Headaches are one of the most common types of pain and one of the most frequent causes of presentation to physicians and clinics. They are also known as cephalgias and may present as isolated phenomena, or can be seen as a symptom of a variety of acute or chronic diseases. Three-fourths of all adults experience headaches in the US. In that, nine out of 10 women and seven out of 10 men experience them. Headaches represent 10 percent of all visits to the emergency room and the public spends over $2 billion annually on over the counter medications to treat headaches. Biomedicine and Traditional Chinese Medicine have developed their own systems to treat them.


Headaches are multifactorial and complex. They can be affected or exacerbated by internal and external stimuli. Well known triggers include muscular tension, stress, fatigue, diet, menstruation or environmental stimuli such as smoking (nicotine is a vasoconstrictor and carbon monoxide is a vasodilator; together they can trigger a migraine).

Headaches are associated with constriction or dilation of intracranial and extracranial arteries. External structures of the head are pain sensitive and prone to tension. Internally, brain lesions can cause mass, fluid or hemorrhage that affect pain sensitive structures such as arteries, blood vessels and certain cranial nerves (e.g., CN V, VII, IX, X). Hormonal imbalances also account for a great deal.

There are two divisions of headaches in Biomedicine. They are primary headaches, which have no known causality, and secondary headaches, which are related to other pathologies or underlying conditions. Primary headaches account for 90 percent of reports and include (in this order of prevalence) tension, migraine and cluster headaches – all of which are considered vascular – and muscular contraction or a combination if the two. Primary headaches are diagnosed only when underlying diseases are ruled out. Secondary headaches are usually caused by infections or trauma.

Biomedical treatment of headaches can be varied via drugs, stress relief, lifestyle changes and prevention. Common analgesics include aspirin, acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), narcotics, caffeine and antibiotics. Theses can be administered via nasal, oral, parenteral, or rectal routes. They usually dull pain receptors and do not help with the true cause.

As part of a prevention program most moderate exercise has been found to be helpful in decreasing the frequency of headaches. Exercises that reduce stress and increase cardiovascular capacity were the more effective.

Traditional Chinese Medicine (TCM)

In TCM, headaches are seen as blockages of qi, blood (xue) and body fluids (jin ye) in the channels of the head with various disharmonies such as excess (shi) and deficiency (xu) disorders in the upper and lower parts of the body. Two-thirds of headaches are considered excess, and may affect any of the 11 channels (mai) that cross the head. These channels are the Liver, Ren, Du, Yin and Yang Qiao, and the six regular Yang Mai.

Headache etiology includes constitution, emotions, overwork, excessive sexual activity, diet, accidents and external pathogenic factors. Constitution depends on parental health months before and at the time of conception and the conditions of the actual pregnancy. Overworking parents may have a child with Spleen Xu or digestive weakness with headaches on the forehead that may be easily affected by food intake. Emotions are a common cause of headaches and may present with various symptoms. Overwork may cause Kidney Yin Xu and headache in the whole head. Excess sexual activity may temporarily deplete Kidney Essence and may cause occipital or whole head pain. Diet may cause the most variables due to food energetics, and modern food additives that have not necessarily been explored via TCM. Accidents will cause blood stasis (Yu Xue) and may present at a later or unrelated time. External factors such as wind easily effect the upper body. In assessing and diagnosing it is important to take all of this into consideration.

TCM prevention and treatment of headaches includes but is not limited to acupuncture (best for acute), Tui Na, herbal treatments, dietary recommendations and qi gong.

I am not associated with Duke University. I do however appreciate their efforts in researching this medicine.


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