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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)

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The above gives a clear explanation of the idea of Wind and Bile being 2 primary causes of Headache (in this case, one-sided Headache. This concept agrees very well with TCM.

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)

Headaches caused by 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.

TCM Differentiation of Headaches

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).

TCM differentiates between Headaches caused by External and those caused by Internal Factors. External attack of Wind-Cold or Wind-Heat (suchas the start of a Codl or Flu) can cause acute Headaches. These usually come with other symptoms of Wind attack, such as Fever, Chills, runny nose or sore throat.

External Causes

Wind-Cold–sudden onset headache, pain in the neck and into the upper back and shoulder, sensitive to cold and wind, runny nose, pale face, floating and weak pulse
Formula: Chuan Qiong Cha Tiao San
Wind-Heat–pain with a feeling of distention, sensitive to wind, thirsty, red face and eyes, pulse floating and fast.
Formula: Yin Qiao San

Internal Causes.

Liver Heat–pain, dizziness, irritable, insomnia, bitter taste, red tongue with little yellow coat, pulse: deep, wiry and forceful.
Formula: Tian Ma Gou Teng Yin or Long Dan Xie Gan Tang
Kidney Deficiency–headache with empty feeling in the head, dizziness, lower back pain, fatigue, tinnitus, red tongue with little coat, pulse is deep and week.
Formula: Da Bu Yuan Jian or Liu Wei Di Huang Wan
Qi and Blood Deficiency–headache with dizziness, easily frighten, worse with fatigue or exertion, shortness of breath, sensitive to wind, pale face, pale tongue with thin white coat. Pulse deep and weak.
Formula: Ba Zhen Tang or Bu Zhong Yi Qi Tang
Phlegm–dull headache, foggy head, phlegm in the chest, swollen tongue with teeth mark. Tongue coat white and sticky, pulse deep and wiry or deep and slippery, slow
Formula: Ban Xia Bai Zhu Tian Ma Tang
Heart Deficiency–Headache with Insomnia, palpitations, anxiety. Maybe the spirit is unsettled from strong emotion
Formula: Tian Wang Bu Xin Dan
Blood Stasis–chronic headache with fixed location, sharp or stabbign pain; maybe Purplish tongue or tongue with spots, coat thin and white, pulse deep and thin.
Formula: Tong Qiao Huo Xie Tang or Xue Fu Zhu Yu Tang

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.

Categorization according to Channel in TCM

Based on the Meridian theory, TCM classifies Headaches based on the Meridian affected.

Taiyang
This affects the Bladder Meridian and therefore is felt at the back of the neck. It often overlaps a modern medicine diagnosis of Tension Headache.
Guiding Herb–Notopterygium Qiang Huo or Saposhnikovia Fang Feng
Shaoyang
Typically throbbing headaches on the side of the Head, overlapping diagnosis with Migraines.
Guiding Herb–Bupleurum Chai Hu or Ligusticum Chuan Xiong
Yangming
Frontal Headache, felt over the sinus. It is typically seen with acute Sinusitis.
Guiding Herb–Angelica dahurica Bai Zhi or Pueraria Ge Gen
Taiyin
Heavy headache feels like there is a tight band around the head, caused by Spleen deficiency and Damp.
Guiding Herb–Atractylodes Cang Zhu
Shaoyin
Chronic headache that feels like pain deep inside the head, due to Kidney deficiency.
Guiding Herb–Asarum Xi Xin
Jueyin
Pain at the Vertex or top of the Head. It can be related to metabolic disturbances like Hypoglycemia.
Guiding Herb–Evodia Wu Zhu Yu or Ligusticum Gao Ben

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
• Dan Zhi 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 Wan Bu Xin Dan–Heart Blood and Yin deficiency (Headache with insomnia)

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Headaches in General

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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

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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

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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.

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Headache caused by Melancholy

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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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Headache From Hangover

Western Tradition

1. Rue, Rose, Bitter Almond, beat with Vinegar and apply to the Head.
2. Wormwood, Betony, Feverfew

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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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Migraine

Migraine is a recurring type of headache typically affecting one side of the head with light sensitivity and nausea. There is often a throbbing pain of varying severity. Some migraines are caused by hormones, certain foods, and stress. Migraine is generally differentiated and treated similarly to Headache. However, stronger medicines may be required due to the severity.

‘Sometimes Migraine leads to facial paralysis; if this is accompanied
by fullness in the temples, then bleeding the Temporal Veins is very
useful’. (Rhazes)

Special Formula:

Hiera Hermetis was commended for stubborn Migraine

DA CHUAN XIONG
Ligusticum Chuan Xiong. 4 parts
Gastrodia Tian Ma. 1 part
This has been studied. (See here)

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