What's in a headache? A TCM view

Chronic headaches can be disabling

Most of us have experienced a headache at one time or another during our adult life. Nevertheless, it may be hard to believe that many people suffer from headaches during childhood and teenage years; and that some very unlucky individuals experience recurrent headaches or migraines that can even occur on a daily basis. According to the World Health Organisation, over 80% of adult females and two-thirds of adult males in developed countries suffer from tension headaches, while up to one adult in 20 experiences headaches on a daily or almost daily basis (1). Not only that, but migraine headaches -the most studied type of chronic headache- is one of the top 20 causes of years lived in disability. All in all, headaches can be a disabling symptom that can substantially diminish the quality of life of sufferers and affect their relationships and work productivity.

Conventional medicine classifies headaches into two main types: Primary and Secondary. Primary headaches are those that occur independent of any other condition, while secondary headaches may occur as a result of injury, infection, circulatory disorders, conditions that affect the brain, toxins, alcohol and drugs, or medication. The most common primary headaches are tension-type headaches which often occur as a result of stress, bad posture or life-style, migraines which are severe headaches usually accompanied by nausea and light sensitivity, and cluster headaches which are very severe headaches that come in bouts of weeks of months and tend to affect one side of the head and the back of one eye. Common secondary headaches include those caused by trauma to the head, medication overuse, and pain-killer overuse. The twisted reality experienced by sufferers of chronic headaches is that they may not only have primary headaches but also develop secondary headaches as a result of regular intake of pain killers (2).

Conventional treatments for chronic headaches are limited to different types of pain killers and anti-inflammatory drugs, vasodilators (drugs that make the blood vessels dilate), and nerve blocks for the occipital nerve in the case of very severe recurrent headaches. Besides the risk of side effects from long-term daily intake of these drugs, sometimes even the strongest painkillers will not make a difference when the headache is severe while vasodilators and anti-inflammatory drugs only work for some people but not others. Similarly, nerve blocks only seem to work for certain types of severe headaches. As a result, many people experience disabling symptoms that not only include the headaches themselves but tiredness induced by chronic pain, stress from not being able to perform normal activities or work, digestive problems from medication over-load, and many more. 

 Traditional Chinese Medicine (TCM) views:

TCM diagnosis is not limited to the symptoms

“Different treatments, same disease” is a commonly quoted TCM statement. Headache is a good example of this as different individuals presenting chronic headaches may receive completely different TCM treatment approaches. The reason for this is that in TCM many factors are taken into account before defining a person’s diagnosis and subsequent treatment. Energy levels, quality of sleep, the functioning of different organ systems, and emotional issues - just to name a few - are invariably part of the case history and will serve to inform each individual diagnosis. At the centre of this we will find the specific characteristics of the headache such as the quality of the pain, the patterns such as time of day and factors triggering or worsening attacks, and the specific site of the headaches as well as the quality of the pulses and the tongue. 

There are two basic mechanisms that can trigger headaches: excess and deficiency. Generally speaking, excess is reflected by fullness, blockage, and strong acute symptoms; while deficiency is reflected by emptiness and moderate symptoms that may nevertheless be more constant and debilitating. Deficiency is basically a condition of emptiness and under-functioning of the body, in turn Excess conditions consist of accumulation and blockage usually due to toxicity and products that the body cannot either metabolise or excrete. Both excess and deficiency can be caused by lack of moderation in diet and life-style, exposure to extreme climatic conditions, toxicity, and a general lack of balance between rest and activity. In many cases, excess symptoms (“full” and severe) can be caused by long-term deficiency; and vice-versa. This makes the diagnostic skill of the practitioner essential to provide long-term relief although short-term relief can be easily achieved with acupuncture. Once the causative factors have been determined, a suitable diet and relevant changes in life-style should be recommended so that headaches are not unwittingly being triggered by daily habits.

The most common TCM patterns involved in chronic primary headaches are detailed in the table below, based on Maciocia's  in-depth explanation of TCM patterns of headaches (3). Bear in mind this is not a comprehensive list, just the most common patterns encountered at the clinic, and that your individual constitutional traits should be part of the picture too.

 

Possible TCM diagnosis	Headache characteristics	Other possible symptoms
Excess patterns:
Liver Yang rising	Intense, severe, throbbing/stabbing pain, affects one or both temples/eyebrows and can be felt behind the eyes acute pain. May be accompanied by nausea/vomiting, visual disturbances, can occur during the weekend after an intense/stressful week.	Dizziness, tinnitus, deafness, dry throat, insomnia and irritability may be part of the picture.
Liver Fire	Similar to headache from Liver Yang rising but more intense and more fixed in one place. More likely to be accompanied by nausea/vomiting	As above but more intense symptoms plus symptoms reflecting fire such as thirst, bitter taste in the mouth, constipation, red eyes.
Liver Qi Stagnation	Intense pain, not throbbing. Affects forehead or temples. May move from side to side. May be caused by anxiety/stress.	Pain or distension in the rib area, nervous tension, poor digestion, belching, flatulence, bloating.
Dampness	Dull/heavy pain, may feel as if head is tight. Affects the whole head or forehead. Thinking may be difficult and symptoms may be worse in the morning.	Persistent catarrh, nausea, poor appetite, fullness in chest/epigastrium.
Deficiency Patterns:
Liver Blood deficiency	Pain may be moderately severe. Affects top of the head and sometimes forehead. May be worse in the afternoon or evening or occur at the end of menstrual period. Lying down can bring some relief. May be worsened by tiredness.	Low energy, poor concentration, poor memory. Insomnia, dream-disturbed sleep, irritability. Tired and dry eyes and floaters in visual field.
Kidney deficiency	Dull ache, felt in whole head or “inside the brain”; sometimes affects the occiput. Dizziness and a feeling of emptiness in the head may accompany headache. May be triggered by strenuous or sexual activity.	Lower back ache, weak knees, frequent urination, dizziness, tinnitus. Either night sweating and hot flushes or constant feeling of cold.

TCM treatment:

Acupuncture for headaches

Acupuncture can be very effective for relieving pain during an episode of acute or chronic headache and will also aid relaxation which will further contribute to bringing pain relief. I have seen how regular acupuncture treatment can dramatically reduce the severity and frequency of recurrent headaches. This is more often than not supported by suitable changes in life-style and the reduction in analgesic medication.

Chinese herbal remedies may be needed in cases of very severe headaches or in cases where the headaches have been occurring over a long period of time. Herbal remedies will also help solve underlying disharmonies particularly when there is a deficiency behind the chronic headaches.

What you can do:

Diet 

 1. The following foods and substances can by their very nature contribute to the imbalances underlying chronic headaches. In addition, caffeine and other stimulating substances literally force Qi upwards thus directly contributing to the headaches themselves, so all of these should be avoided by all chronic headache sufferers:

• Stimulants such as coffee, tea, coca cola, and other caffeinated drinks.
• Alcohol and drugs
• All artificial chemical substances which can produce toxicity and blockage in tissues and in the digestive system thus preventing the absorption of real nutrients. These include chemicals additives, preservatives, colourings, and flavourings. Pre-pepared meals and junk foods will invariably contribute to the underlying causes of your headaches unless you actually recognise the contents of the products you buy as "food". If the packaging says "natural" colourigns and flavourings, it does not mean the product is natural. What it means is that there is as substance "extracted" from or "chemically similar" to something natural, so do not fall for this.
• Spicy, greasy and heavy foods, and eating late at night: This will create heat in the body and contribute to stagnation in the Stomach and in the Liver channel. When Qi becomes blocked or stagnant and cannot flow properly through the channels, pressure may build up which sends the Qi upward quite vigorously like vapour in a pressure cooker. This can result in many symptoms including severe headaches.
• Mature cheeses, chocolate, red wine, coffee, oranges, and orange juice are notorious headache triggers so best to stay away from them.

2. Instead, all headache sufferers would benefit from:

• Nourishing yourself according to your needs: A balanced diet consisting of freshly prepared food and adequate amounts of protein depending on your level of activity is key for the management of chronic headaches. TCM regards food and drink as the fuel that provides the whole body with Qi and Blood. Without this, there cannot be long-lasting improvements in any chronic condition. Consuming the right foods, in the right amounts, and at a suitable time of day is recommended. A TCM practitioner can give you specific advice on this but a general overview of diet and digestion according to TCM can be found here. 
• Sufferers of Excess type headaches need to exercise moderation with food and drink especially heavy and difficult to digest foods as they can create further blockage and increase the severity of their symptoms
• Those who experience Deficiency type headaches may be able to consume moderate amounts of spices such as ginger and cinnamon and should make sure to consume good quality protein on a daily basis. Meat eaters may get away with good quality chicken or meat once per day but vegetarians need to ensure a constant supply of protein and consume some form of it with every meal, preferably not cheese but pulses, nuts, seeds, soya products, or quinoa.

Relax and rest 

Relaxation can help reduce the severity of headaches

• Avoiding stress as much as possible could help you avoid a potent headache trigger. If this is not possible, you can follow some of the tips in my previous post on stress. 
• Migraines and headaches related to the menstrual cycle are often associated with stress and with lack of rest. Avoiding stress, practising relaxation techiniques, and having enough rest is particularly important especially in the days preceding menstruation, and during it. Becoming familiar with what happens with your hormones throughout the month and how to maintain a healthy cycle could be helpful. Visit my post on the menstrual cycle for some tips.
• Relaxation techniques can help us cope with pain. The normal response to any kind of pain is to tense up in an attempt to feel less pain. However, tensing the body can only contribute to increased pain and easily initiate a vicious circle in which pain levels increase due to our physical reaction. Learning to relax through breathing, yoga or meditation techniques can greatly contribute to our ability to cope with pain as it enables us to “relax through the pain” thus making it more bearable. Similarly, treatments such as massage, acupuncture, and reiki can induce deep relaxation and a parasympathetic response that can counteract headaches. 
• Sufferers of chronic headaches need to make an effort to balance rest and activity. Both not moving at all and doing too much – work, exercise, sexual activity- and comparatively getting the wrong amount of rest needed to restore your energy, will contribute to the imbalances that cause chronic headaches. Making an attempt to use your available energy wisely will have a beneficial effect on you whole health.

Exercise: 

• Moderate exercise encourages the movement of Qi and alleviates symptoms produced by the blockage of Qi and Blood particularly in sufferers of Excess type headaches. Conversely, strenuous exercise such as running, may provide temporary relief but can also contribute to the mechanisms behind headaches so be careful about the type of exercise that you choose. A qualified TCM practitioner can offer you individualised advice as to the most suitable types of exercise for you.
• Those who experience Deficiency type headaches need to be more careful about exercise and only do any if their energy levels permit it. Exercising when tired, during the menstrual period, or just after it, may exacerbate deficiencies and contribute to headaches.

Try not abuse pain killers    

• As mentioned at the beginning of this post, frequent use of pain killers can induce what is called “rebound headaches”, which is a type of secondary headache. This only occurs in people who are susceptible to headaches and makes life extremely difficult when the primary headaches are frequent and severe and pain killers are necessary.  
• Apart from therapeutic approaches that can provide pain relief such as acupuncture, massage, healing, or aromatherapy; exploring ways of coping with pain such as relaxation techniques, yoga, and self-hypnosis may be worth a try so that you do not have to resort to pain killers all the time.   

 The TCM organs most frequently involved in chronic headaches are the Liver, Kidneys, and Spleen. It may be useful to read my previous posts on these organs to learn how they work and how to prevent them from getting more out of balance.

Chronic headaches make life very difficult, and often there is not much help to be found from the medical profession.  As with many other chronic conditions, headache sufferers often do not realise that their diet and life-style may be not only contributing to headaches but also triggering them. Becoming aware of this and learning to adjust your life-style will not only give you tools to improve your symptoms but will most certainly benefit your general health and well-being as a whole.

REFERENCES:

1. The informative fact sheet on headaches from the World Health Organisation. Found online here: http://www.who.int/mediacentre/factsheets/fs277/en/

2. The NHS informative page on headaches caused by painkiller overuse. Found online here: http://www.nhs.uk/Livewell/headaches/Pages/Painkillerheadaches.aspx

3.  Maciocia, Giovanni (2008) The Practice of Chinese Medicine: The treatment of diseases with acupuncture and Chinese herbs. 2nd edition. pp. 1-64.