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How Chinese Medicine Understands Headache Disorders

With the hectic pace of modern life, many stressful situations are avoidable, an increasing number of people suffer from headaches. Headache is only a symptom, the cause of which is not necessarily in the head, problems in other parts of the body can also contribute to headaches. Since the causes and symptoms of headaches can be so different, headaches should be diagnosed and treated according to individual conditions, in particular for chronic and recurrent types such as migraine, traumatic headache or headache of neurovascular origins. These headaches cannot simply be relieved by pain medications, doctors treat them with a variety of drugs and based on the patterns of headaches, which are the most productive way to cure or alleviate the painful conditions.

Head orifices are the openings
on the head such as the eyes,
ears, nose and mouth.

Traditional Chinese medicine (TCM) regards the head as "the confluence of yang" and "the dwelling of lucid yang," which mean the head is closely connected with other parts of the body, and all the organs are responsible for nourishing it. Moreover, TCM holds that the brain is the sea of marrow, which is derived from kidney essence and nourished by food nutrients. The head connects with the internal organs through the meridians and collaterals; it also has orifices to communicate with the external directly. When external or internal factors impede the flow of meridians, disturb nutrient supply to the head, and block the head orifices, headaches will occur. Since there are many triggers or causes for headaches, the frequency and severity vary considerably between individuals. It may be a challenge to diagnose and treat headaches sometimes.

Clinically, TCM physicians rely on specific headache details to analyze the pathological changes inside the body; the information help them find the underlying disharmony patterns and provide guideline for the treatments. Below are TCM views on some headache disorders and the treatment principles.

Migraine | Supra-orbital pain | Distending sensation in the head
Heaviness sensation in the head | Headaches and menstruation
Headaches during pregnancy


Migraine in Western medicine is a recurrent headache with unknown causes. Typical migraine headaches are one-sided, pulsating or throbbing, moderate or severe pain, worse with activity, and often with other symptoms like nausea, vomiting, sensitivity to light or noise. The manifestations are generally thought to be neurovascular dysfunctions that are commonly triggered by stress, fatigue, insomnia, menstruation and weather changes.

From a TCM perspective, migraine is mainly due to invasion of wind and fire that cause meridian obstructions, and disturb the flow of blood and qi in the head. Also, liver dysfunction and its pertaining meridian have played important roles in the development process. TCM treatment for migraine aims to calm the liver, dispel the pathogens and unblock the meridians. The treatment plan should be individualized according to specific disharmony patterns.

TCM disharmony patterns

Headache manifestations

Therapeutic principles

Stagnation of liver qi

Distending or pulsating pain on one side of the head, accompanied by emotional depression, chest stuffiness and occasional belching

Soothe the liver, relieve stagnation, regulate qi and stop pain

Hyperactivity of liver yang

Distending pain in the head, accompanied by dizziness, blurred vision, ear ringing, irritability, insomnia, mouth dryness and flushed face

Calm the liver, subdue yang and nourish yin

Blood stasis obstructing the collaterals

Persistent and steady headaches, pricking or pulsating pain, accompanied by forgetfulness and palpitations

Activate blood, unblock collaterals and stop pain

Retention of coldness and static fluid

Headaches with cloudiness and heaviness sensations, or feel like a tight band around the head, accompanied by distention in the chest and upper abdomen, nausea or vomiting, excessive sputum, stomach upset that tends to be alleviated by warmth, cold limbs, no appetite and fatigue

Warm the middle burner and restore its normal qi flow, eliminate dampness and resolve phlegm

Supra-orbital pain

The pain is located above the eyebrows, either one-sided or two-sided, or spreading over the forehead. TCM claims that the pain is mainly caused by invasion of wind-heat pathogens or wind pathogens along with stasis. Also, dysfunctions of the stomach and gallbladder meridians have played important roles in the development process.

TCM disharmony patterns

Headache manifestations

Therapeutic principles

Invasion of

Pain above the eyebrow or distending feeling in the forehead, accompanied by red and tearing eye, and sensitivity to light. There may also exterior symptoms such as fever and aversion to wind blowing. A red tongue tip, and thin yellow tongue coating, the pulse is floating and rapid

Disperse wind and clear heat

Wind-stasis obstructed collaterals

Pricking or stabbing pain above the eyebrow, sensitivity to light, the pain may be further aggravated by pressing. The tongue is dark-purplish or has purple spots on it, and the pulse is taut and hesitant. Individuals may have a history of head injury

Disperse wind, activate blood and stop pain

Distending sensation in the head

The head develops a distending sensation, which may feel like the head is splitting in serious cases. This is a usual complaint among headache sufferers. In TCM, headache with a distending feeling is usually resulted from abundant qi and blood flowing into the head region that lead to localized stagnation, and disturb the head orifices. The usual disharmony patterns are:

TCM disharmony patterns

Headache manifestations

Therapeutic principles

Invasion of

Headaches with a distending, or even a splitting sensation, accompanied by fever, aversion to wind blowing, thirst, flushed face, bloodshot eyes, a red tongue covered by yellow coating, floating and rapid pulse

Disperse wind and clear heat

Up-bearing of liver yang

A distending feeling in the head, accompanied by dizziness, ear ringing, numbness and tingling of the limbs, insomnia, lumbar soreness, knee weakness, flushed face, a red tongue with yellow coating, taut and rapid pulse. The symptoms are aggravated by fatigue or emotional stress

Calm the liver, subdue yang, nourish the kidney and liver

Flaming up of liver fire

A distending feeling in the head, or more severe like the head is splitting, accompanied by bloodshot eyes, bitter sense in the mouth, lower chest discomfort, irritability, dream-disturbed sleep, a red tongue with yellow and greasy coating, taut and rapid pulse

Purge liver fire, clear heat and eliminate dampness

Heaviness sensation in the head

Headache sufferers sometimes describe that they had a heavy feeling in the head, like the head being covered or put on heavy objects. This feeling is commonly seen in tension headache, headache of cervical origin or headaches due to functional disorders. TCM holds that dampness is the most common contributing factor for a heavy head feeling. As dampness pathogens are heavy and turbid in natures, they tend to disturb the movement of qi and lead to a sluggish flow of the meridians. Others disharmonies such as stagnation of the liver, dysfunction of the middle burner and improper ascending of lucid yang can also result in a heavy head feeling.

TCM disharmony patterns

Headache manifestations

Therapeutic principles

Wind-dampness obstruction

A heavy head feeling, fatigue, limb heaviness, chest stuffiness, no appetite, urinary difficulty, loose bowels, a white and greasy tongue coating. The symptoms are aggravated during rainy or humid weathers

Dispel wind and eliminate dampness

Damp-heat irritation

A heavy head feeling, or even a distending pain in the head, flushed face, hot sensation of the body, irritability, no appetite, chest stuffiness, gastric and abdominal distention, scanty and yellowish urine, constipation, a red tongue with yellow-greasy coating. The symptoms get worse in the afternoon

Clear heat and resolve dampness.

※ If the symptoms are caused by a hangover, physicians like to use a prescription named

Phlegm-dampness obstruction

A heavy head feeling, or even headache with dizzy and foggy feelings, chest stuffiness, stomach upset, excessive sputum or saliva, fatigue, a bulky tongue with teeth marks around the edge and a white-greasy coating

Invigorate the spleen, dry dampness, resolve phlegm and restore the qi movement

Stagnation of liver

Heavy and dizzy head feelings, lower chest discomfort, stomach upset, belching, mental depression, dream-disturbed sleep, forgetfulness, poor appetite and loose bowels. The symptoms usually fluctuate along with emotional stress

Sooth the liver, regulate qi and harmonize the middle burner

Deficiency of middle burner

Persistent heavy head feeling, or dizzy, heavy and empty feelings in the head, accompanied by paleness, fatigue, breath shortness, poor appetite, loose bowels, a pale tongue

Invigorate the middle burner, replenish qi, and promote the ascending of lucid yang

Headaches and menstruation

Headaches in women are related to changes in the levels of female hormones during a menstrual cycle. The headaches can be one-sided or two-sided and in various durations, they may also accompanied symptoms like vomiting, no appetite, general weakness and paleness.

TCM holds that during or around menstruation, the body's conception vessel and thoroughfare vessel are exuberant and flushed with abundant qi and blood, the excessive qi and blood will empty into the uterus and produce regular menses. Meanwhile, the blood and qi supply to the head is reduced which lead to a temporary weakness of the region, pathogens may take advantage of the situation and attack the head. When the head orifices become dysfunctional or blocked, there will be headaches. Women who already have qi and blood problems, hyperactive liver, or yin deficiency are likely to develop headaches during menstruation. TCM treatment always aims to regulate qi and blood, and unblock the meridians and collaterals. Moreover, TCM physicians will consider the menstrual phases when selecting the herbs. Headaches during menstruation are often associated with disharmonies like blood deficiency, liver fire and blood stasis.

Click to see the headaches in premenstrual disorders and menopausal disorders.

Headaches during pregnancy

Headaches are common during pregnancy. Most of them are harmless that are due to normal changes in the hormone levels, and an increase in blood volume and circulation. However, if your headaches get worse or are persistent, you should see a doctor to rule out any serious problems.

From a TCM perspective, since plenty of blood flow down to the uterus and has used to nourish the fetus, the body tends to be in blood deficiency or yin deficiency disharmony. When the head is under nourished or disturbed by the relative excess of yang, there will be headaches. Below are common disharmony patterns of headaches during pregnancy.

TCM disharmony patterns

Headache manifestations

Therapeutic principles

Liver hyperactivity and blood deficiency

Persistent dull pain in the head, dizziness, blurred vision, palpitations, discomfort in the lower chest, sallow complexion, a pale tongue, taut and thready pulse

Nourish blood and clear the liver

Yang hyperactivity and yin deficiency

Frequent headaches with a distending feeling, dizziness, ear ringing, irritability, a red and dry tongue, the pulse is taut, thready and rapid

Nourish yin and subdue yang