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Expert Advice-Treatment of Headaches in Traditional Chinese Medicine(TCM):

Averting Headaches with Acupuncture and 

Chinese Herbs

Is acupuncture an effective treatment for migraines and other types of headache? "Yes, indeed," is the confident answer of acupuncture practitioners around the world. Every day, headache sufferers come to acupuncture clinics in the United States and China and find relief for their symptoms. For people who have been plagued by headaches for years, this relief comes as a gift from one of the most ancient healing traditions in the world. Chinese herbal medicine is another valid modality for treating and averting headaches. The use of traditional Chinese herbs to treat headaches if just beginning to be appreciated by American patients.

Roger G. is a 37 year-old gentleman who came to my clinic a year ago for severe migraine headaches. He had suffered from migraines since he was thirteen, and for the last seven years his headaches had been a daily occurrence, leaving him in constant pain and destroying any chance of leading a normal life. His wife came with him that first day, and said to me, "You have to help him Ė our whole family has been affected by Rogerís headaches." Roger gave me a list of all the medications he had ever taken: various prophylactic agents including beta-blockers, tricyclic agents, and muscle relaxants. In the past few years, he had been using more and more analgesic medication to allow him to function well enough to hold down a job. He was taking Excedrin, aspirin, and generic Sudafed three times every day. When he had especially severe headaches, he received Wigraine and Imitrex injections every week.

I started acupuncture treatments on Roger three times per week. After a little more than two weeks, his headaches were significantly reduced. Instead of experiencing daily headaches, he was headache-free three to four days a week. I reduced the treatment to twice per week, then once per week. After three months, Roger was totally headache free. Now I see him about once a month for a "tune-up," and he remains free of pain.

Every year about seventy million Americans suffer from recurring headaches. Twenty- six million of them are identified as migraine sufferers. The goal of both conventional Western medicine and traditional Chinese medicine in the case of headaches is to relieve pain and enable people to function well in their lives. But while the ultimate goal is the same, the diagnostic paradigm and treatment modalities of these two types of medicine are fundamentally different. In the remainder of this article, we contrast the Western approach to headaches with the Chinese medicine approach, and also list some Chinese herbal remedies for specific headache patterns.

Conventional Western Medicine for Headaches
Modern scientific research has established the following mechanisms for headaches. Headache pain begins with the trigeminal nerve, which is located in the brain stem and carries sensory impulses to and from the face. When the trigeminal nerve is stimulated by a headache trigger such as anxiety, glare, noise, anger, improper diet, medications, or hormones, a burst of neurotransmitters is released. One of these neurotransmitters, serotonin, has the function of screening out "unimportant" signals to the brain, and admitting signals that demand attention. Serotonin fluctuation is the biochemical and neurological foundation of understanding headaches. Low serotonin levels make people more vulnerable to headaches.

The International Headache Society differentiates the following types of headaches based on the number of attacks per month, length of time per attack, characteristics of the pain, and other accompanying symptoms.

Migraine Headache. Unilateral quality is the characteristic that distinguishes migraine from other types of headache. Typical symptoms of migraines include: intense head pain; nausea or vomiting; seeing an aura (halo of light) around objects; sparkling, rainbow-like colors and black spots in field of vision; extreme sensitivity to light; fever; chills; aching; and sweating. Each migraine attack could last for several days.

Tension Headache. A typical attack is characterized by a mild to moderate squeezing or pressing pain which is steady and non-throbbing on both sides of the head, back of the neck, and the facial area. It can last from an hour to several hours. It may occur one or more times in a week.

Cluster Headache. This headache is excruciatingly painful. The penetrating and non-throbbing pain is felt behind the eyes or in the temples. The incidence of cluster headaches continues for two to three months at a time. Each attack can last from 45 minutes to two hours. Attacks tend to occur at night, especially in the spring or autumn season.

Post-Traumatic Headache. This results from head or neck injury. The pain can be experienced as dull, aching, stabbing, sharp, or excruciating at the site of the injury. Each attack can last from twenty minutes to all day. Attacks occur in clusters or can be continuous. Sometimes the headache strikes within 24 to 48 hours of the initial trauma, while in other cases it takes months, or even years, for it to appear.

Disease-Related Headache. Many disease conditions produce headaches as part of their pathology. These include: brain tumor; allergies; temporomandibular joint pain (TMJ); nerve pain; disorders of the head, neck, ear, nose, throat and mouth; stroke; high blood pressure; constipation; and sleeping disorders.

Americans consume 80 billion tablets of aspirin a year, and headaches are cited as the number-one reason for aspirin use. In addition to the over-the-counter drugs that are readily available to the public, physicians prescribe a variety of drugs to keep the "pain messengers" from reporting to the brain, or to abort an attack in progress, or to prevent an attack from occurring. Available pain killers range from analgesics, narcotics, antidepressants, ergotamine derivatives, and anti-migraine drugs to beta-blockers and calcium channel blockers. Unfortunately, many of these drugs have unwanted side effects. What people really want is relief from their headache pain, without harmful side effects.

Acupuncture for Headaches
Acupuncture is not only effective for migraine headaches, but also works very well with tension headaches, cluster headaches, post-traumatic headaches, and disease-related headaches that might be due to sinus problems, TMJ, stroke, high blood pressure, or sleeping disorders. The greatest advantage of acupuncture over Western medicine is that it does no harm. Unlike synthetic drugs and surgery, acupuncture has virtually no side effects. Acupuncture, as an effective treatment modality, was applied to headaches from the earliest beginnings of traditional Chinese medicine. Traditional Chinese medicine has a very coherent, consistent and philosophically-based framework for headache etiology, physiology, diagnosis, and treatment strategy.

It is not possible, in an article of this length, to explain the theory of traditional Chinese medicine in detail. The key concepts of Yin and Yang, and vital energy (Chi) are important, as well as an understanding of the meridian system. Yang energy tends to go upwards and outwards. All the bodyís Yang meridians meet in the head, and they facilitate the flow of Blood and Chi into the head. A clear mind and pain-free head depend on having a sufficiency of Chi and Blood flow, well-functioning internal organs, and a correct rising and falling of Yin and Yang energy. There are a number of conditions, patterns, or dysfunctions that can cause headaches. The most common are: a deficiency of Chi, which prevents Chi and Yang from circulating properly; a deficiency of Blood, so that the meridians arenít properly nourished, and insufficient Blood is circulating to the head; a blockage of the meridians by external pathogenic factors. Acupuncture treatment can harmonize the organs, balance Yin and Yang, tonify Chi and Blood, and clear blocked meridians.

Now that acupuncture has come into wider use in the United States, both patients and professionals are asking questions about how acupuncture works in a modern, scientific sense. What are the mechanisms? Is there any scientific evidence that supports the effectiveness of acupuncture? There have been a number of scientific studies and clinical trials since the 1970s, and these have tended to substantiate the ancient theories of traditional Chinese medicine. Researchers and scientists now believe that acupuncture can bring about many biochemical changes in the body:

Serotonin Changes: Acupuncture treatments affect several of the bodyís neurotransmitters, bringing about changes in the blood serum levels of these neurotransmitters. Scientists have found that low serotonin levels make people more vulnerable to headaches. The ability of acupuncture to regulate serotonin levels was extensively studied by experts in China, Japan, and Canada. Changes in serotonin levels in both the brain and the spinal cord can be achieved with acupuncture.

Endorphin Changes: Dr. Jisheng Han, a world-renowned professor in acupuncture research, discovered endorphin-type neuropeptides in the 1970s, when China launched the acupuncture research program for Acupuncture-induced Analgesia (AA). He showed that electrical stimulation of acupuncture needles released different levels of endorphin compounds in the central nervous system. Endorphins are natural pain killers in the body. It is this mechanism that is most widely cited to explain the effectiveness of acupuncture treatments in relieving pain, including headache pain.

Acetylcholinesterase Changes: A study showed that acupuncture can reduce pain by regulating blood acetylcholinesterase (Ach) activity, which indicates that pain relief from acupuncture treatments is related to peripheral cholinergic neurotransmitters.

Serum Magnesium Changes: Acupuncture treatments affect the levels of trace elements in blood serum. Scientists found that a low level of magnesium in serum is correlated to migraines. A very recent clinical study conducted in the Department of Acupuncture and Orthopedics at Hubei Institute of Traditional Chinese Medicine indicates that acupuncture treatments can increase the blood magnesium level.

Endogenous Opioid System: Morphine and morphine-like substances (opioids) have been used for the relief of pain since antiquity. It was found recently that cells in certain regions of the brain bind opiates stereospecifically, and that the analgesic potency (pain-relieving capacity) of a drug correlated directly to its binding affinity for these receptors. This led to a search for naturally-occurring endogenous opioid peptides (pain-killing substances that the body naturally produces). Eukephalines, B-endorphin, dynorphin, orphanin FQ, and endomorphin were discovered between 1975 and 1997. Electroacupuncture, using different frequencies, can accelerate the release of endogenous opioids in the central nervous system.

In addition to the scientific biochemical studies cited above, several clinical trials of acupuncture therapy support the effectiveness of acupuncture treatments in the relief of migraine headaches. A randomized clinical study with thirty participants was conducted in the Department of Neurology, University College Hospital, London, England. The study results showed that there was a significant reduction in pain intensity and medication intake for patients who received acupuncture treatments. In another study investigating the long-term outcome of using acupuncture to treat migraine, led by Dr. Baischer of the Department of Psychiatry at the University of Vienna, the results showed that the improvements which are achieved with acupuncture therapy are stable over a long period of time. The frequency of migraine attacks was significantly reduced during a five-week observation period immediately after treatment, and also during a three-year follow-up period.

When physicians in this country refer their patients to an acupuncturist, the most common reason is for headache treatment. Headache is also included in the list of forty-three conditions recognized by the World Health Organization (WHO) for which acupuncture is effective. Safe and effective treatment of pain was the most important evidence that persuaded the Food and Drug Administration (FDA) to upgrade acupuncture needles from "experimental use only" to "approved for use by professionals." The National Institutes of Health (NIH) endorses acupuncture treatments for headaches.

Chinese Herbal Medicine for Headaches
Although headaches may be caused by different triggers, occur in different locations and at different times, Chinese medicine practitioners differentiate groups of symptoms into a specific pattern, and then treat that pattern as it manifests in each individual patient. Each pattern is described in terms of the type of pain experienced, general body conditions, appearance of the patientís tongue, and palpation of the patientís pulse. A headache pattern may be caused by external effects, such as chemicals, weather, and other environmental factors; or by internal imbalances, such as a Blood Deficiency or Kidney Deficiency. The following section lists the most commonly-encountered headache patterns, with characteristic symptoms, and also gives the Chinese herbs that are used to treat each pattern.

Wind Cold Pattern. Symptoms include: sporadic pain, stiff, aching shoulders; an aversion to cold temperatures; aggravation of the condition by wind; absence of thirst; a thin-white tongue coating; and a floating-tight pulse. Leading herbs for this pattern include ligustici wallichii (chuan xiong), schizonepetae (jing jie), and ledebouriellae (fang feng).

Wind Heat Pattern. Symptoms include: a painfully-swollen sensation in the head; severe, "splitting" pain; fever, or an aversion to warm temperatures; red face; red eyes; thirst; constipation; dark-colored urine; a red tongue body with a yellow tongue coating; and a floating-rapid pulse. Top herbs for this pattern include ligustici wallichii (chuan xiong), actractylodis (bai zhi), and chrysanthemum (ju hua).

Wind Dampness Pattern. Symptoms include: heavy-feeling pain; a "muzzy," or confused feeling; a feeling of heaviness in the whole body; chest congestion; aggravation of symptoms by damp weather; difficult urination; loose bowels; a sticky-white tongue coating; and a soggy pulse. Useful herbs for this condition are notoptergii (qiang huo), duhuo radix (du huo), and ligustici wallichii (chuan xiong).

Liver Yang Pattern. Emotional disturbance (especially feelings of anger) is the primary origin of this pattern. Symptoms of the pattern include: pain with dizziness; anxiety; anger; insomnia; hypochondriac (under the ribcage) pain; red face; a bitter taste in the mouth; a thin-yellow tongue coating; and a wiry-strong pulse. Top herbs for this pattern include gastrodiae elatae (tian ma), and uncariae (gou teng).

Kidney Deficiency Pattern. General weakness is the basic cause of this pattern. Symptoms include: low-level pain with a feeling of "emptiness"; dizziness; sore back; fatigue; spontaneous seminal emissions (in men), or abnormal vaginal discharge (for women); ringing in the ears; sleeplessness; red tongue; and a thin-weak pulse. The leading herbs include rehmannia (shu di huang), corni officinialis (shan zhu yu), dioscoreae (shan yao), and lycii chinensis (gou qi zi).

Blood Deficiency Pattern. Chronic illness or loss of blood is the cause of this pattern. Symptoms include: pain with dizziness; heart palpitations; fatigue; pale complexion; a pale tongue body with a thin-white tongue coating; and a thin-weak pulse. Leading herbs include angelica sinensis (dang gui), paeoniae lactiflorae (bai shao), rhemannia (sheng di huang), and ligustici wallichii (chuan xiong).

Blood Stagnation Pattern. Symptoms include: chronic pain; pain in a fixed location; sharp pain, such as pain from a head injury; a purple tongue body with a thin-white tongue coating; and a thin or thin-choppy pulse. Top herbs for this pattern include persicae (tao ren), carthami tinctorii (hong hua), and paeoniae rubra (chi shao).

Phlegm Retention Pattern. Chronic over-weight or the habitual consumption of sweet and fatty foods are the main cause of this pattern. Symptoms include: dull head pain with a feeling of heaviness and/or muzziness; a sensation of fullness and oppression of the chest; a feeling of nausea and phlegm retention in the throat; a white-sticky tongue coating; and a slippery or wiry-slippery pulse. Herbs for this pattern include pinelliae (ban xia), citri reticulatae (chen pi), and atractylodis (bai zhu).

When a headache sufferer considers the treatment options available, he or she should remember that acupuncture and Chinese herbal medicine provide a safe, drug-free treatment that is stable over time and has no adverse side effects.