Do you get throbbing temples like an electric drill boring inward every time your period arrives? Pain so severe it makes you vomit and fear light, forcing you to curl up in the dark until your period ends... This is not an exaggeration! Over 50% of women experience menstrual migraines. What can be done?
Why do migraines occur with every period?
Dr. Que Poh Yuen Albert, a TCM Gynecology Expert at Singapore's Gong Fang Tang TCM, states that menstrual headaches are the body's "blood deficiency alarm"! Fluctuations in Qi and blood during menstruation trigger the headache, but the core pathogenesis lies in:
Blood Deficiency Failing to Nourish Type (Over 60%)
Key Pathogenesis:
Menstrual blood loss → Sea of Blood emptiness → Failure of nourishment to the brain orifices → Dull headache
Spleen-Stomach weakness → Insufficient production of Qi and blood → Pain worsens after period
Typical Signals:
Headache location: Empty pain/dull ache on top of head or back of head
Onset time: Worsens from day 2 of period until after period ends
Accompanying symptoms: Sallow complexion, heart palpitations, insomnia, pale/scanty menstrual blood, pale tongue with thin coating
Liver Fire with Blood Stasis Type (Common in Young Women)
Key Pathogenesis:
Liver blood descends to uterus before period → Liver Yang ascends → Qi and blood rush upward → Distending, throbbing headache
Qi stagnation and blood stasis → Meridian obstruction → Pain like an awl stabbing
Typical Signals:
Headache location: Pulsating, distending pain in the temples
Onset time: Starts 3 days before period, lessens when period begins
Accompanying symptoms: Irritability, bitter taste, dark purple menstrual blood with clots, red tongue tip and edges
How does TCM regulate and treat migraines that come with every period?
Physician Dr. Que Poh Yuen Albert states that long-term reliance on ibuprofen for suppression may damage the gastric mucosa and mask organic lesions! Here, he shares a thousand-year-old gynecological sage formula – Si Wu Tang (Four Substances Decoction). This formula is the foundational formula for treating blood deficiency type menstrual headaches, but it must be "dynamically modified" to adapt to individual differences.
Si Wu Tang is composed of four medicinal herbs: Shu Di Huang (Prepared Rehmannia Root), Dang Gui (Chinese Angelica), Bai Shao (White Peony Root), and Chuan Xiong (Szechuan Lovage Root).
Shu Di Huang in the formula is sweet, warm, thick in flavor and moist in nature. It excels at nourishing Yin blood and replenishing the Kidneys to fill essence, making it a key blood-tonifying herb and the sovereign herb of the formula.
Dang Gui, sweet and warm, tonifies blood, nourishes the Liver, harmonizes blood, and regulates menstruation, serving as the minister herb.
Bai Shao, sour and sweet, nourishes blood, astringes Yin, softens the Liver, and relieves pain, assisting Shu Di Huang and Dang Gui in nourishing blood.
Chuan Xiong, acrid and warm, activates blood circulation, moves Qi, and regulates the flow of Qi and blood, preventing stagnation from the tonification, serving as the assistant and envoy herb.
The four herbs combined have the effect of tonifying blood and regulating blood, effectively improving menstrual migraines caused by Qi and blood insufficiency, and Qi stagnation with blood stasis.
Modifications and Clever Applications:
Headache like being wrapped: Add Qiang Huo (Notopterygium Root) 10g, Bai Zhi (Angelica Dahurica) 10g to dispel wind, overcome dampness, unblock orifices, and relieve pain.
Dizziness with nausea: Add Tian Ma (Gastrodia Rhizome) 12g, Jiang Ban Xia (Pinellia Rhizome Praeparatum) 9g to pacify the Liver, extinguish wind, descend rebellion, and stop vomiting.
Dark purple menstrual blood with many clots: Add Tao Ren (Peach Seed) 9g, Hong Hua (Safflower) 6g to transform stasis, unblock collaterals, and break up blood stasis.
Insomnia and heart palpitations: Add Suan Zao Ren (Spine Date Seed) 15g, Long Yan Rou (Longan Aril) 10g to nourish the heart, calm the spirit, aid sleep, and settle palpitations.
Cold hands and feet: Add Gui Zhi (Cinnamon Twig) 8g, Ai Ye (Mugwort Leaf) 6g to warm the meridians, unblock vessels, and dispel cold congelation.
Medical Case
Patient: Ms. Li, age 30.
Chief Complaint: Headache during menstruation for over 2 years, worsening in the last 3 months.
History: The patient reported that since giving birth 3 years ago, she often felt physically exhausted, weak, dizzy, with blurred vision, heart palpitations, and insomnia. For the past 2 years, headaches and dizziness started with each menstrual period, persisting for 5-6 days after the period ended before slowly easing. During severe pain, she could only take painkillers like Compound Aminopyrine Phenacetin Tablets or Ibuprofen Sustained Release Capsules to relieve the headache, without addressing the root cause, so the headache recurred with the next period. In the last 3 months, the menstrual headaches worsened significantly. She came to our clinic upon a colleague's recommendation.
Initial Consultation: Frontal headache with dizziness and distension, spirit fatigue and lack of strength, pale complexion, weary and disinclined to speak, prefers to close eyes to rest. Scanty menstrual flow, pale color, thin quality, poor appetite, loose stools. Tongue pale, coating thin white; pulse weak and foreceless. Blood pressure 95/60mmHg.
TCM Diagnosis: Menstrual Headache.
Pattern Differentiation: Qi and Blood Deficiency, Brain Marrow Lacking Nourishment.
Treatment Principle: Tonify blood and harmonize blood, regulate menstruation and transform stasis.
Prescription: Modified Si Wu Tang.
Formula Herbs: Dang Gui 12g, Chuan Xiong 6g, Shu Di Huang 15g, Bai Shao 15g, Bai Zhi 15g, Tian Ma 10g, Bai Zhu 15g, Zhi Gan Cao (Honey-fried Licorice) 10g, Da Zao (Jujube) 15g, Gou Teng (Uncaria Stem with Hooks) 15g, Yan Hu Suo (Corydalis Rhizome) 15g. 7 doses. Decoct in water, take one dose daily, divided into 2 doses.
Second Consultation: Upon re-examination after finishing the medicine, migraine symptoms were significantly reduced. Removed Gou Teng from the original formula, added Fu Ling (Poria) and Qian Shi (Euryale Seed). After taking the modified formula, combined with exercise and good rest.
Outcome: When her period came the second month, the headache symptoms had basically disappeared.
