I began getting migraines about 20 years ago. Neurologists, ENT specialists or allergists have not been able to impress upon me anything more than Extra Strength Tylenol for relief. I have been resigned to sleep off the excruciating head pain in a dark room, free from sound and all other sensory input.

The CMDT (Current Medical Diagnosis & Treatment) defines migraines as:

Classic migrainous headache is a lateralized throbbing headache that occurs episodically, following its onset in adolescence or early adult life. In many cases, however, the headaches do not conform to this pattern, although their associated features and response to antimigrainous preparations nevertheless suggest that they have a similar basis. In this broader sense, migrainous headaches may be lateralized or generalized, may be dull or throbbing, and are sometimes associated with anorexia, nausea, vomiting, photophobia, phonophobia, and blurring of vision. They usually build up gradually and they may last for several hours or longer. They have been related to dilation and excessive pulsation of branches of the external carotid artery. Focal disturbances of neurologic function may precede or accompany the headaches and have been attributed to constriction of branches of the internal carotid artery. Visual disturbances occur quite commonly and may consist of field defects; of luminous visual hallucinations such as stars, sparks, unformed light flashes (photopsia), geometric patterns, or zigzags of light; or of some combination of field defects and luminous hallucinations (scintillating scotomas). Other focal disturbances such as aphasia or numbness, tingling, clumsiness, or weakness in a circumscribed distribution may also occur.

Patients often give a family history of migraine. Attacks may be triggered by emotional or physical stress, lack or excess of sleep, missed meals, specific foods (e.g., chocolate), alcoholic beverages, menstruation, or use of oral contraceptives.

Traditional Chinese medicine recognizes many of these imbalanced signs and symptoms, using different medical terminology, and it incorporates tongue and pulse findings to aid in making a diagnosis.

In the Eastern text, Chinese Acupuncture and Moxibustion (CAM), "Headache is a subjective symptom. It can be induced by various acute and chronic diseases ... if headache is an accompanying symptom in the development of a certain disease, it will disappear automatically as soon as the disease is cured."

CAM goes on to explain: "The head is the place where all the yang meridians of the hand and foot meet, and qi and blood of the five zang organs and six fu organs all flow upward to the head. Attacks of endogenous and exogenous factors may cause headaches due to derangement of qi and blood in the head and retardation of circulation of qi in the meridians that traverse the head. Headache caused by exogenous pathogenic factors is mostly due to invasion of pathogenic wind into the meridians and collaterals. It is said: 'When the pathogenic wind invades the human body, it first attacks the upper portion of the body.' Headache caused by endogenous factors often originates from hyperfunction of the liver yang, or deficiency of both qi and blood."

Without recognizing migraines specifically, CAM states three differentiations of headaches: headaches due to invasion of pathogenic wind into the meridians and collaterals; headache due to upsurge of liver yang; and headache due to deficiency of both qi and blood.

Upsurge can also be caused by heat. Dr. John H.F. Shen writes in Chinese Medicine, "Heat (shu) takes place in summer due to the extreme heat. Heat attacks the human body via the bloodstream. Generally, there is dilation of blood vessels and the pores of the skin are closed. Symptoms of exposure to heat are dizziness, headaches, nausea and even fever. Treatment involves cool dispersion, so that the heat may be expelled from the body."

Migraines are excess in nature. Ted Kaptchuk states in The Web That Has No Weaver, "Sudden headaches often appear with external pernicious influences, which disturb the yang or qi of the head. Chronic headaches more often accompany internal disharmonies. Severe headaches are usually signs of excess, while slight, annoying headaches are usually signs of deficiency. The organ most associated with headaches is the liver, because liver qi often rises when the liver is in disharmony."

Reaching the head, heat gives the tongue a reddish body, especially on the sides (liver/gallbladder) and/or on the tip (heart). The tongue may be quivering or deviated from wind, swollen from damp accumulation, dusky with sublingual distention from blood stasis, or have little to no coat, suggesting yin deficiency.

Pulse diagnosis hopefully confirms tongue findings which includes rapid (heat), superficial (wind), soggy or slippery (damp), choppy (blood stagnation), or thin, thready and superficial (yin deficiency).

The Foundations of Chinese Medicine #8211; A Comprehensive Text for Acupuncturists and Herbalists,by Giovanni Maciocia, diagnoses headaches "according to onset, time, location, character of pain [and] condition." An exterior attack of wind-cold has a quick onset and short duration, whereas an interior attack presents slowly. Balancing yin and yang throughout the day, daytime headaches tend to be qi or yang deficiency, as opposed to blood or yin deficiencies expected at night.

Maciocia locates five regions for headache manifestations:

• neck #8211; greater yang channel (wind-cold invasion or interior kidney deficiency);
• forehead #8211; bright yang channel (stomach-heat or blood deficiency);
• temporal #8211; lesser yang channels (wind-cold or wind-heat, or interior liver and gallbladder fire rising);
• vertex #8211; terminal yin channels (usually liver-blood deficiency); and
• whole head (wind-cold).

Patients suffering from migraines report "heavy feelings," which in traditional Chinese medicine, refers to damp or phlegm pathologies. Maciocia writes that kidney deficiency should be considered when patients add the pain is "inside" the head "hurting the brain." Again, the distending and throbbing is the rising or surfacing nature inherent to liver yang, as compared to blood stagnation notes of a "like a nail in a small point" headache.

As for relief, according to Chinese Herbal Patent Medicines (2^nd edition), written by Will MacLean with Kathryn Taylor, we find all kinds of headache formulas. Migraines and cluster headaches are considered separate from headaches that are acute, dull and worse with exertion, frontal and sinus, occipital, post-concussion, temporal or simply tension.

The general index of Chinese Herbal Patent Medicines specifies 10 possible causes with associated formulas, plus one medicated oil for topical usage (po sum on medicated oil). If the diagnosis is liver yang rising, consider tian ma gou teng wan; though keeping yang rising and adding yin deficiency, it is recommended that tian ma wan works better. Keeping with the theme of deficiency, qi ju di huang wan is best for both kidney and liver yin deficiency. If qi stagnation involving the liver is the main issue, chai hu shu gan wan is advised, and jia wei xiao yao wan if heat is added to this same condition. When the heat is blazing called liver fire, long dan xie gan wan is number one. With signs and symptoms including damp, try da chai hu wan for damp heat, and hua tuo zai zao wan for wind damp. When, for example, it is obvious qi and blood are not moving well because of constriction of the vasculature, try xue fu zhu yu wan, and more specifically, when targeting blood stasis the protocol is tong qiao huo xue wan.

To look at each of these in more detail, excerpts from The Clinical Manual of Chinese Herbal Patent Medicines follow:

Tian Ma Gou Teng Wan (p. 576)

• TCM actions: calms the liver, extinguishes wind, clears heat and restrains rising liver yang.
• Biomedical actions: antihypertensive, sedative to the nervous system, calmative.
• Indications: live yang rising and liver wind patterns.
• Migraine highlights: temporal and vertical headaches, stiffness and pain in the neck and shoulders, irritability, insomnia, assist in the treatment of migraine headaches.

Tian Ma Wan (p. 578)

• TCM actions: nourishes liver and kidney yin, nourishes blood, restrains and anchors yang, extinguishes wind.
• Biomedical actions: antihypertensive, sedative, calmative.
• Indications: liver and kidney yin deficiency with liver yang rising (less cooling and better for neck stiffness and pain; balanced between replenishing yin and restraining yang).
• Migraine highlights: vasculature and tension headaches, migraine headaches, stiff neck and shoulders.

Chai Hu Shu Gan Wan (p. 280)

• TCM actions: spreads liver qi, quickens blood, softens liver, harmonizes liver and spleen, and corrects the qi mechanism.
• Biomedical actions: antispasmodic, benefits digestion, carminative, alleviates depression.
• Indications: Liver qi stagnation with little or no deficiency, pain, distension; GI pain; gynecological disorders from liver qi stagnation, depression.
• Migraine highlights: tension and migraine headaches.

Jia Wei Xiao Yao Wan (p. 284)

• TCM actions: softens the liver, regulates liver qi, nourishes the blood and strengthens the spleen, clears stagnant heat from the liver.
• Biomedical actions: Regulates the hormones that influence the menstrual cycle, relieves depressions and emotional stress, cools the body.
• Indications: liver qi stagnation with stagnant heat (menstrual disorders), inflammatory skin disorders with emotional component.
• Migraine highlights: chronic sinus congestion and headaches (migraines), worse with stress.

Long Dan Xie Gan Wan (p. 286)

• TCM actions: clears damp heat from the liver system (heat greater than damp), cools liver fire.
• Biomedical actions: bitter tonic, depurative, anti-inflammatory, detoxicant, cholagogue.
• Indications: liver fire or liver and gallbladder damp heat affecting related areas (ears, eyes, flanks, urogenital system).
• Migraine highlights: liver fire rising through the liver and GB channel (migraine headache).

Da Chai Hu Wan (p. 288)

• TCM actions: harmonizes shao yang, spreads liver qi, purges heat and stagnation from yang ming.
• Biomedical actions: hepatoprotective, aids clearance of residual pathogens, laxative, cholagogue.
• Indications: shaoyang/yangming overlap syndrome #8211; severe fever and GI system, malaise, flulike symptoms, jaundice, chronic damp heat and qi stagnation (gallstones).
• Migraine highlights: migraine headaches and hypertension.

Xue Fu Zhu Yu Wan (p. 252)

• TCM actions: invigorates the circulation of qi and blood, quickens blood, and disperses stagnant blood.
• Biomedical actions: vasodilator, antispasmodic, anti-platelet action.
• Indications: qi and blood patterns (acute and chronic) #8211; blood stagnation movers, including cardiovascular, liver, head, chest, GI tract, gynecological, psychiatric, connective tissue.
• Migraine highlights: migraine headaches.

Tong Qiao Huo Xue Wan (p. 382)

• TCM actions: invigorates blood and disperses stagnant blood, opens the sensory orifices.
• Biomedical actions: vasodilator, antispasmodic, anti-platelet action.
• Indications: blood stagnation affecting the head, purple discoloration of the face and nose.
• Migraine highlights: acute and chronic focal headaches, including migraines and cluster headaches, postsurgical, posttraumatic, and headaches associated with drug reaction.

Hua Tuo Zai Zao Wan (p. 272)

• TCM actions: supplements qi, yin, and blood, dispels wind damp, warms and stimulates circulation of qi and blood through the channels.
• Biomedical actions: tonic, circulatory stimulant.
• Indications: wei syndrome with spastic or flaccid paralysis and hemiplegia (qi and yin deficiency following Wing-stroke or wasting disorders), tremors, poor extremities circulation. ASL, MS, and Parkinson's disease.
• Migraine highlights: chronic headaches and migraines that are worse with exposure to cold, facial pain.

Qi Ju Di Huang Wan (p. 309)

• TCM actions: supplements liver and kidney yin and brightens the eyes.
• Biomedical actions: demulcent febrifuge, hematinic, hypoglycemic, antihypertensive, improves kidney function, regulates adrenal cortex.
• Indications: liver and kidney yin deficiency patterns, visual weakness and eye disorders.
• Migraine highlights: headaches, chronic liver disease and tightness or stiffness of the tendons and muscles, essential hypertension, chronic migraine headaches.

Chinese medicine addresses the complexities of migraine headaches. The physical stress component can be remedied with the mentioned formulas. Emotional elements leading to vasospasm can be more elusive. As such, I and others who suffer from these headaches need to be mindful of our internal environment, spending time practicing mental methodologies devoted to cultivating inner well-being.

References

1. MacLean W, Taylor K. The Clinical Manual of Chinese Herbal Patent Medicines, 2^nd Edition. Sydney: Pangolin Press, 2003; pp. 252-673.
2. Tierney TM, McPhee SJ, Papadakis MA. Current Medical Diagnosis & Treatment, 43^rd Edition. New York: McGraw-Hill, 2004; p. 942.
3. Shen JF. Chinese Medicine. Shanghai, China, 1990; p. 22.
4. Kaptchuk TJ. The Web That Has No Weaver. Chicago: Contemporary Books, 2000; p. 189.
5. Cheng Xinnong, Ed. Chinese Acupuncture and Moxibustion, Revised Edition. Beijing: Foreign Languages Press, 1999; p.462-5.
6. Maciocia G. The Foundations of Chinese Medicine #8211; A Comprehensive Text for Acupuncturists and Herbalists. New York: Churchill Livingstone, 1989; pp. 155-6.

Brendan Armm practices in Santa Monica, Calif., and teaches Oriental medicine and meditation at Emperor’s College of Traditional Oriental Medicine. He can be reached at www.armmacupuncture.com or .