I had a new patient with a chief complaint of a dull headache around the eyes and in the back of the head at the base of the skull. The headache was consistent throughout the day and at times progressed to a more stabbing headache for no particular reason. The patient could not recall any stress or particular event that may have brought on the headache, but did note that she has an issue with teeth clenching. The teeth clenching has been going on for years, however, and this headache only started 2 months ago.
The patient is in her 20's and complained of fatigue and frequently waking up during the night. She said she had no trouble getting back to sleep. She said she was generally more hot than cold and said that she had a problem with frequent urination. She also had some upper back tension that she was seeing a chiropractor for. Her tongue was pink with a redder tip. She had a thin white coat, slightly toothmarked, with purplish sublinguals. Her pulse was deep, weak, and slightly slippery.
I felt that this headache was caused by qi deficiency and treated her as such. I used DU20, GB20, GB14, Taiyang, LI4, CV6, ST36, SP6, and GB41. The needles were retained for 20 minutes. The needling was mostly quite shallow with little to no manipulation. After removing the needles, the patient complained that her headache had become more severe and throbbing. I did some tuina on the GB20 with herbal cream and it brought the pain down a little bit.
Any suggestions on what I might have done wrong? I thought this was a qi deficiency headache due to the pulse and other S/S, however, could this headache been one of excess? I thought I was following the correct point perscription for a deficiency headache in the Tai Yang/Shao Yang meridians and was surprised to learn that the headache had worsened. Please share any thoughts or suggestions you might have. Thanks.
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Your analysis and point selection seem fine for the most part. Sometimes people get worse after an initial treatment, and then they improve a day or two later - or over time they will improve and never experience the temporary worsening that happened the first time. This isn't often due to the practitioner and their treatment choices - it's just nature and the progression of healing.
If I could comment on the points I would say to try a few different things next time. Some of this is keeping in line with your TCM training and some is just the way we do things - so take those with a grain of salt...
As a general order of treatment, we focus quite a bit on tuina - acupuncture/needling is great for what it does, but many conditions also need the physical/structural benefits of tuina - at the very least incorporating it more tends to bring on quicker and more permanent results. So I'm glad to hear you did some, as a response to smoothing out the qi.
With a patient like this (teeth grinding and headaches - even if they may not be technically related) there is some nerve issue in the neck where it innervates the face, etc. So I would start the treatment with tuina in the GB 20 area, and also down the sky window points (SI 16, SI 17, TH 16, etc.) basically along and along the back of the SCM tendon working where the patient is most sensitive. Do just a couple minutes at most of this - then do your needling.
The only suggestion I have for needling, would be that in some cases it is better to use distal/descending points rather than focus on needling the face/head. Your points are technically correct, but I might have replaced GB 14, for example, with a stronger descending point such as LV 3 - and not that it was wrong, but personally I don't use tai yang half as much as it seems to be used as I feel the tuina before and after the treatment does a better job and avoids the possibility of adding too much energy/movement in the head area. Or you could have added in TH 5 with GB 41 for the yang wei dai mai pair and left out LI 4 (which may be better if you are using it with LV 3). You can see the Japanese extraordinary vessel treatment for the yang wei dai mai to get some more ideas for palpatory confirmation and associated symptomology.
Which brings me to the next part, finish the treatment with some of the same tuina now that the nervous system and the patient is relaxed. They should do well.
Hi, as a student of Acupuncture and a patient(migraines) as well, I've seen Du-20 utilized alot for headaches. Unfortunately it seems that even though alot of headaches are due to a defiencey, alot also are combined with an excess pattern as well(i.e Liver qi stagnation, Liver yang rising, Liver fire, Heart fire, etc) and what Du-20 seems to do is draw this excess Upwards, thus creating a headache or even a Migraine.I noticed from what you noted on the Tongue Observation that there was evident stagnation(purple) which is an excess pattern, this stagnation(qi and possibly blood) must have been farely strong or long standing for it to manifest on the Tongue. You're patients sleeping patterns(waking up during the night, but no problem falling back to sleep) is also an indication of a Liver/G.B pattern, I've found that Yintang or Du-24 are usually great substitutes. Hope this helps.
Personally I feel that Tai Yang is overused as is GV 20. The treatment choices will of course depend on where the headaches are experienced by the patient rather than always using GV 20, Tai Yang, etc. Thus the treatment points will change based on the client and their experience of the headaches. Migraines and headaches are also two entirely different conditions and need to be treated as such.
With regards to needling GV 20, it is also important to consider the direction of needling. GV 20, and many other points, can have significantly different effects depending on the direction of needling - so it is important not to raise energy if the pathology is lv yang rising or similar patterns.
It is also important to balance out points such as GV 20 in conditions with rising or stuck energy. You can eliminate any side effects of the points usage with appropriate distal points and tuina and/or cupping after needling.
Thanks for all your helpful and insightful suggestions.
My patient did have a delayed response to my treatment and ended up feeling better after 1 or 2 days. She said her headache decreased from a 6/10 to a 2/10, and she ended up seeing me again for 2 more treatments. I did incorporate some additional points such as SI3 and LV3 along with tuina as you suggested. As of now, the headache seems to have been resolved.
if she had no head injury history, (for stabbing pain means blood extravasated), with upper back pain means maybe is wind cold headache, try "chuan qiong cha tiao san" soup, for acupunture you should move Qi and active Blood, add Ren 4, 6, 17, 4 gates. Gb20, 21,sp10, Du20 and Si Shen Cong(Special).
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