Headache - CatsTCMNotes

Course: Acupuncture Treatment of Disease 2 Date: February 2, 2009 

Class #: 5 – Headache and Migraine 

Headache 

Tou Tong 

Cephalgia is pain of the head. A headache can be an isolated 

phenomenon or could be a symptoms of both acute and chronic 

diseases. Headaches can be primary (no cause you can pinpoint – just 

happens) or secondary (a result of something else). 

Headaches result from stimulation of, traction of, or pressure on any of 

the following pain sensitive structures on the head: 

☯ Blood vessels – there are a lot of nerve endings on the blood 

vessel walls 

☯ Cranial nerves 

o Trigeminal – CN V 

o Glossopharyngeal – CN IX 

o Vagus – CN X 

☯ Tissues covering the cranium 

o Scalp 

o Muscles 

o Ligaments of head/neck 

Some types of headaches in Biomedicine include: 

☯ Vascular headaches. 

As an example, migraines are often classified as vascular headaches. Vascular headaches are the 

result of blood vessels enlarging and compressing an adjacent nerve which causes the headache. 

☯ Muscular contraction headaches. 

Tension headaches are muscular contraction type headaches. Symptoms include 

tightness/stiffness of scalp, neck, shoulder, trapezius, SCM. They can result from emotional 

stress, overwork, common cold (wind-cold), and Taiyang diseases (as outlined in the Shang Han 

Lun). 

☯ Traction or inflammatory headaches. 

Sinus headaches are an example of inflammatory headaches. Inflammatory headaches are the 

result of pressure in the head increasing and causing pain. Other possible causes (in addition to 

sinusitis) can include hemorrhaging in the brain due to stroke, tumors, etc. Be careful not to 

mask over possible tumor symptoms. 

There are many ways to classify headaches. Another classification method is to classify by extracranial, 

the more common and typical type, or by intracranial which is more severe and maybe even fatal. For a 

different classification, one used in the biomedical community rather frequently, check out these notes 

starting on page 5. 

Acupuncture Treatment of Disease 2 – Winter 2009 

www.CatsTCMNotes.com 

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Treatment is often a combination of pain relievers, anti-inflammatories, inhalers, antibiotics, etc. 

Symptoms of a headache when described in biomedical terms include location of pain, nature of pain 

and inducing factor. 

☯ Throbbing or dull pain? 

☯ Nausea? Vomiting? 

☯ Blurred vision? 

☯ Tender scalp? 

☯ Sensitivity to light, odors, and noise? 

Yes to these questions can help determine a migraine status. 

Types of headaches per TCM Classification 

Type Channels Location Etiology Guiding herbs 

Taiyang SI, UB Occiput ☯ Wind 

☯ Wind-Cold 

☯ Stress 

☯ Ma Huang 

☯ Ge Gen 

☯ Qiang Huo 

Shaoyang SJ, GB Temporal ☯ Damp Heat in GB ☯ Chai Hu 

☯ LV Yang 

Yangming LI, ST Forehead ☯ Yangming disease 

i.e., external pathogen 

invasion – sinus 

headache 

☯ Irregular diet 

Coffee, alcohol, etc. 

Jueyin PC, LV Vertex ☯ LV Blood Xu 

☯ Cold in LV channel 

All-over 

headaches 

☯ Huang Qin 

☯ Bai Zhi 

☯ Shi Gao 

☯ Sheng ma 

☯ Gao Ben 

☯ Xi Xin 

☯ Wu Zhu Yu 

(Cold in LV ch) 

☯ Chuan Xiong* 

*Chuan Xiong is the most basic herb for all types of headaches…Chuan Xiong Cha Tiao San formula 

works for allergic and external invasion headaches. Drink 3-5 grams in powder form with green tea. 

TCM Etiology 

Five etiologies to know regarding headaches in TCM: 

☯ Invasion of external pathogens 

o Pressure: wind 

o Temperature: cold or heat 

o Humidity: dry or damp 

You can therefore have headaches with patterns such as wind cold, wind heat, wind damp, wind 

dryness, etc. 



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☯ Emotional disorders 

o Liver – more deficiency related headaches 

o Gall Bladder – more excess related 

☯ Irregular diet 

Overconsumption of spicy foods, alcohol, coffee, etc. 

☯ Overworking 

Consumes yin, leading to an imbalance of yin/yang 

☯ Trauma 

TCM Mechanism 

Blockage of channels in the head 

with disorder of Shi (excess) and Xu in the upper and lower parts of the body. 

Headaches are a Channel syndrome and 2/3 of them are excess in nature. Channels that flow through or 

on the head include: 

☯ The 6 regular Yang channels 

☯ Ren channel 

☯ Du channel 

☯ Yin Qiao channel 

☯ Yang Qiao channel 

☯ Liver 

which is a yin organ with yang functions. 

TCM Differential Diagnoses and Treatments 

Differential diagnoses for headaches are a mix of excess/deficiency and internal/external. 

External evils are excess in nature and are the invasion of external pathogens such as wind-cold, windheat 

and wind-damp. 

Internal evils causing headaches can be excess or deficient. Excesses are Liver Yang/Fire, Turbid 

Phlegm and Inner Wind, and Blood Stasis. Deficiencies are Blood xu and Kidney xu. 

Basic Points to treat Headaches 

☯ GB 20 is suitable for headaches of any kind, including migraines. It also expels wind for 

headaches of either external wind or internal wind. 



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☯ Du 20 balances Yang Qi. Also good for one-sided headaches, vertex headaches, wind in the 

head including that which induces dizziness. 

☯ Taiyang extra point treats headaches and migraines in the temporal region (best to combine it 

with distal points). Also eliminates wind and heat. 

☯ Yintang treats frontal headaches. 

☯ LU 7 + LI 4 host/guest combination. Together these also balance the Yang. 

o LU 7 is the command point for the head and nape of the neck; addresses headaches, stiff 

neck and nape, one-sided headaches. 

o LI 4 is the command point for the face and mouth. Good for headaches, one-sided 

headaches and whole-head headaches. 

☯ UB 10 to treat stiff neck and occipital headaches. Activates and alleviates pain of the Taiyang 

channel. Deadman says it addresses pain and heaviness of the head, headache, wind affecting 

the head, inability to turn the head due to stiffness in the neck. 

☯ SJ 3 activates the SJ channel and alleviates pain. It is used for one-sided headaches and pain 

in the temples. The San Jiao channel is closely associated with the Shaoyang channels, so 

assists in treating Shaoyang headaches. 

☯ SI 3 benefits the occiput, back and neck, activates the channel and alleviates pain. It is 

indicated for stiffness and pain with difficulty turning the neck to one side. It is also useful 

for bilateral pain and pain in the shoulder and upper back. 

Taiyang Headaches GB 20, UB 10, SI 3 

Shaoyang Headaches Taiyang and SJ 3 

Yangming Headaches Yintang extra point 

Jueyin Headaches Du 20, LU 7, LI 4 

Generally: For acute headaches acupuncture is better and faster than herbs. If there is a heavy 

sensation that goes to the forehead and eye area when needling GB 20 the patient’s headache 

should be greatly relieved after the treatment. 

Wind-Cold Invasion Headache 

This is an external excess headache caused by invasion of external pathogens. This type of 

headache is a Taiyang headache and affects the occiput and below. 

UB 12 and 13 as well as SJ 17 help to expel wind. Moxa warms the channels and helps expel the 

cold. 



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Wind-Heat Invasion Headache 


headache is a Yangming headache affected the forehead region and below. 

Wind-Damp Invasion Headache 


headache affects the temporal region or whole head and is a Shaoyang headache. 



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Liver Yang Rising and Flaring up of Liver Fire 

This is an internal excess headache. It affects either the vertex (LV) or temporal area (GB). 

Know these symptoms! 

Retention of Turbid Phlegm and Inner Wind 

This is an internal excess headache. It is primarily though not exclusively a temporal headache. 



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Retention of Blood (Xue) Stasis 

This headache is one of internal excess and can be either acute or chronic. Location can be 

anywhere on the head. 

Blood Deficiency (Xu) 

This is an internal deficient headache and is chronic in nature. It is related to anemia, irregular 

menstrual cycle with heavy bleeding and post-partum bleeding. Headaches are Jueyin headaches 

and may be felt at the vertex or internally. 



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Kidney Xu of Essence or Yin 

This is an internal deficiency and is associated with a Jueyin headache around Du 15 and Du 16. 

Know these symptoms! 



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Migraine 

Pian Tou Tong or “unilateral head pain” 

Biomedically, migraines are defined as a biological 

disorder of the CNS. The most common type of 

migraine is of vascular nature and is due to a rapid 

change in the size of blood vessels. Somewhere in the 

neighborhood of 25million people suffer from 

migraines annually, according to a 1999 study. That 

breaks down to 20% of women and 11% of men that 

will experience at least one migraine in their lifetimes. 

Cost in medical care and productivity loss combined is 

more than $17billion per year. 

The biomedical mechanism causing migraines is an 

insufficiency of serotonin. Serotonin is a 

neurotransmitter – the equivalent of Wei Qi as the 

carrier of Shen – and plays a significant role in the 

contraction and expansion of blood vessels. 

Migraine triggers include: 

☯ Bright lights and sunshine 

☯ Diet factors including MSG, 

chocolate, red wine, etc. 

☯ Noises – loud or noisy sounds 

☯ Stress 

☯ Various smell triggers 

☯ Fluctuation of hormones 

☯ Changes in barometric pressure 

☯ Chemical sensitivities and pollution 

☯ Trauma 

☯ Lots more… 

Symptoms: 

The following list contains both symptoms and the measures by which one is classified as a migraine 

sufferer for biomedical purposes: 

☯ Patient has had at least 5 headaches with similar features lasting 4 – 72 hours per episode. 

☯ Headaches are of moderate to severe intensity and last 2 – 72 hours 

☯ Throbbing, pulsating pain 

☯ Initially begin as unilateral headaches (typically) 

☯ Pain is worse with activity (walking, exercise, esp going up/down stairs, bending over, etc.) 

☯ Pain is often accompanied with nausea/vomiting 

☯ Sensitivities to: 

o Light (photophobia) 

o Sound (phonophobia) 

o Smells (osmophobia) 

☯ Family history of migraines (in TCM this is reflective of a Kidney Essence Xu) 

☯ Cyclical pattern – tend to recur cyclically 

Migraines are classed into two types in the biomedical model: common migraines and classic migraines. 



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☯ Classic migraines have auras, a visual pattern of colors and/or visual disturbances that look 

like lines around what the patient sees. Classic migraine sufferers often have early signs that 

a migraine is coming on which could be dizziness, mild nausea, etc. Classic migraines are 

experienced by 15-40% of migraine patients. 

☯ Common migraines come without any early warnings such as the auras. These are far more 

common and account for 60-85% of all migraines experienced. 

The differences between headaches and migraines. 

Though a migraine could be a two-sided headache, for more commonly they are one-sided. Twosided 

headaches would be a sub-category of headaches. Migraines are associated with more 

throbbing pain, sensitivity to light, cyclical patterns and are far longer in duration than 

headaches. A migraine might last as little as 4 hours or as long as 72 and is often vascular. 

Migraines also often have digestive problems and visual disturbances up to and during the 

migraine. 

Migraines are associated with blood dysfunction, and not just of a deficiency type either. 

Dysfunction of blood leads to mental and shen problems as well as memory problems. Wei 

(defensive) Qi and Ying (nutritive) Qi are the carriers of Shen. If the blood is blocked or 

deficient the Ying Qi also becomes blocked or deficient which leads to Shen disturbance. 

Treatment protocols in western medicine prescribe prozac, propranolol, amitriptyline, and 

carbamazepine to reduce frequency of episodes. Ergotamine is often prescribed upon the first attack and 

sometimes just ibuprofen to relieve pain. 

TCM Etiology 

There are 4 basic etiologies for migraines in TCM: 

1. Invasion of external pathogens 

Changes in weather (wind, heat, cold, etc.), sunshine and bright lights, odors and pollution, 

noises/sounds/voices are considered external pathogens because they can cause migraines for 

those that are susceptible. The 5 sense organs are yang in nature and are therefore easily affected 

by Yang messages such as the pathogens listed above. Entry of these pathogens causes a Yang 

excess and thus the migraine. 

2. Irregular diet 

This causes a disharmony of the Middle Jiao (SP/ST) either due to the Liver overacting on the 

Spleen or due to weakness of the Spleen/Stomach. 

3. Emotional disorder 

Related to the Liver which ends at the vertex. The liver plays a strong role in the head and is in 

charge of the nervous system. 

4. Overworking. 

This causes an excess on the head and a deficiency in the lower part of the body. 



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TCM Mechanism 

Hyperactivity of the 5 sense organs with Excess and Deficient disharmony 

between the upper and lower parts of the body. 

Note that the mechanism for headaches is very similar: blockage of channels with the same type of 

disharmony. 

TCM Differential Diagnoses and Treatments 

Differntial Diagnoses include both excesses and deficiencies. Deficiencies include Ht and Lv blood xu 

and Lv and Kd xu. Excesses include Lv Yang/Fire and disharmony of Lv and MJ. 

Basic Points 

☯ GB 4, 5, 8 

All are indicated for headaches and migraines 

☯ GB 14 

This is the point at which the Gallbladder channel meets the Yang Wei, SJ, ST, and LI 

channels. It can treat headaches in the infraorbital region, forehead, temporal/shaoyang, and 

parietal regions as well as in the eye. 

☯ GB 20 

Indicated for migraines (i.e., “one sided headache” including migraines due to hypertension). 

Deadman says this is the predominant point to treat all diseases of the head, brain and 

sensory organs, especially the eyes. Ah! Maybe that’s why you aim it at either the same side 

or contralateral eyeball when you insert! 

☯ GB 41 + SJ 5 

o GB 41 

For headaches and migraines, occipital pain, vertex pain, eye pain. Because it also 

spreads Liver qi, great for vertex headaches, Liver Yang/fire rising. Also as the confluent 

point of the Dai Mai, can help balance upper and lower body. 

o SJ 5 

Classically indicated for temporal, vertex, and frontal headaches as well as Kidney xu 

headaches because 1) it expels pathogenic factors and is thus useful for headaches 

associated with wind cold, wind heat and wind damp, 2) it is the confluent point of the 

Yang Wei vessel which links all Yang channels, 3) it connects with important points for 

headaches like GB 13-20, ST8 and Du 16, and 4) that’s important because GB and LV 

channels are so closely linked. And that’s where the migraine thing comes in. SJ 5 treats 

migraines arising due to LV disharmony and is often coupled with GB 41 for this very 

purpose. 



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☯ DU 20 

This is the meeting point for Du, Bladder, Gallbladder, and San Jiao yang channels as well as 

the Liver channel. It is the most Yang point in the body and thus regulates Yang. Indicated 

for migraines, vertex pain. It is also said to treat sense organ problems. 

☯ Yintang 

For pain in the forehead 

☯ Taiyang 

Local point for migraine headaches, especially in the temporal region. Also eye pain. 

General rules: you can use gentle energetic body work/touch to help with migraine if the patient can 

tolerate it. You must find the specific/exact point however. If one side is too sensitive to be manipulated 

or touched, treat the opposite/contralateral side. GB 20 is the best point to treat acute headaches in order 

to relieve pain. Use a heavy stimulation here. 

Rising of Excessive Liver Yang/Liver Fire 

As implied this is an excess…but also can be a deficiency. Males experience this type more than 

females, but females may experience this before their periods. 



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Disharmony between LV and MJ with rebellious ST Qi 

This is an excess. Both men and women experience this. In females, occurs 3-5 days before the 

period begins. 

Heart and Liver Xue Xu (blood deficiency) 

This is a deficiency pattern occurring more in females, especially at the end of menses or if there 

is heavy bleeding during menses. 



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Liver and Kidney Xu 

This is also a deficiency pattern, occurring more in females, especially during menopause. 

Know the difference between the different types of headaches and which points to use for each 

Know the basic points as a whole too. 

Know what the external pathogens for headaches are 

Know the differences between Liver fire flaring up and Liver Yang rising 

Review and know the Kidney Xu pattern symptoms and treatment 

Know the difference between headaches and migraines. 



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Headache - CatsTCMNotes

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