TCM Acupuncture and Massage

Chapter 59 Nervous system diseases (1)
headache
An overview of the disease

([-]) Relevant knowledge

Traditional Chinese medicine believes that headache refers to a common disease characterized by the patient's conscious head pain caused by exogenous factors, internal injuries or trauma, resulting in urgency in the veins or loss of support, and poor clear orifices. It is also a common symptom and can occur in the Among various acute and chronic diseases, it is sometimes a precursor to the aggravation or deterioration of some related diseases.Severe headache, prolonged unhealed, paroxysmal, also known as "head wind".Modern medicine believes that headaches are the same as pain in other parts of the body, most of which are caused by pain-causing factors (physical or chemical) acting on receptors in the pain-sensitive tissues of the head, and then transmitted to the central nervous system through pain-sensing pathways. Analyzing, integrating and generating pain sensation.Of course, headaches caused by psychogenic mental factors are purely subjective experiences of patients.

([-]) Etiology and pathogenesis

Traditional Chinese medicine divides headaches into three categories: exogenous headaches, internal injury headaches, and traumatic headaches.Exogenous headaches are mostly caused by the invasion of wind, cold, damp and heat; internal headaches can be caused by blockage of phlegm, hyperactivity of liver yang, or loss of qi, blood, and semen; traumatic headaches can be caused by head injuries.details as follows.

1. Exogenous headaches are mostly caused by careless daily life, sitting and lying in the wind and feeling the evils of wind, cold, heat, heat and dampness, but most of them are caused by wind evils.

(1) Invasion of wind and cold: the climate is very cold in winter, daily life is unsuitable, the wind carries the cold evil and invades, Weiyang is restrained, the cold coagulates the blood and stagnates, blocking the collaterals and causing headaches.

(2) External invasion of wind-heat: middle in Yang collaterals, or wind with damp-heat invading clear orifices, qi and blood rebellion leading to headache.

(3) Living in wetlands for a long time, wading in the rain, rheumatism invades the top, the Qingyang does not rise, and the clear orifices are blinded and headache occurs.

2. Headache due to internal injury The brain is a sea of ​​marrow, which depends on the liver, kidney, essence and blood for nourishment and the transportation and transformation of the spleen and stomach.

(1) Those due to the liver: emotional disharmony, depression and anger damage the liver, liver failure, stagnation of liver qi, long-term stagnation into fire, inflammation of the fire, disturbance of the clear orifices, leading to headache.

(2) Those due to the kidney: insufficient endowment or excessive labor, deficiency of kidney essence, and emptiness of the brain, resulting in headache.

(3) Those due to the spleen: due to physical weakness after illness or delivery, weakness of the spleen and stomach, biochemical insufficiency, or after blood loss.Deficiency of nutrient blood. Headache due to inability to nourish the brain, or due to diet sorghum, loss of spleen transportation, internal generation of phlegm, dampness trapped inside, and failure of Qingyang to ascend, resulting in headache.

3. Trauma, headache, trauma, falling down, head injury, brain concussion, blood stasis internal resistance, vein blockage, blockage leads to pain, easy to cause headache, or flash contusion of the neck, staggered cervical spine, blocked governor vessel, and inability to replenish blood The brain can also cause headaches.

Modern medicine thinks that the reason that headache produces is very complicated, has intracranial, extracranial, has cranial part, also has systemic, also has many headaches that still can't find the cause of disease so far.The main clinical factors are as follows:
(1) Vasodilation: extracranial arterial dilation is most common in migraine and frontal arteritis.During acute and chronic inflammation inside and outside the brain, pathogens and their toxins can cause vasodilation headache; Headache.

(2) Traction, compression or stretching of blood vessels: intracranial space-occupying diseases; acute meningitis and encephalitis, toxic encephalopathy, cerebral edema, hydrocephalus, venous sinus thrombosis, brain tumors or compression of cysticercosis Increased intracranial pressure caused by blockage of cerebrospinal fluid circulation; also seen in lumbar puncture, spinal anesthesia after cerebrospinal fluid outflow is more, intracranial pressure drops, leading to headaches caused by intracranial venous sinus and venous dilatation.

(3) Headache caused by stimulation of the meninges: Acute or chronic inflammatory exudates in the brain (such as meningitis, etc.), or blood from hemorrhagic diseases (such as subarachnoid hemorrhage, etc.) stimulate the meninges, or cerebral edema causes meninges and blood vessels to Headache due to stretching.

(4) Nerve stimulation: cranial nerves (such as the trigeminal nerve, etc.), cervical nerve inflammation, compression, displacement, etc. can cause corresponding neuralgia.

(5) Headache caused by spasmodic contraction of head and neck muscles: head and neck muscle tension, inflammation, local mass, chronic abscess and other neck diseases reflexively cause cervical muscle spasm and persistent contraction, leading to headache.Such as headache caused by cervical spondylosis, also known as muscle contraction headache.

(6) Radiation or referred headaches in organs near the head: lesions commonly seen in the eyes, ears, nose, sinuses, teeth, etc., can spread or reflect to the head and cause headaches.

(7) Caused by other reasons: common psychogenic headaches, mainly due to mental or emotional headaches, such as common neurological headaches, hysteria or depression, etc., and some such as swimming goggle headaches, benign cough headaches, etc. Headaches, cold-stimulus headaches, and coital headaches associated with sexual activity.

([-]) Clinical manifestations

The patient feels that the head includes pain in the forehead, frontotemporal, and parietal occipital areas, which is a common feature of headaches.

1. Traditional Chinese medicine classification Traditional Chinese medicine divides headaches into three types: exogenous headaches, internal injuries and traumatic headaches, each with different symptoms, as follows:
(1) The onset of exogenous headache is generally more acute, and the pain intensity is more severe.

① Headache due to wind-cold: Pain in the back of the neck when suffering from cold, aversion to wind and chills, no thirst, thin white fur, and floating pulse.

②Headache due to wind-heat: headache with bloating, or even cracking headache, fever or aversion to cold, red face, red eyes, sore throat, thirsty to drink, constipation, yellow urination, red tongue, yellow fur, floating and rapid pulse.

③Rheumatism headache: headache as if wrapped in limbs, heaviness in limbs, anorexia and chest tightness, difficulty urinating, loose stools, white and greasy fur, and moist pulse.

(2) Headache due to internal injuries generally has a slow onset and slow pain intensity.

①Liver yang headache: headache and dizziness, upset and irritability, restless sleep at night, fullness in the chest and hypochondriac pain, red face and bitter mouth, thin yellow fur, strong stringy pulse.

②Headache due to kidney deficiency: headache and empty, dizziness, soreness of waist and knees, fatigue, tinnitus, less sleepiness, nocturnal emission, red tongue with little moss, thready and weak pulse.

③ Headache due to blood deficiency: headache, dizziness, continuous illness, pale complexion, fatigue, palpitations, pale tongue with thin fur, thready and weak pulse.

④ Headache with turbid phlegm: dizzy headache, fullness in the chest and abdominal cavity, nausea and phlegm, white and greasy fur, stringy and slippery pulse.

(3) traumatic headache

① Blood stasis headache: head injury, headache, dizziness, pain like a prickly prick, localized pain, instant onset after exertion, prolonged healing, purple tongue, thin white fur, thready pulse.

②Cervical headache: headache, stiff neck pain, motor failure, rotational dizziness, accompanied by dizziness, tinnitus, thin white fur, and stringy pulse.

According to the parts of acupuncture and moxibustion, there are Taiyang, Yangming, Shaoyang and Jueyin headaches.The head is the meeting place of all yang, the three yang meridians of the hands and feet all run along the head and face, and the Jueyin meridian meets at the top. Generally speaking, the Taiyang meridian headache is mostly at the back of the head and connects to the nape; the Yangming meridian headache is mostly at the forehead Pain at the brow bone; Shaoyang meridian headaches are mostly on both sides of the head and connect to the ear; Jueyin meridian headaches are mostly on the top of the head or connected to the eyes.

2. Modern medical classification
Modern medicine divides headache into three types: tension headache, migraine and neuralgia headache.

(1) Tension headache: It is a recurrent headache, which lasts for several minutes to several days each time. The typical symptom is a feeling of pressure and tension. The headache occurs on both sides of the head, and up to 90% of them are tension headaches.Tension headaches are symptoms where the muscles in the head and neck are too tense, the pain is not exacerbated by physical activity, and there is no nausea, but there is sensitivity to light or noise, and sometimes dizziness symptom.The exact mechanism of tension headache is still unclear. It may be caused by mental or physical factors, which may cause involuntary muscle contraction. Purely psychological factors are another important factor. Poor working posture, occupational characteristics, lack of exercise, and poor sleep quality , Personality traits are also possible factors.Journalists, computer workers, secretaries, tailors, drivers and people who are not easy to relax are more likely to have tension headaches.In addition to medication and emotional therapy, heat and neck and shoulder exercises are also helpful.

(2) Migraine: It can be divided into two categories:
① Migraine without warning: usually unilateral, pulsating, and recurrent. Daily activities will aggravate the headache. It is often accompanied by nausea, photophobia, and noise, and lasts for 4 to 72 hours each time.

②Premonitory migraine: recurrent and premonitory before the onset of headache, premonitory symptoms usually appear gradually within 5 to 20 minutes, and generally last no longer than 60 minutes. Visual premonition is the most common premonitory symptom. Other symptoms include paresthesia, speech impairment, or hemiplegia. Headache lasts for about 4 to 72 hours. At the same time, there are nausea and photophobia.

(3) Neuralgia headache: It is the occipital neuralgia in the back of the neck. The pain is like electric shock. When the attack is severe, the patient will feel restless and unable to sleep, and any painkiller can not effectively relieve it.Headaches are sometimes a warning signal from the body. For unexplained headaches, you should see a doctor immediately to find out the exact cause.

([-]) Diagnosis

1. Headache as the main symptom, or pain in the forehead, frontotemporal, vertex, parietal and occiput, or the whole head.There is a sudden attack, and the pain is broken and endless; there are also recurrent attacks, which cannot be cured for a long time, and the pain stops when the pain stops; each attack of the headache can last for several minutes, hours, days, or weeks.

2. Sudden onset of illness or a history of recurrent attacks due to exogenous factors, internal injuries and other factors.

3. Blood routine and blood pressure should be checked. If necessary, cerebrospinal fluid and EEG examinations should be performed. When possible, transcranial Doppler, brain CT and MRI examinations should be performed to help exclude organic diseases and make a clear diagnosis.

([-]) Differential diagnosis

Headache is one of the most common symptoms.There are very few people who do not experience headaches in their life.About 2/3 of people in the healthy population have had a headache, and only 18% of them seek medical advice with headache as the main complaint.When a headache occurs, how to distinguish it, the following items are the main identification points.

1. Acute headache with fever, body aches, fatigue, poor appetite, common in influenza caused by viruses.

2. Sudden headache with nausea, vomiting and disturbance of consciousness may have cerebral hemorrhage or subarachnoid hemorrhage, which is more common in middle-aged and elderly people.

3. The headache caused by glaucoma is mostly in the upper part of the orbit or around the eyeball, and often accompanied by visual impairment.

4. Paroxysmal unilateral or bilateral temple throbbing pain accompanied by nausea and vomiting, more common in young and middle-aged women, may be vascular headache.

5. Blunt headache without increased intracranial pressure can be seen in muscle tension headache, paranasal sinus headache, and cervical headache.Those with increased intracranial pressure should be alert to the possibility of brain tumors.

6. Lightning-like severe pain on one side of the face is often a feature of trigeminal neuralgia.

Headache is a superficial phenomenon of many complex conditions. Usually, it should be treated under the guidance of a specialist. Of course, family members can identify it early according to the characteristics of certain headaches and go to the hospital for neurology specialists to avoid delaying the opportunity for treatment.

([-]) Treatment

1. Be sure to go to the hospital in time to ask a specialist in neurology for an examination. After a detailed medical history inquiry and physical examination, the specialist will determine which diseases the headache may be caused by and what other tests are needed.

2. Do not blindly take painkillers before you have figured out the cause of the headache.If the headache is really unbearable, a specialist should decide whether to take it and which painkiller is appropriate.

3. After clarifying the cause (finding the disease that caused the headache), the key to pain relief is to treat the cause, and then take appropriate painkilling drugs on this basis.

([-]) Prevention

1. Headache prevention tricks
(1) Take appropriate amount of aspirin: For tension headaches that occur 1 or 2 times a month, aspirin or other common anti-inflammatory drugs can come in handy.If you decide to use aspirin for headache, you should take it as soon as the headache starts, otherwise the effect will not be obvious.But overuse of these drugs will cause more pain.

(2) Exercise as usual: If the headache is not too serious, exercise can help improve the situation.If you have a mild tension headache, exercise can help you get rid of it.But if you have a severe headache, avoid exercising to make it worse, especially if you suffer from migraines.

(3) Sleep: Many people use sleep to eliminate headaches, but they should avoid sleeping too much, so as not to cause headaches after waking up.

(4) Don't take a nap: A short nap may get rid of your headache, but if you don't have a headache, it's best not to take a nap.Naps may trigger migraines.Sleeping in an odd position or even on your stomach (stomach-down) can constrict your neck muscles, which can lead to headaches.Sleeping on your back is beneficial.Likewise, when you are standing or sitting quietly, do not lean forward or turn your head in a certain direction.

(5) Hot compress: You can apply hot compress to the neck or take a hot bath.

(6) Deep breathing: Deep breathing is a good way to relieve tension.When your abdomen rises and falls more than your chest, it means you're doing it right.

(7) Self-examination: Experts recommend that you check yourself for any signs of tension, including clenching your teeth, clenching your fists, and hunching your shoulders, which can cause headaches.

(8) Massage acupuncture points.

(9) Use a pencil: put a pencil between the upper and lower teeth, but do not bite the pencil hard.This helps you release tension, as the movement requires muscle relaxation to do so.

(10) Wearing a headband: Wearing a bandage on the head can reduce blood flow to the scalp, thereby reducing migraine headaches.

(11) Do not wear perfume: strong perfume may trigger migraine.

(12) Avoid loud noises: Excessive noise is a common cause of tension headaches.

(13) Pay attention to the amount of caffeine: If you take the right amount of caffeine every day, your blood vessels will dilate, which may contribute to headaches.But taking too much can also give you a headache.Therefore, it's best to limit your coffee intake to a maximum of two cups per day.

(14) Do not chew gum: The repeated action of chewing may tense the muscles, thus triggering tension headaches.

(15) Eat less salt: For some people, high intake of salt can trigger migraines.

(16) Eat on time: Omitting or delaying meals may cause headaches.Missing a meal causes muscles to tighten, and blood vessels in the brain and brain constrict when blood sugar drops due to lack of food.When you eat again, it dilates these blood vessels and triggers a headache.Small, frequent meals can help with headaches.

(17) Avoid foods that are bad for you: Milk is bad for headaches in some people.

Also watch out for other headache-provoking foods, such as hot dogs and some preserved foods, which contain nitrates, chemicals that dilate blood vessels and cause severe headaches.In addition, MSG should also be avoided.

(18) Refuse chocolate: Eating chocolate is not only easy to gain weight, it also contains tyramine, which is the main suspect that causes headaches.In addition, stone fruit and aged cheese also contain tyramine and should be avoided.

(19) Do not smoke while driving: When you are driving on a road with heavy traffic while smoking, and at the same time, do not close the windows, what will happen?You are doubly inhaling carbon monoxide!This gas can negatively affect blood flow to the brain.

(20) Drink less: spirits also contain tyramine.

(21) Taste ice cream slowly: If you eat ice cream in big gulps, you may have a severe headache.Taste slowly so that the mouth gradually adapts to the cold.

(22) Cultivate a sense of humor: If you take things seriously, you may often frown and worry, which may cause headaches.You should learn to relax yourself and look down on things around you.

(23) Use vitamin C and aspirin: High altitudes can cause headaches.At this time, taking vitamin C and aspirin is beneficial.When you are going to travel to high altitudes, you should take 3-5 mg of vitamin C and two aspirin a day the day before departure and during the journey.

(24) Do facial beauty exercises: "Soft exercises" are specially designed for the face and scalp. They can help you relax the muscles in these parts and enable you to take control actions when you first see the symptoms of headache.

① Raise eyebrows: Raise the eyebrows on both sides at the same time, and then lower them.

② Squinting: Quickly squint your eyes, then relax.Next, squint your right eye hard and relax.Next, squint your left eye and relax.

③Frown: Squeeze your eyebrows hard and relax.

④ Open your mouth: Slowly open your mouth to the widest point, and then slowly close it.

⑤ Move the lower jaw: Open the mouth slightly and move the lower jaw left and right.

⑥ Wrinkled nose: Squeeze the nose upwards, as if smelling a bad smell.

⑦ Grimace: Make faces as you please, just like when you were a child.Don't worry, your face won't be deformed.

(End of this chapter)