CHAPTER 14 Headaches and hypertension

Headaches

Headaches are one of the most common symptoms that you will come across in practice. Some patients come for treatment with headaches as their main complaint, as is the case with migraine. They are frequently associated with a variety of ailments such as common colds, sinus problems, hay fever, digestive disorders and muscular skeletal problems.

Tui na is great for headaches; it can bring on-the-spot relief and, in the case of chronic headaches and migraine, regular treatments can produce excellent results.

There are many types of headache and the causes of these are wide and varied. A common 21st century cause is tension and stagnation of Qi in the Yang channel sinews due to stress, emotional holding patterns, excessive computer use and lack of appropriate exercise.

In the case of migraine which seems increasingly common, especially among women, there is a often a combination of stagnation and tension, usually in the Tai Yang and Shao Yang channel sinews, plus Deficiency of Blood and Yin and, consequently, rebellious Yang Qi rising.

In my practice I have found the most common headaches are those related to tension and stagnation of Qi in the Yang channel sinews of the neck, shoulders and back, digestive disharmonies leading to Qi stagnation and the production of Damp and Phlegm, Deficiency of Qi and Blood and Liver-Yang rising due to Deficient Liver-Blood or Liver/Kidney-Yin Xu.

Depending on your diagnosis of the underlying disharmony, Tui na treatment usually involves a combination of several elements, the most common being:

• Releasing the Yang channel sinews, expelling external pathogenic factors and moving and dispersing obstructed Wei Qi

• Strengthening and invigorating Qi and Blood and enabling clear Yang to rise

• Soothing Qi and soothing the Liver

• Nourishing Blood and Yin

• Tonifying the Kidneys

• Harmonizing the Middle Jiao and the Stomach and Intestines

• Tonifying the Spleen, dredging and eliminating Damp and Phlegm

• Descending rebellious Qi

General tips for treating headaches

• Take your time to palpate for tender local points and areas of holding and adhesion, particularly along the Tai Yang and Shao Yang channel sinews in the patient’s neck, nape, shoulders and paraspinal muscles. Stimulate the most tender points with appropriate techniques and release the sinews as you come to work in the affected areas.

• At the beginning of treatment, do some work on the patient’s head and face using the basis of the foundation routine for the head and face. Return to the local work at the end of the treatment.

• Release the neck, nape and shoulders and stimulate any relevant points in these areas.

• If necessary, do any work on the back next; for example, release stagnation and adhesion, stimulate relevant points such as Back Shu, Governing Vessel and Huatuojiaji points, and apply any nourishing Yin style work on the back such as tonifying the Kidneys.

• Work along relevant arm and leg channels. For example, if the patient has a Yang Ming frontal headache, work along the Stomach and Large Intestine meridians; if there is also Damp present then you may also be working on the Spleen and Lung Tai Yin channels. Stimulate your chosen distal points as you work along the channels.

• Do some work on the chest if the headaches are related to Damp, Phlegm, rebellious Qi, Wind invasions or Liver-Qi stagnation.

• Work on the abdomen for headaches related to digestive disharmony and for Qi, Blood and Kidney Xu.

• Work locally on the face and head to finish.

The treatment foundation routines for both the head and face and the neck and nape form an excellent framework for effective local work in the treatment of headaches. If the headaches are coming from an underlying Deficiency, the local work should be applied gently, taking your time over each part. If the headache is due to Excess, create stronger stimulation and apply the techniques briskly for a shorter period of time. In addition to this, add relevant points and techniques that may be applicable to the disharmony.

To help you plan a Tui na treatment for headaches, see Table 14.1 for some suggestions of useful techniques to consider including in the treatment of common patterns of disharmony.

Table 14.1 Suggestions for the treatment of headaches

Presenting disharmony	Useful treatment techniques
Wind-Cold	Gua sha or cupping along the Yang channels of the neck, nape and back Gua fa along the Governing Vessel and Bladder channel Tan bo fa and Na fa to the Bladder channel sinew in the neck, nape and back Kneading and nipping to Well points and Governing Vessel points Pinching–grasping the area of GB21 Clockwise palm Rou fa on Ren4 Ca fa on the back along the Bladder channel and across BL23 Yi zhi chan tui fa, anti-clockwise Rou fa and strong pinching–grasping for point stimulation
Wind-Heat	Gua sha or cupping along the Yang channels of the neck, nape and back Gua fa along the Governing Vessel and Bladder channel Nipping–grasping and kneading–nipping along the Governing Vessel and for stimulating points such as Du14, LI11 and GB20 Ca fa on the back along the Bladder channel Dredge the Yang channels with Na fa and Tui fa
Wind-Damp	Gua sha or cupping along the Yang channels of the neck, nape and back Pinching–grasping the Bladder channel sinew in the neck, nape and back Single-finger Ji dian fa on local head points, i.e. ST8, Du23 and Du20 Dredge the Yang channels with Na fa and Tui fa Pai fa and joined palm Ji fa to the back and limbs Zhen fa, Ji dian fa and Ca fa on the chest Palm Rou fa on Ren12
Liver-Yang rising	Gua sha along the Governing Vessel from Du16 to Du4, the Bladder channel from BL10 to BL23 and the Gallbladder channel from GB20 to GB21 Tui fa, Rou fa and kneading–pinching along the same channels Lifting–grasping along the spine from Du14 to the sacrum An fa on BL18 with intention on descending Qi and soothing Liver The basics of the chest and hypochondrium routine with an emphasis on Tui fa, Rou fa and pushing–pressing the supra- and infraclavicular fossas An fa on ST12 with the intention of descending Qi Tui fa to KD1 Ba shen fa to the neck Gua fa and Ma fa to the sides of the head Kneading–grasping and pulling the ears
Turbid Phlegm obstructing	Gun fa to the shoulders and back Ji dian fa and Yi zhi chan tui fa to the Back Shu points Forearm Rou fa to BL20 Forearm Rou fa over Ren12 and Ren6 coordinated with Gun fa, Pai fa and Ji dian fa down the Stomach channel Kneading–nipping PC6 with single-finger Ji fa on ST40 Apply the basic routine for the chest with an emphasis on An fa, Rou fa, Zhen fa and Ji dian fa; Rou fa or Zhen fa on Ren22 Pai fa and joined palm Ji fa on the back and limbs
Qi Deficiency	Tui fa, palm Rou fa and lifting–gasping along the Governing Vessel from the sacrum to the nape Clockwise Rou fa to stimulate Du4, Du14 and Du20 Pai fa to the vertex Ca fa to Du4 and Du14 Palm Rou fa, Mo fa and figure-of-eight Tui fa over the relevant Back Shu points Tui fa, Rou fa and Ca fa along the relevant Yin and Yang channels in the arms and legs Point stimulation with An fa, clockwise Rou fa and gentle Yi zhi chan tui fa Yin style holding and joining points such as ST36 and Ren12, LU9 and Ren17 Rou fa and tai chi Mo fa on the abdomen Warming palm, work with intention and holding over major points, Deficient organs and the affected areas on the head; work with breath and visualization Direct moxa to tonify points Indirect moxa to stimulate Du20 to raise the Yang
Blood Deficiency	Forearm Rou fa and palm Rou fa over BL14, BL17, BL20 and BL23 Figure-of-eight Tui fa around the relevant Back Shu points Gentle Tui fa, An fa and Rou fa on the chest Yin style holding and joining points Tui fa, Mo fa, Rou fa and Na fa along the Spleen, Liver, Lung and Pericardium channels focusing on the Ying Qi level Warming palm, work with intention and holding over major points, Deficient organs and the affected areas on the head; work with breath and visualization Tai chi Mo fa on the abdomen Palm Rou fa and Zhen fa over Ren4 Direct moxa to tonify points
Kidney Deficiency	Tui fa, Rou fa and Ya fa with the palm along the Bladder channel from the nape to the toe Moderate Gun fa for about 20 minutes along the Bladder channel concentrating on the lower back around the Kidney Back Shu points Forearm Rou fa, figure-of-eight Tui fa and Mo fa over BL23 and BL52 Ca fa over BL23 and BL52 Tui fa, Mo fa, Rou fa and Ca fa along the Kidney channels of the legs Forearm or palm Rou fa and Zhen fa to Ren4, Ren6 or Ren8 Warming palm over the kidneys, the back of the head and over the eyes

Migraine exercise to show to patients

If done at the first signs of a migraine before the headache has come on, this can stop it developing fully. Sit in a quiet place on an upright chair. Take off your shoes and socks and put your feet flat on the floor. Keep your spine straight and place the backs of your hands on your thighs, fingers relaxed. Imagine a thermometer in each hand, and your palms becoming red hot. Try to make the gauge reach maximum. Think of heat moving down your arms from your head to your palms. Do this for about 5 minutes, then stimulate Liv3 and LI4 with Rou fa or pinching–grasping for several minutes on each side until the points ache strongly. Follow this by drinking a glass of water.

Headache case studies

Headache

Main complaint

Izzy, aged 15, was brought along for treatment by her Mum who I was treating for digestive and sinus problems at the time. She had been having a lot of headaches recently, at least once a week, and had fainted a couple of times at school. Her headaches were always on her forehead and were dull in nature; they were particularly bad the week after her period and when she was tired. They were better for rest. She had a poor appetite; I already knew from her Mum that Izzy did not eat well; she would not eat breakfast and often only had a sandwich or some chips for lunch at school; she had been vegetarian for the previous 2 years and ate very little fresh food. She was finding it difficult to concentrate at school and her Mum told me that she had become increasingly uncommunicative which was out of character. Izzy was very keen on sport and led a very busy life with lots of after-school activity.

Secondary complaints

Izzy’s periods started when she was 12. Over the previous 18 months her periods had been very heavy; they lasted for 7 days and often they were painful at the beginning. She felt completely drained during and after her period, and had fainted towards the end of her last two periods.

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