Condition: throbbing pain in the blood vessels above the temples.
Analysis: Clinically speaking, pain or throbbing pain in the temples, with occasional attacks and repeated treatment, are more likely to be neurovascular headaches.
This type of pain is mainly migraine. Of course, migraine can be accompanied by different neurological symptoms or other different types of concurrent symptoms.
Migraine is one of the common types of headache in clinical practice. It is characterized by recurrent attacks of headache with normal intervals between attacks. Migraine can be divided into two types: migraine with aura (typical migraine) and migraine without aura (common migraine or simple migraine), and there is a special type of migraine that is less common in clinical practice, also called complex migraine, which refers to migraine with signs of neurological deficits.
Migraine is an ancient disorder, and it remains the most important research topic in headache. Nevertheless, the causes and mechanisms of the disorder are still not fully understood.
Migraine is a functional vascular headache, and a 30-year follow-up of 73 children with migraine found that although the disease has a long course, it does not cause organic damage and does not lead to serious sequelae. Therefore, there is no need to worry too much about the prognosis of patients with this disease.
Migraine headache characteristics: Migraine patients usually have headache attacks during the daytime, but they can also occur at night after waking up from sleep, and more than half of the headaches are confined to one side of the head, and about 1/4 of the patients have a full headache that can involve either side of the head. In nearly half of the patients, the headache site can change from time to time, but severe headache attacks always involve the same side; in the other half of the patients, the headache is fixed on one side. In a few patients, the headache is located in the occipital area and the top of the head, and even in the face and neck. Therefore, the diagnosis of migraine should not be made only on the basis of the location of the headache.
Definition of migraine: Migraine is a vascular headache, which is a recurrent headache caused by intracranial and extracranial vasodilatory dysfunction. Its attacks are characterized by unilateral or shifting from one side to the other, accompanied by nausea and vomiting, and may be preceded by aura, with intermittent periods as normal, and may have a family history.
Migraine classification: (a) Common migraine (migraine without aura): It is the most common type of migraine, accounting for more than 80% of migraine patients. Aura symptoms may or may not be present, and if there is an aura, it is only a brief and mild blurring of vision. The headache progresses in the same way as a typical migraine, but is often variable from side to side, pulsating in nature, and may be aggravated by physical activity. Sometimes it starts from both sides. The headache lasts for a long time, usually 1 to 3 days, or several days, and is also accompanied by nausea, vomiting, and sweating. There is often a family history. In women, the headache is sometimes associated with the menstrual cycle and is called ‘menstrual migraine’. (2) Typical migraine (migraine with aura): The clinical manifestation is recurrent migraine with the following characteristics: the most common and typical visual aura before the onset of headache, mostly some flickering dark dots, bright spark-like light, “W” flash, “gold star in front of the eyes” or hemianopia (blindness on one side) appear 20 to 30 minutes before the headache. (one side is blind). These symptoms tend to occur in one side of the visual field, peak before the headache arrives, and then disappear. Rarely, the aura may include numbness, facial pins and needles, hemiparesis, or inability to speak. The migraine appears soon after the aura disappears, usually starting from one side of the frontotemporal region (around the temples) or around the orbits, or in a few cases from the parietal or occipital region, gradually spreading to half of the head or the whole head, with the headache gradually increasing from dull pain to drilling or throbbing pain (throbbing pain). It is mostly fixed on one side, but can also be on both sides. The headache can be relieved by pressing the local blood vessels that are throbbing strongly with fingers. The headache is accompanied by pale face, nausea, vomiting and other vegetative neurological symptoms. At this time, the patient is very tired, obviously photophobic and afraid of sound, and likes to lie quietly alone in a dark room. Each headache lasts for a few hours to more than 10 hours. In a few cases, the headache can last for 1 to 2 days, and often returns to normal after a good night’s sleep. Cerebral hemogram and Doppler ultrasound examination mostly have abnormal findings, which can help in diagnosis.
Clinical manifestations of migraine.
(I) Staging performance
Migraine attacks can be clinically divided into three phases: namely, intracranial vasoconstriction phase, extracranial vasodilatation phase and remission phase. Each period has corresponding clinical symptoms.
1.Intracranial vasoconstriction period
It is also called the pre-headache or aura period, which often occurs several minutes or hours before the headache, and mainly manifests as symptoms of cerebral blood supply deficiency. For example, there are often visual symptoms such as gold stars in front of the eyes, partial blindness and visual field defects; individual patients may have transient hemianesthesia, limb weakness and slurred speech, etc., but they rarely develop into permanent damage. The appearance of the above symptoms often indicates the imminent onset of headache.
2.Extracranial vasodilatation period
With the gradual relief of ischemic symptoms, the headache caused by vasodilatation appears immediately and usually lasts for several hours to several days. The headache can be a continuous throbbing pain or dull pain or swelling pain in the frontotemporal region or bilaterally, and most of them are so intense that it affects work and study, accompanied by general weakness, pale or red face, irritability, nausea, vomiting, poor appetite, panic and other vegetative symptoms, and the headache can be reduced or disappeared after sleep. During this period, EEG abnormalities are sometimes seen, and cranial Doppler ultrasonography indicates accelerated blood flow, and cerebral hemogram shows hypotonic or tachyon waves.
3.Relief period
When the vasodilatation and headache attacks continue for a certain period of time and normalize, the patient enters into this period. During this period, the above symptoms disappear and the patient has no obvious discomfort, only a few people have dizziness, weakness and dreaminess. If instrumental examinations are performed during the remission period, most of them cannot find any abnormalities. This period can last for several weeks or months.
In fact, the above three periods cannot be clearly separated and there is no clear interval between them, and the duration of each period varies from person to person. Some patients may have no aura period.
(II) General manifestations
As the intensity of the headache increases, i.e. after a few minutes to a few hours, some accompanying symptoms often appear in common migraine, with nausea and vomiting being the most common, and about 10% of patients having loose stools and some having diarrhea. In addition, photophobia and phonophobia are often symptoms that indicate a generalized irritability to all sensory stimuli and a preference for resting alone in a dark room or lying in bed under a blanket. Patients with severe migraine and photophobia also often feel blurred vision, black spots in front of their eyes, etc.
These symptoms are not aura symptoms of migraine (typical migraine) because migraine aura symptoms must occur before the onset of headache or at least when the headache is not severe. From a group of case studies, it is known that the greater the intensity of the headache, the higher the frequency of concomitant symptoms, especially visual disturbances. However, patients with generalized migraine whose headache symptoms were confined to both occipital regions had a significantly lower incidence of photophobia and phonophobia symptoms and no other visual disturbances during the attack. These results suggest that the visual disturbance symptoms in headache without aura (common type of stubborn headache) are not caused by occipital cerebral ischemia, but are likely due to extracranial factors in the painful region.
The diagnosis of migraine is based on the following points: There are no definite indications for the clinical diagnosis of migraine, and the diagnosis is based on detailed history and exclusion of other diseases. The following points can be used for reference when diagnosing migraine.
(1) Intermittent recurrent attacks with sudden onset and stop, intermittent periods as usual, and a long duration of illness. There is often a positive family history.
(2) Often starts in adolescence, with female onset predominant.
(3) The attacks are mainly throbbing headache, but may also be distending.
(4) The headache is predominantly on one side, but can also be a full headache.
(5) There are no positive neurological signs. The headache attacks are preceded or not preceded by visual, sensory, motor, mental and other aura symptoms or concomitant symptoms, but the attacks are mostly accompanied by nausea, vomiting and other obvious vegetative neurological symptoms.
(6) Family members with or without migraine who have the same disease.
(7) Certain factors such as diet, menstruation, mood swings, and overwork can trigger it. Compression of the common carotid artery, superficial temporal artery, supraorbital artery or short rest or sleep can reduce the headache.
(8) Streak suspicion test is mostly positive, EEG examination occasionally has mild or moderate abnormalities, transcranial color Doppler shows bilateral cerebral blood flow velocity asymmetry, brain imaging (including angiography) and other auxiliary examinations are not abnormal. Treatment with ergotamine preparation is effective.
Treatment of migraine
(I) Western medicine drug treatment
Treatment of migraine should firstly be relaxed mentally, and secondly, trigger factors should be excluded, such as food containing fat, wine and tyramine should be avoided, pay attention to the combination of labor and rest, keep the environment quiet, avoid sunlight and hunger. In case of mental tension, sedatives (such as Valium) and analgesics (such as painkillers) should be given in time to relieve the headache faster. When vomiting is obvious, gastrofacial or morphine can be given. Non-steroidal anti-inflammatory analgesics, such as aspirin 600 mg daily or anti-inflammatory pain 75-150 mg daily, can also be given during headache attacks. The drug has anti-prostaglandin effect and can inhibit platelet agglutination, which is more effective when applied early in the headache attack. Caffeine ergotamine tablet is a special medicine for migraine, 1 to 2 tablets each time. If the attack cannot be relieved, take an additional one after 0.5-1 hour. Do not take more than 6 tablets for a single attack, and do not exceed a total of 12 tablets a day (reduce by half for children); overdose may cause ergot toxicity and is contraindicated in pregnancy and in patients with severe heart, lung and kidney problems.
Since migraine is a recurrent headache, if there are more than 2 to 3 attacks per month, long-term medication should be given for prevention. For example, 30-120 mg per day for the headache; 30 mg per day for the calcium ion antagonist nifedipine, 90 mg per day for nimodipine; 0.5 mg per day for the first time, and gradually increase to 7 mg per time, 4 times per day within one month for dimethyl ergometrine. Hypertension can trigger or aggravate migraine and should be treated at the same time. Those with depression or anxiety should also be given antidepressant or anxiety medication in time. Pregnancy, menopause and oral contraceptives can aggravate migraine in women.
(2) The understanding and effective treatment of migraine in Chinese medicine: Migraine headache in Chinese medicine
According to the expression and symptoms of migraine, TCM believes that migraine is a kind of periodic attack with family tendency, which is manifested by paroxysmal attacks of migraine with nausea, vomiting and visual symptoms before the attack, and then reappears after a period of interval. It is a common type of vascular headache. This disease belongs to the category of “head wind”, “migraine” and “syncope headache” in Chinese medicine.
Migraine mostly belongs to internal injury headache in Chinese medicine, which is induced by wind, fire, phlegm, stasis and dysfunction of liver, spleen, stomach, kidney and other internal organs, and by external evil.
Principles of migraine treatment.
1. The acute attack is mostly induced by wind, liver and yang, phlegm and blood stasis, so the main treatment should be to remove wind, lower fire (latent yang), resolve phlegm and eliminate blood stasis.
2, the remission period should focus on strengthening the spleen, nourishing the liver. Nourish the kidney to prevent recurrence.
3.For severe headache, the onset is urgent, the pain is acute and unbearable, and should be treated with a combination of traditional Chinese and Western medicine, and after the condition is relieved, Chinese medicine should be used to consolidate the effect.
Pain is not passable, and passable is not painful is the classical understanding of the pathogenesis of pain in Chinese medicine.
Phlegm, dampness and blood stasis are the key factors causing the blockage of Qi and blood in this disease. To clear phlegm-dampness and blood stasis can cure migraine, the principle of clearing phlegm-dampness, invigorating blood and removing stasis, the herbal formula of tonifying the spleen and stomach, tonifying qi, tonifying lung and kidney, resolving phlegm, nourishing yin, clearing heat, moving qi and invigorating blood, has been widely used and generally effective for migraine.
Comparison of the efficacy of acupuncture and western medicine: It is concluded that acupuncture is more effective than western medical therapy in the treatment of migraine.
The results of a year-long comparative treatment trial conducted by the Paracelso Clinic in Rome, commissioned by the Italian Ministry of Health, showed that acupuncture was much more effective than Western medicine in treating stubborn migraine headaches.
This clinic divided 120 migraine patients into two groups of 60 each and treated them with Western medicine and acupuncture for one year. For comparison purposes, patients were given scores based on severity and frequency of attacks prior to treatment. The final statistics showed that the group treated with Western medicine dropped from 8,405 to 3,084 points, while the group treated with acupuncture dropped from 9,823 to 1,990 points.
The clinic’s published survey report also said that 800,000 people in Italy suffer from this persistent disease, and the use of acupuncture treatment methods can save more than 1.3 million lira (1 U.S. dollar is about 1,840 lira) per person per year compared to Western medical treatment, a total of more than 1 trillion lira a year for the country to save medical costs. Trials have also shown that acupuncture is very effective in treating alcoholism, for example.
Research and efficacy analysis of acupuncture for migraine: Migraine is one of the most difficult diseases to treat clinically, and there is no ideal cure for it.
The efficacy of acupuncture in the treatment of migraine The results of the current literature show that acupuncture has a definite efficacy in the treatment of migraine. Migraine is a periodic attack disease with unbearable pain during the attack, and the side effects of western medicine treatment are large. Based on the experience of the industry, acupuncture for migraine has the advantage of positive efficacy, safety and non-toxic side effects, but it should not be ignored that there are methodological problems in the current studies, which make the reliability of the results of the research literature low, therefore, from the perspective of evidence-based medicine, it is difficult to make a systematic evaluation of the efficacy of acupuncture solar acupuncture for migraine at present, and it is very necessary to conduct further scientific and systematic research work to come up with There is a great need for further scientific and systematic research work to reach convincing research conclusions.
Efficacy criteria of acupuncture for migraine There is a lack of uniformity in the efficacy criteria used in acupuncture for migraine, and there are few objective indicators applied. It is necessary to select not only pain-related indicators, but also to observe the impact of the disease on patients’ psychological and daily life, and to establish indicators of psychological and social adaptation and quality of life.
Acupuncture treatment for migraine Currently, the most acupuncture treatment for migraine is based on the solar acupoint as the stimulation point, followed by Fengchi, Baihui, Rate Valley, Touwei, Taichong and Lijiao; the stimulation method is based on the milli-acupuncture method, followed by electroacupuncture therapy and blood pricking therapy. It is suggested that the above acupoints and stimulation methods can form a very good program for treatment.