Primary Headaches - Tension-Type Headaches

I. Tension-Type Headaches
 is the most common type of primary headache and accounted for nearly 90% of all headaches as a result of muscle tightening in the back of the neck or other muscle groups in the body. Some researchers suggested that active trigger points TrPs within the suboccipital, upper trapezius, sternocleidomastoid, temporalis, superior oblique and lateral rectus muscles have been associated with chronic and episodic tension-type headache forms(1)

II. Types of tension type headaches 
In general, tension type headaches last from 30 minutes to an entire week, but in some cases, it can last for months or even years, though a typical tension headache of 4–6 hours.
A. Episodic tension-type headache
Episodic tension-type headache can occur randomly and is triggered by temporary nerve tension such as stress, anxiety, anger, etc., and are defined as tension-type headaches occurring fewer than 15 days a month
B. Chronic tension headaches
Chronic tension headaches are defined as tension-type headaches occurring 15 days or more a month for at least 6 months.

III. Signs and Symptoms
1. Pain is mild to moderate, but may be severe  
2. The sensation of tightness or pressure across your forehead or on the sides and back of your head, and headache starts at the back of your head and spreads forward
3.Tenderness on your scalp, neck and shoulder muscles
4. The pain is frequently bilateral on both sides of the head at once
5.  Constant pressure
6. Loss of appetite
7. Sleep disturbances,(2)
8. Etc. 

IV. Causes, Risk factors and triggering
A. Causes
There are no single cause of the headache, but some researchers agreed that tension type of headache are caused by muscle tightening in the back of the neck or other muscle groups in the body but some others suggested that headaches are caused by changes in brain chemicals called neurotransmitters as we mentioned in  a migraine headaches. But in the study, conducted by Dr. and team found that children with frequent episodic tension-type headache (FETTH), at first instance, do not present deficits in the secretion of these cortisol and melatonin(5). Also Dr. Fernández-de-Las-Peñas C and team in the study of immunoglobulin A (IgA) (immune system) concentrations and α-amylase (sympathetic nervous system [SNS]) activity between children with chronic tension-type headache (CTTH) and healthy children, discovered that children with CTTH present with deficits in the immune system, but not dysfunction in the salivary cortisol (hypothalamic-pituitary-adrenocortical [HPA] axis) or sympathetic nervous system (SNS)(6)

B. Risk factors
1. Gender
Women tend to have more headaches than men
2. Changes in estrogen levels during a woman' s period or at menopause
Falling estrogen levels or estrogen withdrawal after periods of sustained higher levels can trigger migraine, and hormonally associated migraine is a specific clinical entity. It is important to diagnose the type of migraine, considering the fact that a decline in estrogen level at the end of menstrual cycle triggers migraine, so it can be treated by low levels of estrogen.(13).    

3. Premenstrual syndrome
In the study of 50 women with headache in perimenstrual period in at least two out of three menstrual cycles, during the last year or longer. Two questionnaires, a questionnaire for headache and a questionnaire for PMS, showed that headache, occurring in perimenstrual period, is not always migraine, but could fulfill criteria for tension-type headache, as well. Specific characteristics of perimenstrual headache, which could distinguish it as a symptom of PMS(15)

4. Stress
Stress can have an impact on one’s mental and physical well-being, including migraine headache. Stress describes a negative concept, life events, and concomitant psychosomatic illnesses should be considered important when evaluating individuals with migraine, and gender aspects need to be taken into account(14)

5. Etc.

C. What trigger tension type headaches
1. Stress, traveling and physical activity
In the study of The 3794 participants (73.3%) were screened for headache history according to the International Headache Society (IHS) criteria, a total of 720 lifetime migraineurs and 1319 tension-type headachers(TTH) have been identified. The most common precipitants for both migraine and TTH were stress and frequent travelling. Stress (odds ratio (OR) 1.4, 95% confidence interval (CI) 1.17, 1.69) was associated with migraine, whereas physical activity (OR 0.72, 95% CI 0.59, 0.87) was related to TTH. Considering MA and MO, frequent travelling (OR 2.2, 95% CI 1.59, 2.99), food items (OR 2.2, 95% CI 1.35, 3.51) and changes in weather conditions and temperature (OR 1.75, 95% CI 1.27, 2.41) exhibited a significant positive association with MA(4)

2. Psychosomatic disorders, autonomic dysfunction, emotional disorders, a poor family history and school stress
Dr. Izmaĭlova IG and the team in the study of prevalence, pattern, risk factors of Headache in the population of schoolchildren said that there was a high comorbidity of primary HA with other psychosomatic disorders mainly with autonomic dysfunction and emotional disorders. The risk factors for chronic HA were a poor family history (familial psychogenias, pain family history, low'socioeconomic status family), and school stress.(8)

3. Physical abuse, sexual abuse, emotional abuse, physical neglect and emotional neglect
Physical abuse, sexual abuse, emotional abuse, physical neglect and emotional neglect are associated to increased risks in triggering all types of headache, including tension types of headache, the team at the University of Toledo College of Medicine said(9)

4. Chronic contraction of the temporalis muscle(12)
5. Irregular meal time (hunger)
6. Overdoes of headache medicine
7. Etc.

V. Diseases associated with tension types of headache
1. Coeliac disease
In the study of 86 patients of headache in children and adolescents with coeliac disease, and any possible relation between these conditions, 18 cases (20.9%) headache was of tension type and in 16 (18.6%) of migraine type(3)

2. Menière's disease
In the observation of High prevalence of systemic autoimmune diseases in patients with Menière's disease, Systemic Menière's disease were more frequently observed in patients with MD and diagnostic criteria for migraine than cases with MD and tension-type headache (p = 0.007)(7)

3. Juvenile myoclonic epilepsy
Juvenile myoclonic epilepsy (JME) compare with the general population revealing a significantly higher prevalence of migraine (RR 4.4), MO (3.6), MA (7.3) and TTH (3.4) (10)

4. Tinnitus
A report from review during the five years running from December 1993 to January 1998, 112 patients who had come to our University Clinic suffering from headache were examined,  71 complain of tinnitus during headache were recruited for the study: 19 patients suffered from migraine without aura, 8 migraine with aura, 15 tension headache, 21 mixed headache, 3 basic migraine and 5 cluster headache(11)

5. Etc.

VI. Prevention
A. Do's and Do not's list, if you are experience migraine headache because of foods, food additives, chemical compounds, alcohol, smoking, stress, life style, etc.
1. Food elimination diet

Certain foods which trigger the over production of IgG antibodies if eliminated from the diet can result in the decreased number of migraine like headaches over 4weeks, some studies suggested that using the ELISA test with subsequent diet elimination advice significantly reduce the number of migraine like headaches at 4 weeks.(E.A.1)

2. Diet restriction
Diet restriction based on IgG antibodies is an effective strategy in reducing the frequency of migraine attacks. In the study conducted by Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey in a 6-week baseline, IgG antibodies against 266 food antigens were detected by ELISA(E.A.2)

3. Foods and chemical compounds trigger  headache
a. Certain foods can trigger the migraine headache attack through an allergic reaction. Citrus fruits, tea, coffee, pork, chocolate, milk, nuts, vegetables and cola drinks have been cited as possible allergens associated with migraine. If you are experience the attack after taking some of those, the best way is to avoid them. Researchers also suggested that substances are tyramine, phenylalanine, phenolic flavonoids, alcohol, food additives (sodium nitrate, monosodium glutamate, aspartame) and caffeine may be the cause of modifications in vascular tone and bring migraine on(E.A,3)

4. Alcohol
As we all known that a small dose of alcohol increase the protective effect on cardiovascular disease, but excessive drinking can increase the frequency of migraine headache as alcoholic drinks are a migraine trigger in about one third of patients with migraine in retrospective studies on trigger factors(E.A4)

5. Smoking
There is evidence that migraine was associated with several lifestyle and socioeconomic factors, In the investigation conducted by University of Copenhagen with a questionnaire containing validated questions to diagnose migraine and questions on lifestyle and socioeconomic factors was sent to 46,418 twin individuals residing in Denmark. 31,865 twin individuals aged 20-71 and most associations such as low education and employment status were probably due to the negative effects of having migraine while others such as smoking were risk factors for migraine.(E.A.5)

6. Others may trigger headache migraine attacks to certain people, such as
a. Too much work (Stress)
b. Too little sleep (Sleep related)
c. Passive smoking (Smoking)
d. Perfume (Chemical compound)
e. Etc.(E.A.6)

7. Moderate exercise
In a study of Forty women with general migraine attending the Neurology Department of the Faculty of Medicine Faculty of Dokuz Eylül University, regular long-term aerobic exercise is found in reduced migraine pain severity, frequency and duration possibly due to increased nitric oxide production.(A.E.7)

8. Management of migraine
Hygiene and behaviour measures capable of ensuring the best possible well-being (regular meals and balanced diet, restriction of alcohol and smoking, regular sleeping pattern, moderate physical exercise and relaxation) have found to reduce the frequent migraine attack(E.A.8)

9. Avoid medication overuse headache (MOH)

There are report that overuse of migraine medication can result of increased frequency to daily or near-daily as a rebound effect comes into play(E.A.9)

10. Etc.

B Nutritional Supplements for Migraine Headache
1. Magnesium
Some studies indicated that deficiency of magnesium is associated with patient with migraine headache as may promote cortical spreading depression, affecting serotonin receptor function, and influence synthesis and release of a variety of neurotransmitters and suggested that empiric treatment with at least oral magnesium is warranted in all migraine sufferers.(E.B.1)

2. Calcium
Calcium deficiency can lead to Hypocalcemia, a serum level of calcium that is below normal, it is manifested by increased neuromuscular irritability, leading to neuromuscular hyperexcitability, anxiety, dysautonomia, oculofrontal headache and migraine(E.B.2)

3. DLPA (DL-phenylalanine)
DL-phenylalanine, an essential amino acid of which is important for our body converts phenylalanine to tyrosine, another amino acid then to epinephrine and norepinephrine, which are important brain chemicals called neurotransmitters. Some researchers suggest that DL-phenylalanine (DLPA) appears to potentiate pain relief and also ease depression in patients receiving opiates for chronic non-malignant pain(E.C.9)

4. Vitamin B2
Riboflavin therapy supplemented may be appropriate alternatives in patients with migraine disorder as it significant decreases in headache frequency, intensity, duration and medication intake (E.C.7)

5. Serotonin
Serotonin, a type of neurotransmitter, passes messages between nerve cells, low serotonin levels in the brain may increase the risk of the process of constriction of the blood vessels as it alters levels of dopamine and stress hormones, and may be part of a complex cellular membrane trafficking dysfunction involving not only the serotonin transporter but also other transporters and ion channels of which trigger a migraine (B.A.7)

6. Coenzyme Q 10 (CoQ10)
In some studies found that deficiency of CoQ10 are common in pediatric and adolescent migraine, but determination of deficiency and consequent supplementation may result in clinical improvement and involving more scientifically rigorous methodology to confirm this observation.(E.B.3)

7. Omega 3 fatty acids

Diet with long-chain n-3 polyunsaturated fatty acids might reduce frequency and severity of migraines in adolescents in astudy conducted by Divisions of Adolescent Medicine. Dr. Harel Z, and the team also sadi that results of this preliminary study suggest that both fish oil and olive oil may be beneficial in the treatment of recurrent migraines in adolescents. Further studies are warranted to compare each of these treatments with other interventions.(E.B.4)



8. 5-Hydroxytryptophan
5-Hydroxytryptophan is a serotonin precursor, a type of neurotransmitter. Some researchers suggested that the quality of serotonin in blood decreases in patients with tension-type headache. The relationship between the intensity of pain syndrome, decrease of work capacity, life quality, and quantity of serotonin in patients with ageing was revealed(E.B.5)

9. Etc.

E.C. Diet for Migraine headache
Certain diet may trigger the attack of migraine headache as a result of allergic reaction in certain people, but it may be helpful to people who are experience migraine headache with no allergic effects
1. Water
Water, an essential for the body’s proper functioning, and dehydration may trigger the migraine attack. Un a study of Fifty migraineurs were asked if insufficient fluid intake could provoke their migraine attacks conducted by The City of London Migraine Clinic, twenty replied "yes," 7 were doubtfully positive, and 23 said "no." In addition 14 of 45 migraineurs at a meeting of the British Migraine association (UK) also recognized fluid deprivation as one of their migraine triggers.(E.C.1) Adding fluid deprivation to migraine patient may reduce the numbers of migraine attacks.

2. Fish oil and Olive oil
Omega-3 PUFA, from fish oil-eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have been studied to consist anti-inflammatory properties of which are useful in the management of inflammatory and autoimmune diseases, including rheumatoid arthritis, Crohn's disease, ulcerative colitis, psoriasis, lupus erythematosus, multiple sclerosis and migraine headaches.(E.C.2)

3. Broccoli
Broccoli is a very good source of magnesium and a good source of calcium. Magnesium, plays an essential in many intracellular processes and in migraine pathogenesis, low levels of magnesium may promote cortical spreading depression, hyperaggregation of platelets, affect serotonin receptor function, and influence synthesis and release of a variety of neurotransmitters of which can trigger migraine headache(B.A.8)

4. Sardines
Sardines contain measurable amount of Omega 3 fatty acid, calcium and CoQ10 of which can be helpful in reducing the frequency of migraine headache (E.B.3)(E.B.2)

5. Spinach
Spinach is an excellent source of both calcium, magnesium, vitamin B2 (riboflavin)
Riboflavin therapy supplemented may be appropriate alternatives in patients with migraine disorder as it significant decreases in headache frequency, intensity, duration and medication intake (E.C.7)

6. Mustard Greens
The World's Healthiest Foods recommends mustard greens as an excellent source of calcium and a very good source of magnesium of which are important in preventing and treating migraine headache (See E.B.1 and 2)

7. Fish
Beside rich in Omega 3 fatty acids, all fish contain more or less DL-phenylalanine, an essential amino acid of which is important for our body converts phenylalanine to tyrosine, another amino acid then to epinephrine and norepinephrine, which are important brain chemicals called neurotransmitters. Some researchers suggest that DL-phenylalanine (DLPA) appears to potentiate pain relief and also ease depression in patients receiving opiates for chronic non-malignant pain(E.C.9)

8. Etc.

For The World Most Healthy Foods, please visit http://healthy-foods-index.blogspot.ca/2011/03/healthy-foods-list.html

 
Treatment
A. Non medication therapies
 1. Manual therapy
Manual therapy such as spinal manipulation, soft tissue therapy, and myofascial trigger point treatment, is a physical treatment primarily used by physiotherapists, massage therapists, chiropractors, etc. in treating musculoskeletal pain, but few data exist for the efficacy of these interventions and researchers have provided us with conflicted results. In a randomized controlled trial of volunteer sample of 26 men and 49 women aged 20 to 59 years who met the diagnostic criteria for episodic tension-type headache as defined by the International Headache Society, conducted by Department of Anatomy and Cell Biology, Odense University, as an isolated intervention, spinal manipulation does not seem to have a positive effect on episodic tension-type headache(a). But in other study, showed that spinal manipulative therapy is an effective treatment for tension headaches, in a 6 wk of spinal manipulative therapy provided by chiropractors or 6 wk of amitriptyline treatment managed by a medical physician(b). In the same study, Amitriptyline therapy had showed slightly more effective in reducing pain at the end of the treatment period but was associated with more side effects.
Other review found that the evidence was weak for effectiveness of chiropractic manipulation for tension headache, and that it was probably more effective for tension headache than for migraines(c)

2. Hypnotic Relaxation
Hypnosis relaxation is a technique of induced relaxation through a cooperative interaction through meditation by oneself or in which the participant responds to the suggestions of the hypnotist. the technique has been used in assistant treatment of many conditions, including tension types of headaches, rheumatoid arthritis, ADHD, etc., In a study of patients presenting to the headache clinic with a diagnosis of tension-type headache that justified prophylactic therapy (frequent episodic tension-type headache or chronic tension-type headache) were given the choice of amitriptyline (AMT) treatment or hypnotic relaxation (HR), and were treated accordingly, conducted by Hadassah University Medical Center,  long-term adherence to treatment with HR exceeded that of AMT. At the end of the study period, 26 of 47 patients who tried hypnotic Relaxation(HR) compared with 10 of 27 who tried AMT continued receiving their initial treatment. Conclusions.- HR treatment was a more popular choice among patients. Patients choosing HR reported greater symptom relief than those choosing AMT and were found to have greater treatment compliance(d)

3. Physical training and relaxation training
In the comparison of 3 nonpharmacologic treatments; acupuncture, relaxation training, and physical training on subjective well-being in patients with chronic tension types of headache (CTTH), Physical training and relaxation training seem to be preferable nonpharmacologic treatments for improvement of central nervous system-related symptoms and subjective well-being for patients with CTTH(e)

4. Biofeedback and Cognitive-behavioral therapy
Some studies find that following sequence: blood-volume-pulse biofeedback followed by cognitive behavioral therapy (Group I) or were given the treatment in reverse order (Group II). The application of biofeedback helps the patient to recognize the influence of thoughts and emotions on bodily reactions and therefore prepares the way for successful cognitive treatment.(16)

5. Etc.



D.  Medicine
1. Episodic tension-type headaches
a. Analgesics and Analgesic/sedative combination
Analgesics, such as over-the-counter analgesics such as ibuprofen, paracetamol/acetaminophen, aspirin, etc. and Analgesic/sedative combination, such as Syndol, Mersyndol and Percogesic, etc. have been used to relieve pain of Episodic tension-type headaches with much success but with some side effects
2. Side effects are not limit to
a. Analgesics
a.1. Irritate the stomach
a.2. Overdoses can cause liver damage
a.3. If you are allergic to caffeine, please use the medicine with caution
a.4. The medicine may interact with other medicine, please consult with your doctor, if you are taking currently medicine.
a.5. Etc.

b. Analgesic/sedative combination
Analgesic/sedative combination is also widely use in treating episodic tension types of headache
a.  Side effects are not limit to
a.1. Do not use the medicine if you are allergic to any cough, cold, or pain medicine
a.2. Over doses of 4,000 milligrams can have serious side effects
a.3. the drug may interact with a blood thinner such as warfarin
a.4. Etc.


2. Chronic tension headache
Chronic tension-type headache is a daily or continuous headache. Patient are required to take medicine continuously, medication include
2.1. Amitriptyline
a. Amitriptyline is a tricyclic antidepressant have been used in the treatment of choice for different types of chronic pain, including Chronic tension headache. Some researchers suggested that although this medication is widely used in the prevention of chronic tension-type headache, few studies have investigated the efficacy of this treatment and the published results are contradictory. But the use of amitriptyline in the prophylactic treatment of chronic tension-type headache, considering the level of scientific evidence of the different studies using the SORT criteria. From this review, 5 articles of evidence level 1, and another 5 articles of evidence level 2 were selected. Following analysis of the 10 studies, and in function of their scientific quality, a level A recommendation was made in favor of using amitriptyline in the treatment of chronic tension-type headache(f)

b. Side Effects are not limit to
b.1. The medication may cause central nervous symptoms, such as blurred vision, confusion, drowsiness, etc.
b.2. Loss of sexual desire
b.3. Lowered blood pressure
b.4. Tremors and sweating
b.5. Etc.
The doses and duration is depending to the nature of the migraine, but in general, patient started the medication at a low dose, and then gradually increased.

2.2. Mirtazapine
a. In a study of Twenty-four nondepressed patients with chronic tension-type headache were included in a randomized, double-blind, placebo-controlled, crossover trial. All patients had tried numerous other treatments. Mirtazapine 15 to 30 mg/day or placebo was each given for 8 weeks separated by a 2-week wash-out period conducted by Glostrup University Hospital suggested that Mirtazapine reduced AUC by 34% more than placebo in difficult-to-treat patients. This finding is clinically relevant and may stimulate the development of prophylactic treatments with increased efficacy and fewer side effects for tension-type headache and other types of chronic pain(g)
b. Side effects are not limit to
b.1. Increased heart rate
b.2. Digestive discomfort such as Nausea Vomiting Diarrhea, etc.
b.3. Blood pressure changes
b.4. Overactive reflexes
b.5. Agitation
b.6. Difficulty sleeping
b.7. Hallucinations
b.8. Etc.

2.3. Venlafaxine
a. In the study of 11 patients with HAT and 7 with PHT were treated with venlafaxine XR (velaxin) in dose 75 mg/d during 2 months, Dr. Diukova GM suggested that the medication significant decrease of pain severity, amount of analgesics and pain-associated symptoms as well as the normalization of functions of antinociceptive systems (the increase in nociceptive flexor reflex threshold) were noted in both groups. It has been concluded that venlafaxine is an effective drug in the treatment of both HAT and PHT(h)

b. Side effects are not limit to
b.1.Nausea -- up to 58 percent of people 
b.2. Headache -- up to 26.1 percent of people 
b.3. Drowsiness -- up to 23 percent of people 
b.4. Dry mouth -- up to 22 percent of people (see Effexor and Dry Mouth) 
b.5. Dizziness -- up to 23.9 percent of people 
b.6. Insomnia -- up to 22.5 percent of people (see Effexor and Insomnia) 
b.7. Nervousness -- up to 21.3 percent of people 
b.8.Loss of appetite -- 17 percent of people 
b.9. Body weakness -- up to 16.9 percent of people 
b.10. Sweating -- up to 19.3 percent of people 
b.11. Constipation -- up to 15 percent of people 
b.12. High blood pressure (hypertension) -- up to 13 percent of people 
b.13. Ejaculation problems -- up to 12.5 percent of people (see Effexor Sexual Side Effects) 
b.14. Anxiety -- up to 11.2 percent of people 
b.15. Shakiness (tremors) -- up to 10.2 percent of people 
b.16. Diarrhea -- up to 8 percent of people 
b.17. Yawning -- up to 8 percent of people
Some the complete list, visit (i)

2.4. Other medicine include topiramate and sodium valproate, etc.

C. Herbal medicine
1. Peppermint
Peppermint contains high amounts of menthol which have long been used in herbal medicine to treat various pain conditions including headache. In a randomised, triple-blind, placebo-controlled, crossed-over study conducted in the neurology Clinic of Nemazee Hospital, affiliated with Shiraz University of Medical Sciences, Shiraz, southern Iran, from March 2007 to March 2008. Menthol solution can be an efficacious, safe and tolerable therapeutic option for the abortive treatment of migraine(G.1)

2. Feverfew
Feverfew and it's ingredient parthenolide have shown the inhibition of the brain chemicals that dilate blood vessels and cause a migraine. Some researchers suggested that a CO(2)-extract of feverfew decreased the migraine frequency from 4.76 by 1.9 attacks per month in the MIG-99 group and by 1.3 attacks in the placebo group (P = 0.0456). Logistic regression of responder rates showed an odds ratio of 3.4 in favour of MIG-99 (P = 0.0049). Adverse events possibly related to study medication were 9/107 (8.4%) with MIG-99 and 11/108 (10.2%) with placebo (P = 0.654). MIG-99 is effective and shows a favourable benefit-risk ratio.(G.2) while others insisted that there are insufficient evidence from randomised, double-blind trials to suggest an effect of feverfew over and above placebo for preventing migraine.(G.3)

3. Butterbur
Butterbur is a creeping underground plant, genus Petasites of 15 -20 species, belonging to the family Asteraceae, native to Northern Hemisphere. In a comparison in a three-arm, parallel-group, randomized trial comparing Petasites extract 75 mg bid, Petasites extract 50 mg bid, or placebo bid in 245 patients with migraine conducted by Albert Einstein College of Medicine, Petasites extract 75 mg bid is more effective than placebo and is well tolerated as a preventive therapy for migraine.(G.4)

4. Ginkgo biloba
Ginkgo biloba is oldest living tree species, genus Ginkgo, belonging to the family Gink-
goaceae, native to China. Some researchers suggested that Gingkolide B, a herbal constituent extract from Ginkgo biloba tree leaves, seems to be effective as preventive treatment in reducing migraine attack frequency and in attenuating the use of symptomatic medication in our small series of children with primary headache in a small sample of 30 young patients(G.5). Other found that Ginkgolide B is effective in reducing MA frequency and duration. The effect is clearly evident in the first bimester of treatment and is further enhanced during the second(G.6)

5. Cannabis
Cannabis is a herbal plant with three putative varieties Cannabis sativa, Cannabis indica and Cannabis ruderalis, native to Central Asia, and South Asia. clinical cannabis indicated that Migraine has numerous relationships to endocannabinoid function. Anandamide (AEA) potentiates 5-HT1A and inhibits 5-HT2A receptors supporting therapeutic efficacy in acute and preventive migraine treatment. Cannabinoids also demonstrate dopamine-blocking and anti-inflammatory effects. AEA is tonically active in the periaqueductal gray matter, a migraine generator and suggested that Migraine, fibromyalgia, IBS and related conditions display common clinical, biochemical and pathophysiological patterns share an underlying clinical endocannabinoid deficiency that may be suitably treated with cannabinoid medicines(G.7)

6. Lavender
Herbalist suggested that rubbing a little lavender oil on your temples, or dropping some in the bath water can be extremely soothing. For the migraine associated with depression or poor digestion, it may be result of the relaxation and coronary circulative effects of the oil(G.8)

7. Dang Qui (Angelica sinensis)
Dang qui is considered as a queen herb in TCM as it tonifies blood, regulatesthe menses, , reduces swelling, expels pus, relieves pain and used in condition of blood stasis and clots(G.9)

8. Ginger (Zingiber officinale)

In a double-blind placebo-controlled pilot study of sublingual feverfew and ginger (LipiGesic™ M) in the treatment of migraine, conducted by Headache Care Center, 3805 S. Kansas Expressway, Springfield, MO 65807, USA., Dr. Cady RK, and the team suggested that sublingual feverfew/ginger appears safe and effective as a first-line abortive treatment for a population of migraineurs who frequently experience mild headache prior to the onset of moderate to severe headache(G10)

9. Etc.

D. Traditional Chinese medicine 
According to Flaws & Sionneau, 2001,p.346; Yin & Liu, 2000, p.370; Blackwell, 1991 Migraine Headache is as a condition of tou feng (Wind in the head) or pian tou tong(pain in one half of the head), and is mainly due to emotional factors causes of Liver Yang hyperactivity and sometimes may be influenced by exterior Wind-Cold factors, common cold and allergy(H.A.). In the report the author indicated that differetiation of the MH depending to the patient’s pathology and the pathodynamics underlying any particular clinical case is likely to be complex. As pain is the single most important clinical feature, Blood stasis should beaddressed in all cases. Thus, one of the formulas described under thesubheading of Blood Stasis will be included in all acute stage treatments. In addition, Interior Wind is also a common feature and this often occurs due to Liver Fire or stagnant Heat in the Liver. In some cases there is also Phlegm,which binds with Wind to exacerbate the symptoms.(Part 2MIGRAINE HEADACHE IN TCM).
Therefore, differentiation of types of headache depending to the symptoms and physical and emotional appearance of the patient, together with family and health history. But in most case blood stasis formula should be used with accompany with other underlining analysis.

H.B. Migraine headache caused by Liver Yang rising with Interior Wind
1. Symptoms
a Visual disturbance
b. Dizziness
c. Irritability
d. Red tongue
e. Wiry pulse
f. Etc.

2. Formula Liver Yang rising with Interior Wind - Tian Ma Gou Teng Yin
a. Gastrodia and Uncaria formula has been used in TCM for hundred of years to treat the symptoms of headache and migraine as a result of ascendant Liver Yang with internal movement of Wind, caused by Liver and Kidney Yin deficiency and exuberant Liver Yang. This formula is best used during the early stages of a Migraine and combines well with Corydalis H for a strong, double strike against Migraine pain.

b. The ingredients including
b.1. Tian Ma (Rhizoma gastrodiae elatae)
b.2. Gou Teng (Ramulus cum uncis uncariae)
b.3. Shi Jue Ming (Concha haliotidis)
b.4. Zhi Zi (Fructus gardeniae jasminoidis)
b.5. Huang Qin (Radix scutellariae baicalensis)
b.6. Yi Mu Cao (Herba leonuri heterophylli)
b.7. Chuan Niu Xi (Radix cyathulae officinalis)
b.8. Du Zhong (Cortex eucommiae ulmoidis)
b.9. Sang Ji Sheng (Ramulus sangjusheng)
b.10. Ye Jiao Teng (Caulis polygoni multiflori)
b.11. Fu-shen (Sclerotium poriae cocos pararadicis)

H.C. Liver Fire
1. Symptoms
a. Red face and eyes
b. bitter taste in the mouth
c. thirst
d. dark and scanty urine
e. constipation with dry stools
f. red tongue with a yellow coat
g. rapid pulse

b. Formula Long Dan Xie Gan Tang
The formula Long Dan Xie Gan Tang has been used in TCM to treat pain in the hypochondriac region, headache, dizziness, red sore eyes, trouble with hearing, ear swelling or infection, traveling the Liver and Gallbladder meridians to relieve liver heat and fire
b.1. Long dan cao (Radix gentianae longdancao)
b.2. Huang qin (Radix scutellariae)
b.3. Shan zhi zi (Fructus gardeniae jasminoidis)
b.4. Ze xie (Caulis mutong)
b.5. Mu tong (Semen plantaginis)
b.6. Che qian zi (Rhizoma alismatis orientalis)
b.7. Chai hu (Radix bupleuri)
b.9. Sheng di huang (Radix rehmanniae glutinosae)
b.10. Gan cao (radix glycyrrhizae uralensis)
b.11. Dang qui (Radix angelicae sinensis)
Author note the formula may damage the Kidney due to the presence of Herb Mu Tong

H.D. Liver qi stagnation
1. Symptoms
a. Chest distention
b. Hypochondriac pain
c. Nausea, vomiting
d. Poor appetite
e. Diarrhea
f. Depression
g. Mood swing
f. Normal tongue
g. Wiry pulse
h. Etc.

2. Formula as a result of Liver Qi deficiency: Xiao Yao San (Bupleurum and Dang-gui Formula)
The formula has been used in TCM to treat anxiety, irritability, stress, and depression due to the challenge of a daily life or premenstrual tension, as a result of liver Qi deficiency
a. Chai Hu (radix burpleuri)
b. Dang Gui (radix angelicae sinensis)
c. Bai Shao (radix paeoniae lactiflorae)
d. Bai Zhu (rhizome atractylodis macrocephalae)
f. Fu Ling (sclerotium poriae cocos)
g. Zhi Gan Cao (honey fried radix glycyrrhizae uralensis)


H.E. Excess syndrome-pattern with Liver Blood stasis:
1. Symptoms
a. Palpable masses in the abdomen
b. Irregular a/or painful menstruation possible with dark clots,
c. purple nails,
d. purple lips
e. Tongue Purple, possibly w/purple spots
f. Wiry pulse

b. Formula for Excess syndrome-pattern with Liver Blood stasis: Chai Hu Shu Gan Tang
The formula has been used in TCM to treat sighing and flank pain due to emotional stress or premenstrual tension, headache as a result liver Blood stasis.
a. Chai hu (Radix Bupleuri Chinensis)
b. Chen pi (Pericarpium Citri Reticulatae)
c. Bai shao (Radix Paeoniae Lactiflorae)
d. Zhi ke (Fructus Aurantii)
f. Chuan xiong (Rhizoma Ligustici Chuanxiong)
g. Xiang fu (Rhizoma Cyperi Rotundi)
h. Gan cao (Radix Glycyrrhizae Uralensis)

H.F. Headache Migraine caused by Wind Phlegm
1. Symptoms
a. Excessive sputum
b. Nausea,
c. Fullness of the chest and/or epigastrium
d. Greasy tongue coat
e. Etc.

2. Wind Phlegm With Heat (if tongue is red tongue with a yellow coat): Wen Dan Tang (Bamboo & Hoelen Formula)
The formula has been used in TCM to treat disharmony between the gallbladder and stomach causes of Qi is blocked in flow transformed phlegm and form of rebellion Qi in the stomach that lead to fear, restlessness, dreaminess and anxiety
a. Zhi Ban Xia (Rhizoma Pinelliae Ternatae)
b. Zhu Ru (Caulis Bambusae In Taeniis)
c. Chen Pi (Pericarpium Citri Reticulatae)
d. Fu Ling (Poriae Cocos)
f. Lian Qiao (Fructus Forsythiae Suspensae)
g. Jin Yin Hua (Flos Lonicerae Japonicae)
h. Yu Jin (Radix Curcumae)
i. Zhi Shi (Fructus Aurantii Immaturus)

3. Formula Wind Phlegm With Cold (if tongue is pale with a white coat): Er Chen Wan (Citrus & Pinellia Combination), ingredients include
The Formula has been used in TCM to treat nausea and abdominal fullness, dizziness and vertigo, etc., as a result of Withe Phlegm with cold causes of phlegm accumulation, spleen-damp, rebellion qi and unharmonization of the center.
a. Chen Pi (Pericarpium Citri Reticulatae)
b. Ban Xia (Rhizoma Pinelliae)
c. Fu Ling (Poriae Cocos)
d. Gan Cao Glycyrrhiza (Radix Glycyrrhizae Uralensis)
f. Sheng Jiang Zingiberis (Rhizoma Zingiberis)

H.F. Blood Stasis
1. Symptoms
a. Fixed pain,
b. Palpitation
c. Pulse appears tense and fast
d. Tongue is purple -
f. bluish-purple

2. Formula for migraine headache caused by blood stasis
Tao Hong Si Wu Wan (Persica, Carthamus & Dang-gui Combination)
The formula has been used in TCM to treat heavy bleeding of dark, purplish, sticky menstrual blood  sharp and fixed abdominal pain before or during the menses, dizziness, dull headache, etc. as a result of blood stasis
a. Shu di huang (Rehmannia glutinosa root-prep)
b. Dang gui (Angelica sinensis root)
c. Bai shao (Paeonia lactiflora root)
d. Tao ren (Prunus persica seed)
e. Hong hua (Carthamus tinctorius flower)
f. Chuan xiong (Ligusticum wallichii rhizome)

H.G. Invasion by Exterior Wind Cold
1. Symptoms
a. Generalized body aches
b. Aversion to cold
c. Chills
d. Mild fever
e. Nasal congestion
f. Thin white coat
g. Floating, possibly a little tight

2. Formula for mihraine headache caused by Invasion by Exterior Wind Cold: Chuan Xiong Cha Tiao Wan (Ligusticum & Tea Formula)
The formula has been used in TCM to treat headache, migraine, or headache on the top, aversion to cold and fever, dizziness, nasal obstruction as a result of Exterior Wind Cold
a. Bo he (Herba Menthae Haplocalycis)
b. Chuan xiong (Rhizoma Ligustici Chuanxiong)
c. Jing jie (Herba Schizonepetae Tenuifoliae)
d. Qiang huo (Rhizoma Seu Radix Notopterygii)
e. Bai zhi (Radix Angelicae Dahuricae)
f. Gan cao (Radix Glycyrrhizae Uralensis)
g. Fang feng (Radix Saposhnikoviae Divaricatae)
For more information of Chinese herb in Western view, please visit http://chineseherbsinnutrientsperspective.blogspot.ca/2011/10/chinese-herbs-in-western-view-health.html
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