News Letter, August, 2014, © Copyright
Jun Xu, M.D. Lic. Acup., Hong Su, C.M.D., Lic. Acup.
Rehabilitation Medicine and Acupuncture Center
1171 East Putnam Avenue, Building 1, 2nd Floor
Greenwich, CT 06878
Tel: (203) 637-7720
Joan T. is a 16-year-old-girl. She was brought by her mother, come to me for severe headache. Joan started to have headache since age 12 when she started to have her period. Her mother and herself told to me her headache is very severe, when she has four or five days per week. The pain is dull and affects both sides of the temporal area and also focussed on the left eye with very deep pain, sometimes the pain will start from the neck shooting up to the temporal area. The pain is so severe and very often the pain prevent her go to school. Because of so many days four to five days a week, so if she will go to school she always call her mom to pick up her back to home, which interferes her study so much and one day her mother decided to bring her home in a American way to teach her the home school, so her mother borrowed so many books and stated to teach her at home and her mother quit her job. She taught her mathematics, English, and world history and physics etc. However, now she is 16 years old, junior in high school. It is a time for her to prepare her college entrance exam and prepare all the application to the college. However, at this time her headache is getting severe and she could not think whenever she started she feels headaches and she had poor sleep and now she is very stressed, always crying and when she came to my office she was very depressed and she did not want to talk and because of the severe headaches and stress that she started to eat all the junk food so she looks very obese. Her mom reports she went to all different kind of doctors, everybody gave her different medications, however, none medication helped her. Her SAT exam will commence within two months and, however, she even did not finish one book preparation for her SAT exam, so her mom is very frustrated and brought her to me to evaluate and treat.
By physical examination, this was a slight obese young girl, very depressed and stressed. She spoke in a low tone; she did not like light, felt pain by touching her temporal area and back of the scalp, i.e. the occipital area.
The patient might have one of the following three types of primary headache, i.e., tension headaches, cluster headache, and migraine. She might as well have a mix of the two or three of the following headache.
Tension headache is the most common type of chronic frequent headaches. The symptoms of tension headache include the steady pain on both side of the head and with feeling of pressure and tightness around head and as a band is put tightly around it. The pain usually increased over period of hours when the pain gets worse, which might develop pulsating quality. The pain radiates from neck, back, eyes or other body parts.
Cluster headache is often described as a sharp, penetrating or burning sensation on the one eye. The patients always state the pain is focused on one eye like somebody punched her or his eye and this pain is sudden onset without warning within a few minutes excruciating pain develops and people with the cluster headaches appears restless and the pain is so severe, some patients report the pain is even worse than childbirth. The cluster headache usually lasts about 2 to 12 weeks, some chronic cluster headache may continue for more than a year. These sometimes go with seasonal change.
A migraine headache is a throbbing or pulsating headache that is often one side and associated with nausea and vomiting, and sensitive to light, sound, and smell with sleep disruption and depression. These attacks are very often recurrent and do not change with age, sometimes develop a chronic migraine headache.
There are two types of migraine headache, migraine with aura and migraine without aura. Most auras are visual and are described as bright shining light around objects or at the edges of field of vision or zig‑zag lines with wave image or hallucinations, some may experience temporary vision loss and motor weakness, speech, or language abnormalities, dizziness, vertigo, tingling, or numbness
The causes of headaches are usually different.
The causes of tension headaches are usually caused by stress, muscular tension, and gouty arthritis on the neck or spine, postural changes, vascular dilatation, protracted coughing or sneezing and fever and depression and temporal mandibular joint disorder etc.
The cause of the cluster headaches is unknown, however, cluster headache also well known to be triggered by alcohol, nitroglycerin, or similar drugs.
The cause of migraine headaches is unknown either. It is very often. There is a family history of disorder and migraine headache can be triggered with many stimulants for example alcohol, weather, altitude, exertion, food, and color and contrasting pattern, hormonal change, hunger, lack of sleep, medicine, perfume and stress etc.
From the western medicine point of view, there is many different kind or medications to treat headaches. For example, Topamax, Imitrex are using for migraine headaches with some successful cases. However, beta blockers, antiseizure medication, calcium channel blockers, tricyclic antidepressants, and analgesics such as aspirin, ibuprofen, acetaminophen etc are tried to treat migraine, cluster, and tension headaches. However, most of these drugs can not provide significant improvement for above headaches. Therefore, more and more patients are starting to look for alternative treatments. Acupuncture is one of the best therapies for the headaches.
Chinese medicine classifies headaches into two categories:
1. External wind attack headaches: the headaches are caused by external factors, such as wind cold and wind heat. The headaches usually have a character of acute onset and very severe and constant attack.
Wind Cold: it shows periodic attack, the pain always is connected with neck and upper back and aversion to wind and cold, the head feels heavy, likes to have a band to tight around the head. The patient does not feel thirsty, and have thin and white coating on the tongue with floating pulse.
Wind Heat: feels expending headache from inside of the head, accompanied with fever and aversion to heat and wind, reddish face and eye, feels thirsty, constipation, yellowish urine, red tongue body with yellow coating on the tongue and floating pulse.
2. Internal organ dysfunction headaches: internal headaches usually are slowly onset and the pain is mild and sometimes feels emptiness within the head. When patients are on stress and overwork, the pain will be worse. The pain is on and off and usually last for long time.
According to traditional Chinese medicine, head is the collection of all the Yang Meridians. The six Yang Meridians all distribute to the head and face and also liver Meridians go up to the top of the head, therefore, headaches can be diagnosed based on the meridian distribution. If we know the Meridians distribution, so then we will be easier to make clear diagnosis and treatment.
1. Tai Yang (Urinary Bladder) meridian headache usually located at top of the head and back of the head and connected to the neck.
2. Yang Ming (Large Intestine) meridian headache usually is on front of the head, i.e. the forehead including upper portion of the eye.
3. Shao Yang (Gall Bladder) meridian headache usually is on the bilateral temporal area and radiates to the ear.
4. Jue Ying (Liver) meridian headache usually is on the top of the head sometimes connecting to the eyes and frontal head. (Large Intestine) meridian headache
Acupuncture treatment for headaches:
First ask the patient the location of the headache and the severity of the headache, i.e. find out which internal organ shows dysfunction.
Second ask the patient about their accompanied symptom, differentiate the wind cold from the wind heat.
1. For Tai Yang (Urinary Bladder) meridian headache, i.e. the headache locates on top of the head and back of neck. We choose the following, GB20 Feng Chi and DU16 Feng Fu and DU19 Hou Ding and BL9 Yu Zhen and BL60 Kun Run and SI3 Hou Xi.
|1||Feng Chi||Gall Bladder 20||In the depression between the upper portion of m. sternocleidomastoideus and m. trapezius, on the same level with Fengfu (Du 16)||Headche, vertigo, insomnia, pain and stiffness of the neck, blurred vision, glaucoma, red and painful eyes, tinnitus, convulsion, epilepsy, infantile convulsion, febrile diseases, common cold, nasal obstruction, rhinorrhea.|
|2||Feng Fu||Du 16||Directly 1 inch above the mid point of the posterior hair line, directly below the external occipital protuberance, in the depression between m. trapezius of both sides||Headache, neck rigidity, blurring of vision, epistaxis, sore throat, post-apoplexy aphasia, hemiplegia, mental disorders.|
|3||Hou Ding||Du 19||On the midline of the back of head||Headache, vertigo, mania, epilepsy|
|4||Yu Zhen||Urinary Bladder 9||1.3 inch lateral to midline of the body, on the lateral side of the superior border of the external occipital protuberance||Headache, neck pain, dizziness, ophthalmalgia, nasal obstruction|
|5||Kun Lun||UrinaryBladder 60||In the depression between the external malleolus and archillus tendon||Headache, blurring of vision, neck rigidity, epistaxis, pain in the shoulder, back and arm, swelling and heel pain, difficult labor, epilepsy|
|6||Hou Xi||Small Interstine 3||On the ulnar side, proximal to the 5th metacarpophalangeal joint, at the end of the transverse crease.||Pain and rigidity of the neck, tinnitus, deafness, sore throat, mania, acute lumbar sprain, night sweat, fever, contracture and numbness of the finger, shoulder and elbow pain|
- For Yang Ming ((Large Intestine) meridian headache, i.e. the headache locates on the front of the head, i.e. the forehead including upper portion of the eye. The acupuncture points are Yin Tang and Tai Yang (Extraordinary Points), Lu 7 Lie Que, LI 4 He Gu, GB 14 Yang Bai
|1||Yin Tang||Extraordinary Point||Midway between the medial ends of the two eyebrows.||Headache, head heaviness, epistaxis, rhinorrhea, infantile convulsion, frontal headache, insomnia|
|2||Tai Yang||Extraordinary Point||In the depression about 1 inch posterior to the midpoint between the lateral end of the eyebrow and the outer canthus||Headache, eye diseases, deviation of the eyes and mouth|
|3||Lie Que||Lung 7||Superior to the styloid process of the radius, 1.5 inch above the transverse crease of the wrist.||Cough, pain in the chest, asthma, hemoptysis, sore throat, spasmodic pain of the elbow and arm|
|4||He Gu||Large Intestine 4||On the dorsum of the hand between th e1st and 2nd metacarpal bones, approximately in the middle of the 2nd metacarpal bone on the radial side.||Headache, pain in the neck, redness swelling and pain of the eye, epistaxis, nasal obstruction , rhinorrhea, toothache, deafness, swelling of the face, sore throat, arotitis, trismus, facial paralysis, febrile die\seases with anhidrosis, hidrosis, abdominal pain, dysentery, constipation, amenorrhea, delayed labour, infantile convulsion, pain, weakness and motor impairment of the upper limbs.|
|5||Yang Bai||Gall Bladder 14||On the forehead, 1 inch directly above the midpoint of the eyebrow||Headache, pain of the orbital ridge, eye pain, vertigo, twitching of th eyelids, ptosis, tearing|
For Shao Yang (Gall Bladder) meridian headache, i.e. the headache usually is on the bilateral temporal area and radiates to the ear. The following points are chosen, GB 20 Feng Chi, Extra Point 1 Tai Yang, SJ 5 Wai Guan, ST 8 Tao Wei, GB 38 Yang Fu, GB 39 Jue Gu.
|1||Feng Chi||Gall Bladder 20||As above|
|2||Tai Yang||Extraordinary Point||As above|
|3||Wai Guan||San Jiao 5||2 inches above the transverse crease of the dorsum of wrist, between the radius and ular.||Fever, headache, cheek and neck pain, deafness, tinnitus, elbow and arm pain, hand tremor|
|4||Tou Wei||Stomach 8||0.5 inch within the anterior hairline at the corner of the forehead||Headache, blurring of vision, eye pain, tearing|
|5||Yang Fu||Gall Bladder 38||4 inch above and slightly anterior to the tip of the lateral malleolus, on the anterior border of the fibula||Migrane, pain in the outer canthus, axillary region, scrofula, lumbar, chest, hypochondriac and lateral leg.|
|6||Jue Gu||Gall Bladder 39||3 inch above the tip of the external malleolus, 1 inch below Yang Fu||Apolexy, hemiplegia, pain of the neck, abdominal distension, pain in the hypochondriac region, muscular atrophy of the lower limbs, spastic pain of the leg, beriberi.|
- For Jue Ying (Liver) meridian headache usually the pain is on the top of the head
and many time it connects to the eyes and frontal head. Du 20 Bai Hui, Liv 3 Tai Chong, Lung 7 Lie Que
|1||Bai Hui||Du 20||On the midline of the head, cross the line of two ear tips||Headache, vertigo, tinnitus, nasal obstruction, aphasia by apoplexy, coma, mental disorders, prolapse of the rectum and the uterus|
|2||Tai Chong||Liv 3||On the dorsum of the foot, in the depression distal to the junction of the first and second metatarsal bones.||Headache, dizziness and vertigo, insomnia, congestion, swelling and pain of the eye, depression,, infantile convulsion, deviation of the mouth, pain in the hypochondriac region, uterine bleeding, hernia, enuresis, retention of urine, epilepsy, pain the anterior aspect of the medial malleolus|
|3||Lie Que||Lung 7||See above||See above|
If the patient with above symptoms accompanied with the wind cold or wind heat signs, we will add the following points
- Wind Cold: GB 20 Feng Chi, Extra Point Tai Yang , ST 8 Tou Wei, GB 8 Shuai Gu, UB 12 Feng Meng, UB 60 Kun Lun.
|1||Feng Chi||Gall Bladder 20||See above|
|2||Tai Yang||Extraordinary Point||See above|
|3||Tou Wei||Stomach 8||See above|
|4||Shuai Gu||Gall Bladder 8||Superior to the apex of the auricle, 1.5 inch within the hairline.||Migraine, vertigo, vomiting, infantile convulsion.|
|5||Feng Meng||Urinary Bladder 12||1.5 inch lateral to the midline of the body, at the level of the lower border of the spinous process of the second thoracic vertebra||Common cold, cough, fever and headache, neck rigidity, back pain|
|6||Kun Lun||Urinary Bladder 60||See above|
|1||Feng Chi||Gall Bladder 20||See above|
|2||Tai Yang||Extraordinary Point||See above|
|3||Tou Wei||Stomach 8||See above|
|4||Shuai Gu||Gall Bladder 8||See above|
|5||Da Zhui||Du 14||Below the spinous process of the seventh lumbar vertebra, approximately at the level of the shoulders||Neck pain and rigidity, malaria, fever, epilepsy, cough, asthma, common cold, back pain and stiffness|
|6||Wai Guan||San Jiao 5||See above|
Wind Heat: GB 20 Feng Chi, Tai Yang, St 8 Tou Wei, GB 8 Shuai Gu, Du 14 Da Zhui, SJ 5 Wai Guan,
Acupressure tips for patients:
- If you have headache, please differentiate the site of the headache, i.e. identify if you have Tai Yang, Yang Ming, Shao Yang, or Jue Ying headache.
- After you identify the site of the headache, then try to locate the points by following the above tables and pictures.
- Acupressure the points with your knuckle, press with the comfortable pressure on the points, count 20 counts then change to another points. You should use the symmetric points at the same time.
- Your acupressure points mainly locate on the head, use the head points as the major acupressure points. You may ask your friends or family members to help you with moderate acupressure.
Acupuncture Tips for Practitioners:
- The most important is to identify which meridian headache your patient belongs to, i.e. Tai Yang, Yang Ming, Shao Yang, or Jue Ying.
- Identify the external type, i.e. wind cold or wind heat. If you could combine the meridian with the external type, your acupuncture effects will be much more than the average acupuncturists.
- The distal points, i.e. on the hands and feet, are very important for your treatment. Please do not ignore the distal points.
- Please put your patients in a quite and low illuminated room, with electrical stimulation for 30 min.
5. Many headaches may be triggered by occipital neuralgia, trigeminal neuralgia, common cold, sinusitis and allergy etc. For those headaches secondary to the above, we have to treat the original trigger. We should treat the sinusitis, occipital neuralgia, trigeminal neuralgia, common cold, allergy, etc. If we can effectively treat the original trigger of the primary headache, our patient’s recovery rate will be much higher the average of acupuncturists. For many years, 99% of my patients felt much improved after my treatment because I not only treat the symptom of headache, but I also treat the trigger factors.
Joan’s headache is very complicated. From the western medicine point of view, her headache belongs to migraine headache. However, her headache always triggered by occipital neuralgia and worsen with her hormone and menstruation. Every time when she has hormonal change and also sometimes occipital nerve pain, her headache symptom would get worse. Therefore, she has four to five attacks per week.
After I made a clear diagnosis, first I used GB20, DU16, and Bai Hui and also Tai Yang, and LI4. The patient underwent my treatment three times a week for about two months and she also was injected with cortisone to block her left and right occipital nerve pain, her headache is much-much better. After my treatment, the patient took her SAT test and applied for college, she was accepted into the Boston College and after two years follow up, her mother reported that Joan is great and she has no any major headache attack. She survived her college study. Her mother is very-very thankful to me.