Chronic Headache, Migraine and TMJ

Virtually everyone is familiar with the pain of a headache. However, for some of us the repeat attacks of migraines or chronic headaches greatly reduce our quality of life. To properly understand and treat chronic headaches and migraines they must first be accurately diagnosed, their triggers and relieving factors identified, followed by the application of appropriate treatment using an integration of standard medicine and traditional Chinese medicine (acupuncture, herbal medicine, diet modification, lifestyle counseling). When evaluating the medical research on using acupuncture and natural medicine to treat chronic headaches and migraines the evidence of efficacy is strong. The largest study of acupuncture and chronic headaches recently published in the prestigious British Medical Journal in 2004 declared, "Acupuncture leads to persisting, clinically relevant benefits for primary care patients with chronic headache, particularly migraine." It has since been adopted as one of the primary therapies of choice for migraine sufferers in the British healthcare system.

The magnitude of the headache problem in the United States and worldwide is enormous. Tens of millions of Americans suffer from headaches and 78% of Americans have problems with recurrent headaches at some point in their lives. Over 20% of adult females suffer from migraine headaches, and half of these women are severely disabled during headache episodes. Headaches are categorized into two types. Primary headaches, such as migraines, cluster headaches, tension headaches and depression headaches, are due to intrinsic dysfunction in the nervous system. Secondary headaches, such as flu headaches, sinus headaches and blood sugar headaches, have their source outside the central nervous system. Traditional Chinese medicine further breaks down the classification of headaches by the type of pain, location and triggers. This further breakdown becomes vitally important when successfully treating the root cause of the headache disorder.

By far the most commonly seen headaches clinically are migraines, tension headaches, cluster headaches and sinus headaches. Migraine headaches occur in women three times more frequently than men. In 90% of these cases there is a family history of migraines. Typically, migraines are severe, unilateral, throbbing and may be accompanied by nausea, visual disturbances and noise/light sensitivity. The pathophysiology is complex and standard treatment has limited success through the use of pharmaceuticals, such as Imitrex and Zomig. Tension headaches are most common in the mid-afternoon and are associated with the muscles of the shoulders, neck and back of head. They often feel like a tight band around the head which slowly expands until it affects the entire head. Standard treatment includes migraine medications and even botox injections, which I would not recommend as it can lead to atrophy of the affected muscles. Cluster headaches mostly affect middle age men. Their pathophysiology is largely unknown and they are described as excruciating pain behind one eye or over the temple. Standard treatment is limited to anti-migraine agents or DHE. Sinus headaches are typically confined to the front of the head and face and are described as pressure pain. They are often triggered by colds, allergies, chronic sinusitis and changes in barometric pressure. The pain of these headaches is often worsened when leaning forward. Standard treatment is typically limited to chronic antihistamine/decongestant use.

Unfortunately, the standard Western medical treatments for these headaches often fall short of preventing or addressing pain. Furthermore, the root cause of headaches typically goes unaddressed. It is through its holistic view of the body and powerful targeted treatments that traditional Chinese medicine is able to not only treat the pain of headaches, but also identify and treat the headache disorder's root cause.

Traditional Chinese medicine (TCM) recognizes that these headache categories are far from the same in every person. Not only are the types of pain and triggers different from person to person, but each of us has an individual constitution, with all its inherent strengths and weaknesses. For instance, for many women migraines frequently occur at certain times during the menstrual cycle. TCM recognizes that the pain of these attacks needs to be addressed, but also a gentle balancing of the hormones responsible for proper function of the menstrual cycle needs to be provided. In tension headaches, it is not enough to simply release tension from the muscles of the neck and shoulders, but the fundamental way the patient's body responds to day-to-day stress needs to be addressed.

TCM has many tools at its disposal for the treatment of headaches, but the most commonly used are acupuncture, herbal therapy, dietary therapy and lifestyle counseling. Acupuncture is the insertion of sterile hair-thin needles at neurologically sensitive points of the body to stimulate a targeted central nervous system regulating response. It has profound effect on the neurovascular system, and there is no other medical modality which works by the same mechanism of action. TCM herbal therapy makes use of the largest and most clinically used pharmacopoeia on the planet. Traditional formulas are extremely safe and effective in treating all types of headaches. Many headaches also have dietary triggers and TCM recognizes that certain foods need to be eliminated or added to the diet during treatment. Finally, lifestyle is powerful medicine. Often certain activities, such as the way we sleep, work or exercise are greatly affecting our headache symptoms and need to be adjusted. Furthermore, targeted relaxation exercises can often be helpful to relax the nervous system and prevent attacks.

Headaches are so commonplace that many of us have accepted the pain and disruption of our lives as normal. However, it is not normal, and it is extremely treatable.