Lots of people have intense headaches they call "migraines" that may or may not be classified that way by an MD. Migraines are often a very intense headache that is accompanied by a throbbing or pulsing sensation, usually on one side of the head. It can be accompanied by "auras" - a kind of warning system that includes visual disturbances like flashes of light, blind spots in the vision, or a kind of halo around objects. Some patients also experience sensitivity to smells and sounds. Auras and other sensory disturbances can preclude the pain by minutes, hours or can be concurrent with the onset of pain. Migraines can last for hours or days with pain so intense it interferes with or halts daily activities. Some patients experience numbness and tingling on the face or limbs that can spread during the pain attacks, difficulty with language or speaking, and muscle weakness.
Western medicine generally offers medication that is taken regularly to prevent migraines or make them less painful, but doesn't really understand the cause or offer a cure. Recent studies and trials are testing botox as a possible preventative. Medications can cause problems as they are difficult to metabolize out in the kidneys and liver and can be stressful to the stomach. Even something like Excedrin Migraine if used for 10 days a month for three months can trigger a medication over-use headache! The same is true for aspirin, ibuprofen, and several other pharmaceuticals - even triptans like Imitrex, which are prescribed for migraines!
Triggers are thought to include:
Hormone changes - estrogen fluctuation specifically, which triggers headaches in women.
Beverages - alcohol (especially wine), caffeine (especially coffee, but sometimes even chocolate).
Stress - big cause for some patients.
Sensory stimulation - bright light, loud sounds, strong smells.
Physical exertion - even sex.
Weather - sudden changes of weather, barometric pressure changes.
Medications - vasodilators like nitroglycerin, oral contraceptives
Foods - processed foods, salty foods, aged cheeses for instance. Sometimes eating irregularly, skipping meals, or even fasting can trigger a migraine. Food additives like aspartame and MSG can trigger these as well. My dad had cluster headaches - triggered by the nitrates/nitrites found in processed meats.
Headaches of all kinds from a Chinese medicine and acupuncture approach
Look at headaches not by the western medicine diagnosis, but by what channel is affected and how it as affected. Is there stiffness and tightness that goes along with it? Do you see blood stasis or stagnation when you do your intake? If there are eye disturbances with headaches, did you palpate the Liver channel to see if it is reactive? Was there a trauma that preceded the onset of the headaches? Where was it and what channels were affected?
The nuts and bolts are that something is blocking flow of Qi and/or blood in the head and there might also be a deficiency in the lower body that is contributing to this. Our job is to figure out what and apply points that
Taiyang headaches These are on the Small Intestine and/or Bladder meridians and are generally felt in the occipital area. Tension headaches are generally this type. They can be generated by stress, poor posture, intense visual activity like looking at a computer monitor, video game, tablet, or phone for longer periods of time. They might also be a result of wind-cold, or wind affecting the Small Intestine and Bladder channels in the upper back and neck. Sometimes these headaches, especially if they are tension driven, will creep up over the top of the head and can get the Shaoyang channel involved.
Shaoyang headaches These affect the Shaoyang regions of the head and neck, often expressing as pain in the temporal/Taiyang region of the head. The channels affected are the Liver and Gallbladder channels. They can be affected by damp heat in the Gallbladder channel and by Liver Yang rising. Overwork which results in the overconsumption of Yin can allow the Liver Yang to rise and cause Shaoyang type headaches.
Yangming headaches Affecting the Large Intestine and Stomach meridians, these headaches are generally on the forehead area. They can be caused by pathogenic invasion of the Yangming channels (wind heat, wind cold, wind, damp, etc), or can be triggered by an irregular diet with overconsumption of something that jacks with the Yangming channel (think caffeine and alcohol).
Jueyin headaches People feel these at the top of the head, as the Liver/Jueyin channel has a branch that travels here. Liver blood xu and cold in the Liver channel are common causes. Strong emotions can trigger these too.
Empty, all over headaches These can be associated with Liver blood xu and also with the Shaoyin channel. Shaoyin channel headaches can radiate throughout the inside of the head or might be felt behind the eye.
Your approach from an herbal perspective might be very different than your acupuncture treatment. I've had a few patients whose migraines were triggered by barometric pressure fluctuations whose root cause was tied to a Liver Blood deficiency, Liver Qi stagnation, and Liver Blood stagnation. Getting those under control reduced the migraines down to just a couple per year in one case and only occasionally after drinking red wine for another.
Acupuncture basic protocols
Severe migraine - in progress
Shaoyang Migraines - Bleed Taiyang The Taiyang point is a classic TCM extra point. If a patient comes in with a severe migraine in progress, especially if they have a history of nausea and vomiting, bleed Taiyang on the same side as the migraine. Apply any needles to the opposite side.
Shaoyang Migraines - Bleed Ear Apex I've also had a lot of success bleeding the ear apex point. Before you start, ask the patient where their pain is on a scale of 1-10. For anything above a 2, bleed the ear apex, squeezing out several drops of blood and asking the patient to re-evaluate their pain on the 1-10 scale. The pain should drop pretty quickly. Keep bleeding until they get down to a 2. Now needle Master Tung's Huo Ying and Huo Zhu, Gallbladder 41 (Shu stream point) for Shaoyang headaches on the Gallbladder and Liver meridians. I also the rest of Dr. Robert Chu's WTH protocol, which I find anchors the Liver energy, grounds the patient, and addresses any Wood overacting on Earth energy causing nausea, vomiting, and/or diarrhea.
Shaoyang or Shaoyin migraines San Zhong/Three Weights includes Gb 39, the influential point of marrow, so this is good for anything in the brain. The Gallbladder channel is the lower San Jiao/Shaoyang channel. The Shaoyang channel connects to the Shaoyin channel, so this set of points treats not just the Gallbladder chanel, but also the Shaoyin/Kidney channel The Kidney influences the brain, bone, and wind. Therefore, this point treats just about anything that happens in the skull - migraines, trigeminal neuralgia, brain tumors, strokes, wind phlegm, facial paralysis, and more.
This is a repeat problem that has been going on for more than 3 months. The patient in this scenario doesn't have a current migraine in progress.
Start with cupping I recommend you do a lot of cupping on the neck and shoulders first. In the initial treatments you could see a lot of dark purple, grape jelly looking bruising, especially if there is chronic tension in the area and/or Blood and Qi stagnation and stasis. Start with this. If you haven't already taken it, look at Susan Johnson's "Ancient Art of Cupping" on eLotus. Terrific stuff. If you pay the $14.95 for the video course, you get a PDA credit, applicable toward your state or NCCAOM renewal. After you cup, then do points for migraines, choosing intelligently based on the channels you see affected, guide points, point categories, etc.
Menjin 66.05 - Door Metal One great point for migraines is St 43, which Master Tung's acupuncture refers to as Menjin. Needle this on the opposite side from the pain. This invokes an instant Taiyang and Yangming connection, addressing both the Wood and the Earth channels.
San Zhong/Three Weights can be used for chronic migraines just like it can for migraines in progress. See the explanation above.