Headaches

Dear Dr. Bartlett,

Can you treat headaches with acupuncture? My Mom has terrible headaches; she’s had them for years. She gets them five days a week. She has to spend most of the day lying down. She had one Sunday when I was visiting. It’s hard to watch. I was wondering if there’s anything acupuncture could do for her. I’d sure like to find something that could help her. Jack Collins, Asheville, NC

I am pleased to report that acupuncture is indeed an effective treatment for headaches of all kinds, including migraines, sinus and stress induced headaches.

Standard western medicine diagnoses headaches according to type or physical causes: cluster headaches (headaches grouped together in the same day of over several weeks), tension headaches (due to tight muscles in the neck and base of the head), sinus headaches, headaches due to head trauma or migraine headaches (severe pain, often accompanied by nausea and seeing auras). These different types of headaches are all basically treated in the same manner, using weaker or stronger analgesic drugs to provide symptomatic relief of pain. The problem is that this symptomatic approach to treatment does not address the root cause of the disease. Many patients suffer for years, decades or even lifelong with pain, that may temporarily abate with medication, but never completely resolves.

In contrast, Traditional Chinese Medicine (TCM) employs an individualized approach to treatment: diagnosis by constitutional patterns of related symptoms affecting the patient’s entire body. Pattern diagnosis allows acupuncturists to specifically direct treatment to address the root cause of the disease that produces the pain. This root cause is different for each patient. TCM’s individualized approach to treatment yields effective clinical results and provides a long term resolution of symptoms.

There are three constitutional patterns of headaches commonly seen in clinic. The first is what I will call a Qi Rising headache 1, caused by too much Qi2 (energy) rising to the head. The Qi Rising headache presents with pain that is induced by or worsened with stress, or accompanied by irritability or frequent anger. Generally, the pain is on the temples or above the ears, but can also be behind the eyes, on the top of the head or at the base of the skull. When this headache presents with severe, throbbing or pounding pain, accompanied by symptoms of nausea or vomiting (stomach qi rising up) or visual lights or auras, it is diagnosed as a migraine headache in western medicine.

The explanation of how this pattern causes headaches goes like this: when we are angry or under stress we tighten up. When we tighten up, we constrict our Qi, or energy. This bound-up Qi builds up pressure that must somehow escape, causing irritability and angry outbursts (it’s a cycle). The emotional outburst does not fully release the Qi, which is light and has a tendency to travel upward. So the bound-up Qi pushes upward to the head, causing headaches. For this reason, an integral component of treatment for Qi Rising headaches includes stress management, because as long as the patient continues to internalize stress, the pattern will perpetuate itself.

The second commonly seen headache in clinic is the Damp headache. This headache includes a subset of Phlegm induced headaches that present in conjunction with allergies, sinus problems and head colds. Patients with this type of headache feel a pressure type pain in the head, often behind the eyes or in the sinuses. They may describe a band-like sensation, or a heavy-headed feeling, that may be accompanied by symptoms of poor concentration or ‘foggy’ headedness, poor appetite or heavy limbs. These Damp headache patients are walking barometers, and commonly report that the headache is worse with weather changes, particularly during cloudy or rainy weather.

In this pattern TCM sees the root issue is poor digestive function, which cannot process fluids properly, causing them to accumulate into phlegm or dampness. The pressure, heaviness and fullness are due to the excess, accumulated fluids in the head, causing pain. Poor appetite indicates weak digestive function. Because an excessive amount of fluids has accumulated, the body has difficulty maintaining homeostasis. Cloudy or rainy weather throws off the delicate balance, and headaches worsen.

The third TCM headache pattern presenting commonly in clinic is the Blood Stagnation headache, due to poor blood circulation. A sharp, stabbing pain in a fixed location characterizes this headache that commonly occurs after a traumatic injury to the head. Women with this type of headache often have painful periods with blood clots. In Chinese medical theory, pain is caused by stagnation of Qi and Blood. In this pattern, it is blood that is not circulating properly and the stagnant blood produces a fixed, sharp or stabbing pain, also described as piercing or shooting pain.

There are many other TCM patterns of headaches that present less commonly (or even rarely) in clinic, so I will leave discussion of those patterns for the textbooks.

As each of these headaches has a different presentation and constitutional pattern, TCM practitioners (acupuncturists) treat each of these headaches differently by using a combination of acupuncture and Chinese herbal formulas. If weak digestion and excess fluids are the problem (Dampness or Phlegm) we use points and herbs to strengthen digestive function and drain excess fluids. Tangerine peel is often used, in combination with other herbs. Moving Qi and blood treats a blood stagnation headache. Acupuncture works with, and effectively moves Qi. Peach seed and safflower are a synergist herbal combination to move blood. To treat a qi rising headache we anchor qi (like sandbags holding down a hot air balloon) to prevent it from rising to the head. Points in the feet are often used, in conjunction with heavy minerals, such as oyster shell.

How effective is Chinese medicine in treating headaches? Several 2005 studies demonstrated decrease in pain and frequency of treatments with acupuncture. In July, 2005 ABC News reported a German study showing that acupuncture cuts the rates of headaches by nearly half in a study of 270 people.

“A significant proportion of patients with tension-type headaches benefited from acupuncture,” Dr Wolfgang Weidenhammer, from the Center for Complementary Medicine Research at Technische Universitat in Munich, said. “Acupuncture was well tolerated and improvements lasted several months after completion of treatment,” he said.3

Another 2005 study, at the University of North Carolina, adds to a growing body of clinical research supporting acupuncture’s role as a headache therapy. This study of 74 chronic headache sufferers found that those who added a six-week course of acupuncture to their medical treatment reported less pain and better quality of life compared to those who didn’t get the therapy. “Adding acupuncture to their treatment clearly improved their situation,” said the study’s lead author Dr. Remy Coeytaux, an assistant professor in the University of North Carolina at Chapel Hill School of Medicine’s department of family medicine.

Results of the study were reported in the October, 2005 issue of the journal Headache, which is published by the American Headache Society. The International Headache Society criteria for chronic tension-type headache are headaches on 15 or more days a month (180 days per year), for at least six months. Seventy-four patients recruited to participate in the study were already receiving treatment in the Headache Clinic at UNC Hospitals. To be eligible for the study, a person had to suffer from headaches at least 15 days a month. However, most participants reported that they had headaches nearly every day.

Results: Patients who received only medical management did not demonstrate improvement in any of the standardized measures. . . Patients who received acupuncture were 3.7 times more likely (CI, 1.7 to 8.1) to report less suffering from headaches at 6 weeks. . .

Conclusion: Headache-specialty medical management alone was not associated with improved clinical outcomes among our study population. Supplementing medical management with acupuncture, however, resulted in improvements in health-related QoL [quality of life] and the perception by patients that they suffered less from headaches. (Headache 2005; 45:1113-1123).

Let me demonstrate acupuncture’s effectiveness in treating headaches by sharing a dramatic, acupuncture headache case that presented while I was attending acupuncture college. A patient (I’ll call her Connie) came into the student clinic, holding a prescription for morphine in her hand. Connie was an attractive, young woman who been suffering from severe migraine headaches, occurring on a daily basis for several years. The doctors did not know what to do for her other than to continue prescribing stronger and stronger painkillers, the standard western medical treatment for headaches. At 20 years of age, Connie now had a prescription for a mind-altering, highly addictive drug, and not real hope that the headaches would stop. Connie remembered our clinic, and decided to come see if acupuncture could help her before she filled the morphine prescription.

During the initial evaluation, we asked Connie standard, Chinese medical questions about how long she had been having headaches, what seemed to make it better or worse, what type of pain she felt, and where on her head the pain was located, followed by a TCM review of systems to reveal Connie’s pattern imbalances. Using this information, we arrived at a TCM diagnosis of her condition, and developed an acupuncture point prescription for her treatment. During the treatment, we inserted two needles and then paused to observe Connie’s reaction to acupuncture. After a few minutes Connie began to cry. Concerned, we asked Connie why she was crying. Connie told us that this was the first time in several years that she had felt the pain go away. Connie was shedding tears of relief.

How did the acupuncture stop Connie’s pain? Chinese medical theory sees that Qi (energy) moves in vessels, called channels or meridians. Just as we have a blood vessel, nervous and lymphatic system, TCM recognizes a vessel system that qi moves in. The channels begin at the tips of the fingers and toes and travel to the head. Scientists have photographed the meridians which show a color change with infrared photography.3

Acupuncturists determine the specific location on the head that the pain is to identify which meridian is affected, and then use local points on the affected channel near the painful area, and include points at the end of the affected meridian, on the arms or legs. When there is pain, there is a blockage in the flow of Qi (energy) on the affected channel. Acupuncturists employ points at the distal ends of meridians to open up and reestablish the smooth flow of qi in the affected meridian. The acupuncture points have specific functions, such as moving qi and Blood, anchoring qi, or regulating fluids. Acupuncture points are selected with regard to function to address the constitutional pattern affecting the patient. In Connie’s case, the two needles were inserted on acupuncture points on her foot and ankle, located on the affected meridian.

I have treated many patients with headaches and find that the headaches usually begin to abate within five to seven acupuncture treatments. Often patients notice that pain diminishes during or immediately after the acupuncture treatment. Chronic headaches that have gone on for many years, or severe migraines often take longer to resolve. Given some continued care, I expect that even longstanding, chronic headaches will resolve with acupuncture treatment.

1 In TCM, this pattern is known as a Liver Yang Rising headache. For simplification, I am naming it Qi Rising as this term is easier for those uninitiated in Chinese medical theory to understand.
2 Qi (pronounced Qi) is the energy of life, differentiating a living, breathing, animated being from a cold, still corpse. It is Qi that provides warmth and movement for the body so that the hands grasp, legs walk, the organs perform their functions of digestion, elimination, breathing, pumping blood, thinking and reproduction.
3 Acupuncture Shown to Relieve Tension Headache. July 29, 2005. www.ABCNews.com
4 Yin Lo. What are Meridians? Can We See Them? Acupuncture Today March 2004; 5(3): 10, 12.