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Headache and Migraine
Classical Classification of Headache:
- Cephalgia–pain over the whole head; sometimes violent, other times mild; either acute or chronic
- Cephalea–intolerable headache; weakens the head and senses; has paroxysms; violent pain, tinnitus, pulsing of the forehead veins, sight and hearing affected.
- Hemicrana–one-sided headache; similar to the preceding (Galen and others treated them as one)
- Congelatio–headache from cold numbness; originates in the rear of the head and takes away sense and feeling (similar to Lethargy or Stupor)
Causes of Headache
Headaches were long recognised to have numerous causes: the Heat of the Sun, bathing, change of air, wind, strong scent of spices, the smell of wine, drunkenness, stinking meat, garlic, onions, mustard, strokes, blows, bruising or great motions of the mind (excess thinking or emotions), sleep straight after dinner, excess bleeding; worms in the ears, nostrils, or stomach; choler (bile) in the stomach, repletion of the Stomach, immoderate or unnatural mixture of humors, and various other causes. (Wirtzung)
Normally, Headaches are caused by intemperance of one of the 4 Humors:
- Blood: head is hot, forehead feels heavy, eyes and face are red, full veins in the face; urine is red and fatty, the pulse is soft.
- Bile: great heat from the nostrils, tongue is dry, insomnia, thirst, pain tends to the right side of the head.
- Melancholy: head is cold, dull color of the face, veins are not visible, little sleep, fear and worry; pain tends to the left side of the head.
- Phlegm: senses are heavy and dull, feels cold, sleeps long, lethargic, greatest pain at the rear of the head.
In TCM theory, Headaches can often be associated with Wind, in addition to another factor: for example a Heat-type Headache can be referred to as Wind-Heat, Cold-type Headache to Wind-Cold, Phlegm-type Headache to Wind-Phlegm etc. Headache may also be caused by Blood stagnation with fixed pain; by chronic deficiency where the patient is weak and the headache dull, or from Trauma (which causes Blood stagnation).
Headache can also be divided into excess and deficient types. Excess is primarily of Heat, Cold, Wind or Phlegm, while deficiency may primarily be Blood, Qi or Yang deficiency.
Formulas most used in TCM
According to a survey of Taiwanese databases related to the treatment of Migraines, the following 10 formulas are most used in TCM (see research here):
- Chuan Xiong Cha Tiao San–statistically, the most used formula
- Jia Wei Xiao Yao San–Liver Qi stagnation with Heat
- Ge Gen Tang
- Xue Fu Zhu Yu Tang–Blood stagnation, with fixed, stabbing pain
- Ban Xia Bai Zhu Tian Ma Tang–Wind-Phlegm headache
- Qing Shang Juan Tong Tang
- Xiao Chai Hu Tang–Spleen deficiency with Liver excess, or half-interior, half-exterior syndrome
- Tian Ma Gou Teng Yin–Internal Wind with Heat
- Bu Zhong Yi Qi Tang–Spleen Qi deficiency, or Spleen Qi sinking
- Tian Wang Bu Xin Dan–Heart Blood and Yin deficiency (Headache with insomnia)
Headaches in General
Headache from Bile or Heat
Symptoms
Head and forehead feel hot, red eyes, belching, loathesomeness, thirst, dry mouth, bitter taste; pain is pricking, sharp, more commonly on the right hand side of the head, maybe with dizziness, the body is hot, little appetite, insomnia, irritable, angry, pulse is hard and fast, urine reddish, face yellowish. Especially in hot and dry times of the year, and in young people.
Diet
Stewed Lentils, Spinach, Chicory, Purslane, Lettuce and leafy vegetables, broths, stewed Apples and Pears, broths of Veal and Hens; drinks: whey, barley water with a little Pomegranate or Lemon juice added. Avoid wine and meat.
Medicines
Barley, Four Cold seeds, Lettuce leaf and seed, Purslane, Plantain, Black Nightshade, Violet, Water Lily flower, Poppy seed, Sandalwood
Externally
1. Oxyrrhodinum (equal parts of oil of roses, rose water, and vinegar of roses). Apply soaked linen cloths across the forehead from one temple to another. If the heat is extreme Camphor should be added.
2. Egg white beaten 1
Rose water 1 oz.
Waters of Elder and Fennel ½ oz. ea.
Add 5 small Walnuts, beaten, and a little Saffron. Mix well; lay on the forehead with wool.
3. Ointment of Roses (Mesue)
4. Infrigidans Galeni ‘Cold Cream’ (washed wax 2 oz., oil of Roses 4 oz.)
5. Ungentum Populeum
Symptoms
Head and forehead feel hot, red eyes, belching, loathesomeness, thirst, dry mouth, bitter taste; pain is pricking, sharp, more commonly on the right hand side of the head, maybe with dizziness, the body is hot, little appetite, insomnia, irritable, angry, pulse is hard and fast, urine reddish, face yellowish. Especially in hot and dry times of the year, and in young people.
Diet
Stewed Lentils, Spinach, Chicory, Purslane, Lettuce and leafy vegetables, broths, stewed Apples and Pears, broths of Veal and Hens; drinks: whey, barley water with a little Pomegranate or Lemon juice added. Avoid wine and meat.
Medicines
Barley, Four Cold seeds, Lettuce leaf and seed, Purslane, Plantain, Black Nightshade, Violet, Water Lily flower, Poppy seed, Sandalwood
Externally
1. Oxyrrhodinum (equal parts of oil of roses, rose water, and vinegar of roses). Apply soaked linen cloths across the forehead from one temple to another. If the heat is extreme Camphor should be added.
2. Egg white beaten 1
Rose water 1 oz.
Waters of Elder and Fennel ½ oz. ea.
Add 5 small Walnuts, beaten, and a little Saffron. Mix well; lay on the forehead with wool.
3. Ointment of Roses (Mesue)
4. Infrigidans Galeni ‘Cold Cream’ (washed wax 2 oz., oil of Roses 4 oz.)
5. Ungentum Populeum
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Western Tradition
Headache from Bile / Heat
Decoction for Chronic Heat-type Headache (Mesue) Syrup of Hops Tincture of Balm Elixir of Camphor Abbots Confect of Rose (Diarrhodon Abbatis) New Rose Powder (Rosata Nouvelle) Powder of Three Sandalwoods (Diatrionsatalum) Troches of Camphor (Nicholas) Electuary of the Juice of Rose (Mesue) Pills for Headache from Bile and Phlegm Pills of Violet (Habbe Banafsha) (Unani) Oil of Violet Oil of Rose Headache from Liver Headache Syrup of Hops Tincture of Balm Powder of Rhubarb Powder to Cool the Liver Powder of Three Sandalwoods (Diatrionsatalum) Sandalwood 18 (Tibetan Medicine) Extra Formulas
Decoction for Chronic Heat-type Headache Roman Wormwood 1 oz. Fumitory 8 drams Raisins stoned 1 oz. Agrimony 5 drams Bugloss flower 6 drams Dodder Endive seed Agaric 3 drams Boil in 3 lbs down to 1.5 lbs. (De Morbis Internis Curandis, Mesue, 1551) Pills for Headache from Bile and Phlegm Aloes 6 drams Yellow Myrobalan 4 drams Mastic 3 drams Rose 2 drams Saffron 1 dram Form Pills. (De Morbis Internis Curandis, Mesue, 1551) |
TCM Classification
Wind Heat
acute headache, cough, sore throat, blocked nose, maybe yellowish or green or clear or white mucus, stiff neck, restless, fever, floating rapid pulse Yin Qiao Jie Du San Fang Feng Tong Sheng San Liver Heat / Liver Yang Rising (Bile) sharp, acute or pulsating headache, dizziness, irritable and angry, insomnia, red eyes, red face, bitter taste, high colored urine . Dan Zhi Xiao Yao San (TCM) Long Dan Xie Gan Tang Qi Ju Di Huang Wan Tian Ma Gou Teng Yin |
Headache caused by Cold or Phlegm
Symptoms
Headache which is not extreme, feeling heavy and Cold, tiredness, sleepiness, excess saliva, runny nose with clear mucus, pale face, loss of taste. Sennertus notes that Cold headaches can be caused by cold air and cold winds, showing this category is associated with Wind-Cold Headache of TCM.
Diet
Warming and drying; roasted meats; spiced food and wine; eat a little Marmalade after food
Medicines
Nutmeg, Mace, Cinnamon, Clove, Marjoram, Rosemary, Mastic
Externally
1. Pills to Chew: Mastic 2 drams, Pepper 1 dram, Caper root-bark half dram; powder and form pills with Vinegar of Squill; hold in the mouth
2. A gargle: Mustard seed 1 oz., Pepper 3 drams, Hyssop 1 handful; seethe in red wine with a little Honey. Use as a gargle.
3. Scented balls to smell: Cinnamon, Clove, Nutmeg, Aloeswood, Marjoram 2 drams each; with a little Musk and some Mastic, form balls. Various warming aromatics can be used to smell.
4. Promoting Sneezing is very useful in Cold Phlegm type Headache; sniffing Pepper or Hellebore root was used
Headache which is not extreme, feeling heavy and Cold, tiredness, sleepiness, excess saliva, runny nose with clear mucus, pale face, loss of taste. Sennertus notes that Cold headaches can be caused by cold air and cold winds, showing this category is associated with Wind-Cold Headache of TCM.
Diet
Warming and drying; roasted meats; spiced food and wine; eat a little Marmalade after food
Medicines
Nutmeg, Mace, Cinnamon, Clove, Marjoram, Rosemary, Mastic
Externally
1. Pills to Chew: Mastic 2 drams, Pepper 1 dram, Caper root-bark half dram; powder and form pills with Vinegar of Squill; hold in the mouth
2. A gargle: Mustard seed 1 oz., Pepper 3 drams, Hyssop 1 handful; seethe in red wine with a little Honey. Use as a gargle.
3. Scented balls to smell: Cinnamon, Clove, Nutmeg, Aloeswood, Marjoram 2 drams each; with a little Musk and some Mastic, form balls. Various warming aromatics can be used to smell.
4. Promoting Sneezing is very useful in Cold Phlegm type Headache; sniffing Pepper or Hellebore root was used
Headache from Wind
Symptoms
The key indication for Wind type pain is its moving and changeable nature, much like Wind itself. The pain may be tight or tearing by nature, changes place, and is aggravated by wind or draughts, as well as stress and overthinking.
The key indication for Wind type pain is its moving and changeable nature, much like Wind itself. The pain may be tight or tearing by nature, changes place, and is aggravated by wind or draughts, as well as stress and overthinking.
Headache caused by Melancholy
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Western Tradition
Chronic Headache
Tincture of St. John's wort Decoction of Woods Decoction for Chronic Heat-type Headache (Mesue) Theriac for Pain of the Head Pills of Hiera (Habbe Ayarij) (Unani) Arab Confect Purging Melancholy (Confectio Ham) Hiera Logadii Chronic Headache from Melancholy Arab Confect Purging Melancholy (Confectio Hamech) Arabian Pills (Nicholas) Hiera Logadii Triphala of Stoechas (Itrafil of Stoechas) (Unani) |
From TCM
While TCM has no direct correlation with Melancholy, Melancholy types of Headache can be associated with Qi Stagnation in acute cases, with Dampness, or with Deficiency of Yin and Blood Stagnation in chronic cases. |
Headache From Blood Stagnation
Headache with fixed, constant or recurrent pain; maybe with history of Trauma; insomnia, restless, poor memory, dull complexion, dark under eyes, maybe purplish lips, tongue and nail beds, choppy pulse
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Western Tradition
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From TCM
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Special Formula:
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HEADACHE FROM OLD INJURY
Dang Gui Ligusticum Chuan Xiong Angelica Bai Zhi Mistletoe (Sang Ji Sheng) Notoginseng San Qi Salvia Dan Shen Cyperus Xiang Fu (The Formulas of Dr. John H.F. Shen) |
Headache From Hangover
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Western Tradition
1. Rue, Rose, Bitter Almond, beat with Vinegar and apply to the Head.
2. Wormwood, Betony, Feverfew |
Other Categories of Headache from TCM
TCM recognises Headaches from acute and chronic causes. Acute are from external attack of Wind and are therefore of the same cause as Colds and Flus. Note the formulas for Acute Headache from Wind are formulas used for Cold and Flu. Chronic are from Organ or Humoral imbalance.
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Acute (External) Causes
Wind Cold Attack acute headache, aversion to wind, no sweating or mild sweating, aching muscles, runny nose with clear mucus, chills (fever low if present), stiff neck, pulse is on the surface. Ma Huang Tang Gui Zhi Tang Chuan Xiong Cha Tiao San Wind Heat acute headache, cough, sore throat, blocked nose, maybe yellowish or green or clear or white mucus, stiff neck, restless, fever, floating rapid pulse Yin Qiao Jie Du San Fang Feng Tong Sheng San |
Internal Causes from Deficiency
Blood Deficiency headache, pale face, weak, feels the cold, dizziness, poor memory, palpitations, weak and low pulse, pale lips and tongue. Si Wu Tang Special Formula: Dang Gui Ligusticum Chuan Xiong Gastrodia Tian Ma Tribulus Ci Ji Li Lycium Gou Qi Zi Angelica Bai Zhi (The Formulas of Dr. John H.F. Shen) Kidney Deficiency dull headache, head feels empty, dizziness, tinnitus, back pain, weak knees, insomnia, sallow and weak appearance, spermatorrhea Qi Ju Di Huang Wan Zuo Gui Wan |
Migraine
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Western Tradition
Special Medicines:
Hiera Hermetis was commended for stubborn Migraine Hemicranea conferunt–for Migraine
Infusion of Hiera Decoction of Wormwood Syrup of Betony (Bononiense) Tincture of St Johns wort Oxymel of Squill Powder of Rosemary Compound (Dianthos) (Nich.) Hiera Hermetis Troches of Saffron (Nicholas) Troches of Scammony Pil. Cochia Pills for Migraine (Galen) Pills for Migraine (2) (Galen) Electuary of Frankincense (Diaolibanum) (Nicholas) Diacastoreum Adrianum Nicolai (with a decoction of Sage in wine) Mithridate Theriac Galeni Tincture of Mastic Tincture of St. Johns wort Mustard Plaster Oil of Spikenard Oil of Wormwood Oil of Squill Oil of Bay Garuda 5 (Khyung Lnga) (Tibetan Medicine) Headache and Migraine, to Purge Powder of Rhubarb (Fuchs) Pil. Aggregative Greater (Mesue) Golden Pills (Pil Aurea) Common Pills Imperial Pills Hiera Hermetis Arabian Pills Pilulae Alhandal Pills of Hiera Simplex Pills of Hiera with Agaric Pills of Mastic (Mesue) Pill of Three Things with Rhubarb Stomach Pills (Mesue) Triphala of Zamani (Itrafil Zamani) (Unani) |
TCM Classification
TCM treatment for Migraines is generally as for Headache categories above. Acute Migraines where there is not a history of regular Migraine attacks may be treated with the medicines as for Acute Headaches, above.
Wind-Phlegm Ban Xia Bai Zhu Tian Ma Tang Qi Stagnation Xiao Yao San Dan Zhi Xiao Yao San Yue Ju Wan Wind-Heat or Liver Heat Dan Zhi Xiao Yao San Fang Feng Tong Sheng San Long Dan Xie Gan Tang Blood Stagnation Tao Hong Si Wu Tang Xue Fu Zhu Yu Tang Yang Deficiency Fu Zi Tang |