Headache

=Headache/Tóu Tòng= //Western Diagnosis:// cephalalgia - head pain

Etiology
1. common sx of systemic or intracranial infection, head injury, intracranial tumor, severe hypertension, cerebral hypoxia, EENT 2. most pts however suffer from muscle tension, migraine, idiopathic 3. try to determine what hurts- nerves, arteries, other tissues ---intracranial vs. extracranial 4. headaches are a common final pathway

History
1. OPQRST ---rapidity of onset ---times of day ---location: unilateral not as commonly benign ---recent head trauma ---hypertension 2. relationship to meals, foods 3. stress 4. eyestrain, visual defects 5. fevers, sinusitis 6. occupation 7. toxic exposure 8. allergies 9. improper yoga, exercise 10. family history

Signs & Symptoms
1. must determine frequency, duration, character, location, severity 2. palpate head, mastoid processes, occiput 3. neck - stiffness, tightness 4. ophthalmoscopic, press on eyeballs 5. jaundice, herpes lesions on face 6. malocclusion of teeth

Testing
1. CBC, chem screen, ESR, glucose, UA, CSF, EENT, x-ray, MRI, CT scan

Non-vascular
most commonly diagnosed condition in US ---70% of all non-vascular HA ---from muscle spasm, postural strain ---gradual onset ---cyclical periods of tension and relaxation ---intermittent, moderate tightness ---general or fronto-occipital ---tender neck and skull muscles ---often bizarre pain - vise-like ---vertex or general ---< emotional disturbance ---history ---variable ---eyestrain, otitis, sinusitis, TMJ syndrome ---variable depending on cause ---mild to severe, localized initially then becomes generalized as tumor grows, intermittently persistent ---slowly progressive weakness, convulsions, visual changes, aphasia, vomiting, mental changes ---better or worse with postural changes ---hx of EENT infection, lung abscess, rheum Ht disease ---constant, severe, generalized ---fever, vomiting ---preceding upper respiratory infection ---trauma, changes in consciousness
 * muscle tension**
 * anxiety**
 * post-traumatic**
 * EENT lesions**
 * brain tumor**
 * brain abscess**
 * meningitis**
 * subdural hematoma**

Vascular
---rupture of arteriosclerotic vessel from hypertension or thrombus ---abrupt onset, severe ---steadily increasing neuro deficits ---rupture of intracranial aneurysm, usually congenital ---abrupt onset, severe ---syncope, vomiting, dizziness, stiff neck, + Kernig’s, Brudzinski's & Babinski’s ---moderate, generalized, pulsating, constant ---hx of exposure ---infections, alcohol, uremia, lead, arsenic, CO ---throbbing, paroxysmal ---vertex, occiput ---mostly in males ---appear in clusters of days to weeks and then not for months or years ---paroxysmal ---abrupt onset of severe pain ---last 1/4-3 hours ---unilateral - eye, neck, temple, face ---histaminic sx ipsilaterally: vasodilation; periorbital edema, flushed cheek, rhinorrhea, lacrimation ---pupillary constriction, injected conjunctiva, tenderness over common carotid arteries
 * intracerebral hemorrhage**
 * subarachnoid hemorrhage**
 * toxic states**
 * hypertension**
 * Cluster**

Etiology
i. family hx + ii. more in women [~3/4 of cases] iii. begins between ages of 10-30 iv. often gone after age 50 - hormonal? v. vascular instability vi. prodrome may be due to vasoconstriction of cerebral blood vessels vii. Headache from vasodilation viii. possible platelet abN - aggregation

Signs & Symptoms
i. short period of depression, irritability, restlessness, anorexia ii. prodrome - scintillating scotomas, visual field defects, paresthesias, dizziness, mood swings iii. uni or bilateral iv. sx usually follow a pattern in each pt v. behind one eye spreading out vi. N, V, photophobia vii. cold, cyanotic extremities viii. desire for dark and quiet vix. prominent scalp arteries x. lasts hours to days xi. tx - vasoconstrictors (caffeine, ergotamine), food allergies, tanacetum parthenium(feverfew) xii. Mg, Vit. B2 (riboflavin)

Treatment
1. find cause and tx it 2. Elimination diet -Feverfew -Butterbur -Riboflavin [15mg. will generally be enough] -Avoid cheese, chocolate, beer, wine; allergens such as wheat or dairy

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=================================================================== //TCM Pathology:// Tóu = head; Tòng = pain

Headache is a subjective symptom commonly seen in clinical practice. Headaches may occur as a symptom of an acute or chronic disease (secondary headache) or independent of any other condition (primary headache).

The entire head may be affected, or pain may be localized to the frontal, temporal, occipital, and/or vertex regions. Pain may radiate to the eyes, cheeks or teeth.

The head is the meeting point for the clear Yang Qi of the body; it is also the location of the Sea of Marrow.

-Tension headaches -Classic migraine -Common migraine -Cluster headaches
 * Primary Headaches:Types**

Symptoms of Tension Headache
Band-like tightness or pressure in the back of the head and upper neck Also described as a band of pressure encircling the head with the most intense pain over the eyebrows. Pain is usually mild (not disabling) and bilateral (affecting both sides of the head).

Not associated with an aura, nausea, vomiting, or sensitivity to light and sound. Usually occur sporadically (infrequently and without a pattern) but can occur frequently and even daily in some people. Most people are able to function despite their tension headaches.

Tension Headache Treatment
-Aspirin -Ibuprofen (Motrin, Advil) -Acetaminophen (Tylenol) -Naproxen (Aleve) -Massage -Biofeedback, stress management

Migraine Headaches
A form of vascular headache caused by vasodilatation of the large arteries of the brain. Vasodilation stretches the nerves that coil around the blood vessels, causing the nerves to release chemicals. The chemicals cause inflammation, pain, and further vasodilation which magnifies the pain.

Symptoms of Migraine Headaches
-Described as an intense, throbbing or pounding pain that involves one temple. (Sometimes the pain is located in the forehead, around the eye, or at the back of the head). -Usually unilateral; about a third of the time the pain is bilateral. -Unilateral headaches typically change sides from one attack to the next. (In fact, unilateral headaches that always occur on the same side should alert the doctor to consider a secondary headache).

-Nausea, vomiting, diarrhea, facial pallor, cold hands, cold feet, and sensitivity to light and sound commonly accompany migraine headaches. -Migraine sufferers usually prefer to lie in a quiet, dark room during an attack. -A typical attack lasts between 4 and 72 hours.

40%-60% of migraine attacks are preceded by premonitory (warning) symptoms lasting hours to days. The symptoms may include: -sleepiness -irritability -fatigue -depression or euphoria -yawning -cravings for sweet or salty foods.

Types of Migraine Headaches

 * Classic migraines:** patients experience an aura before their headaches; are usually much more severe than common migraines.
 * Common migraine:** accounts for 80% of migraines. There is no aura before a common migraine.

Migraine Aura An estimated 20% of migraine headaches are associated with an aura. The most common auras are: Flashing, brightly colored lights in a zigzag pattern (referred to as fortification spectra), usually starting in the middle of the visual field and progressing outward; and A hole (scotoma) in the visual field, also known as a blind spot. Some elderly migraine sufferers may experience only the visual aura without the headache. A less common aura consists of pins-and-needles sensations in the hand and the arm on one side of the body or pins-and-needles sensations around the mouth and the nose on the same side. Other auras include auditory (hearing) hallucinations and abnormal tastes and smells.

Migraine Headache Treatment
-Using a cold compress to the area of pain -Resting with pillows comfortably supporting the head or neck -Resting in a room with little or no sensory stimulation (light, sound, odors) -Withdrawing from stressful surroundings -Sleeping -Drinking a moderate amount of caffeine -Nonsteroidal anti-inflammatory drugs (NSAIDS) -Acetaminophen (Tylenol) -Combination medications: include Excedrin Migraine, which contains acetaminophen and aspirin combined with caffeine.
 * Self-Care at Home:**

Abortive: -Triptans, which specifically target serotonin. They are all very similar in their action and chemical structure. -Sumatriptan (Imitrex) -Zolmitriptan (Zomig) -Eletriptan (Relpax) -Naratriptan (Amerge, Naramig) -Rizatriptan (Maxalt) -Frovatriptan (Frova) -Almotriptan (Axert)
 * Medical treatment of migraine headaches:**

The following drugs are also specific and affect serotonin, but they affect other brain chemicals. Occasionally, one of these drugs works when a triptan does not. Ergotamine tartrate (Cafergot) Dihydroergotamine (D.H.E. 45 Injection, Migranal Nasal Spray) Acetaminophen-isometheptene-dichloralphenazone (Midrin)

The following drugs are mainly used for nausea, but they sometimes have an abortive or preventive effect on headaches: Prochlorperazine (Compazine) Promethazine (Phenergan)

Weak narcotics; used primarily as a "backup" for the occasions when a specific drug does not work: Butalbital compound (Fioricet, Fiorinal) Acetaminophen and codeine (Tylenol with Codeine)

-Antihypertensives: -Beta-blockers (propranolol [Inderal]) -Calcium channel blockers (verapamil [Covera]) -Antidepressants: -Amitriptyline (Elavil) -Nortriptyline (Pamelor) Anticonvulsants: -Gabapentin (Neurontin) -Valproic acid (Depakote) -Topiramate (Topamax) -Antihistamines and anti-allergy drugs -Diphenhydramine (Benadryl) -Cyproheptadine (Periactin)
 * Preventive:** considered if a patient has more than 1 migraine per week; goal is to lessen the frequency and severity of the migraine attacks. Medications include the following:

Botulinum toxin (BOTOX ®) injection
 * Other Therapy:**

Cluster Headaches
Come in groups (clusters) lasting weeks or months, separated by pain-free periods of months or years. Pain typically occurs once or twice daily, but some patients may experience pain more than twice daily. Each episode of pain lasts from 30 minutes to an hour and a half. Attacks tend to occur at about the same time every day and often awaken the patient at night from a sound sleep.

The pain typically is excruciating and located around or behind one eye. Some patients describe the pain as feeling like a hot poker in the eye. The affected eye may become red, inflamed, and watery. The nose on the affected side may become congested and runny. Unlike patients with migraine headaches, patients with cluster headaches tend to be restless. They often pace the floor, bang their heads against a wall, and can be driven to desperate measures. Cluster headaches are much more common in males than females.

Cluster Headaches Treatment
-Inhalation of high concentrations of oxygen (though this will not work if the headache is well established) -Injection of tryptan medications -Injection of lidocaine into the nostril -Dihydroergotamine (DHE, Migranal), a vasoconstrictor -Caffeine

Preventative cluster headache treatment options may include the following: -Calcium channel blockers [for example, verapamil (Calan, Verelan, Verelan PM, Isoptin, Covera-HS), diltiazem (Cardizem, Dilacor, Tiazac)] -Prednisone (Deltasone, Liquid Pred) Antidepressant medications: -Lithium (Eskalith, Lithobid) -Valproic acid, divalproex (Depakote, Depakote ER, Depakene, Depacon), and topiramate (Topamax) (often used for seizure control)

Causes of Secondary Headaches
The International Headache Society lists eight categories of secondary headache. A few examples in each category are noted (this is not a complete list): -Head and neck trauma -Blood vessel problems in the head and neck -Stroke or transient ischemic attack (TIA) -Arteriovenous malformations (AVM) -Carotid artery inflammation -Temporal arteritis (inflammation of the temporal artery) -Causes of Secondary Headaches -Non-blood vessel problems of the brain -Brain tumors -Seizures -Idiopathic intracranial hypertension (once named pseudotumor cerebri): excessive cerebrospinal fluid pressure within the spinal canal. -Medications and drugs (including withdrawal from those drugs) -Infection -Meningitis -Encephalitis -HIV/AIDS -Systemic infections

Problems of homeostasis: -Hypertension -Dehydration -Hypothyroidism -Renal dialysis -Problems of the eyes, ears, nose throat, teeth and neck -Psychiatric disorders

TCM Etiology and Pathogenesis
Exogenous pathogenic factors: Wind is the primary pathogenic factor. “When injured by Wind, the upper part of the body will be affected first.” Wind, Yang in nature, has the ability to attack the meeting point of all Yang Qi, which is the head. Wind then carries other pathogens into the body. Wind-Cold can congeal Qi and Blood, Wind-Heat can flare upwards disturbing the flow of Qi and Blood, and Wind-Dampness can block the flow of Qi. Any of these processes can obstruct the flow of clear Yang Qi to/in the head, resulting in headache.

Internal organs dysfunction: the Brain relies on Essence and Blood from the Liver and Kidney for nourishment. It also depends on the Spleen and Stomach to transform and transport water and food, and to distribute Qi and Blood upwards to the head. Therefore, dysfunction of the Liver, Kidney, and Spleen leads to malnourishment of the head. In addition, formation of Phlegm secondary to dysfunction of the Spleen can also inhibit clear Yang Qi from reaching the head.

Trauma: head trauma can disrupt Qi and Blood flow, leading to Blood stasis in the channels and collaterals. The resulting headache will occur in a fixed location.

Note: Blood stasis – even without a history of traumatic injury - can often complicate other patterns of chronic headaches based on the notion that “Enduring diseases lodge in the collaterals.”

Ext. vs. Int.
distending, heavy, constant || Dull, empty, lingering, worse with exertion, intermittent ||
 * Type || Exterior || Interior ||
 * Onset || Sudden || Gradual ||
 * Severity || Severe || Mild ||
 * Pain Characteristics || Sharp, throbbing, burning,

Identification of Channels by Location
Back of head, occiput, into the neck: **Taiyang** Forehead, eyebrows, and maxilla: **Yangming** Temporal and/or auricular region: **Shaoyang** Vertex and eyes: **Jueyin** Radiating to the cheeks and teeth: **Shaoyin**

Accompanying Symptoms:
Sharp, stabbing pain with fixed location, worse at night, usually chronic though maybe acute, history of head trauma: **Blood stasis** Accompanied by nausea and vomiting: **Phlegm-Turbidity** Dull = **Deficiency (Qi and Blood)** Heaviness = **Dampness, Phlegm (usually accompanied by dizziness & possibly N/V)** Distending/throbbing = **Liver Yang Rising (sides), Liver Fire (sides or vertex); Wind-Heat (whole head)** Stiff = **Wind-Cold** Sharp, stabbing = **Blood stasis** Empty = **Kidney deficiency**

Provocation and Palliation
Activity/rest Worse with activity, better with rest: **Qi and Blood def.** Better with light activity: **LV Yang rising**

Time of day Worse in daytime: **Qi/Yang def.** Worse in evening or at night: Blood or Yin def.; **Blood stasis**

Weather, temperature: Worse with heat, better with cold: **LV Yang rising or LV Fire** Worse with cold: **Yang def.** Worse in damp weather: **Dampness or Phlegm**

Emotions: Worse with anger: **LV Yang rising, LV Fire** Worse with relaxation: **LV Yang rising**

Sexual activity: Worse after sex: **KI def.** Better after sex: **LV Fire**

Food: Worse after eating: **Dampness, Phlegm** Better after eating: **Qi and Blood def.**

Menstruation: Worse before menses: **LV Yang rising or LV Qi stag.** Worse during menses: **LV Fire or Blood stasis** Worse after menses: **Blood def.**

Pressure: Worse with pressure: **Exc.** Better with pressure: **Def.**

Wind-Cold Invasion
[Chuan Xiong (Ligusticum Root) 9g, Jing Jie (Schizonepeta) 9g, Bai Zhi (Angelica Root) 6g, Qiang Huo (Notopterygium Root) 6g, Xi Xin (Asarum) 3g, Fang Feng (Ledebouriella Root) 6g, Gan Cao (Licorice Root) 6g, Bo He (Field Mint) 9g]
 * Main Symptoms:** Headache accompanied by stiffness of the neck and back
 * Additional Symptoms:** Aversion to cold, absence of thirst
 * Tongue:** Thin, white coat
 * Pulse:** Tight, floating, superficial
 * Treatment Principles:** Eliminate Wind, scatter Cold, relieve pain
 * Herbal Treatment:** Chuan Xiong Cha Tiao San (Tea-Blended Ligusticum Powder)

Wind-Heat Invasion
Chuan Xiong Cha Tiao San + Bai Jiang Can (Stiff Silkworm) 6g Ju Hua (Chrysanthemum flower) 12g
 * Main Symptoms:** Distending or “splitting” headache
 * Additional Symptoms:** Fever, aversion to wind, flushed face, thirst with desire for cold drinks, runny nose with yellow discharge, sore throat, swollen tonsils, red eyes, constipation, dark urine
 * Tongue:** Red, dry, white or yellow coat
 * Pulse:** Rapid, floating
 * Treatment Principles:** Eliminate Wind, clear Heat, relieve pain
 * Herbal Treatment:** Ju Hua Cha Tiao San (Chrysanthemum Flower Powder to Be Taken with Green Tea)

Wind-Damp Invasion
[Qiang Huo (Notopterygium Root) 6g, Du Huo (Pubescent Angelica Root) 6g, Gao Ben (Chinese Lovage Root) 6g, Fang Feng (Ledebouriella Root) 6g, Man Jing Zi (Vitex Fruit) 6g, Chuan Xiong (Ligusticum Root) 6g, Zhi Gan Cao (Honey-fried Licorice Root) 3g]
 * Main Symptoms:** Headache with sensation of heaviness, made worse by damp or cloudy weather
 * Additional Symptoms:** Heaviness of extremities, loss of appetite, sensation of chest and epigastric oppression, scanty urine, constipation, loss of appetite, fever
 * Tongue:** White, greasy coating
 * Pulse:** Soft
 * Treatment Principles:** Eliminate Wind, resolve Dampness, relieve pain
 * Herbal Treatment:** Qiang Huo Sheng Shi Tang (Notopterygium Dampness-Overcoming Decoction)

Liver Yang Rising
[Tian Ma (Gastrodia Root) 9g, Gou Teng (Uncaria Stem and Thorn) 12g, Shi Jue Ming (Abalone Shell) 18g, Shan Zhi Zi (Gardenia Fruit) 9g, Huang Qin (Scutellaria Root) 9g, Chaun Niu Xi (Cyathula Root) 12g, Du Zhong (Eucommia Bark) 9g, Yi Mu Cao (Leonurus) 9g, Sang Ji Sheng (Mistletoe) 9g, Ye Jiao Teng (Knotweed Stem) 9g ,Fu Shen (Poria Root) 9g]
 * Main Symptoms:** Throbbing or distending headache accompanied by dizziness and vertigo
 * Additional Symptoms:** Irritability, restlessness, restless sleep, costal pain, red eyes, flushed face, bitter taste in the mouth, tinnitus, hypochondriac pain and/or distention
 * Tongue:** Red, thin yellow coating
 * Pulse:** Wiry, forceful, thin, rapid
 * Treatment Principles:** Soothe Liver, descend Liver Yang, relieve pain
 * Herbal Treatment:** Tian Ma Gou Teng Yin (Gastrodia and Uncaria Beverage)

Kidney Essence/Yin Vacuity
[Shu Di Huang (Cooked Rehmannia Root) 24g, Shan Zhu Yu (Cornus Fruit) 12g, Shan Yao (Dioscorea Root) 12g, Gou Qi Zi (Lycium Berry) 12g, Ren Shen (Ginseng) 9g, Dang Gui (Tangkuei) 9g, Zhi Gan Cao (Honey-fried Licorice Root) 6g] [Shu di huang (Cooked Rehmannia root) 24g, Shan zhu yu (Cornus fruit) 12g, Shan yao (Dioscorea root) 12g, Ze xie (Alisma tuber) 9g, Mu dan pi (Moutan root bark) 9g, Fu ling (Poria) 9g]
 * Main Symptoms:** Headache with a sensation of emptiness of the head with dizziness and vertigo
 * Additional Symptoms:** Weakness and aching of the low back and knees, fatigue, seminal emission, tinnitus, insomnia
 * Tongue:** Red, scanty coating
 * Pulse:** Thin, thready, forceless
 * Treatment Principles:** Strengthen the Kidney, supplement Essence, nourish Yin, relieve pain
 * Herbal Treatment:** Da Bu Yuan Jian (Major Origin-Supplementing Brew)
 * Kidney Yin Vacuity:** Liu Wei Di Huang Wan (Six Flavor Pill with Rehmannia)

Kidney Yang Vacuity
Herbal Treatment: You Gui Wan (Right-Restoring Kidney Yang Pill) [Shu Di Huang (Cooked Rehmannia Root) 24g, Shan Yao (Dioscorea Root) 12g, Shan Zhu Yu (Cornus Fruit) 9g, Gou Qi Zi (Lycium Berry) 12g, Lu Jiao Jiao (Deerhorn Glue) 12g, Tu Si Zi (Cuscata Seed) 12g, Du Zhong (Eucommia Bark) 12g, Dang Gui (Tangkuei) 9g, Rou Gui (Cinnamon Bark) 6g, Zhi Fu Zi (Processed Aconite) 6g]
 * Main Symptoms:** Headache accompanied by cold body
 * Additional Symptoms:** Pale complexion, cold extremeties, sore low back and knees, tiredness, fatigue
 * Tongue:** Pale
 * Pulse:** Deep, slow, thready
 * Treatment Principles:** Warm and supplement Kidney Yang, relieve pain

Jin Gui Shen Qi Wan (Golden Coffer Kidney Qi Pill) [Shu Di Huang (Cooked Rehmannia root) 24g, Shan Zhu Yu (Cornus fruit) 12g, Shan Yao (Dioscorea root) 12g, Ze Xie (Alisma tuber) 9g, Mu Dan Pi (Moutan root bark) 9g, Fu Ling (Poria) 9g, Rou Gui (Cinnamon bark) 3g ,Pao Fu Zi (Blast-fried Aconite) 3g]

Qi Vacuity
[Huang Qi (Astragalus Root) 15g, Ren Shen (Ginseng) 9g, Bai Zhu (Atractylodes Root) 9g, Dang Gui (Tangkuei) 9g, Chen Pi (Tangerine Peel) 6g, Sheng Ma (Cimicifuga Root) 3g, Chai Hu (Bupleurum Root) 3g, Zhi Gan Cao (Honey-fried Licorice Root) 6g]
 * Main Symptoms:** Constant dull headache aggravated by over exertion
 * Additional Symptoms:** Weakness, fatigue, loss of appetite
 * Tongue:** Pale, thin white coating
 * Pulse:** Weak
 * Treatment Principles:** Supplement Qi, relieve pain
 * Herbal Treatment:** Bu Zhong Yi Qi Tang (Center-Supplementing Qi-Boosting Decoction)

Blood Vacuity
Main Symptoms: Dull headache accompanied by dizziness and vertigo, symptoms aggravated by over exertion Additional Symptoms: Pale and lusterless complexion, blurred vision, palpitation, tiredness, fatigue, difficulty falling asleep, possible history of bleeding Tongue: Pale Pulse: Weak, thready Treatment Principles: Nourish Blood, relieve pain Herbal Treatment: Si Wu Tang (Four Gentlemen Decoction) [Dang Gui (Tangkuei) 12g, Bai Shao Yao (White Peony Root) 12g, Shu Di Huang (Cooked Rehmannia Root) 12g, Chuan Xiong (Ligusticum Root) 9g, Ju Hua (Chrysanthemum Flower) 9g, Man Jing Zi (Vitex Fruit) 9g, Huang Qin (Scutellaria Root) 3g, Gan Cao (Licorice Root) 6g]

Phlegm Turbidity
[Fa Ban Xia (Processed Pinellia Tuber) 9g, Tian Ma (Gastrodia Root) 6g, Fu Ling (Poria) 6g, Ju Hong (Red Tangerine Peel) 6g, Bai Zhu (Ovate Atractylodes Root) 15g, Gan Cao (Licorice Root) 3g, Sheng Jiang (Fresh Ginger) 3g, Da Zao (Jujube Fruit) 2 pc]
 * Main Symptoms:** Headache accompanied by dizziness and heaviness of the head
 * Additional Symptoms:** Epigastric and chest fullness and stuffiness, nausea, vomiting phlegm and/or mucus
 * Tongue:** White, greasy coating
 * Pulse:** Slippery, wiry
 * Treatment Principles:** Transform Turbid Phlegm, descend rebellious Qi, relieve pain
 * Herbal Treatment:** Ban Xia Bai Zhu Tian Ma Tang (Pinellia, Ovate Atractylodes and Gastrodia Decoction)

Blood Stasis
[Chi Shao yao (Red Peony Root) 3g, Chuan Xiong (Ligusticum Root) 3g, Tao Ren (Peach Seed) 9g, Hong Hua (Carthamus Flower) 9g, Cong Bai (Scallion white) 3g, Da Zao (Jujube Fruit) 5 pc, She Xiang (Musk) 0.1g, Huang Jiu (Yellow wine) 50cc]
 * Main Symptoms:** Persistent, fixed stabbing headache
 * Additional Symptoms:** Possible history of trauma to head
 * Tongue:** Dark, purplish
 * Pulse:** Choppy, thready, wiry
 * Treatment Principles:** Quicken the Blood, resolve stasis, relieve pain
 * Herbal Treatment:** Tong Qiao Huo Xue Tang (Orifice-Freeing Blood-Quickening Decoction)

Tx of Headache with Acupuncture and Moxibustion
By Location: Local and Distal Points
 * Frontal headache:** ST8, Yintang, DU23, LI4, ST44
 * Vertex headache:** DU20, SI3, BL67, LR3
 * Occipital headache:** GB20, BL10, GV 19, BL60, SI3
 * Temporal headache:** Taiyang, GB8, TB5, GB41, GB43

Exterior Syndromes
 * W-C:** GB20, BL12, LI4, LU7 + points for affected channel
 * W-H:** LI4, LI11, GB20, GV14, TB5 + points for affected channel
 * W-D:** LI4, LU7, GB20, ST8, SP9 + points for affected channel

Interior Syndromes
 * Liver Yang Rising:** GB20, DU20, GB5, GB43, LR2
 * Kidney Yin Vacuity:** DU20, BL23, BL18, KI3, SP6, DU23
 * Kidney Yang Vacuity:** DU20, BL23, CV4, KI3, DU4, DU23
 * Qi Vacuity:** DU20, CV6, BL20, ST36, LI4, DU23
 * Blood Vacuity:** BL18, BL17, BL20, SP6, DU23, ST36
 * Phlegm Turbidity:** CV12, ST36, ST40, DU20, Yintang, LI4
 * Blood stasis:** Ashi points, LI4, SP6, LR3, ST36, SP10

Guiding Herbs

 * Taiyang**: Qiang Huo, Ge Gen
 * Yangming**: Bai Zhi, Man Jing Zi
 * Jueyin:** Wu Zhu Yu, Gao Ben, Chuan Xiong
 * Shaoyang:** Chuan Xiong, Chai Hu, Tian Ma
 * Shaioyin:** Xi Xin

Clinical Pointers for Treating Headache
-It is imperative to rule out serious underlying pathology before treating headache in the clinic. Severe headaches of recent onset that have not been evaluated require immediate referral, particularly if pain is increasing in severity.

-Pay specific attention to the duration of the headache, as well as to the pain characteristics and specific location of the pain.

-To treat stubborn headaches, incorporate herbs that move Blood and unblock the collaterals. In chronic headache, the pathology involves a deep obstruction in the collaterals. This complication of obstructed circulation of Qi and Blood in the small collaterals causes the poor response to therapy requiring the addition of herbs such as Tao Ren, Hong Hua, Chi Shao, Si Gua Luo as well as “insect” medicinals such as Quan Xie, Wu Gong, and Di Long to root out the pathogen.



=---= =Treatment= cold compress coated in a combo of lavender and peppermint essential oils.

Drainage
Liver/Kidney if excess crystals present

Orthomolecular Treatment
-Tryptophan -5-HTP

Phytotherapeutic Treatment
-Feverfew -Rosemary -Majoram herbal tea -Partenelle -Meadow-sweet -German Chamomile