bubble_chart Content

Almost everyone experiences some form of headache in their lifetime. Although a headache is a symptom, it can severely impact quality of life. It is often accompanied by issues like anxiety, depression, and insomnia, and in severe cases, can lead to disability.

According to statistics, about 75% of adults worldwide experience at least one headache per year. Statistics from the Taiwan Headache Society indicate that approximately 2 million people in Taiwan suffer from migraines, with a migraine prevalence rate of 9.1%, while the prevalence of tension-type headaches is as high as 70% to 80%. Headaches can occur at any age, but migraines typically begin in adolescence or early adulthood. Women are more prone to headaches than men, especially migraines, which are three times more common in women than in men.

Besides severely affecting the individual patient's life, the large number of headache sufferers also has a significant socio-economic impact. Therefore, correctly understanding and managing headaches is not only a personal health need but also an important public health issue.

Classification and Symptoms

Strictly speaking, a headache is not a specific disease but rather a symptom, an alarm bell indicating that the body's health is signaling a warning.

Modern medicine classifies headaches into three main categories:

• Primary Headaches: "Primary" means they are not caused by other diseases. This type accounts for over 90% of all headaches. It mainly includes the following types:
  • Tension-type Headache: Also known as "stress headache," it is the most common type. It involves mild to moderate pain and discomfort in the head, neck, and scalp, characterized by a persistent feeling of tightness and pressure. Attacks can last from minutes to hours or even days. It might cause slight nausea but usually not vomiting, photophobia, or phonophobia.
  • Migraine: Characterized by throbbing pain on one side of the head (though it can be bilateral), with moderate to severe intensity. It is often accompanied by nausea, vomiting, photophobia, and phonophobia. Routine physical activity aggravates the pain. Attacks last 4 to 72 hours. About one-third of patients experience aura symptoms before the headache, such as visual disturbances (seeing flashes, zigzag lines), sensory changes, or speech difficulties. The prevalence in women is three times that in men. 90% of migraine patients have a family history of migraines.
  • Cluster Headache: This is a rare (0.1% to 0.4%) but extremely severe headache, also known as "suicide headache." The pain is excruciating, located around one eye, the upper orbital region, or the temple, accompanied by ipsilateral autonomic symptoms like conjunctival injection, lacrimation, nasal congestion, rhinorrhea, eyelid edema, or sweating on the forehead and face. Each attack lasts 15 minutes to 3 hours, with 1 to 8 attacks possible per day, recurring in cyclical patterns.

  Headache Type	Pain Characteristics	Duration	Associated Symptoms	Prevalence
  Tension-type Headache	Bilateral, pressing	Variable	Rarely nausea or vomiting	30%～80%
  Migraine	Unilateral, throbbing	4～72 hours	Nausea, vomiting, photophobia, phonophobia	~9.1% (Taiwan)
  Cluster Headache	Unilateral, periorbital	15～180 minutes	Lacrimation, nasal congestion, eyelid edema	0.1%～0.4%

• Secondary Headaches: These are headaches caused by other diseases, accounting for less than 10% of all headache cases. Possible causes include: head trauma, cerebrovascular diseases (e.g., stroke), brain tumors, intracranial infections, sinusitis, medication overuse, etc. These headaches are typically accompanied by other neurological or systemic symptoms and require prompt medical attention to treat the underlying condition.
• Other Headaches: Mainly pain caused by lesions of the nerves themselves, such as trigeminal neuralgia (known as the "suicide disease"), glossopharyngeal neuralgia, occipital neuralgia, etc.

When headaches occur frequently, more than 15 days per month for over three months, it is termed chronic headache. These headaches may evolve from primary headaches or be secondary. Medication overuse is a common cause of headache chronification.

This article primarily discusses tension-type headaches and migraines.

Causes and Triggers

Different types of headaches have different causes and triggering factors.

• Causes of Tension-type Headache: Tension-type headaches are mainly related to sustained contraction of head and neck muscles. Long-term poor posture, work stress, emotional tension, and other factors can cause persistent tension in the scalp, neck, and shoulder muscles, releasing pain-inducing substances and causing headaches.
• Causes of Migraine: The exact cause of migraines is not fully understood in modern medicine. It is currently believed to be related to genetics, neurovascular activity, and changes in brain chemicals. Over 90% of migraine patients have a family history. During a migraine attack, there might first be neural dysfunction (like cortical spreading depression), followed by cerebral vasodilation and sterile inflammation, leading to pain. In women, it may also be related to hormonal changes, with higher incidence during menstruation, pregnancy, and menopause.

Common headache triggers:

• Processed meats, alcohol, caffeinated beverages.
• Bright lights, flashing lights, noise, strong odors.
• Lack of sleep or oversleeping.
• Weather changes, barometric pressure changes, sudden temperature shifts.
• Stress, anxiety, emotional tension, depression.
• Oral contraceptives, hormone replacement therapy drugs.

Western Medical Treatment and Efficacy

Treatment for acute attacks:

• General analgesics, suitable for mild to moderate headaches.
• Specific migraine medications that constrict dilated cerebral blood vessels and inhibit neuroinflammation, used for moderate to severe migraines. However, they must be used cautiously in patients with cardiovascular diseases. Second-line drugs like ergot derivatives have more severe side effects.
• Antiemetics: Relieve associated nausea and vomiting.

When treating headaches with Western medicine, one might also suffer from Medication Overuse Headache (MOH)! This type of headache occurs due to excessively frequent use of acute pain relievers, leading to chronification or worsening of headaches.

The Holistic View of Traditional Chinese Medicine

Records of headaches date back to the "Huangdi Neijing" (Yellow Emperor's Inner Canon), and subsequent medical texts have discussions on "headache," "migraine," and "head wind." TCM believes headaches are caused by internal and external factors, analyzed and treated based on the principle of pattern differentiation. TCM analysis does not focus solely on the head but involves seeking the cause through "pattern differentiation" based on the patient's specific symptoms, attack characteristics, constitution, etc., to explore the underlying macroscopic cause and mechanism.

TCM typically classifies headaches into two major categories: external contraction and internal injury:

• External contraction is caused by external factors. TCM has sayings like "Only wind can reach the summit (top of the head)" and "When injured by wind, the upper part is affected first." The head, being the highest point of the body, is most susceptible to invasion by wind pathogens. Wind often invades the body alongside cold, heat, or dampness, leading to wind-cold, wind-heat, or wind-dampness type headaches. For example, a headache after exposure to wind and rain and catching cold belongs to wind-cold; a headache occurring in a hot, humid, stuffy summer environment belongs to wind-dampness or wind-heat. A headache caused by having a fan or air conditioner blowing directly on the head for a while also belongs to wind-cold.
• Internal injury originates from disharmony of Qi, blood, Zang-Fu organs, and meridians inside the body. Common causes:
  • Emotional dysregulation (most important internal cause): Long-term stress, emotional depression, anger, or agitation can lead to liver Qi stagnation. Stagnated Qi can transform into fire over time, forming liver fire flaming upward; or fire pathogens can consume Yin fluids, leading to Liver Yang Hyperactivity. These can disturb the head, causing severe headaches, often accompanied by irritability, red face and eyes, etc.
  • Dietary irregularities: Preference for spicy, grilled, greasy, sweet foods, or alcohol can damage spleen and stomach function, leading to internal phlegm turbidity, which blocks the meridians. Clear Yang Qi cannot ascend to the head, resulting in dull, heavy, and distending headaches.
  • Improper work and rest: Overexertion or excessive sexual activity can consume the body's Yin blood and essence. The liver stores blood, and the kidneys store essence. Deficiency of essence and blood leads to insufficient nourishment of the head by Qi and blood, or kidney essence deficiency leads to emptiness of the "sea of marrow," causing the brain to lack nourishment. This results in empty pain or dull pain, often worsening after fatigue.
  • Congenital insufficiency and chronic debility: Some patients have a family history, related to congenital constitution. Imbalance of Qi, blood, Yin, and Yang after a prolonged illness can also easily trigger headaches.

Headaches from external pathogens have a sudden onset and shorter course, often appearing immediately after exposure to the pathogen. With correct treatment to dispel wind, eliminate pathogens, unblock collaterals, and relieve pain, they can be cured without recurrence. However, incorrect treatment or deep invasion of pathogens may leave a root, turning into chronic headaches, such as stubborn headaches due to cold pathogens congealing in the meridians leading to "cold congealing and blood stasis."

Internal injury headaches are often closely related to internal Zang-Fu organ dysfunction caused by various unusual life states, commonly:

• Long-term stress, emotional stagnation → Liver Yang Hyperactivity, Liver Stagnation transforming into Fire
• Excessive thinking, overwork, staying up late → Qi and Blood Deficiency
• Dietary irregularities, preference for rich, fatty, strong-flavored foods → Internal Phlegm Turbidity
• Aging and physical decline or excessive sexual activity → Kidney Essence Deficiency
• Trauma or chronic illness → Blood Stasis obstructing collaterals

Clinically, internal injury headaches are far more common than external contraction headaches. Those patients with long-term, recurrent chronic headaches often turn to TCM for regulation and treatment after finding no success with Western medical treatment.

Core Pathological Mechanisms

Despite the diverse causes, the core pathogenesis of headaches in TCM can be summarized into two major categories: "Pain due to obstruction" and "Pain due to lack of nourishment."

• Pain due to obstruction (Excess pattern): This refers to the blockage of the meridians and Qi-blood pathways by various pathogenic factors. Local obstruction causes Qi and blood to accumulate and stagnate, leading to swelling and distension, which compresses nerves and causes pain. Severe obstruction can cause more intense distending pain, stabbing pain, or throbbing pain. Factors that obstruct Qi and blood pathways include:
  • External pathogens obstructing collaterals: External contraction headaches are precisely due to external wind, cold, dampness, etc., invading the body and directly blocking the head's meridians, causing poor circulation of Qi and blood and resulting in pain. Headache due to wind-cold manifests as contraction, spasm, pain involving the neck and back, alleviated by warmth and worsened by wind and cold. Dampness pathogen has heavy, turbid, and sticky characteristics. Patients experience heavy-headed pain, as if wrapped in a damp towel, with a general feeling of heaviness in the body, worsening on cloudy or rainy days.
  • Phlegm Turbidity: Refers to the viscous accumulation of various metabolic waste or improperly utilized nutrients (like triglycerides, cholesterol) in the circulatory "pipes," significantly increasing resistance in the pathways, greatly reducing flow velocity, and affecting the normal distribution of energy and supplies. This type of headache often involves dizziness and heaviness, presenting as a diffuse distending pain or a sensation of a heavy object pressing on the head. Damp weather or consuming greasy food can exacerbate phlegm-dampness and worsen the headache. These patients may also have spleen-stomach dysfunction or metabolic syndrome.
  • Blood Stasis obstructing collaterals: Trauma or long-term stagnation leads to blood stasis in the vessels, making it difficult for Qi and blood to pass. This headache is often needle-like, fixed-location pain, with a longer course, and less related to weather or emotions.
  • Liver Yang Hyperactivity, Liver Fire flaming upward: Due to emotions, stress, staying up late, etc., the liver's Yin-Yang balance is disrupted, producing excessive, upward, hyperactive "Yang Qi" or "Fire Qi." This has the characteristics of rushing upward, flaring upward, and agitation, disturbing the normal flow of Qi and blood in the head's meridians (especially the liver and gallbladder channels), causing rebellion and abnormal flow velocity, resulting in throbbing, pulsating pain. Fire pathogen consumes body fluids, making blood viscous and causing poor circulation, which is also a form of "phlegm turbidity obstruction." This blazing heat energy that only rises and does not descend acts like a plug blocking the normal downward reflux from the head, causing Qi and blood to stagnate in the head and trigger severe distending pain. Liver fire is the "root" (Ben), and "obstruction" is the "branch" (Biao).
• Pain due to lack of nourishment (deficiency pattern): Nourishment refers to nourishing substances like Qi, blood, Yin, and essence. Insufficient nourishment results in the inability to moisten the meridians of the head and the brain marrow, thus causing pain. This pain is usually dull, empty pain, worsening after fatigue. It is further divided into:
  • Qi and Blood Deficiency: Insufficient Qi and blood fail to nourish the head, often due to acquired spleen-stomach disharmony.
  • Kidney Essence Deficiency: Emptiness of the sea of marrow, the brain lacks nourishment, often due to congenital kidney Qi deficiency.

By grasping the above principles, TCM practitioners can respond to myriad changes with consistency, easily managing various headaches.

Acupuncture Treatment

Acupuncture is an important method for treating headaches. By stimulating specific acupoints, it unblocks meridians, harmonizes Qi and blood, and quickly relieves pain, often with immediate effect. It is particularly effective for tension-type headaches and migraines.

What You Can Do During a Headache...

When a headache occurs, you can try the following methods to alleviate symptoms:

• Rest: Rest in a dark, quiet environment for more than 30 minutes can help relieve headaches, especially migraines.
• Cold or warm compress: For acute distending or throbbing pain, apply an ice pack or cold towel to the forehead, temples, or back of the neck to constrict blood vessels and soothe pain. For scalp tightness and stiff neck/shoulders, use a warm, moist towel on the neck and shoulders to help relax muscles.
• Massage: Massaging the scalp, back of the neck, and shoulders can relieve tense muscles and ease headaches.
• Acupressure:
  • Taiyang (EX-HN5): In the depression about one fingerbreadth behind the midpoint between the outer end of the eyebrow and the outer canthus.
  • Fengchi (GB20): Below the occipital bone, in the depression between the upper ends of the sternocleidomastoid and trapezius muscles, level with the earlobe.
  • Baihui (GV20): On the midline of the head, at the midpoint of the line connecting the apexes of both ears.
  • Hegu (LI4): On the dorsum of the hand, between the first and second metacarpal bones, at the midpoint of the second metacarpal bone on the radial side.
  Press these points with the fingertip with appropriate pressure until a moderate soreness/distension/pain sensation is felt. Do this for 3-5 minutes each time to help relieve headaches.
• Deep breathing: Practice sustained, slow, abdominal breathing: inhale for a few seconds, hold for a few seconds, exhale for a few seconds. Repeat several times to help reduce pain.

Daily Health Maintenance

The following daily health measures can significantly reduce the frequency and severity of headache attacks.

• Maintain a fixed sleep schedule; avoid lack of sleep or oversleeping.
• Manage work time, set reasonable goals, cultivate hobbies, and maintain a positive attitude.
• Eat regular meals at fixed times.
• Develop a habit of regular, moderate exercise, such as brisk walking, swimming, or cycling.
• Practice relaxation, meditation, mindfulness-based stress reduction, etc., to relieve stress headaches.
• Adjust computer screen brightness to be just clear enough, not too bright; adjust the screen center height to your eye level when looking straight ahead; take a 10-minute break every 50 minutes of screen time.
• Maintain correct sitting posture, head up and chest out, to prevent neck and shoulder stiffness.
• Perform neck stretches, chin tucks, shoulder rolls, and head turns. Applying heat to the neck and shoulders, taking a hot bath, or getting a massage can also help relax the neck and shoulders.
• Keep the head and neck warm in cold or windy weather.
• Try to minimize the use of painkillers to avoid Medication Overuse Headache.

Be Especially Wary of These Types of Headaches

Certain sudden headaches may indicate serious diseases, even leading to disability, and require immediate medical attention:

• Headache accompanied by limb weakness, speech difficulty, visual field deficit: Could be a precursor to brain tumor, stroke, cerebral ischemia, or other serious brain diseases.
• Thunderclap headache: Explosive, severe pain that peaks within one second. May indicate a ruptured brain aneurysm, stroke, or other emergencies. Delayed treatment can lead to death or severe disability.
• Severe headache accompanied by fever, neck stiffness, confusion, difficulty speaking, etc.: Could be meningitis or other brain infections.
• Headache after head trauma: Headache that persists or worsens after a head injury, especially if accompanied by drowsiness, nausea/vomiting, confusion, memory loss: Could indicate intracranial hemorrhage.
• Positional headache: Headache that significantly worsens within minutes of sitting up or standing and rapidly improves within minutes of lying flat: Could be a cerebrospinal fluid leak.

If you experience any of the above headaches, please seek immediate medical attention to avoid missing the critical treatment window!

Conclusion

Headache is a common but potentially underestimated health problem. Correctly understanding the types, causes, and treatment options for headaches is key to effective management. Beyond taking painkillers, you have a partner in Traditional Chinese Medicine that treats you as a complete, interconnected whole. With TCM, combined with daily health maintenance, most headache patients can achieve significant improvement.