Migraine Headache and Traditional Chinese Medicine |
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Migraine headache is a common condition with a prevalence of 17.6% females and 5.7% males. It was estimated that 23 million persons older than 12 years of age have severe migraine headaches. Medical research showed that there was a 60% increase in the disease from 1980 to 1989. The social and economic effects of migraine are staggering, between $2 to $17.2 million are lost in productivity per year. A successful treatment plan for migraine headache has not only medical but also serious economic and social implications (Capobianco et al, Mayo Clin Proc 1996, 71:1055-66). Diagnostic Issues Conventional Western Medicine Migraine headache is a recurrent neurovascular headache disorder characterized by attacks of debilitating pain associated with photophobia, phonophobia, and nausea and vomiting. The highest incidence of migraine occurs between the ages of 20 and 35, and is often associated with a positive family history of the disease. Migraine headaches are classified into two diagnostic categories: migraine with and without aura. Migraine without aura (common migraine) consists of unilateral or generalized cephalgia, throbbing or pulsatile in nature, in conjunction with nausea, vomiting, and photophobia. Migraine with aura is preceded by a 15-20 minute episode of visual or sensory aura. Auras are most likely visual alterations, usually experienced as hemianopsia and scotomata that enlarge and spread peripherally (Sinclair, Altern Med Rev 1999, 4(2):86-95). Traditional Chinese Medicine From the viewpoint of traditional Chinese medicine (TCM), migraine headaches are classified according to the overall condition of the patient, not only the nature of the headache. The headache is a result of disturbance or imbalance of Yin-Yang within the Zang-Fu organ system or the Channel system (Meridians), which are the two principal systems that regulate the functions of the body and mind. The diagnosis of TCM is the unique pattern differentiation of the clinical symptom-complexes, which represent specific pathological conditions that can be adjusted or reversed to physiological conditions by TCM therapeutic techniques such as medicinal herbs, acupuncture and Qi Gong therapy. The disharmony of the Liver system is the most common reason causing migraine headache. According to the Zang-Fu theory, the Liver is the organ system that regulates the flow of Qi as well as stores the soul (related to mental activity). The smooth flow of Qi regulates emotional activities as well as ensures that the overall body activity operates normally. The disharmony of the Liver system, most commonly deficiency of Yin energy or excess of Yang energy, causes irregular Qi flow and Blood stasis, and accumulates Heat inside the body. Both the Qi stagnation and the Heat accumulation may result in migraine headache. The Liver type of migraine shows moderate to severe intensity, sometimes with pulsating quality and aggravation by walking stairs or physical exercise. This type of migraine is commonly in conjunction with emotional strain or stress, feeling of oppression in the chest and hypochondrium, depression or anxiety, reddened tongue with thin coating, and taut pulse. Deficiency of the Kidneys is another common reason to cause migraine, especially for those patients with a long history of headache. According to the theory of the Five Elements (Phases), Water (Kidney) energy produces Wood (Liver) energy. The Kidney deficiency, caused by prolonged illness, may result in the Liver Yin deficiency and trigger headache. The Kidney deficient type of migraine shows mild to moderate intensity and is commonly in conjunction with weakness of lower back, low energy, lassitude, pale tongue, deep and weak pulse. Clinically there is a third type of migraine, which is the combination of the Liver type and the Kidney type of headache. The Liver Qi stagnation and Kidney deficiency may co-exist in the same patient. Migraine headaches are also triggered by other pathogenic factors such as Wind, Damp Heat and Cold. Examining the nature of the headache usually helps to identify the factors causing the headache. For example, Wind causes a moving headache (the location of the pain changes); Damp results in a headache with heaviness; Cold causes a headache that may get worse when the temperature drops. In addition, the location of the headache also makes a difference. The forehead headache is usually related to Stomach meridian, the crown and back headache is related to Bladder meridian, while the side headache is usually related to the Liver or Gall Bladder meridian. However, the major pathophysiological change of the body is the Qi stagnation and Blood stasis. Pattern differentiation process recognizes the signature symptoms for each organ system as well as the pathogenic factors. Proper diagnosis should be made thorough analyzing the complete history of the patients and all presenting symptoms, followed by checking the tongue and taking pulse. Treatment Conventional Western Medicine Currently no cure exists for migraine with allopathic medicine, although some degree of control can be achieved using symptomatic therapy, including simple analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), ergot derivatives, dihydroergotamine, serotonin agonists, and even corticosteroids or opioid analgesics. Because of the possible side effect of the drugs for migraine, more and more people have started to search for alternatives. TCM approaches to solving migraine focus on the imbalance of the whole body, which is the common reason causing headache. TCM therapies, a combination of Chinese herbs, acupuncture, manipulation, and Qi Gong therapy, are often more specific to each patient's condition according to their specific diagnostic categories. Traditional Chinese Medicine Acupuncture is the most common therapy for migraine. Efficacy of acupuncture towards migraine headache has been reported by many independent studies. Clinical trials showed significant decrease in the number of headaches and their duration after acupuncture treatment. The attacks were less severe and drug intake was reduced and did not re-increase until follow-ups (Vincent, Clin J Pain 1989, 5:305-12; Baischer, Headache 1995, 35:472-74; Lenhard et al, NZ Med J 1983, 96:663-6). Acupuncture analgesia has been thoroughly studied since the 70s. The major finding through these studies indicated that acupuncture stimulates endogenous morphine-like molecules such as endorphin and monoamine to block the pain signal. But acupuncture does far more than just the pain relief. It modulates endocrine and nervous system and stimulates self-healing process of the body. The actual mechanism is still unknown. Acupuncture therapy uses very thin needles to stimulate acupuncture points on the skin. For migraine headache the following acupuncture points are commonly used: Hegu (LI 4), Tainchong (Lv 3), Zulinqi (GB ), and Fengchi (GB ) etc. From my experience, a non-invasive electroacupuncture is also useful for this condition. Electroacupuncture is a method of stimulating acupuncture points with mild electric current. A number of points along the Stomach and Gall Bladder meridian on shoulder, neck and head, are often used. Electroacupuncture effectively relieves headache and relaxes tension of the muscle around the neck and shoulder. Chinese Tui Na (manipulation) for the neck and back also helps to relieve the headache. Dosage, duration and frequency of the therapy depend on individual patient. Most patients get some degree of relief after a single treatment. But the pain may come back after a few hours to a couple of days. This is due to the imbalance of the body. Multiple treatment is highly recommended because acupuncture analgesia has proven to be accumulative. Normally twice a week for 4-6 weeks (8-12 visits) is recommended. Complex cases with severe imbalance of the body may need longer time. For most of the cases, a properly prescribed Chinese herbal formula helps the patient to recover faster. Chinese herbal medicine is another common therapy for migraine headache. Chinese herbal medicine has been used to balance the body with natural products for thousands of years. The theory behind Chinese herbs is the unique Yin-Yang and Zang-Fu theory, which is parallel to Western physiology. For the disharmony of the Liver system, the principle of treatment is to smooth the flow of Liver Qi and clear the Liver Heat. The prescription is based on specific symptoms of each patient as well as the experience of each practitioner. Decoction of Bupleurum chinensis (Chai Hu), Angelica sinensis (Dang Gui) and Paeonia lactiflora (Bai Shao) in combination with other herbs is commonly used. For the pattern of Kidney deficiency, the principle of treatment is to reinforce vital energy of the Kidney and Liver. The prescription is usually the decoction of Rehmannia gutinosa (Di Huang), Dioscorea opposita (Shan Yao) and Cornus officinalis (Shan Yu Rou) with modifications. Patent formula is also available for both cases. Chinese herbal medicine is the core of traditional Chinese therapies for migraine headache and is very powerful to balance the body. It significantly reduces the pain, shortens the headache attacking time, reduces the frequency of the migraine and prevents the headache from happening. The duration of Chinese herbal treatment is usually 1-2 months and also depends on individual patient's condition. The tense lifestyle in the modern society is one of the reasons causing migraine headache and other related illness. The regularity of lifestyle, such as eating, resting and sleeping, is important for migraine patients in addition to the herbal and acupuncture treatment. Regular physical exercise, emotional control techniques and other calm activities are also necessary to prevent migraine attacking. Qi Gong is an ancient Chinese technique to actively promote circulation of Qi in the body and adjust the body inner clock to the natural clock. Similar to Yoga meditation, Qi Gong is the Chinese way to control and cultivate the energy of our body. It also serves as emotional control technique to prevent migraine headaches. Tai Ji Quan is another popular exercise in Chinese society. It combines Qi Gong and physical exercise and allows people to practice regularly to relax and adjust the conflict among the organ systems caused by the modern lifestyle. Both Qi Gong and Tai Ji Quan can be very good self-help techniques for migraine. Diet is considered an important influence of health and illness in TCM. Food is believed to be part of the medicine and affects the result of the herbal treatment. According to Chinese theory, food is classified into different groups according to their nature and taste. Fatty and greasy foods, alcohol, coffee or sweets can produce Dampness and Heat, while spicy also produces Heat. Migraine patients should avoid those food items in their diet, especially for those patients diagnosed with the disharmony of the Liver. On the other hand, diet is believed to complement the nature of each human body. Properly designed diet plan according to Chinese theories will compensate Yin-Yang nature of the body and benefit the overall health in a long run. Consult a TCM practitioner for more information about the diet of each specific case. |
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