On and off parietal headache for 2 years, aggravated 2 weeks

RECORD OF FIRST VISIT

Date of First Visit: 04 Sep 08	Name:
Age : 22	Gender: Female
CHIEF COMPLAINTS : On and off parietal headache for 2 years, aggravated 2 weeks
DESCRIPTIONS (4 diagnostic methods)
A) Asking
Present illness history The patient suffers from a headache for about 2 years. The pain occurs randomly, but mostly in the evenings when she studies or concentrates for hours. It normally starts with dull pain from the vertex and around DU-20 Baihui and radiates to the ear region and the eye balls. She described her pain as electric shock that comes and goes with distending sensation. This can be relieved if she massages and presses along the eyebrows. She does not have any injury on head related to this problem and the most recent pain occurred about 2 weeks ago. No chill/Fever. No dizziness. Little thirstiness (prefers cold drink). Good appetite. She often gets hot sensation on her face while having headache. Spasm on the eyelid (right side). No bitter taste in the mouth. Mild hot sensation in the five centres. Shoulder and lower back pain. Frequent sighing. Mood swings. Dreamful sleep. Hypochondriac pain. Urination is normal and stool is little loose.
Past illness history: None
Life style: Student. Easy going.
Family history: Grandfather had pancreatic cancer.
Menstruation, marital & obstetrical history: Single. 14. Last period on 04-Aug-08. Premenstrual distension. Scanty dark red coloured menses with clots (not always). Leucorrhea in white colour with fishy smell.
B) Inspection
General : Flushed cheeks Tongue : Red tongue with very thin white coating
C) Auscultation / Olfaction
Sound : NAD Odours : NAD
D) Palpation
Pulse : String-taut, weak on Chi Body areas : N/A

CASE SUMMARY

DIAGNOSIS

A) Diagnosis Parietal headache

B) Syndrome Differentiation Hyperactivity of Liver yang underlying Liver and Kidney yin deficiency

C) Explanation

The shortage of Liver yin can implicates Kidney yin, and vice versa. Deficient Liver and Kidney yin results in disharmony between yin and yang. The Liver yang is hyperactive and the qi and blood go up with Liver yang. It resulted in distending pain in head and eyes, hot sensation on the face and the five centres as well as dry throat. Frequent sighing and spasm on the eyelid are all Liver deficiency signs. The excessive yang disturbed the mind so she has got emotional up-and-downs and dreamful sleep. The lumbar could not be filled up due to Kidney yin deficiency, so she has also got lumbar pain. The scanty dark red coloured menses due to Liver yin deficiency and her tongue which is red with very thin white coating shows yin deficiency leading to the deficiency heat. The pulse is taut, showing hyperactivity of Liver yang and weak pulse on the Chi portion also indicates deficiency of Kidneys as well.

TREATMENTS

A) Treatment Principles - Descend the arisen Liver yang, sooth the Liver, and promote flow of qi to stop pain.

B) Treatment Methods

1. Needling

Prescription : - Taichong / Baihui / Yintang / Hegu / Neiguan / Sanyinjiao

Explanations : - Hegu and Taichong are “FOUR GATES”. Hegu is a common point for diseases on the head and face and pain syndromes and with Sanyinjiao, both points are good for tonifying the Spleen to produce more blood which may nourish the marrow, since the brain is the sea of marrow. Taichong soothes the Liver and pacifies Liver yang, therefore, is good to be chosen for a parietal headache. Baihui is a local point that promotes qi circulation to stop pain and Yintang was chosen for her headache that often radiates to the eye region. Neiguan was also chosen for regulation of qi and particularly to pacify the Liver this time.

2. Moxibustion

Prescription :

Explanations :

3. Cupping

Prescription :

Explanations :

4. Electro Acupuncture

Prescription :

Explanations :

5. Microsystems

Select microsystems : Ear ( ), Hand ( ), Foot ( ), Scalp ( ), Nose ( ), Other ( )

Prescription :

Explanations :

6. Life Style Advice

Because the patient and I have been together for years so I know her quite well. Even she told me that she is easy going and does not get stressed easily, but I know that she is pretty sensitive and easily influenced by the environment and atmosphere where she is in. Therefore I recommended her try to calm the mind and not to take things too seriously; otherwise it would build up a mental stress on her. Also I recommended her to try yoga to help maintaining her body and also controlling her mind at the same time.

HEADACHE

DEFINITION

A headache (cephalalgia in western medical terminology) is a condition of pain in the head; sometimes neck or upper back pain may also be interpreted as a headache.

TCM ETIOLOGY and PATHOGENESIS

The head is the highest place of the body where qi and blood of zangfu organs and yang meridians of foot and hand gather as well as Du meridian which dominates all the yang of the body flow up. This is why the head is regarded as the converging place of the entire Yang. 1. Invasion of various pathogens and endogenic diseases may directly or indirectly cause derangement of qi and blood, obstruction of meridians and collaterals on the head, leading to headache. Six exogenous pathogens can attack the vertex and inhibit the flowing of lucid yang. 2. Dysfunction of liver in maintaining the free flow of qi and prolonged depression will turn into heat which may go up and disturb the head; yin deficiency of liver and kidney may lead to hyperactivity of liver yang. 3. Constitutional weakness, deficiency of qi and blood as well as malnutrition of brain may result in headache.

DIFFERENTIATION AND TREATMENTS

1. Invasion of pathogenic wind into meridians and collaterals

Clinical manifestation

Headache occurs on exposure to wind. The pain may extend to the nape and back. It is a violent, boring and fixed pain, string-taut pulse, white thin tongue coating. The type also called “head wind”.

Treatment principle

- Expel the exogenous wind and promote qi circulation in meridians and collaterals

Acupuncture treatments

- Baihui / Fengchi / Taiyang (plus+ points depending on the pain area & syndrome differentiation) § Frontal headache: add Yangbai / Yintang / Cuanzhu / Hegu / Neiting § Temporal headache: add Touwei / Shuaigu / Waiguan / Zulinqi § Occipital headache: add Tianzhu / Dazhui / Houxi / Jinmen § Parietal headache: add Sishencong / Taichong / Neiguan / Yongquan 1. Invasion of pathogens: add Hegu / Lieque 2. Hyperactivity of Liver-yang: add Taichong / Sanyinjiao 3. Deficiency of qi and blood: add Qihai / Zusanli / Pishu

2. Hyperactivity of Liver yang

Clinical manifestation

- Headache, vertigo, severe pain on bilateral sides of the head, irritability, hot temper, insomnia, red face, bitter taste in the mouth, string-taut pulse, red tongue with yellow coating.

Treatment principle

- Calm and sooth the Liver and clear heat

Acupuncture treatments

- Refer to the first differentiation

3. Insufficiency of qi and blood

Clinical manifestation

- Lingering headache, dizziness, vertigo, lassitude, lustreless face, pain relieved by warmth and aggravated by cold, overstrain or mental stress, weak, thread pulse, thin white tongue coating.

Treatment principle

Release the Exterior, restore the descending of Lung-Qi, promote fluids and stop cough.

Acupuncture treatments

- Refer to the first differentiation

W.M.S. Researches & Explanations: HEADACHE	(Reference: Wikipedia)
Definition
A headache (cephalalgia in medical terminology) is a condition of pain in the head; sometimes neck or upper back pain may also be interpreted as a headache. It ranks amongst the most common local pain complaints and may be frequent for many people. The vast majority of headaches are benign and self-limiting. Common causes are tension, migraine, eye strain, dehydration, low blood sugar, hypermastication and sinusitis. Much rarer are headaches due to life-threatening conditions such as meningitis, encephalitis, cerebral aneurysms, extremely high blood pressure, and brain tumors. When the headache occurs in conjunction with a head injury the cause is usually quite evident. A large percentage of headaches among women are caused by ever-fluctuating estrogen during menstrual years. This can occur prior to, or even during midcycle menstruation. Treatment of an uncomplicated headache is usually symptomatic with over-the-counter painkillers such as aspirin, paracetamol (acetaminophen), or ibuprofen, although some specific forms of headaches (e.g., migraines) may demand other, more suitable treatment. It may be possible to relate the occurrence of a headache to other particular triggers (such as stress or particular foods), which can then be avoided.
Pathophysiology
The brain in itself is not sensitive to pain, because it lacks nociceptors. Several areas of the head can hurt, including a network of nerves which extend over the scalp and certain nerves in the face, mouth, and throat. The meninges and the blood vessels do have pain perception. Headaches often result from traction to or irritation of the meninges and blood vessels. The membrane surrounding the brain and spinal cord, called the dura mater, is innervated with nociceptors. Stimulation of these dural nociceptors is thought to be involved in producing headaches. Similarly the muscles of the head may be sensitive to pain.
Types
There are five types of headache: vascular, myogenic (muscle tension), cervicogenic, traction, and inflammatory. 1. Vascular The most common type of vascular headache is migraine. Migraine headaches are usually characterized by severe pain on one or both sides of the head, an upset stomach, and, for some people, disturbed vision. It is more common in women. While vascular changes are evident during a migraine, the cause of the headache is neurologic, not vascular. After migraine, the most common type of vascular headache is the "toxic" headache produced by fever. Other kinds of vascular headaches include cluster headaches, which are very severe recurrent short lasting headaches, often located through or around either eye and often wake the sufferers up at the same time every night. Unlike migraines, these headaches are more common in men than in women. 2. Muscular/myogenic Muscular (or myogenic) headaches appear to involve the tightening or tensing of facial and neck muscles; they may radiate to the forehead. Tension headache is the most common form of myogenic headache. 3. Cervicogenic Cervicogenic headaches originate from disorders of the neck, including the anatomical structures innervated by the cervical roots C1–C3. Cervical headache is often precipitated by neck movement and/or sustained awkward head positioning. It is often accompanied by restricted cervical range of motion, ipsilateral neck, shoulder, or arm pain of a rather vague non-radicular nature or, occasionally, arm pain of a radicular nature. 4. Traction and inflammatory Traction and inflammatory headaches are symptoms of other disorders, ranging from stroke to sinus infection. Specific types of headaches include: Tension headache, Migraine, Idiopathic intracranial hypertension (headache with visual symptoms due to raised intracranial pressure), Ictal headache, Cluster headache, "Brain freeze" (also known as: ice cream headache), Thunderclap headache, Vascular headache, Toxic headache, Coital cephalalgia (also known as: sex headache), Hemicrania continua, Rebound headache (also called medication overuse headache, abbreviated MOH), Red wine headache, "Spinal headache" (or: post-dural puncture headaches) after lumbar puncture or related procedure that will lower the intracranial pressure, Hangover (caused by heavy alcohol consumption), A headache may also be a symptom of sinusitis. Like other types of pain, headaches can serve as warning signals of more serious disorders. This is particularly true for headaches caused by inflammation, including those related to meningitis as well as those resulting from diseases of the sinuses, spine, neck, ears, and teeth.

Case Conclusion

The diagnosis of this case is parietal headache due to hyperactivity of Liver yang underlying Liver and Kidney yin deficiency. I provided one acupuncture treatment on Taichong, Hegu, Baihui, Yintang, Neiguan, and Sanyinjiao. Baihui worked very well and the patient got the qi gaining sensation during the treatment. For Taichong and Hegu, the patient told me that she got that feeling on one side only, so I gave her more stimulation on the other side. Two days after the first treatment, she told me that she got the same headache but it was very mild and relieved very soon. I suggested her having six treatments but she could not make it due to transport problem.

I would like to use those points (especially Baihui, Hegu, Neiguan, Sanyinjiao) to the similar problem but to change some points according to the syndrome differentiation for each different case. Because this was the first time that this patient has ever had acupuncture, so I wish that she had a positive experience on this treatment.