CHAPTER 20 Headaches During Periods
Headache occurring at period time is an extremely common problem. When chronic headache is linked to the menstrual cycle it must be treated by regulating the menses and the Uterus, plus any other treatment that may be called for.
Headaches at period time may occur before, during or after the period; the incidence is more or less equal. As a rough guide, headaches occurring before the period are due to Qi or Blood stagnation; headaches during the period, to Liver-Yang rising; headaches after the period, to Blood deficiency. However, this is only a rough diagnostic guide and, in practice, there may be deviations from the above rule.
Excessive physical work, including sports, may injure the Spleen and lead to Qi and Blood deficiency. Blood deficiency is aggravated after the period because at this time the Penetrating Vessel, which is the Sea of Blood, is in a state of relative emptiness. Deficient Blood fails to nourish the Brain and this results in deficient-type headaches which usually occur during or after the period.
Anger, repressed anger, resentment, frustration, worry and guilt may lead to Liver-Qi stagnation which may turn into Fire. Liver-Fire has the tendency to flare upwards, all the more so during the periods when the Qi of the Penetrating Vessel may rebel upwards. This causes headaches before or during the period.
Another possibility is that emotional strain leads to deficiency of Liver-Blood and/or Liver-Yin and the ensuing uprising of Liver-Yang. This also leads to headaches before or during the period.
Yet another possibility is that Liver-Qi stagnation gives rise to Liver-Blood stasis; when this happens, Blood accumulates and does not flow into the Uterus and Penetrating Vessel properly at period time. Since the Liver channel enters the Brain, this condition of Blood stasis may cause headaches before or during the period.
The main pathological conditions causing headaches at period time are:
Blood deficiency and Liver-Yang rising tend to occur in women with a background of deficiency, i.e. deficiency of Blood and/or Yin, while Liver-Fire and Blood stasis tend to occur in women with a Yang constitution and a tendency to Full conditions.
Dull headaches on the vertex during or after the period, dizziness, palpitations, insomnia, blurred vision, tiredness, dull, pale complexion. Tongue: Pale and Thin. Pulse: Choppy or Fine.
LU-7 Lieque (on the right) and KI-6 Zhaohai (on the left), Ren-4 Guanyuan, ST-36 Zusanli, SP-6 Sanyinjiao, LIV-8 Ququan, BL-20 Pishu, BL-18 Ganshu, BL-23 Shenshu. All with reinforcing method; moxa can be used on Ren-4, ST-36 and SP-6.
This remedy aims at treating eye problems deriving from Blood deficiency. However, it is also suitable to treat deficiency-type headaches from Blood deficiency as some of the herbs that reach the eyes also treat headaches, e.g. Ju Hua, Man Jing Zi and Bai Ji Li.
This remedy is a variation of the formula Ba Zhen Tang Eight Precious Decoction which nourishes Blood and tonifies Qi. It has been modified with the addition of Kidney tonics. The tongue presentation appropriate to this remedy is a Pale and Thin body.
Dull headaches on the vertex during or after the period, dizziness, palpitations, insomnia, blurred vision, tiredness, dull, pale complexion. Tongue: Pale and Thin. Pulse: Choppy or Fine.
A 52-year-old woman suffered from headaches occurring after the period. Her periods were still coming regularly but were rather scanty. Her hair was falling out and her skin was dry. She had never been able to conceive although she tried for many years. She also felt very weary and depressed, especially so after her period. She also lacked any motivation and ‘everything was an effort’. She found it difficult to fall asleep and had had a lump in her left breast for 20 years. Her iron storage level was very low (3). Her pulse was very Weak and Empty on the deep level but also slightly Fine and Wiry on the left. Her tongue was Pale on the sides, had a Heart crack and a rootless coating.
This is quite a complex condition. The main pattern that emerges is that of Liver-Blood deficiency manifesting with scanty periods, hair falling out, dry skin, infertility, insomnia, a Fine pulse and a Pale tongue on the sides. There are, however, other patterns that manifest with only a few symptoms. The Wiry quality of the pulse indicates that there is some stagnation of Liver-Qi from emotional stress, also evidenced by the Heart crack on the tongue. The stagnation of Liver-Qi was a contributory factor to the development of the breast lump, another being Phlegm (as the lump felt soft to the touch). Yet another pattern is a Kidney-Yin deficiency, again manifesting with few symptoms and principally the emptiness of the pulse at the deep level, the rootless tongue coating and the lack of motivation and exhaustion. The falling hair and dry skin attributed to Liver-Blood deficiency may also be caused by Kidney-Yin deficiency, or this may contribute to them. To sum up, there are two excess conditions (stagnation of Liver-Qi and Phlegm) and two deficiency ones (Liver-Blood and Kidney-Yin deficiency). In addition, this may be classified as a case of Mind Weakened, i.e. low spirits, depression, lack of motivation and physical and mental exhaustion.
The headaches occurring after the period were her main presenting symptom and they were due to Liver-Blood deficiency. I therefore started by treating her with a variation of the formula Ba Zhen Tang Eight Precious Decoction:
The first eight herbs constitute the formula Ba Zhen Tang.
After one course (30 days) of this formula, this patient felt a lot better in herself and her headaches disappeared. Her iron storage levels also climbed to 13. The patient is still under treatment and I foresee that she will probably eventually need to change to a formula to nourish Kidney-Yin and Blood.
Severe throbbing headaches in the temples, eyes or sides of the head before or during the period, heavy menstrual flow, dizziness, flashes in the eyes, bitter taste, thirst, red face, dry stools, dark urine, irritability. Tongue: Red with yellow coating and redder sides. Pulse: Wiry and Rapid.
LIV-2 Xingjian, T.B.-5 Waiguan, G.B.-43 Xiangu, LIV-3 Taichong, L.I.-4 Hegu, L.I.-11 Quchi, SP-6 Sanyinjiao, KI-3 Taixi, Taiyang, G.B.-5 Xuanlu, G.B.-6 Xuanli, G.B.-9 Tianchong. All with reducing or even method. No moxa.
This remedy is a variation of the formula Long Dan Xie Gan Tang Gentiana Draining the Liver Decoction which drains Liver-Fire. The tongue presentation appropriate to this remedy is a Red body with redder sides and with a dry, yellow coating.
Severe throbbing headaches in the temples, eyes or sides of the head before or during the period, heavy menstrual flow, dizziness, flashes in the eyes, bitter taste, thirst, red face, dry stools, dark urine, irritability. Tongue: Red with yellow coating and redder sides. Pulse: Wiry and Rapid.
LIV-2 Xingjian, T.B.-5 Waiguan, G.B.-43 Xiangu, LIV-3 Taichong, L.I.-4 Hegu, L.I.-11 Quchi, SP-6 Sanyinjiao, KI-3 Taixi, Taiyang, G.B.-5 Xuanlu, G.B.-6 Xuanli, G.B.-9 Tianchong. All with reducing or even method. No moxa.
Throbbing headache in the temples, eyes or sides of the head before or during the period, irritability, dizziness, flashing lights in the eyes. Tongue: the body colour may be unchanged or Pale if Liver-Yang rising derives from Liver-Blood deficiency. Pulse: Wiry, or Wiry on the left and Fine on the right.
LU-7 Lieque (on the right) and KI-6 Zhaohai (on the left), Ren-4 Guanyuan, SP-6 Sanyinjiao, KI-3 Taixi, LIV-8 Ququan, T.B.-5 Waiguan, P-6 Neiguan, G.B.-43 Xiangu, LIV-3 Taichong, Taiyang, G.B.-5 Xuanlu, G.B.-6 Xuanli, G.B.-9 Taichong. Ren-4, SP-6, KI-3 and LIV-8 should be needled with reinforcing method; all the others with reducing or even method.
This remedy is specific to treat headaches from Blood deficiency and Liver-Yang rising. The tongue presentation appropriate to this remedy is a Pale and Thin body indicating Blood deficiency. If there is a tendency to Yin deficiency, the body might be slightly Red and with insufficient coating.
Throbbing headache in the temples, eyes or sides of the head before or during the period, irritability, dizziness, flashing lights in the eyes. Tongue: the body colour may be unchanged or Pale if Liver-Yang rising derives from Liver-Blood deficiency. Pulse: Wiry, or Wiry on the left and Fine on the right.
LU-7 Lieque (on the right) and KI-6 Zhaohai (on the left), Ren-4 Guanyuan, SP-6 Sanyinjiao, KI-3 Taixi, LIV-8 Ququan, T.B.-5 Waiguan, P-6 Neiguan, G.B.-43 Xiangu, LIV-3 Taichong, Taiyang, G.B.-5 Xuanlu, G.B.-6 Xuanli, G.B.-9 Taichong. Ren-4, SP-6, KI-3 and LIV-8 should be needled with reinforcing method; all the others with reducing or even method.
A 45-year-old woman had been suffering from severe headaches since the age of 16. These occurred with regularity at mid-cycle and were of a throbbing character. They occurred over the eyes and were accompanied by dizziness, blurred vision and nausea. She tried hormone replacement therapy for 18 months but this only made the headaches worse. She also suffered from backache, tinnitus and night sweating. Her periods came regularly every 26 days and lasted about 4–5 days; they were not painful and the blood was not particularly dark. Her urination was frequent and the urine pale and she suffered from cold feet. Her pulse was very Weak on both Rear positions and her tongue was Pale and Swollen.
This is a clear example of headache from Liver-Yang rising: the throbbing character of the headache, the dizziness, blurred vision, nausea and location of the headache, all clearly indicate this pattern. In this case, Liver-Yang rising originates from a Kidney deficiency: although it may seem strange, it was in this case a Kidney-Yang deficiency. This can happen because, as was pointed out several times, the Yin and Yang aspects of the Kidneys are not separate but an indivisible whole; thus when they are deficient, especially in women over 40, nearly always both Yin and Yang are deficient, albeit in different degrees. That it is Kidney-Yang deficiency is clear from the Pale colour of the tongue, the frequent urination and the chilliness.
The treatment principle adopted was to tonify the Kidneys and subdue Liver-Yang. She was treated with acupuncture and prepared remedies.
With acupuncture, I selected points from the following:
As a prepared remedy, I prescribed the Three Treasures’ Bend Bamboo which nourishes the Liver and Kidneys and subdues Liver-Yang.
After four treatments, the headaches were reduced in intensity and did not occur at mid-cycle any longer. When menstrual headaches lose their relation with the periods, I usually interpret this as a good sign: it means that the menstrual function is regulated and the residual headaches, although still occurring because the basic pattern is still there (in this case Liver-Yang rising), no longer occur in conjunction with the period. After another 30 treatments (at 2-week intervals), her headaches all but disappeared.
A 40-year-old woman had been suffering from headaches before and after the period: interestingly, the headaches had started after an operation for sterilization (tube ligation). The headaches were located behind the eyes, on either side, and were throbbing in nature; they were accompanied by nausea, blurred vision, a bitter taste, thirst and dizziness. Her periods were regular and rather scanty. On interrogation, it transpired that she also suffered from palpitations, dizziness, tingling of her limbs, poor memory, blurred vision and night sweating. Her tongue was Pale and Swollen and her pulse was Choppy and Weak, particularly on both Rear positions.
The headaches are typical of Liver-Yang rising with their throbbing character, dizziness, blurred vision and nausea. The bitter taste and thirst also indicated some Liver-Fire. The origin of Liver-Yang rising was primarily Liver-Blood deficiency as was clearly shown by the blurred vision, dizziness, poor memory, tingling, scanty periods, Pale tongue, Choppy pulse and palpitations (this last symptom due to Liver-Blood deficiency affecting Heart-Blood). There was a slight Kidney deficiency as evidenced by the night sweating and Weak pulse on both Rear positions. Finally, there was also some Phlegm and Spleen-Qi deficiency as evidenced by the Swollen tongue.
The treatment principle adopted was to nourish Liver-Blood, tonify the Spleen, subdue Liver-Yang and tonify the Kidneys. I treated her with herbal medicine and acupuncture.
After the first decoction, I added Xia Ku Cao Spica Prunellae 4.5 g remembering that there was also some Liver-Fire (bitter taste and thirst).
After four courses of decoctions (of 15 days each), she was completely free of headaches.
Stabbing headache in the temples, eyes or sides of the head before the periods, dark menstrual blood with clots, painful period, abdominal pain. Tongue: Purple. Pulse: Wiry or Choppy.
Invigorate Blood, harmonize the Penetrating Vessel, remove obstructions from the Connecting channels.
SP-4 Gongsun (on the right) and P-6 Neiguan (on the left), P-6 Neiguan, SP-10 Xuehai, BL-17 Geshu, ST-29 Guilai, SP-6 Sanyinjiao, KI-14 Siman, LIV-3 Taichong, Du-20 Baihui, G.B.-17 Zhengying. All with reducing or even method.
This remedy is a variation of Xue Fu Zhu Yu Tang Blood Mansion Eliminating Stasis Decoction. It invigorates Blood and eliminates stasis and it can be used for headaches because it is directed at the Upper Burner. The tongue presentation appropriate to this remedy is a Purple body.
Stabbing headache in the temples, eyes or sides of the head before the periods, dark menstrual blood with clots, painful period, abdominal pain. Tongue: Purple. Pulse: Wiry or Choppy.
Invigorate Blood, harmonize the Penetrating Vessel, remove obstructions from the Connecting channels.
SP-4 Gongsun (on the right) and P-6 Neiguan (on the left), P-6 Neiguan, SP-10 Xuehai, BL-17 Geshu, ST-29 Guilai, SP-6 Sanyinjiao, KI-14 Siman, LIV-3 Taichong, Du-20 Baihui, G.B.-17 Zhengying. All with reducing or even method.
Menstrual headaches respond very well to treatment with acupuncture or herbs used singly or in combination. The most difficult pattern to treat is that from stasis of Blood and the easiest is that from deficiency of Blood. Usually the combination of both acupuncture and herbs gives quicker results.
As for prevention, it is essential that a woman who suffers from menstrual headaches should not consume excessive amounts of tea or coffee or, preferably, should not drink them at all. With the patterns of Liver-Yang rising and Liver-Fire, she should also abstain from consuming sour foods such as vinegar, orange juice, grapefruit juice, pickles, red currants, yoghurt, etc. These foods will upset the Liver and increase pain.
For those suffering from the pattern of Blood deficiency, it is important not to overwork and to take adequate rest. A short period of rest lying down after lunch is very beneficial: it is important to lie down as the Blood flows back to the Liver then and has a regenerating effect.