Headaches & Migraines in Chinese Medicine | TCM Guide

Almost everyone gets a headache once in a while.

Sometimes the cause is obvious. You didn't sleep enough. You skipped lunch. You spent six hours staring at a computer. You had too much wine. Or maybe your day contained more aggravation than your head could tolerate.

But what causes recurring headaches is far more complicated, and interesting.

Traditional Chinese Medicine doesn't regard "headache" as a diagnosis. We consider it a symptom, or the "branch" of deeper imbalance.

To correct this imbalance, we need to get to the "root". So we ask questions. Where is the pain is located? What does the pain feel like?  What makes it better or worse, and what other symptoms occur with it?

A throbbing headache at the temples may suggest a very different TCM pattern from a dull headache at the back of the head.

Where Is the Headache?

The location of a headache can provide useful clues.

In TCM, different areas of the head are associated with different channels and organ systems.

Pain at the temples or sides of the head is often associated with the Gallbladder channel and may occur with Liver or Gallbladder patterns.

Pain at the forehead is commonly associated with the Stomach channel and may be related to digestive imbalance, Phlegm, Heat, or weakness.

Pain at the top of the head may be associated with the Liver channel.

Pain at the back of the head and neck may involve the Bladder or Gallbladder channel and can occur with external Wind (common cold), muscular tension, or deficiency patterns.

Pain behind the eyes is frequently associated with Liver patterns.

What Does the Headache Feel Like?

A dull, empty, or lingering headache may suggest a deficiency of Qi, Blood, or Kidney Essence.

A sharp, fixed, stabbing headache may suggest Blood Stasis.

A heavy headache with a foggy feeling may suggest Dampness or Phlegm.

A severe, throbbing headache may be associated with Liver Yang Rising, Liver Fire, or other excess patterns.

Liver Yang Rising

One of the best-known TCM patterns is Liver Yang Rising.  This pattern is often associated with migraines.

The Liver is responsible for helping Qi move smoothly through the body. It is also associated with the smooth regulation of emotions and with maintaining a balance between Yin and Yang.

When Liver Yin or Blood becomes insufficient, Yang may rise excessively toward the head.

This can produce headaches or migraines that are often throbbing and located at the temples, sides of the head, or behind the eyes.  These symptoms are sometimes accompanied by dizziness, irritability, ringing in the ears, poor sleep,  or distortions in vision.

Though these symptoms are often characterized as "excess", in fact, Liver Yang Rising is more often caused by deficiency.

Treatment may focus on calming rising Yang, but it must also address the underlying deficiency that allowed it to rise in the first place.

Liver Fire

Liver Fire is a stronger Heat pattern, and is considered an "excess" pattern.

The headaches may be intense, pounding, or bursting. The person may feel very hot, irritable, restless, or angry.

There may also be red eyes, a bitter taste in the mouth, thirst, disturbed sleep, or constipation.

Stress can aggravate the pattern, but Liver Fire is generally considered more excessive and heated than simple Liver Qi Stagnation.

The treatment principle may involve clearing Heat and calming the Liver.

Liver Qi Stagnation and Tension Headaches

Not every Liver-related headache involves Heat or rising Yang.

Sometimes Qi simply becomes constrained.

Stress, frustration, resentment, emotional tension, and long periods of inactivity can contribute to Liver Qi Stagnation.

This may produce headaches along with tight shoulders, neck tension, frequent sighing, irritability, chest or rib-side tightness, or digestive upset.

These headaches may appear during stressful periods and improve when the person relaxes, exercises, or gets away from the source of the tension.

Many people are familiar with this pattern even if they have never heard the term Liver Qi Stagnation.

Their neck gets tight.

Their shoulders rise toward their ears.

And a few hours later, their head begins to hurt.

Blood Deficiency

Some headaches occur because the head is not being adequately nourished.

In Chinese medicine, this may be described as Blood Deficiency.

The pain is more likely to be dull rather than pounding.

The person may also experience fatigue, dizziness, poor concentration, dry skin, pale complexion, insomnia, or palpitations.

Women may notice that these headaches are worse after menstruation, particularly when menstrual bleeding is heavy.

Qi Deficiency

Headaches caused by Qi Deficiency may also be dull and persistent.

They may worsen with exertion or fatigue and improve with rest.

The person may have low energy, weak digestion, poor appetite, shortness of breath, or a tendency to feel exhausted easily.

Sometimes the headache is less dramatic than a migraine but more persistent.

The goal may be to strengthen Qi rather than merely move or disperse it.

Blood Stasis

A headache that is extremely fixed in one location, particularly if it feels sharp or stabbing, may suggest Blood Stasis.

Blood Stasis means that the circulation of Blood through an area is impaired.

The pain may be chronic, stubborn, and always occur in the same place.

A history of head injury or trauma may sometimes be relevant.

In TCM, treatment may focus on moving Blood and improving circulation, but new or severe headaches after an injury should always receive appropriate medical evaluation first.

Dampness and Phlegm

Some headaches feel less like pounding pain and more like having a heavy blanket wrapped around the head.

The person may feel foggy, heavy, sluggish, dizzy, or nauseated.

Chinese medicine may describe this as Dampness or Phlegm obstructing the head.

These patients may also experience bloating, loose stools, heaviness, fatigue, or excessive mucus.

Treatment may therefore address digestion as well as the headache itself.

Headaches and Menstruation

Headaches that regularly occur before, during, or after menstruation are especially interesting from a TCM perspective.

A headache before the period, especially with irritability, breast tenderness, or cramping, may involve Liver Qi Stagnation or Liver Yang Rising.

A headache during the period with sharp, fixed pain and clots may suggest Blood Stasis.

A headache after the period, particularly with fatigue and dizziness, may point more toward Blood Deficiency.

Three women can all have "menstrual migraines" and yet have three different Chinese medicine patterns.

Migraines With Nausea

Migraines are often accompanied by nausea or vomiting.

From a TCM perspective, this can indicate that Liver dysfunction is interfering with the Stomach. This is called Liver Invades Stomach, and results in Rebellious Stomach (digestive) Qi

Stomach Qi is supposed to descend. When it rebels upward, nausea and vomiting can occur.

So the headache and the digestive symptoms may be part of the same pattern.

Weather and Headaches

Some people know a storm is approaching before they look at the forecast.

Their body tells them.

In Chinese medicine, headaches that are strongly influenced by damp or windy weather may involve external Wind, Dampness, or an underlying weakness that makes the person particularly sensitive to environmental changes.

Headaches associated with colds and respiratory infections are also often discussed in terms of external Wind patterns.

These are treated differently from chronic deficiency headaches or internal Liver patterns.

Acupuncture for Headaches and Migraines

Acupuncture is commonly used in Chinese medicine for headaches and migraines.

Treatment is usually based on the individual's pattern rather than on a fixed collection of "headache points."

A practitioner may choose points intended to move Qi, calm the Liver, clear Heat, nourish Blood, resolve Phlegm, relax the neck and shoulders, or address another underlying imbalance.

Local points around the head and neck may be combined with points on the arms, legs, hands, or feet.

This can seem strange to someone unfamiliar with acupuncture.

Why put a needle in the foot for a headache?

Because acupuncture treatment follows the channels and the overall pattern, not simply the location of the pain.

Chinese Herbs for Headaches

Chinese herbal medicine also distinguishes among different types of headaches.

A formula intended for a hot, throbbing Liver Yang headache might be entirely unsuitable for a weak, exhausted person with a dull Blood Deficiency headache.

Herbal treatment may be designed to calm Liver Yang, clear Heat, move Qi, invigorate Blood, nourish Blood, strengthen Qi, resolve Phlegm, or dispel external Wind, depending upon the pattern.

Remember, the headache is not the diagnosis.  The pattern is the diagnosis.

Keeping Track of Your Headaches

People with recurring headaches may learn a great deal by paying attention to when they occur.

Notice whether the headache follows stress, lack of sleep, skipped meals, certain foods, alcohol, menstruation, weather changes, neck tension, or prolonged computer use.

Also notice the location and character of the pain.

These details can be extremely useful in both Chinese and conventional medicine.

When a Headache Needs Immediate Medical Attention

Most headaches are not dangerous, but some should not be treated as routine migraines.

A sudden, extremely severe headache, a new headache after significant head trauma, or a headache accompanied by weakness, confusion, fainting, difficulty speaking, loss of vision, high fever, severe neck stiffness, or other major neurological symptoms requires prompt medical evaluation.

A new or substantially different headache later in life should also be discussed with a healthcare professional.

Chinese medicine can complement conventional care, but it should never delay investigation of a potentially serious medical problem.