Headache and Migraine

Headache covers symptoms in both skull and upper neck regions, resulting from either migraine, tension headache, cluster headache, sinus and etc.

There are two main categories of headache, namely, Primary and Secondary Headache. Primary headache refers to the pain orginated from head, including Tension Headache, Migraine, Cluster Headache and Trigeminal Neuralgia. As for Secondary headache, it is the painful symptom developed subsequently after original medical diseases. For example, high blood pressure can cause headache.

Tension headache is the main reason for headache, which can account for 90% of clinical headache cases. Patients would usually complain of pain over forehead. Tension headache usually related to tight fascia of scalp, and it can deteriate with emotional stress. Patients might also complain of aphobia, overdosage of anathesia, or long term emotional stress. What is more, Neck tightness could also cause neck pain.

Pulsative headache usually relates to blood vessel origin, and it can further differentiate into migraine or cluster headache. Majority of pulsative headache are due to migraine, and only 1% is caused by cluster headache. According to result of prevalence study, 60% of migraine sufferers would complain of one side symptom and they also suffer hyper-sensative to light and noise. The patients would mailnly be female, aged 22 to 55, and be too sensitive to light and noise. Furthermore, type of migraine can also looked into and divided as usual or typical. Lots of people complaint of signs, such as transmit impairment in visual, tactile sensation, and motor control. Usual migraine can last for 4 to 12 hours, while typical migraine sustains within 1 hour. As for the frequency of attack, on average, it would be about 1.5 monthly, 10% of them would suffer weekly, while 15% of migraine patients would have symptoms for 15 days in every month.

Flow chart for migraine diagnosis:

《素問.奇病論》：＂帝曰：人有病頭痛以數歲不已，此安得之，名為何病。歧伯曰：當有所犯大寒，內至骨髓，髓者以腦為主，腦逆故令頭痛，齒亦痛。＂

《濟生方.頭痛門》：＂凡痛者，血氣俱虛，風、寒、暑、濕之邪傷於陽經，伏留不去者，名曰厥頭痛。＂

《蘭室秘藏．頭痛門》云：＂太陽頭痛，惡風脈浮緊，川芎、羌活、獨活、麻黃之類為主；少陽經頭痛，脈弦細，往來寒熱，柴胡為主；陽明頭痛，自汗發熱惡寒，脈浮緩長實者，升麻、葛根、石膏、白芷為主；太陰頭痛，必有痰，……蒼朮、半夏、南星為主；少陰經頭痛，三陰三陽經不流行而足寒氣逆為寒厥，其脈沉細，麻黃附子細辛為主；厥陰頭頂痛，或吐痰沬厥冷，其脈浮緩，吳茱萸湯主之。＂

《臨證指南醫案．頭痛》鄒時乘按：＂頭為諸陽之會，與厥陰肝脈會於巔，諸陰寒邪不能上逆為陽氣窒塞，濁邪得以上據，厥陰風火，乃能逆上作痛。故頭痛一症，皆由清陽不升，火風乘虛上入所致。觀先生於頭痛治法，亦不外此。如陽虛濁邪阻塞，氣血瘀痹而為頭痛者，用蟲蟻搜逐血絡，宣通陽氣為主；如火風變動，與暑風邪氣上鬱而為頭痛者，用鮮荷葉、苦丁茶、蔓荊、山梔等，辛散輕清為主；如陰虛陽越而為頭痛者，用仲景復脈湯、甘麥大棗法，加膠、芍、牡蠣，鎮攝益虛、和陽熄風為主；如厥陰風木上觸，兼內風而為頭痛者，用首烏、柏仁、穭豆、甘菊、生芍、杞子輩，熄肝風、滋腎液為主。＂

Linde, K., Allais, G., Brinkhau, B., YuFei, Y., Mehring, M., Shin, B., . . . White, A. (2016). Acupuncture for the prevention of tension-type headache [Abstract]. The Cochrane Database of Systemic Reviews, 19(4). doi:10.1002/14651858.CD007587.pub2. (Read)

Liu, S., Wang, Z., Su, Y., Qi, L., Yang, W., Fu, M., Jing, X., Wang, Y., & Ma, Q. (2021). A neuroanatomical basis for electroacupuncture to drive the vagal–adrenal axis. Nature, 598(7882), 641–645. https://doi.org/10.1038/s41586-021-04001-4