Headache is a very common complaint, one of the three most common symptoms for which a patient comes in to see any type of medical practitioner. Chinese medicine distinguishes between situations in which headache is the primary or only complaint, such as migraine, and those in which headache is merely a symptom of or accompanies another illness. Headache may, in fact, be found in almost any disease or diagnosis. In those cases where headache is a secondary complaint, we treat the primary illness and let the headache resolve of itself when the primary condition is harmonized. Chinese medicine always tries to focus on treating the root condition, the underlying imbalance that allows ill health to develop and prosper in the body, rather than simply eliminating or reducing the most obvious symptoms of that imbalance. However, in cases of acute headache where the pain is severe, a practitioner will focus in the short term on relieving that severe pain so that the patient is able to function again; then, the attention returns to harmonizing the underlying imbalance. It is in this way that Oriental medicine helps to maximize health and quality of life, while preventing or slowing the progression of disease. Only conditions in which headache is the primary symptom will be discussed below.

The head is important for many reasons, most obviously because it houses the brain and many of the sensory organs. Chinese medicine teaches that all of the Yang meridians, or energy channels, meet in the head, and that all of the qi and blood in the body flows upwards to the head. For these reasons, the head is particularly susceptible to disturbances in qi and blood, or imbalances that affect the circulation of energy in the Yang meridians. The most common type of imbalance causing headache is that associated with frustration or anger, either expressed or suppressed, which causes rising Liver yang. In Chinese medicine, the liver organ is responsible for the smooth flow of energy throughout the body, as well as for the storage of the blood at night when a person sleeps. The liver is a Wood organ, an idea taken from the ancient 5 element philosophy wherein wood represents growth and a tendency to push forward, the way that trees in springtime flourish, pushing upward into the sky and downwards into the earth. When this tendency to growth, or expansion, is frustrated, or when there is not sufficient fluid to soothe and nourish the liver organ system, energy is obstructed and may rise excessively. Or, conversely, fluid and energy may be insufficient to rise to the head and nourish the brain and sensory organs. This describes the two basic conditions for headache: one in which qi, or energy, is excessive, and the other in which qi and blood are deficient. These may be distinguished by the type of pain felt by the patient, as well as by accompanying symptoms. For example, an excessive headache is more likely to be sharp, possibly throbbing, and accompanied by agitation, while a deficient headache will more likely be dull, spread throughout the head, and accompanied by fatigue.

Causes of headache include anything that may obstruct the smooth flow of energy and blood in the body, either locally, such as traumatic injury (a blow to the head), or systemically, such as emotional frustration affecting the liver organ system. In addition, any factor that reduces the abundance of qi and blood may cause a deficiency of these vital substances, preventing full nourishment of the head. Examples of these factors include:

  • An inherited tendency to blockage or deficiency. In this case, headaches may run in the family.

  • Irregular sleep and long work hours which may produce frustration and, over the long-term, deficiency of qi and blood.

  • Illness, especially chronic, long-term, or severe illnesses.

  • Poor nutrition and eating habits, allergies, certain drugs.

  • Trauma, especially to the skull or neck.

The most important factor may be emotional stresses, and the headache may even serve a purpose of motivating a move away from or change in the stressful situation. Examples are:

  • Anger –which is most likely to produce a headache on the side of the head or temples. Feelings of frustration and resentment are included in this category. As mentioned above, this emotion is most closely related to the liver system.

  • Worry – which is most likely to produce a headache on the forehead or top of the head. It is most commonly a dull headache. Worrying knots up the body energy, affecting the spleen, lung and heart systems.

  • Fear and Shock – which are most likely to produce a headache over the whole head. Fear and shock are emotions that deplete the kidney system, leading to inadequate nourishment of the brain.

Dietary factors may also affect headache. For example, overeating, eating while working, or eating too much hot, spicy food may cause a sharp headache around the forehead. Migraine sufferers may be especially sensitive to certain foods, such as chocolate and alcohol. Other triggers for migraine include stress, missing meals, too little or too much sleep, and oral contraceptives.

The most common diagnoses for headache in Chinese medicine fall into the following categories:

Pathogenic wind – Headache due to pathogenic wind is most likely to affect the nape of the neck and upper back. The pain may begin as a dull tension and progresses to a strong, piercing, fixed pain. This type of headache is seen in the beginning stages of an infection; the wind is thought to carry the infectious agent into the body. Wind tends to rise to the head where it obstructs the movement of qi and blood. Sudden change in weather, or exposure to wind may cause an acute headache of this type. If heat, or fever, is a strong element in the attack, the headache may be felt on the forehead.

Liver Excess – Headache due to Liver excess is most likely to affect the sides of the head, and may reach to the very top of the head. The headache will tend to be sharp and throbbing, and may be brought on by anger. This type of headache is better when the patient moves around, and gets worse with lying down, with sour foods, with pressure on the head, and with emotional upset. It may also occur more often before the menstrual period. In the rare case of very severe headache due to Liver Fire, the headache improves after sex.

Qi and Blood Deficiency – Headache due to qi and blood deficiency is most likely to affect the top of the head, but may encompass the entire head. The pain tends to be dull and lingering. This type of headache is better when lying down and improves with eating and resting; the patient feels better with pressure on the head or rubbing. The headaches occur more often after the menstrual period and when feeling stressed. Dizziness, blurred vision, and low energy commonly accompany the headache.

Trauma – Headache due trauma is centered about the location on the skull at which the trauma occurred. The pain tends to be severe, throbbing, and well circumscribed in location. Headache immediately after a blow to the head is readily understood, but it should be noted that headaches may recur in the same spot long after the initial trauma. A chronic subclinical stagnation of energy and blood may be left behind after healing, which makes that spot more sensitive to future imbalance.

Any trauma to the head should be thoroughly checked by a health professional for possible complications. In addition, any severe, acute headache, or chronic headache that increases in severity should be thoroughly evaluated. Though rare, headache may be an initial sign of meningitis, cerebral hemorrhage, cerebral tumor, hypertension, glaucoma, or various infections; these conditions must be considered and treated with western, as well as Chinese, medicine.

The various conditions described above are often found mixed in a single patient, with the predominating factor changing with changes in the patient’s life situation. Phlegm or damp may be part of any of the symptom pictures. When these factors are present, the headache tends to be duller and the head to feel heavy. In this case, the headache is more likely to linger, and takes longer to treat effectively.

Acupuncture has proven extremely successful in the treatment of headache and migraine. Because the causes of headache are complex, it is important to focus treatment on the root of the problem and a combination of Chinese and western medicine is most effective. As with most conditions, the longer the patient has suffered from headaches, the longer it takes to complete treatment. Cases in which there is blood stasis, such as in trauma, or phlegm take the longest to clear, the most intractable cases requiring up to a year of some form of therapy, such as herbal tablets. Cases due to wind may be cleared in a single, or just a few, sessions of acupuncture.

Qi gong meditation, light exercise, and breathing exercises are helpful for those who suffer chronically from headache.