HEADACHES Flashcards
HEADACHES ætiology
Constitutional deficiency Emotional stress Overwork Excessive sexual activity Irregular diet Trauma Childbirth
HEADACHES channels
Internal Organs involved; channels involved
Important to know channels of the head for acupuncture treatment of headaches.
“Palace of Yang”
Yang channels communicate on the face; only Yang channels reach the head.
Yin channels reach the head internally: LIV and HT
Distal points of arm and leg channels have similar actions, almost interchangeable: LI 4 and ST 44, SI 3 and BL 65, TW 2 and GB 43
Meridians of the Head-POSTERIOR REVIEW
GV
TW
SI
BL
Meridians of the Head-SIDE REVIEW
ST/LI
BL/SI
GB/TW
Meridians of the Head-FRONTAL VIEW
ST/LI
BL/SI
GB/TW
CV
HEADACHES pathology LIV-YANG DEF OF YANG EX OF YIN DEF OF YIN
Excess of Yang
_Liver Yang rising, Liver Fire with signs of heat
_Intense, usually throbbing pain
Deficiency of Yang
_ST Qi Def (frontal) or KD Yang Def. (occipital)
_Dull, mild pain
Excess of Yin
_Dampness and Phlegm
_Dull, but intense pain
Deficiency of Yin
_LV and HT Blood deficiency; Yin or KD Essence deficiency
HEADACHES-DX
CHANNELS
INTERNAL ORGANS
TYPIES
Channel or Internal Organ (pattern Dx)? Channel: where on the head is the pain? Type of Pain: what type of pain? Amelioration and aggravation: better or worse? _Chronic H/A worse in daytime _-Deficiency of Qi/Yang or Dampness _Chronic H/A worse in evening \_\_Blood or Yin deficiency
HEADACHES-DX Diagnosis according to PAIN: DULL HEAVINESS Distending pain: Pulling: Stabbing
Diagnosis according to PAIN:
Dull: deficiency
Feeling of heaviness: Dampness or Phlegm
Distending pain: Liver Yang or Liver Fire, exterior Wind heat
Stiff: exterior Wind-Cold; if chronic Liver Yang rising
Pulling: internal Liver Wind
Stabbing, boring: Blood stasis
HEADACHES patterns
Exterior Wind Cold Wind Heat Wind Dampness Interior Full: Liver Yang, Fire, Wind & Qi Stagnation; Cold; Dampness; Phlegm, Phlegm Wind; Food Retention; Blood stasis; Stomach heat Empty: Qi, Blood and Kidney deficiency
HEADACHES treatment
R+B
Root and the Branch (manifestation)
_Place emphasis on one or the other
__Severe pain: focus on Branch
__Mild pain: focus on the Root
Manifestation first, Root secondly
_Severe cases require Branch treatments, when pain is reduced then treat Root
Root only
_Mild infrequent pain, treat root cause
HEADACHES point RX
LOCAL
DISTAL
Local points are chosen by channel involved
GB 4, 5, 6, 8, 9, 14, and 20
BL 10
ST 8
Distal points focus on the pattern involved
Example: Liver Yang H/A on GB channel
LIV 3 to treat pattern; GB 43 to treat channel
GB 43, TW5
BL 60
ST 44, LI 4
Yang Ming Headaches CHANNELS PATHWAY SX RX:: L & D
Frontal h/a, trigger point activity, disorders of ST, SP, LI, LIV & GB.
Common pathology: ST heat, ST & GB disharmony, SP Qi def., phlegm damp, Qi constraint, Wind heat and sinus congestion
Pain:
Dull: Phlegm damp, Wind damp, Qi def.
Tight, constant: LIV Qi constraint
Splitting, pounding, throbbing: Wind heat, Toxic heat, Summer heat, ST heat, GB & ST disharmony, LIV Fire
Points:
Local: Yin Tang, GV 23, GB 14, BL 2, GB 20
Distal: LI 4, ST 36, ST 44, ST 41
Yang Ming Headaches
-REFERRED PAIN FROM TRIGGER POINTS:
REFERRED PAIN FROM TRIGGER POINTS: Sternocleidomastoid Semispinalis capitis Frontalis Zygomaticus major Masseter Splenius cervicus
Shao Yang Headaches CHANNELS PATHWAY SX RX:: L & D
Temporal h/a, associated with trigger point activity, especially sternocleidomastoid; LIV & GB, Qi and Blood stasis. May be unilateral or bilateral; Blood stasis usually unilateral. Often concentrate behind the eyes.
Pain:
Dull, background: Blood deficiency
Tight, constant: Liver Qi constraint
Splitting, pounding, throbbing: LIV Yang rising, LIV Fire, GB and ST disharmony
Common Points:
Local: GB 20, TAI YANG, ST 8, GB 1, GB 8
Distal: TW 5 + GB 41, LIV 3 + LI 4, GB 34 + GB 21, LU 7
Shao Yang Headaches
-REFERRED PAIN FROM TRIGGER POINTS:
REFERRED PAIN FROM TRIGGER POINTS: Sternocleidomastoid Trapezius, upper, near GB 21 Temporalis Semispinalis captitis Suboccipital group
Tai Yang Headaches CHANNELS PATHWAY SX RX:: L & D
Occipital h/a, from EPI, KD deficiency, LIV Qi constraint; pathology of the BL, SI and GV channels; trigger point activity in muscles
Pain:
_Dull, heavy: Wind Damp
_Dull, empty: KD deficiency
_Tight, constant: Wind Cold, LIV Qi constraint
_Splitting, pounding, throbbing: Ascendant LIV Yang
Common Points:
Local: GB 20, GV 16, BL 10
Distal: SI 3 + BL 62, LU 7, GB 41, BL 60
Tai Yang Headaches
-REFERRED PAIN FROM TRIGGER POINTS:
REFERRED PAIN FROM TRIGGER POINTS: Low and middle fibres of Trapezius Sternocleidomastoid Semispinalis Splenius Suboccipital group Multifidus
Jue Yin Headaches CHANNELS PATHWAY SX RX:: L & D
Vertex h/a, Liver pathology, deficient Qi and Blood. Distinct, localized; distinguish from a BL or Du channel h/a that extends down to the occiput and neck.
Pain
Dull: Qi and Blood def.; Liver Qi constraint
Tight, boring: Ascendant Liver Yang; Cold in LIV & ST
Common Points:
Local: GV 20, BL 7, GB 20, GV 23
Distal: LIV 3, BL 67, SI 3, BL 60
Jue Yin Headaches
-REFERRED PAIN FROM TRIGGER POINTS:
REFERRED PAIN FROM TRIGGER POINTS:
Sternocleidomastoid
Splenius capitus
HEADACHES Western terms
TENSION H/A– common
dull persistent pain, feeling of tightness or pressure, varies in intensity
often late in day
can last minutes to years
usually related to stress, triggered by emotions
usually both sides of head
CLUSTER H/A– very severe
usually starts 2-3 hours after falling asleep
burning penetrating sensation around or behind one eye, can radiate to cheeks or near ear
more severe pain than migraine
occurs nightly for 1-3 weeks, episodes months or years apart
HEADACHES Western terms
MIGRAINE H/A– common especially in women
throbbing pain
usually starts on one side of head, may spread to other side or elsewhere on the head
often accompanied by nausea/vomiting, cold hands, photosensitivity, sensitive to sound
warning signs 10-30 minutes before – tingling or numbness in body, speech impaired
frequency varies, may be related to menstrual cycle
4-72 hours duration
can be triggered by stress, emotion, hormonal change, weather change, lights, smell
HEADACHES Western terms
SINUS H/A– associated with sinus congestion or infection
intense pressure and pain in forehead and cheeks, often tender to touch
worse in damp weather and when lying down
REBOUND H/A– aka medication-overuse headache
body adapts to medication, develops pain without it depends on drugs – opiates/barbituates can trigger with only 5-8 doses/month
worse if medication contains caffeine
headache treatments don’t work during rebound cycle
occur daily, often waking the person in early morning
improve with painkillers, return when meds wear off
persist throughout day, worse with physical or mental exertion
tx quit or taper off meds
if heavy-duty, may need doctor supervision, even hospitalization
stress management – resist knee-jerk impulse to take meds at first sign of headache
HEADACHES Western terms
Emergency Red Flag Cases:
Meningitis: severe headache of entire head, acute onset, pronounced rigidity of neck, fever, vomiting. most common in young children.
Brain Aneurysm: acute onset, “the worst headache of my life”
Subural Hematoma: headache immediately following trauma (or delayed after trauma): progressive severity with loss of consciousness
Urgent Referral Cases:
Brain Tumor: persistent headache, progressively worse in severity and frequency despite treatment
Glaucoma: headache around or behind eyes, associated with pressure behind eyes, visual disturbance (easy to mistake for migraine). patients usually middle aged or older
HEADACHES Western terms
Other causes of headache:
Trigeminal neuralgia, ear infection, dental pain, TMJ, arthritis in neck, trauma/whiplash
headaches can also be caused by over 300 systemic diseases such as hypertension, endocrine disorders, liver or kidney failure, metabolic disorders…
NOTE: If headaches are frequent, long-standing or severe; or with sudden onset or sudden change/worsening of symptoms; refer to PCP or neurologist for evaluation.
