The means of identifying headache type is a challenge for physicians who specialize in head pain, not to mention those who suffer from this condition. A headache can have a migrainous quality without actually fitting all the criteria to be classified strictly as a migraine. Although quite different in terms of severity and location, tension-type headaches can occur episodically in those who also suffer from migraines.
Migraines vs tension headaches
The lines are not necessarily clearly drawn when it comes to distinguishing between headache types, especially when the pain is severe. The International Headache Society (IHS) has set parameters to assist with identifying migraine. The criteria for a diagnosis of migraine are:
| Duration | Lasting at least 4 hr. with a duration of up to 72 hr. |
| Severity | Debilitating; interferes with normal daily activities |
| Symptoms | Nausea, photophobia & phonophobia (sensitivity to light and noise) |
| Location | Unilateral; on one side of the head |
| Pain | Pulsating quality |
Although acupuncture treatment does not rely strictly on western medicine diagnoses, it does help to assign criteria, as points and herbs enter channels that correspond with the location on the body, as well as specific strategies for type, duration, and severity of pain. Co-morbidities (co-existing health conditions) are also important to report to address the whole person.
When referring to migraine symptoms, note that physicians base diagnosis on the presentation of each and every one of the above symptoms, without exclusion. If you report all five of the criteria except for one, the diagnosis would then be listed as “migraine minus one” (Davidoff, 2002). Or, if you present with some other variation that does not match all criteria, but still closely resembles migraine, i.e., severe and debilitating unilateral headache, without nausea or aura, you may be diagnosed with “migrainous disorder” (Davidoff, 2002).
Tension headaches were once believed to be a completely separate type of headache from migraine, however, in recent years this distinction has been under more scrutiny as there is more overlap than once thought in the incidence of these two headache types. In fact, it is not that uncommon for headaches to escalate over time, starting out as tension-type and developing into migraine, for example. There are also cases whereby a less severe tension-type headache occurs often, concurrently with migraine episodes once or twice a month. This variability is now being more diligently recorded by headache specialists.
| Duration | Lasts anywhere from 30 minutes to 7 days |
| Severity | Mild to moderate intensity |
| Symptoms | No more than one of photophobia or photophonia; no nausea |
| Location | Bilateral; Hat band distribution (like a tight band around the head) |
Acupuncture Works for Head Pain
In Chinese Medicine, migraine and tension headaches are both classified as “tou tong” or head pain. Specific points on the head and extremities (hands and feet) are almost always selected because they are empirical for head pain, meaning their use has been documented with a high reported success rate over a long span of time, even centuries. One classic example is Large Intestine 4, the point lying at the midpoint between the forefinger and the thumb.
Acupuncture diagnosis may differ from one patient to another, and the underlying constitution of each individual informs the body as to how signs and symptoms manifest. For example, a person who experiences headaches that feel like “a band is wrapped around the head and tightening” and whose tongue has a thick, slimy white coat, shows the presence of Dampness, a type of pathogen, will be treated using a strategy to “Eliminate Dampness and Transform Phlegm.” Another individual may have stabbing pain localized above the eye, a tongue diagnosis of a red coat with light yellow fur, and a stringy pulse, thereby showing more signs of stagnation and heat. Therefore, the focus for treatment is to “Clear Heat, Reduce Stagnation.” Points and herbs have many, many functions. This is the reason that treatment can fluctuate according to changing signs and symptoms, and one person’s treatment will be completely different from another.
A Note On When to Seek Treatment for Headaches
It is not always easy to predict when you are going to get a migraine. Once there is an escalating pattern of pain, not only is it difficult for the patient to leave the house (or darkened room), but it is also difficult for the practitioner to intervene in time and it can be likened to trying to stop a “running train.”
In working with migraine sufferers, I have learned that treating migraines during the pre-prodromal period or well before symptoms start to occur (i.e., auras or blurry fields of vision, nausea, sensitivity to light and noise), or in between headache episodes, represents the best time to help decrease frequency and intensity of migraine headache. Usually, a series of treatments, typically four to six in regularly spaced intervals of one or two weeks between, is recommended as a starting strategy.
However, it should also be noted that receiving treatment during the incidence of a mild-to-moderate headache can often stop it right in its tracks, so do not hesitate to call or make an appointment in such instances.
herbal medicines for migraine
Many people take NSAIDs or stronger prescriptive medicines like DHE that block neurogenic inflammation. I can totally understand the need for pharmaceuticals in the event of severe head pain, one of the worst kinds of pain in the body. While meds may still be necessary when first undergoing acupuncture treatment, it may be possible to lessen the dosage and frequency over the course of a few weeks to months. Of course, the goal is to greatly reduce or even eliminate the need for prescriptive meds, which often have damaging effects on the Liver, and substitute them with a holistic health approach that includes acupuncture, herbal medicines, a healthy nutritional balance, adequate exercise, and ample water intake.
Herbal medicines in particular offer real benefits for reducing pain while also acting to reduce or prevent headache recurrence. Herbs work on multiple systems with constituents that help to control inflammation, strengthen immunity, reduce pain, and more. One common result of herbal therapy is a marked reduction in the severity and frequency of headaches. Not only that, herbal medicines can actually strengthen the body’s resistance to the triggers for migraine headaches, especially when adding adaptogenic and immune-modulating herbs to the mix.
Like acupuncture treatment, specific herbal strategies for various types of head pain and their etiologies require attentiveness. Most formulas that address pain as the chief complaint include herbs classified as “blood invigorators;” these herbals are noted for their ability to stoke sluggish circulation and restore the flow of blood into channels (lines of energy) as well as actual blood vessels.
One of the most effective herbs for migraine is bupleurum, chai hu (Radix bupleuri) root, a woody herb, widely renowned for its ability to circulate Liver qi throughout the system and to also help detoxify the blood (Bensky & Gamble, 1993). Bupleurum is a cooling herb that is also used to reduce fever, smooth the flow of blood, and ease emotional distress — all symptoms of Liver qi stagnation. Severe headaches of any type, including both migraine and tension-type, are linked to Liver syndromes in Traditional Chinese medicine; treatment will almost always include points and herbs that both soften and support the Liver.
References
Barkin, R. & Jay, G. (Eds.). (2017). Primary headache disorders part II. Disease-a-Month, 63(12), 339-368.
Bensky, D. & Gamble, A. (1993). Chinese herbal medicine materia medica. Eastland Press: Seattle, Washington.
Davidoff, R. (2002). Migraine: Manifestations, pathogenesis and management. Oxford University Press: USA.
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