Let's begin this article with an overview of the Western biomedical research on migraine as it relates to the menstrual cycle. Migraine occurrence is statistically higher 0-2 days prior to menses, 0-5 days after menses begins, and at mid-cycle, during the ovulation phase (Johannes, 1995, p. 1076). Hormone levels rise and fall with the menstrual cycle. Migraines induced by the onset of menses, at mid-cycle, and again premenstrually, are related to the abrupt fall in estrogen. Premenstrual migraines are associated with the fall of estrogen and progesterone levels. Estrogens "induce vasodilation through mechanisms involving the arterial endothelium and through endothelial-independent actions. Progestins have varying effects on arterial tone, including induction of vascular smooth muscle relaxation, as well as smooth-muscle constriction," (Sarrel, 1999, p. 205). Estrogens also promote blood clotting, which may play a role in menstrual migraines. Studies have shown that women with menstrual migraines do not have different levels of these hormones; rather, they respond more sensitively to the changes in hormone levels (Loder, 2001, p. 189).
The platelets of migraine sufferers are quite different from normal platelets, both during and between headaches. There is a significant increase in the amount of aggregation, in the manner of serotonin release, and in the structural composition of platelets. The biggest factor is the difference in serotonin metabolism. Serotonin plays a major role in the state of relaxation or constriction of blood vessels, and is used in the chemical transfer of information from one cell to another. There seems to be no difference in total serotonin content between normal platelets and the platelets of migraine sufferers; however, the quantity increases until a migraine is produced.
Vascular instability can play a major role in migraines. The blood vessels of the temple are often visibly dilated. Although the vessels are dilated, the person often appears pale, suggesting the dilation of large vessels and the constriction of small vessels. Studies measuring blood flow to the brain show a reduction of blood flow. Often, the blood flow is quite low prior to a migraine attack. This is followed by a stage of increased blood flow, which may last up to 48 hours. Some evidence suggests that migraine patients have an inherited abnormality in their control of blood vessel constriction and dilation. Migraine sufferers experience dizziness upon standing and seem to be unusually sensitive to physical and chemical changes in blood vessels.
Now, let's look at the famous formula tong qiao huo xue wan. This formula is used classically when blood stasis has been diagnosed in the head and is particularly useful in the treatment of menstrual migraine. We can examine each herb in the formula for TCM indications and pharmacology.
Through the integration of biomedical research and TCM theory, we can see how useful this formula can be in the TCM treatment of menstrual migraine. Clinically, I administer this formula with the initial onset of symptoms. I have worked with several brands, and recommend a dosage of 10 to 12 pills every 4 to 6 hours, depending on the size of the patient and the severity of the migraine. This strategy has proven quite successful in the prevention and treatment of severe migraine. Many sufferers report the prevention of a migraine attack with a few doses of tong qiao huo xue wan.
Additionally, I treat the constitutional pattern. It may be Liver qi stagnation, Liver fire, phlegm damp, blood deficiency, or Kidney and Liver yin deficiency with ascending yang. By treating both root and branch, we can treat the whole person and reduce the number, severity, and duration of migraines induced by the menstrual cycle.
Resources
One of the longest nerves in the body is known as the vagus nerve (VN). The VN is the 10th pair of cranial nerves that originates at the brain stem in the medulla oblongata. This nerve is part of the parasympathetic nervous system, which is a part of the ANS. Research suggests ear acupuncture can activate the VN.
In prior issues, Neil discussed the Gallbladder Official as a whole (March 20 including points 17 and 24); points 37-41 (June 2013); points 1, 16, and 20 (May 2021); and points 2-3, 8-9, and 12-13 (April 2024). This article focuses on GB points 7, 10, 14-15, 18-19, 21, and 23.
Knee osteoarthritis (OA) is a leading cause of pain and disability, often managed with pharmacological and surgical interventions. However, acupuncture has long been used as a non-invasive treatment for knee pain, and recent research provides new insights into its underlying mechanisms.
