February 2009

Migraine Headaches

By Elliot Wagner, O.M.D., L.Ac., Doctor of Oriental Medicine

Migraines are not ordinary headaches, and causes and clinical approaches are unique to this complex pain disease. Because of this, I thought it might be useful to discuss this common, though difficult problem.

Migraines fall into two categories, depending on how the pain develops and the accompanying symptoms. Migraines preceded by aura symptoms such as visual or auditory hallucinations, or by sensitivity to light or sound, used to be known as classical migraine. They now are categorized by the International Headache Society as migraine with aura. Migraines without a preceding aura used to be called common migraines. They now are known as migraine without aura. They are much more common, making up 70% of all migraines.

To be classified as migraine, a headache must have the following characteristics: at least five headaches that last from four to seventy-two hours with at least two of these qualities: pain on one side of the head, pulsation or throbbing, moderate to severe pain, and pain that intensifies with routine movement. To qualify as a migraine without aura these qualities are enough. A migraine with aura must fit these descriptions, and be preceded by an aura, as well. As painful as they are, migraines are not simply painful headaches. Migraine is a disease, with an overall pattern akin to epilepsy in its tendency to be chronic, episodic and life-interrupting.

The early writers on migraine conjectured that migraine was caused by swelling of the cranial arteries pressing on nerves. Now it appears that a trigger — which may be a normal food to which the migraine sufferer is especially sensitive, stress, muscular tension, or hormonal changes — sets off a state of deactivation and reduced blood flow in the trigeminal nerve system which may be responsible for the migraine aura. This brings about the migraine itself, which occurs with vascular inflammation and subsequent localized swelling and pain sensitization. These are treated by western physicians with a variety of drugs, including blood pressure medications, anti-epileptic medications, and the newer drugs that correct serotonin imbalance.

In Chinese medicine most disease mechanisms associated with migraine have to do with the liver, and treatment primarily focuses on this complex organ. Additionally, in virtually all migraine, whatever the diagnosis, we see symptoms that have to do with blood stasis in the small vessels of the brain. Whatever the pattern, we use acupuncture and Chinese herbal medicine as principal treatments. Migraine patterns include, to use Chinese medical terminology:

  1. Liver Depression with Qi and Blood Weakness. This pattern includes symptoms of menstrual hormonal changes, depression, fatigue, cold hands and feet, and abdominal pain.
  2. Hyperactive Liver Pattern. This pattern often includes severe pain in or behind the eye or at the temple, dizziness, anger, restless sleep or pain at night, a bitter taste in the mouth, avoidance of light, and visual distortions.
  3. Cold Pattern. This includes symptoms of severe cold pain at the top of the head and very cold hands and feet.

Chinese medicine can be a lifesaver for migraine sufferers. Effective treatment includes herbal medicine, acupuncture, heat treatment, and care for imbalance in absorption and elimination, as we tend to find digestive problems to be common in severe migraine.