Headache may occur as a predominant symptom during, before or after the menstrual period and constitutes a special disorder in gynecology.

Etiology and Pathogenesis

Qi and blood are chiefly involved in this disorder. It may be caused by deficiency of blood, stagnation of blood leading to obstruction of vessels or emotional upsets leading to stagnation of qi with fire formation. Blood deficiency, liver-fire hyperactivity and blood stasis are the common clinical types.

Diagnosis and Differential Diagnosis

A. Diagnostic evidence

a) Headache related to the menstrual cycle which appears during, before or after the menstrual period.

(b) Headache appearing periodically with the cycle and disappearing after menstruation.

B. Differential diagnosis

It should be distinguished from headache due to common cold during menstruation which may be accompanied by a superficies-syndrome with symptoms such as fever, chilliness, stuffy and running nose, etc., and which occurs without periodicity. By contrast, headache during menstruation occurs periodically with the cycle, there is no superficies-syndrome present.

Syndrome Differentiation and Treatment

The sthenic type headache usually occurs before or during the menstrual period, and its pain is distending or stabbing in character, while the asthenic type occurs usually after or at the end of menstrual period, and its pain is dull and aching in character and accompanied by dizziness. The general therapeutic principle is that of regulating qi and blood to nourish the upper orifices.

A. Blood-deficiency syndrome

Manifestations: Headache occurring during or after the menstrual period, accompanied by dizziness, palpitations, sleeplessness, fatigue, pale tongue with thin coating and feeble and thready pulse.

Therapeutic principles: Nourish blood, and benefit qi.

Prescription: The Modification of Eight-Ingredient Decoction for Tonifying Qi and Blood

Radix Angelicae Sinensis 10 g
Rhizoma Chuanxiong 10 g
Radix Paeoniae Alba 15 g
Radix Rehmanniae Praeparata 15 g
Radix Codonopsis Pilosulae 15 g
Rhizoma Atractylodis Macrocephalae 10 g
Poria 15 g
Radix Glycyrrhizae Praeparata 6 g
Fructus Lycii 15 g
Radix Polygoni Multiflori Praeparata 20 g

Remarks: For cases with deficiency of yin-blood and upward attack of liver-yang manifested as headache with empty sensation after menstruation radiating to the orbits and accompanied by tinnitus, dizziness, nausea, desire for quietness, dryness of mouth without desire to drink, menorrhagia with light-colored menses, menstrual period prolonged by 8-10 days, headache aggravated by menorrhagia, pale and corpulent tongue with thin white coating and thready and wiry pulse, the therapy of tonifying yin, nourishing blood, calming the liver and suppressing yang should be adopted and the following prescription:

Radix Rehmanniae 15 g
Fructus Mori 15 g
Radix Paeoniae Alba 15 g
Fructus Leonuri 15 g
Fructus Lycii 15 g
Radix Angelicae Sinensis 10 g
Rhizoma Chuanxiong 6 g
Fructus Ligustri Lucidi 12 g
Semen Astragali Complanati 12 g
Flos Chrysanthemi 10 g
Magnetitum (decocted) 30 g In a case where the woman's headache has been relieved but she still experiences dizziness, dryness of eyes, insomnia, dreaminess, palpitations and poor memory, use Bolus of Ginseng for Nourishing Ying-Blood or King of Heaven Cardio Tonic Pill.

B. Liver-yang hyperactivity syndrome

Manifestations: Distending pain over the head during menstruation or even stabbing pain over the vertex, dizziness, tinnitus, irritability, bitter taste in the mouth, dryness of throat, red tongue with thin yellow coating and wiry, thready and rapid pulse.

Therapeutic principles: Nourish yin and clear away heat, soften the liver, and calm wind.

Prescription: The Modified Decoction of Lycii and Chrysanthemi and Rehmanniae Praeparata

Folium Ilex Cornutae 10 g
Spica Prunellae 10 g
Fructus Atriplex Sibiricae 10 g
Radix Rehmanniae 15 g
Radix Rehmanniae Praeparata 15 g
Fructus Corni 10 g
Rhizoma Dioscoreae 15 g
Rhizoma Alismatis 10 g
Cortex Moutan Radicis 10 g
Poria 15 g
Fructus Lycii 15 g
Flos Chrysanthemi 10 g

Remarks: For cases with hyperactivity of liver-fire manifested as severe headache before menstruation, stiffness of neck or hypertension, flushed face, redness of eyes, irritability, constipation, yellow urine, bitter taste in the mouth, dryness of the throat, menstrual cycle preceded by profuse red menses, leucorrhagia with yellowish discharge, purple-red tongue with thin yellow coating and wiry and smooth pulse, the therapy of calming the liver and purging fire is recommended and the Modified Decoction of Gentianae for Purging Liver-Fire taken before menstruation, which is composed of Radix Gentianae (10 g), Radix Scutellariae (10 g), Fructus Gardeniae (10 g), Radix Rehmanniae (15 g), Rhizoma Alismatis (10 g), Semen Plantaginis (10 g), Caulis Akebiae (10 g), Cortex Moutan Radicis (10 g), Folium Ilex Cornutae (10 g), Ramulus Uncariae cum Uncis (10 g) and Lumbricus (10 g). As for cases with hypertension, the above prescription should be used with the addition of Pulvis Margaritae (decocted first, 30 g) and Pulvis Cornu Saigae Tataricae (3 g, taken by mixing with the decoction).

C. Blood-stasis syndrome

Manifestations: Severe headache occurring before or during menstruation which is usually localized and unilateral and aggravated by pressure, difficult menstruation, oligomenorrhea with menses containing clots, lower abdominal pain, dull-colored tongue with petechiae on the margin and wiry and unsmooth pulse.

Therapeutic principles: Activate blood circulation, eliminate blood stasis, and dredge meridians.

Prescription: The Modified Decoction of Four Drugs with Persicae and Carthami

Radix Angelicae Sinensis 10 g
Rhizoma Chuanxiong 10 g
Radix Paeoniae Rubra 10 g
Semen Persicae 10 g
Flos Carthami 10 g
Radix Rehmanniae 15 g
Radix Achyranthis Bidentatae 10 g
Radix Salviae Miltiorrhizae 20 g
Lumbricus 12 g

Remarks: Headache Powder made of Scorpio (6 g), Rhizoma Chuanxiong (6 g), Succinum (3 g) and Folium Ilex Cornutae (10 g); taken orally; 3 grams twice a day with warm water.

Copyright 1995 Hopkins Technology