II. Symptoms
Each aura symptom may last between five and 60 minutes and starting on one side of the head and gradually spreading and intensifying.
1. Dizziness
2. Double vision
3. Loss of balance
4. Confusion
5. Slurred speech
6. Hearing changes
7. Body tingling
8. Temporary blindness
9. Etc.
III. Causes and Risk facts
A. Causes
1. Alcohol consumption
There are some reported that Alcoholic drinks are a migraine trigger in about one third of patients with migraine in retrospective studies on trigger factors, but some researchers suggested that a relationship between the intake of alcohol and the migraine attack is not clear, a small dose of alcohol is not contraindicated either for enjoyment or its protective effect on cardiovascular disease.
2. 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(B.A.6)
3. Weather
In the study 4039 visits for migraines (ICD-9: 346) that occurred at an Ottawa hospital between 1993 and 2000. Meteorological conditions using hourly readings from a fixed-site monitoring station, indicated that ER visits for migraines are related to weather conditions occurring within the 24 hours preceding presentation.(3)
4. Certain medications
Overuse of acute migraine medications can lead to the development of chronic migraine, depending upon within-person characteristics (eg, headache frequency), class of drug, and frequency of medication use.(4)
5. Emotional stress, sunlight or bright light, sleep deprivation, and hunger
In a study of One thousand six hundred and seventy-nine students aged 11-18 years conducted by University of Beni. The overall prevalence of headache was 19.5%, the prevalence of migraine was 13.5% as a result of emotional stress, sunlight or bright light, sleep deprivation, and hunger(5)
6. Female hormonal changes
Some researchers suggested that women who use hormonal contraceptives and hormone replacement treatment may increase the risk of migraine occurrence.(B.A.4)
7. Alcohol, Bright lights, Sleep, Menstruation, Perfume, etc.
Beside the causes above, out of 126/179 replies, other factors triggering migraine attack include too much work (under the stress category 54/64), reflected sunlight (under the light category 35/44), too little sleep (under the sleep category 19/24), red wine (under the alcohol category 20/22), passive smoking (under the smoke category 11/11), menstruation (under the menstruation or break from the pill category 12/14) and perfume (under the fumes/heavy scents category 12/15). Hormones, light and stress were reported to cause at least 50 % of MA attacks in 62%, 47% and 42% of participants, respectively. No participants reported alcohol to be the trigger of 50% or more of their attacks. In the groups of participants with "light", "fumes/heavy scents", "smoke" or "physical effort" as triggers, nearly all patients reported that an exposure time to the trigger of less than 3 hours (90-100% of patients) was necessary to trigger an attack and a latency to onset of attack of less than 3 hours (90-100% of patients) in the study conducted by University of Copenhagen and Glostrup Hospital, Denmark J. (B.A.11)
8. Caffeine withdrawal
Over consumption of caffeine and caffeine withdrawal can causes migraine-like caffeine withdrawal headaches. In the study conducted by Meir General Hospital, Sapir Medical Centre, indicated that Children and adolescents with high daily caffeine consumption in the form of cola drinks may suffer from caffeine-induced daily headache. Gradual withdrawal can be achieved without withdrawal headache and with complete disappearance of the induced chronic daily headache.(8)
9. Consumption of nitrates found in food
Nitric oxide (NO), a free radical is a very important molecule in the regulation of cerebral and extra cerebral cranial blood flow, rterial diameters and nociceptive processing, in a very small dose. Glyceryl trinitrate (GTN), a pro-drug for NO, causes headache in normal volunteers and a so called delayed headache that fulfils criteria for migraine without aura in migraine sufferers(B.A.11)
10. Physical over-exertion
Intensive exercise can increase risk of basilar artery headache. There is a case of a 51-year-old woman who suffered from a sudden attack of throbbing headache in the parieto-temporal region, accompanied by nausea, after 20 minutes of swimming practice in a pool. The headache disappeared after about 3 hours of bed rest. However, soon after she began to practice swimming in the pool a few days later, throbbing headache in the same region recurred(10)
11. Altitude
Human are born to adapt when exposure to high attitude, but when the mechanisms fail, depending on the rate of ascent and the altitude some may be experience acute mountain sickness (AMS) with headache as its predominant symptom(11)
12. Menstrual Migraine
Menstrual Migraine is caused by fluctuation of the levels of estrogen and progesterone in a woman menstrual cycle, it can be treated by phytoestrogens without stimulation of the endometrium, with decreased risk with long-term use.(B.A.10)
13. Etc.
B. Risk factors
1. Gender
Significant sex differences exist in migraine and other headache disorders, 75% of all migraine sufferers are women, it may be the result of menstrual cycle and pregnancy causes of the fluctuations of female hormones.
2. Age
Migraine headache migraine affects population of all age, but children with the chronic disorder eventually will see the disorder either disappear or transit to mild-type headaches, when they grow into adulthood.
3. Family history
If one the family member of the direct family has experienced headache migraine, the risk of the same disease of the other members increased by 75%.
4. Etc.
IV. Diseases associated with Basilar Artery headache (BAM)
1. Epilepsy (seizure disorders)
There are evidence that an individual can suffer both from headaches (either migraine and/or other type of headache) and epilepsy. Some researchers found that headaches sometimes occur simultaneously with, or very close in time to, the seizure: one that occurs at the same time as an epileptic seizure is known as an "ictal epileptic headache" or as "hemicrania epileptica"; one that precedes a seizure is known as a "pre-ictal headache"; and one that follows a seizure is known as a "post-ictal headache". There is a particular type of pre-ictal headache, known as "migralepsy", which occurs during or just after a migraine aura.(a)
2. Stroke
Headache is a common symptom at the onset of acute ischemic cerebrovascular disease. Simultaneous development of migraine-like headache and stroke make differentiation sometime difficult to establish between migraine-induced stroke and migraine-like headache attributed to ischemic stroke(b)
3. Neuro-otological manifestations
In the study of 200 unselected patients with migraine (Series I), 80 migrainous patients referred because of their symptoms for full neuro-otological examination (Series II), and 116 patients with tension headache who served as controls (Series III), persisting vestibulocochlear derangements were found in 77.5 per cent of Series II, largely vestibular and of both central and peripheral origin. Involvement of the vertebrobasilar vascular system appears to be the most likely explanation. Possible links between Ménière's disease, benign paroxysmal vertigo and migraine(c)
4. Tumor
Migraine with typical aura can occur in association with an occipital lobe tumor, as in case of 60-year-old woman in whom migraine with typical aura heralded the presence of an occipital lobe tumor. Her headache was characterized by recurrent episodes of visual aura confined to the left visual field followed by right hemicranial throbbing headaches accompanied by nausea, photophobia, and phonophobia(d)
5. headache of subarachnoid hemorrhage and meningitis
In the review of Sumatriptan, as an agent for the treatment of acute migraine, but also may be used to alleviate not only migraine headache, but also headache of subarachnoid hemorrhage and meningitis(e)
6. Brain infarcts
In the evaluation of 780 participants (mean age 69, 58.5% women) with detailed headache assessment for the association of overall and specific headaches with volume of white matter hyperintensities, brain infarcts, and cognition, conducted by Unit 708--Neuroepidemiology, Paris, France. tobias, migraine with aura was the only headache type associated with brain infarcts(f)
7. Etc.
V. Diagnosis
Depending to the differentiate of symptoms of which are similar but difference than others with a complete medical history and physical exam.
1. Attacks last from 4 to 72 hours
2. Patients are usually symptom-free between attacks
3. Headache is at least two of the following
a. Unilateral (on one side)
b. Pulsating
c. Moderate to severe
d. Aggravated by routine activities
4. Accompanying symptoms may include
a. Photophobia (more sensitive to light)
b. Phonophobia (more sensitive to noise)
c. Nausea and Vomiting
5. Etc.
VI.Types of diagnosis
The aim of the diagnosis is to rule other causes of the diseases
1. CT scan
CT scan can dive your doctor a three-dimensional view of your blood vessels of the brain to look for masses and other abnormalities that cause migraine headache
2. Magnetic resonance imaging (MRI)
By using radio waves and magnetic fields to take pictures, MRI scan provides very high quality of a cross-sectional slice and lengthwise slices of the brain and thus providing the better and detail image of location of tumor and the surrounding structures. It is one of most likely early test ordered by a doctor to diagnose tumors, strokes, aneurysms, neurological diseases and other brain abnormalities and the blood vessels around the brain.
3. Spinal tap (lumbar puncture)
A spinal tap is a procedure performed when a doctor needs to look at the cerebrospinal fluid (also known as spinal fluid), by inserting a thin needle between two vertebrae in your lower back to extract a sample. If your doctor suspects the onset of migraine headache is caused by inflammation of the membranes and cerebrospinal fluid surrounding your brain and spinal cord
4. Etc.
VII. 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 Basilar Migraines
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)
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)
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 exerciseThere 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)
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 Basilar Migraines
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. Melatonin
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)10. Etc.
B. Nutritional Supplements for Basilar Migraines
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. Melatonin
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
C. Diet for Basilar Migraines
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
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
VIII. Treatments in conventional medicine
A. Types of therapy (Non medication treatment)
1. 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.(F.A.1)
2. Relaxation training/thermal biofeedback (RTB)
Relaxation therapy is a technique helped to enhance the relaxation response with an aim to relieve stress, control anxiety, improve sleep, and have a better quality of life in general. In the study conducted by University of Pittsburgh Medical Center, found that 41.3% of patient reported a significant headache reduction in relaxation training/thermal biofeedback (RTB).
(F.A.2).
3. Etc.
B. Medication
B.1. Medication to relieve acute migraine pain
Depending to the severity of the disease, acute attacks may be best prescribed by a prescription version of an NSAID, of which have a potent vasoconstricting action (constricting blood vessels) and patients are instructed to take them during or at the onset of a migraine. including
1. Triptan
a. Triptan are a family of tryptamine-based drugs used in the treatment of migraine headache and cluster headache. In the comparison of subcutaneous sumatriptan and oral administration formulation, subcutaneous formulation has a faster time of onset and high rate of efficacy when compared with the oral formulation, but the oral formulation appears to be better tolerated.(F.B.A.1)
b. Side effects of Triptan are not limit to
b.1. Nausea
b.2. Dry mouth
b.3. Tingling
b.4. Burning,
b.5. Dizziness
b.6. Drowsiness
b.7. Warm or cold sensations
b.8. Feelings of heaviness, pressure, or tightness
b. Other severe symptoms include coronary spasm, heart disease, shortness of breath, changes in vision, etc.
2. Ergotamine
Ergotamine has been used to treat migraine for a century and is still considered to be the most effective therapeutic agent for acute attacks andt good responses of the medication are associated with plasma concentrations of 0.2 ng/ml or above within one hour of administration.
In the same study, researchers also emphasized the principal adverse effects of ergotamine include nausea, vomiting, weakness, muscle pains, paraesthesiae and coldness of the extremities and suggested dosage must therefore be limited to no more than 10mg per week to minimise toxicity.(F.B.A.2)
3. The oral calcitonine gene-related peptide antagonist telcagepant
In a recent study conducted by University of Liège, in comparison of the oral calcitonine gene-related peptide antagonist telcagepant(CGRP) and triptans, found that its efficacy is almost comparable but its tolerance is superior. The same is true for the 5HT-1F agonist lasmiditan, another agent devoid of vascular effects. Researchers also said that the drugs with a better efficacy or side-effect profile than triptans may soon become available for acute treatment. The future may also look brighter for some of the very disabled chronic migraineurs thanks to novel drug and neuromodulation therapies.(F.B.A.3)
4. Etc.
B.2. Medication to prevent migraine pain
Medication used to prevent migraine pain are normal prescribed for patient who are experience frequent migraine attacks, severe side effects from acute treatment drugs or ineffectiveness of acute treatment drugs and together with behavioral therapy and lifestyle adjustments.
1. Beta-blocker (usually propranolol [Inderal] or timolol [Blocadren])
a. Beta-blocker are also known as beta-adrenergic blocking agents, use to block norepinephrine and epinephrine from binding to beta receptors on nerves to prevent migraine headache. Some researchers suggested that the addition of combined β blocker plus behavioural migraine management, but not the addition of β blocker alone or behavioural migraine management alone, improved outcomes of optimised acute treatment.(F.B.B.1)
b. Side effects are not limit to
b.1. Beta-blocker may interact with other medicines, such as thioridazine, chlorpromazine, etc.
b.2. Most common side effects include dastrointestional discomfort such as stomach cramps, nausea and vomiting.
b.3. The medication may also increase nervous symptoms, including headache, depression, confusion, dizziness, etc.
b.4. Etc.
2. Anticonvulsants (usually divalproex [Depakote] or topiramate [Topamax])
a. Anticonvulsants or anti seizure are medication used to treat epileptic seizures, bipolar disorder as mood stabilizers and neuropathic pain. In the study conducted by Department of Neurology, Canisius Wilhelmina Ziekenhuis, anticonvulsants, considered as a class, reduce migraine frequency by about 1.3 attacks per 28 days compared with placebo, and more than double the number of patients for whom migraine frequency is reduced by > or = 50% relative to placebo.(F.B.B.2)
b. Side Effects are not limit to
1. The medication may also increase central nervous symptoms such as dizziness, drowsiness, unsteadiness, feeling dull difficulty concentrating, focusing, mood swing, etc.
2. The medicine may cause gastrointestinal discomfort such as nausea, and vomiting.
3. Other side effects include liver or kidney damage and decrease the amount of platelets in your blood
4. Etc.
3. Tricyclic antidepressants (usually amitriptyline [Elavil])
a. Tricyclic antidepressants are also known as cyclic antidepressants, a chemical compound used to treat depression by affecting chemical messengers, neurotransmitters, in the brain. In the study conducted by Ohio University, Athens, found that amitriptyline is more effective than placebo for migraine and tension headache. Amitriptyline also seems to be more effective than serotonin reuptake inhibitors, although few direct comparisons are available.(F.B.B.3)
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.
B.3. Medication for children
According to the recommendation of The American Academy of Neurologys practice guidelines
1. children Under 12 years old
a. Ibuprofen (Advil)
a.1. Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) used as as an analgesic for relief of symptoms pain as aresult of inflammation of certain diseases. In adult, researchers found that ibuprofen 200 and 400 mg are effective in reducing headache intensity and rendering patients pain-free at 2 hours. Photophobia and phonophobia improved with 400 mg dosing (F.B.C.1). Children should reduce the amount of medication according to the guideline.
a.2. Side Effects are not limit to
a.2.1. Common side effects include nausea, dyspepsia, gastrointestinal ulceration/bleeding, headache, dizziness, rash, etc.
a.2.2. Less common side effects include esophageal ulceration, heart failure, renal impairment, confusion, etc.
a.2.3. Etc.
b. Acetaminophen
b.1. Acetaminophen is a pain reliever to treat moderate to moderately-severe pain. Some researchers suggested that Tramadol/acetaminophen reduces the severity of pain, photophobia, and phonophobia associated with migraine headache, but does not reduce migraine-associated nausea. Tramadol/APAP might be an appropriate option for the management of moderate-to-severe migraine headache(F.B.C.2)
b.2. Side effects are not limit to
b.2.1. Common side effects include nausea, vomiting, sweating, diarrhea, irritability, etc.
b.2.2. Less common side effects include liver or kidney failure, heart problems, seizures, etc.
b.2.3. Etc.
2. Children 12 and older
a. Sumaptriptan (Imitrex) is a triptan sulfa drug used for the treatment of migraine headaches. some researchers found that nasal sumatriptan may be effective in aborting migraine in young children (aged 5 to 12 years). It also suggests that there may be subgroups for which it works well. This information suggests that double-blind, placebo-controlled studies are necessary to determine the overall effectiveness of nasal sumatriptan in this age group(F.B.C.3)
b. Side effects are not limit to
b.1. Most common side effects include flushing, sensations, weakness, drowsiness, or dizziness, etc.
1. PeppermintA. Types of therapy (Non medication treatment)
1. 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.(F.A.1)
2. Relaxation training/thermal biofeedback (RTB)
Relaxation therapy is a technique helped to enhance the relaxation response with an aim to relieve stress, control anxiety, improve sleep, and have a better quality of life in general. In the study conducted by University of Pittsburgh Medical Center, found that 41.3% of patient reported a significant headache reduction in relaxation training/thermal biofeedback (RTB).
(F.A.2).
3. Etc.
B. Medication
B.1. Medication to relieve acute migraine pain
Depending to the severity of the disease, acute attacks may be best prescribed by a prescription version of an NSAID, of which have a potent vasoconstricting action (constricting blood vessels) and patients are instructed to take them during or at the onset of a migraine. including
1. Triptan
a. Triptan are a family of tryptamine-based drugs used in the treatment of migraine headache and cluster headache. In the comparison of subcutaneous sumatriptan and oral administration formulation, subcutaneous formulation has a faster time of onset and high rate of efficacy when compared with the oral formulation, but the oral formulation appears to be better tolerated.(F.B.A.1)
b. Side effects of Triptan are not limit to
b.1. Nausea
b.2. Dry mouth
b.3. Tingling
b.4. Burning,
b.5. Dizziness
b.6. Drowsiness
b.7. Warm or cold sensations
b.8. Feelings of heaviness, pressure, or tightness
b. Other severe symptoms include coronary spasm, heart disease, shortness of breath, changes in vision, etc.
2. Ergotamine
Ergotamine has been used to treat migraine for a century and is still considered to be the most effective therapeutic agent for acute attacks andt good responses of the medication are associated with plasma concentrations of 0.2 ng/ml or above within one hour of administration.
In the same study, researchers also emphasized the principal adverse effects of ergotamine include nausea, vomiting, weakness, muscle pains, paraesthesiae and coldness of the extremities and suggested dosage must therefore be limited to no more than 10mg per week to minimise toxicity.(F.B.A.2)
3. The oral calcitonine gene-related peptide antagonist telcagepant
In a recent study conducted by University of Liège, in comparison of the oral calcitonine gene-related peptide antagonist telcagepant(CGRP) and triptans, found that its efficacy is almost comparable but its tolerance is superior. The same is true for the 5HT-1F agonist lasmiditan, another agent devoid of vascular effects. Researchers also said that the drugs with a better efficacy or side-effect profile than triptans may soon become available for acute treatment. The future may also look brighter for some of the very disabled chronic migraineurs thanks to novel drug and neuromodulation therapies.(F.B.A.3)
4. Etc.
B.2. Medication to prevent migraine pain
Medication used to prevent migraine pain are normal prescribed for patient who are experience frequent migraine attacks, severe side effects from acute treatment drugs or ineffectiveness of acute treatment drugs and together with behavioral therapy and lifestyle adjustments.
1. Beta-blocker (usually propranolol [Inderal] or timolol [Blocadren])
a. Beta-blocker are also known as beta-adrenergic blocking agents, use to block norepinephrine and epinephrine from binding to beta receptors on nerves to prevent migraine headache. Some researchers suggested that the addition of combined β blocker plus behavioural migraine management, but not the addition of β blocker alone or behavioural migraine management alone, improved outcomes of optimised acute treatment.(F.B.B.1)
b. Side effects are not limit to
b.1. Beta-blocker may interact with other medicines, such as thioridazine, chlorpromazine, etc.
b.2. Most common side effects include dastrointestional discomfort such as stomach cramps, nausea and vomiting.
b.3. The medication may also increase nervous symptoms, including headache, depression, confusion, dizziness, etc.
b.4. Etc.
2. Anticonvulsants (usually divalproex [Depakote] or topiramate [Topamax])
a. Anticonvulsants or anti seizure are medication used to treat epileptic seizures, bipolar disorder as mood stabilizers and neuropathic pain. In the study conducted by Department of Neurology, Canisius Wilhelmina Ziekenhuis, anticonvulsants, considered as a class, reduce migraine frequency by about 1.3 attacks per 28 days compared with placebo, and more than double the number of patients for whom migraine frequency is reduced by > or = 50% relative to placebo.(F.B.B.2)
b. Side Effects are not limit to
1. The medication may also increase central nervous symptoms such as dizziness, drowsiness, unsteadiness, feeling dull difficulty concentrating, focusing, mood swing, etc.
2. The medicine may cause gastrointestinal discomfort such as nausea, and vomiting.
3. Other side effects include liver or kidney damage and decrease the amount of platelets in your blood
4. Etc.
3. Tricyclic antidepressants (usually amitriptyline [Elavil])
a. Tricyclic antidepressants are also known as cyclic antidepressants, a chemical compound used to treat depression by affecting chemical messengers, neurotransmitters, in the brain. In the study conducted by Ohio University, Athens, found that amitriptyline is more effective than placebo for migraine and tension headache. Amitriptyline also seems to be more effective than serotonin reuptake inhibitors, although few direct comparisons are available.(F.B.B.3)
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.
B.3. Medication for children
According to the recommendation of The American Academy of Neurologys practice guidelines
1. children Under 12 years old
a. Ibuprofen (Advil)
a.1. Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) used as as an analgesic for relief of symptoms pain as aresult of inflammation of certain diseases. In adult, researchers found that ibuprofen 200 and 400 mg are effective in reducing headache intensity and rendering patients pain-free at 2 hours. Photophobia and phonophobia improved with 400 mg dosing (F.B.C.1). Children should reduce the amount of medication according to the guideline.
a.2. Side Effects are not limit to
a.2.1. Common side effects include nausea, dyspepsia, gastrointestinal ulceration/bleeding, headache, dizziness, rash, etc.
a.2.2. Less common side effects include esophageal ulceration, heart failure, renal impairment, confusion, etc.
a.2.3. Etc.
b. Acetaminophen
b.1. Acetaminophen is a pain reliever to treat moderate to moderately-severe pain. Some researchers suggested that Tramadol/acetaminophen reduces the severity of pain, photophobia, and phonophobia associated with migraine headache, but does not reduce migraine-associated nausea. Tramadol/APAP might be an appropriate option for the management of moderate-to-severe migraine headache(F.B.C.2)
b.2. Side effects are not limit to
b.2.1. Common side effects include nausea, vomiting, sweating, diarrhea, irritability, etc.
b.2.2. Less common side effects include liver or kidney failure, heart problems, seizures, etc.
b.2.3. Etc.
2. Children 12 and older
a. Sumaptriptan (Imitrex) is a triptan sulfa drug used for the treatment of migraine headaches. some researchers found that nasal sumatriptan may be effective in aborting migraine in young children (aged 5 to 12 years). It also suggests that there may be subgroups for which it works well. This information suggests that double-blind, placebo-controlled studies are necessary to determine the overall effectiveness of nasal sumatriptan in this age group(F.B.C.3)
b. Side effects are not limit to
b.1. Most common side effects include flushing, sensations, weakness, drowsiness, or dizziness, etc.
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. Others
Many herbs such a Fenugreek, Black willow, Marjoram, St. John's wort, fennel or caraway seed tea hane been used to relieve pain or symptoms of migraines, but they are not mention here because lack of studies.
For information of The World Most Popular Herbs - Health Benefits and Side Effects, visit
http://theworldmostpopularherbs.blogspot.ca/2011/10/world-most-popular-herbs-health.html
C. In traditional Chinese medicine (TCM)
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)
C.1. 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)
C.2. 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
C.3. 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)
C.4. 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)
C.5. 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)
C.6. 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)
C.7. 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)
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