce the deficiency and pathology.Many of these cases will be amenable to treat-
some points to reduce the excess. The needle technique ment by acupuncture. However, when a patient presents
can then be varied according to the function of the distal with a recent history of persistent headaches but has no
points, with even technique on any local points, or else it history of similar headaches, a Western medicine diag-
is permissible to use even technique on all the points. nosis should be sought because of the possibility of
If the syndrome is Xu: during a headache use even tech- serious pathology (especially brain tumour). This is
nique. Between attacks use reinforcing method. unusual but important to recognise because it will re-
quire Western medicine intervention or a combined
EFFECTS OF FOODS AND DRINKS IN approach utilising Western and Chinese medicine.
HEADACHE AND MIGRAINE Sources
'Headache’ translated by Richard Temple from Nei Ke
Alcohol generates Damp-Heat. It particularly has a heat- Xue, Shanghai Academy of TCM.
ing effect on the Liver, whilst its Damp qualities may
weaken the Spleen or generate Phlegm-Damp. Alcohol ‘Migraines and TCM’ by Bob Flaws.
has a dispersing effect on the Qi, directing it upward and ‘The Foundations of Chinese Medicine’ by Giovanni
outward, and this upward movement will easily trigger Maciocia.
Liver-Fire or Yang Rising. Red wine is especially sour Peter Deadman - personal communication.
and therefore has a particularly strong effect on the
Liver.

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