Western Diagnosis: Cyclic Migraine
Medical History: Unremarkable. One MVA 8 years ago in which she had LBP and R shoulder pain but no problems for 4 years now. Occasional tension headache (one every 6-8 months).
Questioning exam: History of CC: Started 2 months after menarche. Migraines seen 10 out of 12 months per year (cyclic) and 5+ times a year non-cyclic. Has tried various contraceptives to help with migraines without benefit.
Description of Migraine: unilateral Right side. pain starts in occiput and wraps around of R side (GB channel). Severe pain noted above apex of R ear and behind R eye. Nausea is noted 90% of the time but rarely vomiting. Visionary disturbances include: tunnel vision, blurred, auras, lines, and/or flashing lights.
Triggers: Start of menstruation or 1 day before. Stress. Sinus problems. Overpowering odors.
Provocative: Light. Sound. Smells. Stress. Menstruation.
Palliative: Isolation. Imitrex. Excedrin. Relaxation techniques.
Pulse exam: Physical Exam: Abnormal amount of tension of muscle groups in occiput, neck and shoulders. Cervical ROM in normal range. Tenderness noted around eyes (especially orbital ridge). Tenderness forehead and apex of the ear. Mostly in the GB channel area.
Pulse: wiry in liver pulse, slippery spleen pulse, slight thready in both kidney Yin and Yang pulses.
Tongue exam: Tongue: red tip and edges, swollen with teeth marks.
OM Diagnosis: TCM diagnosis: Liver Qi stasis affecting the GB channel. Liver overacting on Spleen. And Spleen Qi deficiency. Phlegm accumulation in sinuses.
Treatment Principle: Move and regulate Liver Qi. Tonify Spleen Qi. Reduce damp phlegm accumulation.
Point Prescription: Point Prescription: Liver 3, Sp 6, St36, GB 41, GB20, GB 8, GB14, LI4, Extra point Yintang. Local ashi of muscles of upper back occassion.
Herbal Prescription: Xiao Yao Wan at 10 pills 3x day.
Lifestyle Prescription: Yoga and mediation.
Results: 6 acupuncture treatments over a 3 week time. 2 additional treatments since then. She is now migraine and tension headache FREE. She coulds in on occassion for maintenance (every 6 months)
Synopsis: Classic case of migraine with Liver/Gallbladder involvment. Classically treated successfully with great results.