Case Study - Migraine

OBSERVATIONS
A 23-year old women walks into my office complaining of a migraine headache that started yesterday. She has experienced migraines often since she was seventeen.

Over-the-counter (OTC) pain medication doesn’t work. She has tried migraine-specific prescription medication also. Usually, sleeping in a dark room is the only non-pharmaceutical option that doesn’t make the migraine worse. But, the next day, she feels weak and her head still aches.

She said she feels weak in general, doesn’t have stamina and feels under the weather frequently. Her sleep is light. She wakes up easily during the night and has a lot of dreams. Sometimes, she gets a “charlie-horse.” She also reported getting “backed up about once every 2 mouths” with stomach aches and cramps. Her tongue and face are pale. Her pulse is thready and rapid.

In the course of talking, she mentioned she is the youngest of five siblings and didn’t feel cared for enough and that is why she “is fragile.”

Before I share my diagnosis, let me make a quick comment about Traditional Chinese Medicine (TCM): TCM uses the Five Element Theory system of categorization to describe conditions and processes throughout the body. Five organs pairs (Liver/Gall Bladder, Lung/Large Intestine, Spleen/Stomach, Heart/Small Intestine, and Kidneys/Urinary Bladder) correspond to these elements and are used to describe different syndromes. Each organ has Yin and Yang properties that affect its function. Yin generally refers to the structure while Yang refers to energy and function. When Yin and Yang are balanced, everything functions with no distressing symptoms.

“To Western medicine, understanding an illness means uncovering a distinct entity that is separate from the patient’s being; to Chinese medicine, understanding means perceiving the relationships between all the patient’s signs and symptoms.”(1) Chinese medicine is holistic. “When that person is ill, the symptom is only one part of a complete bodily imbalance that can be seen in other aspects of his or her life and behavior.”(2)

DIAGNOSIS
I diagnosed the 23-year old woman’s migraines as the result of Liver Yang rising to the head due to Liver Blood deficiency.

“In health, Liver-Qi rises upwards and spreads in all directions to promote the smooth flow of Qi in all parts of the body… In disease, the rising movement of Liver-Qi can get out of control, resulting in a separation of Yin and Yang and the excessive rising of Liver Yang” which can cause headaches. (2)

Being Blood deficient is indicated by the symptoms:

• she feels weak,
  
• wakes easily,
  
• her leg muscle cramps
  
• as well as by her pale face, pale tongue, and thready pulse.

According TCM Five Element Theory, the Liver stores Blood and controls Sinews. When there is deficiency of Blood, the person will experience muscle weakness or cramps, and the tongue and complexion are pale.

TREATMENT
The way to “cure” her migraines is to prevent those headaches from occurring by subduing the Liver (bringing the Liver Yang back into balance with the Liver Yin) and to nourish her using food, herbs, and supplements that are considered Blood tonics. Tonifying her Blood will help with her to deal with stress. She will be physically and emotionally stronger and better able to cope with life. The effect of stress on her Liver then will not trigger the headaches. Treating the core cause of the problem instead of suppressing the pain eliminates the migraines.

I performed acupuncture on points along her Liver channels and “opened the neck and head” by relaxing the muscles utilizing the Gall Bladder points. (Remember, in TCM Five Element Theory the Gall Bladder is paired with the Liver.)

I prescribed two Chinese formulas for her to take three times per day. One is designed to subdue Liver Yang and the other is to tonify Liver.

OUTCOME
Five days later, my patient reported she still felt very relaxed since the treatment and “didn’t even have the slightest headache at all.” She is still using the herbs at least twice a day.

GOING FORWARD
Wellness is a dynamic process. It is an active commitment to live a balanced and fulfilled life. Most people focus on their immediate pain, failing to see the underlying issues. With the help of acupuncture treatments and the Chinese herbs it is possible for this woman to restore and maintain a balanced life which will not only eliminate her migraines, but benefit her total body function and well being.

Resources:

1. THE WEB THAT HAS NO WEAVER: UNDERSTANDING CHINESE MEDICINE by Ted J Kaptchuk, O.M.D.
   (ISBN 0-8092-2933-1z)
2. THE FOUNDATIONS OF CHINESE MEDICINE by Giovanni Maciocia
   (ISBN 0-443-03980-1)