Internal vs. External Causes of Headaches
External causes include exposure to the elements, like wind, water, heat, or cold, and also exposure to pathogens like bacteria or viruses which we call “heat/toxins” in Chinese Medicine. This includes common cold, sinusitis, head cold, and in more severe cases hypothermia or sun stroke. Chinese medicine can also treat externally contracted headaches (for example from cold and flu) very well without pharmaceuticals, but that is beyond the scope of this document. I wish to present only the Internal causes of chronic or long term headaches.
In cases where one has a headache from an external cause, and it’s not a commonly recurrent event, the occasional use of western drugs can be a quick and easy way to alleviate the short term suffering. Unfortunately the more common scenario is that these conditions persist or come back often because the immunity is weak and/or there is an underlying imbalance of the internal organ systems. In this case there is an external and an internal cause of the headaches. According to the principles of Chinese Medicine, one would treat or eliminate the external causes first, thus eliminating the acute symptoms, and then treat the internal causes to prevent the recurrence of symptoms. A good example would be chronic sinus infections causing headaches. An external exposure to wind and cold could aggravate or trigger a sinus headache, but after treating it with decongestants and antibiotics, the symptoms recur even without exposure to wind and cold. This pattern would indicate an underlying internal condition, quite possibly a weak immune system stemming from a number of different internal patterns of disharmony. For the purpose of this discussion, we will omit the discussion of Chinese Medicine treatment of externally caused headaches, and focus on the chronic internal patterns. If an external condition exists, as evidenced by symptoms of a cold or infection with heat and swelling, sinusitis, ear infection or otitis media, sore throat, aversion to cold, cough or lung problems, etc. one would first treat the external condition before looking into the diagnosis and treatment of the underlying internal causes.

Internal Patterns of Disharmony Leading to Headaches:
I. Liver Yang Rising

The most common pattern in Chinese Medicine leading to chronic migraines and headaches of a severe nature is one of Liver Yang Rising or Liver Fire. The pattern of Liver Yang Rising usually leads to its more severe sister pattern of Liver Fire, which is basically more severe and listed as a separate category after Liver Yang Rising. Both patterns are a classic example of an imbalance of Water and Fire or Yin and Yang within the body. A Deficiency of Water or Yin leads to a flaring up of Fire or Yang. An example would be “Liver Fire caused from a Deficiency of Liver and Kidney Yin”. This, I would venture to say, is probably THE most common pattern of imbalance in humans today. It is largely a result of over-stimulation, over-medication, over-chemicalization and electro-magnetization that is the hallmark of our modern western civilization. This pattern is actually a secondary Excess pattern which has a deeper root in a Deficiency pattern of the Liver and Kidneys, as we will discuss shortly. Let’s look at the symptoms of “Liver Yang Rising” first:
1) Headache of a strong, intense, distending nature (having the feeling of swelling out and expanding as if from internal pressure), and includes throbbing, bursting, or pulsating pain. It could also be described as sharp. A very sharp pain, like a knife or hot poker, or a “splitting” headache can fall in this category, but usually means there is also “Blood Stagnation” as well. You can check the symptoms of Blood Stagnation on page 15. The headache is often diagnosed as a migraine, or headache of a severe nature.
2) The location is often times in the occipital area (the back of the head) with pain radiating to the neck muscles or upper back; in the temples or eyebrow region or on one or both sides of the head; or behind the eyes. Basically it can affect the whole head. It can move around or be fixed in one spot.
3) This is usually is a chronic condition already lasting months or years, and the bouts tend to be more often (daily to weekly) and often coming on in the afternoon or evening.
4) The headache only occurs on the “weekend”. This pattern is usually due to excessive work, long hours, and high stress related jobs which tend to mask the headache when one is working, but surfaces during periods of rest or inactivity. Very common in med students, emergency room nurses, and other high stress, high workload occupations.
5) This headache is often connected with an emotional imbalance like anger, frustration, or resentment, either expressed or repressed. This is actually the hallmark symptom for this pattern. Manifestations include irritability; marked impatience, throwing fits of anger, and patterns including disorganization, disinterest, procrastination, distractibility, or a hypersensitive character. For children and adults this often results in diagnoses like ADD (attention deficit disorder) or ADHD (with hyperactivity). Chronic excessive emotions of this nature can actually be the cause of this pattern of headaches.
6) Dizziness or vertigo
7) Dry throat or mouth in general.
8) Nausea or vomiting, with possible acid reflux disorders like GERD (gastro-esophageal reflux disorder) or acid regurgitation.
9) Visual disturbances including seeing an aura or other types of visual distortions like flashing lights; blurred vision.
10) Pain, redness, or dryness of the eyes.
11) Tinnitus (ear ringing).
12) Bitter and dry taste in the mouth and/or a red face (classic symptoms, rare, but very diagnostic, this would be another hallmark group of symptoms).
13) Throbbing or burning pain along the sides of the chest (another rare classic symptom)
14) Constipation or dry stools, tending toward the mild side.
15) Insomnia or restless sleep.
16) The headache is aggravated by heat, anger, after excessive sexual activity or vigorous exercise, or after eating sour foods like citrus or vinegar; light, sound, smell, vibration, or other stimuli can onset or aggravate the headache; it can also be made worse with pressure or massage.
17) The headache is alleviated by cold applications (temporarily), light exercise, reduction of external stimuli (being in a dark, quiet room), or in rare cases sexual activity. Sometimes patients report relief in a sitting position or propping the head up with pillows when lying down.
18) The headache usually happens before the beginning of a woman’s menstrual period (as a PMS symptom), but this may vary.
19) Gallbladder related disorders including gallstones or bile duct obstruction.
20) Liver related disorders including hepatitis, cirrhosis, elevated liver enzymes, liver cancer.
21) The classic tongue is a red body with yellow coating, and this would be the case in an acute or aggravated condition, but more often the tongue will present as some deficiency pattern which is the root of this pattern, as described below.
22) The classic pulse is wiry, so feels rather forceful like a thick guitar string and rapid, so 90 plus beats per minute, but this is the acute flare-up stage. The actual pulse may show as a deficiency pattern as described below.

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