Migraine in the UK

UK figures report that 33% of women and 13% of men suffer with migraines, and according to NICE:

​Migraine is often underdiagnosed in primary and secondary care​, with 1 in 4 people fulfilling the International Headache Society criteria for migraine ​being​diagnosed as ​'​non-migranous headache​'. GP Diagnosis is based on the patient's presenting symptoms​​, with many headaches lasting 2-72 hours, and symptoms of moderate or severe pain which is pulsing, throbbing, of unilateral location, and may be accompanied by vomiting, auras and photosensitivity.

NICE classification of migraine:

• Primary headaches, which are not associated with an underlying condition for example migraine, tension-type headache, and cluster headache.
• Secondary headaches, which occur as a result of underlying local or systemic pathology for example due to trauma, intracerebral infection, vascular disorders, medication overuse or neoplasm.
• Patients with recent ​hypoxia, hypertension, preeclampsia, infection, carbon monoxide exposure, drug withdrawal,​ cranial neuropathies​ should be considered.​

Where serious causes of secondary headache have been ruled out:
​the patient is asked to keep a diary over a few weeks to record frequency, duration and severity of ​the migraine and its​ associated symptoms, ​and ​prescribed ​ov​er the counter medications taken to relieve ​symptoms , and​ advised​ ​avoid ​possible triggers.

​Prescribed medications for of acute migraine uses NSAIDs, Paracetamol, Aspirin, Triptans, but ​contraindications include those with cardiovascular conditions, liver ​and renal ​function​ problems​, pregnancy, breastfeeding women, the young and the elderly, ​with some adverse effects ​reported ​with other drug interactions.

There is therefore a role for herbal medicine treatment where these pharmacological medications are contraindicated, and where there is an unsatisfactory resolution. Many patients presenting with migriane to the Chinese Herbal Medicine clinic have suffered for years with worsening symptoms unresponsive to any other interventions

What happens when a Migraine Patient attends a Chinese Medicine Clinic?

In the clinic, a Chinese Herbal Medicine consultation records a full case history​, including any previous investigations, and would always refer a patient for GP attention where serious causes of the headache had not been considered by the patient or investigated. In addition to this case history, a tongue diagnosis and a pulse diagnosis will be taken to assess the body, and the nature, location, severity, frequency, quality and accompanying symptoms of the migraine being taken.

Female migraine patients often report co-morbidities such as Pre Menstrual Tension, PMDD, Gynecological Disorders including Endometriosis, Painful Periods, Infertility, Perimenopause and Menopause, so a detailed diagnosis of the menstrual cycle and gynecological history is taken.

Some headaches may be classed as acute and 'external in origin' and arising from exposure to:

• Wind Cold
• Wind heat
• Wind Dampness
  
• Summerheat
  

But the vast majority of cases presenting to the clinic are chronic, are internal and have their roots in the 'patterns of disharmony' in the internal zang fu organs, where they are further subdivided into deficiency and excess types.

Common deficiency patterns include​

• Liver ​Blood deficiency 

• Liver Yin deficiency 

• Liver and Kidney-Yin deficiency

• Liver and ​Kidney-Yin and
• Kidney-Yang deficiency

Common Excess patterns include:

• Liver Yang Rising & Liver​ Wind​
• Liver F​ire

• Liver ​Depression Qi Stagnation ​
• Dampness
• Cold affecting the Liver and Stomach
• Phlegm​ Dampness
• Blood Stasis

Thorough careful discernment ​​of the ​internal ​origins of the headache​ and any organs and​ channels affected​, ​a diagnosis is made, and a herbal medicine prescription is prescribed that treats the root of the problem, with follow up assessment. This is normally a few weeks after the first prescription to see any progress. The prescription may be either in a powdered or raw herb format, with RCHM members using only Pharmaceutical Grade herbs form the approved supplier scheme

W​here ​the menstrual cycle​ impacts on the migraine, a patient may take a differing prescription that reflects the changes during the menstrual, follicular, ovulation and luteal phases​​ to balance hormones.

It is common for patients to have the resolution of the accompanying symptoms upon resolution of the migraine, as the migraine in Chinese Medicine is seen as a symptom of the underlying problem.

Getting to The Root of the problem should bring lasting resolution not only of symptoms of migraine but improve overall health.

References: 
https://cks.nice.org.uk/topics...​