The approach to headaches or headache pain is problematic to say the least, both for its diffusion and for the multiplicity of its aspects; this disease affects, in fact, only in Italy between 6 and 7 million people, especially women, who suffer from it four times more than men; both for the disabling sequelae that this pathology, more often than not, entails, with a marked worsening of the quality of life of the patients who suffer from it. The international classification of essential headaches (The International Classification Headache – II Ed. 2004) highlights how the causes of this disorder are many and can be summarized as follows: 

• Primary Forms : Migrants (with or without aura); Muscle-Tensive (TTH); Cluster of headaches and other trigeminal headaches
• Secondary Forms : Trauma headaches; Cervical or cranial vascular disease headaches; Headaches from intracranial non-vascular changes; Infectious headaches; Headaches from morpho-functional alterations of the head or face (nose-eyes-paranasal sinuses); Headaches from psychiatric disorders
• Other types of Headaches: Headaches from central and primary cranial neuralgia, facial pain and headaches of other origins.   

Main forms of headaches with their characteristics

The term migraine is commonly referred to as a headache or “headache”, but in reality this term in medicine refers to a particular type of headache in which the ” intense pain affects one side of the head” and is often accompanied by other symptoms such as nausea, vomiting, photophobia (aversion to light), phonophobia (aversion to sounds), dizziness with nausea and mental confusion, depending on the intensity of the pain. Migraine with visual or sensitive aura, that is the symptomatic procession that often precedes migraine-like pain, so much so that the usual patient recognizes the symptoms, is present in 10% of patients suffering from essential headache.

The pain usually affects one side of the head first, is throbbing with accompanying symptoms such as absence of hunger, nausea and aversion to light, sounds, noises and forces the patient to bed and in the dark for 1-2 hours. Migraine without aura is the most frequent one, it affects, in fact, about 60-70% of migraine sufferers, has more nuanced and definable accompanying symptoms: mood disorders, gastrointestinal, water retention or increased diuresis etc. ; in these cases the painful crisis can last longer, up to several days and is generally accompanied by paleness, irritability and swelling at various levels.

Vertebrobasilar migraine is characterized by alterations in blood circulation on a hormonal or endocrine basis, especially in young women often in conjunction with the menstrual cycle, has throbbing pain in the occipital area accompanied by vomiting, blurred vision and in some cases loss of consciousness. There are rare cases of migraine involving the III ocular cranial nerve with divergent strabismus and the paralytic form with evident motor and sensory symptoms. 

By cluster headache  we mean a form of headache that mainly affects humans (ratio 8/1), with violent pain always on the same side of the head, which lasts an average of 30 minutes. Associated symptoms are: redness with watery eyes and nasal obstruction, on the pain side. This type of headache occurs “in clusters”, ie with attacks close in time, with more crises per day, at fixed times, which last for days or months, even spaced out by years of complete well-being. 

Tension or muscle tension headache . This term defines a particular headache in which the non-intense pain is of a severe type, such as a weight or a tight band on the head, without the accompanying signs typical of migraine. This type of headache affects about 30-50% of headache patients, with a prevalence for women (75% of cases), with an average age of 30 years. The pathogenesis is controversial, but it seems that muscular and vascular modifications come into play with pain deriving from the contracture of the scalp muscles. 

In Traditional Chinese Medicine , headache is defined as toutong (pain in the head) or toufeng (wind in the head). It is important to note that the head orYang Palace is the meeting place of all main  Yang meridians : Thai Yang – Shao Yang – Ying Ming of the hand and foot, with the tendon-muscular meridians, distinct and longitudinal luo; as well as the main Yin meridians of the Liver and Heart . From these close connections it clearly follows how all the energetic imbalances of the organs or viscera can cause headaches and therefore, as pathologies at various levels of the organism, they can be traced back to headache pain.

The classification of headaches in TCM can be exemplified in : 

Headaches of external origin :
Cosmic causes: in these headaches all climatic factors such as cold, humidity, heat with their particular characteristics can be called into question, but it is above all the wind , which penetrates the facial block ( wind points , Yang Ming meridian of the face ) and creates the typical migrating headache with the symptomatological set of rhinorrhea, tearing and redness of the eyes.
Injuries: they can cause stasis of blood ( xue ) and of the circulation of Qi or vital energy.
Going into more detail, we can say that Wind / Cold headaches the classic ” air blow ” occurs by blocking the circulation of Qi and xue   at the back of the head with anterior irradiation; in the case of Wind / Moisture headaches, the headache is linked to the digestion of food in the stomach with consequent Spleen Qi deficiency and severe, ” circle ” pain ; while in the case of headaches resulting from Wind / Heat, Tan / Fire are produced which block the circulation of energy in the meridian. Finally, in the case of trauma of various kinds it is almost always the stasis of xue(blood), which causes widespread headache.  

Headaches of internal origin :
· are often involved in one of the 7 Passions ( Qi quing), which are “strong” emotions linked to important and significant episodes of existence, these involve a stasis of the Liver Qi which easily transforms into Fire, which in addition to disturbing the head (headache), prevents the regular functioning of the various organs.
· A deficiency of the kidney YIN can cause repercussions on the Liver with an excess of Yang of the Liver rising upwards, causing headache.
· An incongruous diet with excess fat can cause an excess of Tan, understood as catarrh in the broad sense, or an excess of one of the flavors can obstruct the circulation of IQ and result in a headache.
· The lack of blood ( xue ) due to serious illness or haemorrhage can be the cause of headaches due to a bad blood supply, therefore of nourishment to the head.   

All these internal causes can, therefore, act and link together in various ways, because in Traditional Chinese Medicine (TCM) there is a close correlation between the various organs ( zang ) and their lodge of belonging which are five according to theLaw of the 5 Movements (Figure 2), which outlines the main characteristics, where:
the Lodge of Fire is represented by the Heart zang that is: circulation, vessels, red, heat, bitterness, joy, Summer season, South 
the Lodge of the Earth is represented by the Spleen that is: transformation, yellow, humidity, sweet, taste, reflection, 5th season (end of state) 
the Metal Lodge is represented by the Lung : breathing, skin, white, dryness, smell, spicy, sadness, Autumn season, West 
The Water Lodge is represented by the Kidneys :filtration / reproduction, hearing, hair, bones, cold, black, salty, fear, season Winter, North 
La Loggia del Legno is represented by the Liver : reserve of blood, muscles, sight, green color, acid, anger, season Spring, East .
If, as previously stated, any internal imbalance can give rise to headache in Traditional Chinese Medicine there are four conditions that are most frequently called into question in their etiopathogenesis:  

1. Yang ascent of the liver
2. Yin deficiency of the liver and kidney
3 Spleen
deficiency 4. Xue deficiency

Let’s see the main pictures in more detail:  
1.      Liver Yang liberation headaches (Yang rising): they show typical signs of wind and liver fire: headache pain, insomnia, dizziness , tinnitus, red eyes and face, irritability . 
 2.      Headache from Yin deficiency of Kidney and Liver : in this situation there is a lack of Yin and xue of liver and kidney for nourishment of the marrow and the ” sea of ​​medolls” that is the brain, resulting in the feeling of ” head empty “and” mental confusion “accompanied by lower back pain and sometimes widespread asthenia.
 3.      Kidney and Liver Yin deficiency headaches : due to altered or non-processing of food due to Spleen Qi deficiency with stagnation of Tan / Moisture obstructing the meridians, pain is often accompanied by nausea and vomiting , chest tightness, swelling abdominal, heaviness, edema, anorexia and asthenia.
4.      Xue deficiency headaches : in this case the blood deficiency may fail to nourish the Heart, Fire will be produced which releases upwards and causes the headache, the accompanying symptoms are palpitations, pallor , anemia, dizziness, insomnia and also signs of involvement of theShen (the psyche) with memory impairment.
 Wanting then, to exemplify the headaches from the symptomatological point of view, we will have important differential characteristics because the forms from external causes present intense pain with sudden onset, with paroxysmal attacks and climatic aggravations characteristic of wind, heat, cold, humidity; while the forms of internal causes present with a chronic pain, with slow onset, in which the triggering causes are almost always to be found in psycho-physical or alimentary stress.  
The therapist schemes proposed in Acupuncture for the treatment of headachesthey are multiple due to the specific and contingent situations of individual patients, but it is possible to recorph some general treatment schemes, which can be customized if necessary.        

Possible Therapeutic Schemes in Acupuncture: 

Intutti i tipi di cefalee sia da cause esterne, sia interne:  GV20 – GB20 – LI4 – LU7 – TaiYang extra (FM2) ·
A cui è possibile aggiungere altri agopunti in ragione delle localizzazioni:
Per Cefalea frontale:  YinTang extra (FM1) – GV23 – GB14
Per Cefalea temporale:  TE5 – GB8
Per Cefalea parietale: SI3 – BL67
Per Cefalea occipitale: BL10 – BL60
Inoltre in base alla cause esterne od interne delle Cefalee è possibile schematizzare alcuni protocolli di terapia agopunturistica che tengano conto delle peculiarità di ognuna di queste forme:
·         Nelle cefalee da cause esterne Vento/Freddo dove è il freddo che agisce contraendo e bloccando la circolazione del Qi e di Xue sono consigliati  i seguenti agopunti: BL2 – BL10 – BL60   ·         Nelle cefalee da cause esterne Vento/Umidità dove l’umidità accumulata crea ostacolo alla circolazione dell’energia nei meridiani gli agopunti più utilizzati sono: ST36 – SP6
·         Nelle cefalee da cause esterne conseguenti a Vento/Calore dove è in azione il binomio calore/fuoco vengono consigliati soprattutto gli agopunti: GV14 – LI11
·         Nelle cefalee esterne conseguenti a traumatismi a cui consegue la stasi di sangue si possono utilizzare i punti del Meridiano di Vescica: BL17 – BL43

Le cefalee da cause interne potranno trovare giovamento in terapie agopunturistiche diversificate in base ai quadri che sono stati precedentemente individuati, quindi:
1.      per le Cefalee da liberazione di Yang di Fegato potranno essere consigliati i seguenti agopunti: BL18 – LV2 – LV3 – KI3 – Yin Tang extra (FM1), a cui poter aggiungere: GB43.
2.      per le Cefalee da deficit di Yin di Rene e Fegato vengono utilizzati soprattutto gli agopunti: BL18  – BL23 – KI3 – LV3.
3.      per le Cefalee da deficit di Milza la terapia proposta è sui principali punti di Stomaco  e Milza: BL20 – BL21 – ST36 – ST40 – SP3.
4.      per le Cefalee da deficit di Xue  dove a risentirne è soprattutto il Cuore e lo Shen i punti consigliati sono prevalentemente: BL17 – BL20 – BL23 – SP6 – SP10.

Legenda: GV = Du Mai o Meridiano straordinario Vaso Governatore; GB = Meridiano principale di Vescica Biliare ; LI  = Meridiano principale di Grosso Intestino; LU = Meridiano principale di Polmone; TE = Meridiano principale di Triplice Riscaldatore; SI  = Meridiano principale di Intestino Tenue; ST = Meridiano principale di Stomaco; BL = Meridiano principale di Vescica; LV = Meridiano principale di Fegato; KI = Meridiano principale di Rene; FM = punti fuori meridiano.

*Dr.ssa Loredana Tocalli Medico Chirurgo Omeopata  Agopuntore

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