Menstrual Migraines?

by Cathy Chase, MS, CA

East meets West: Treating Menstrual Migraine with Tong Qiao Huo Xue Wan                        

Let’s begin with an overview of the Western biomedical research on migraine as it relates to the menstrual cycle.  Migraine occurrence is statistically higher 0-2 days prior to menses, 0-5 days after menses begins, and at midcycle during the ovulation phase.  (Johannes,1995, p.1076).  Hormone levels rise and fall with the menstrual cycle.  Migraines induced by the onset of menses, at midcycle, and again premenstrually are related to the abrupt fall in estrogen.  Premenstrual migraine is associated with the fall of estrogen and progesterone levels.  Estrogens “induce vasodilation through mechanisms involving the arterial endothelium and through endothelial-independent actions.  Progestins have varying effects on arterial tone, including induction of vascular smooth muscle relaxation as well as smooth muscle constriction.” (Sarrel,1999, p.205).   Estrogens also promote blood clotting which may play a role in menstrual migraine.  Studies have shown that women with menstrual migraine do not have different levels of these hormones, rather they respond more sensitively to the changes in hormone levels. (Loder,2001, p.189).

The platelet of migraine sufferers is very different from the normal platelet, both during and between headaches.  There is a significant increase in the amount of aggregation, the manner of serotonin release, and structural composition of the platelet.  The biggest factor is the difference in serotonin metabolism.  Serotonin plays a major role in the state of relaxation or constriction of blood vessels and is used in the chemical transfer of information from one cell to another.  There seems to be no difference in total serotonin content between normal platelets and platelets of migraine sufferers however, the quantity becomes higher until a migraine is produced.

Vascular instability can play a major role in migraine.  The blood vessels of the temple are often visibly dilated and compression of the carotid artery temporarily relieves migraine pain.  Although the vessels are dilated, the person often appears pale, suggesting dilation of large vessels and constriction of small vessels.  Studies measuring blood flow to the brain show a reduction of the blood flow.  Often the blood flow is very low preceding a migraine attack.  This is followed by a stage of increased blood flow that may last for 48 hours.  Some evidence suggests that migraine patients have an inherited abnormality in their control of blood vessel constriction and dilation.  Migraine sufferers experience dizziness upon standing and seem to be unusually sensitive to physical and chemical changes in blood vessels.

Now, let’s look at the famous formula Tong Qiao Huo Xue Wan.  This formula is classically used when Blood Stasis has been diagnosed in the head and is particularly useful in the treatment of menstrual migraine.  We can examine each herb in the formula for the TCM indications and pharmacology.

• Chi shao:  invigorates the Blood, dispels Blood Stasis, clears Heat, cools the Blood, and clears Liver Fire.  Tranquilizing, analgesic, anticonvulsive, and coronary artery dilating.
• Chuang xiong:  useful for all types of headaches, invigorates Blood, expels Wind, and alleviates pain.  Antispasmodic, tranquilizing, hypotensive, and vasodilative.
• Cong bai: disperses Cold, unblocks Yang, and relieves Toxicity.  Sudorific, antipyretic, and expectorant.
• Da zao:  tonifies Spleen, nourishes Blood, Harmonizes herbs and reduces Toxicity.  Antiallergic.
• Hong hua:  invigorates Blood, dispels Blood Stasis, and alleviates pain.  Hypotensive and dilates coronary arteries.
• Sheng jiang:  warms the middle jiao and alleviates vomiting, and  reduces Toxicity of the other herbs.  Antiemetic, stomatic, sudorific, and vasodilator.
• She xiang:  opens Orifices, invigorates Blood, reduces swelling, and alleviates pain.  CNS stimulant, hypotensive, and anti-inflamatory.
• Tao ren: breaks up Blood Stasis especially in menstrual disorders.  Anticoagulant, hypotensive, antiphlogistic, and analgesic.

Through the integration of biomedical research and TCM theory, we can see how useful this formula can be in the TCM treatment of menstrual migraine.  Clinically, I administer this formula with the initial onset of symptoms.  I have worked with the Mayway brand and recommend dosage to be 10 to 12 pills every 4 to 6 hours depending on the size of the patient and severity of the migraine. This strategy has proven very successful in the prevention and severity of migraine.  Many sufferers report the prevention of a migraine attack with a few doses of Tong Qiao Huo Xue Wan.   Additionally, I treat the constitutional pattern present.  It may be Liver Qi Stagnation, Liver Fire, PhlegmDamp, Blood Deficiency, or Kidney and Liver Yin Deficiency with Ascending Yang.  By treating both the root and the branch, we can treat the whole person and reduce the number, severity, and duration of migraines induced by the menstrual cycle.

Resources

Bensky, Dan and Andrew Gamble.  Chinese Herbal Medicine:  Materica Medica. Seattle, Washington:  Eastland Press, 1993.

Bensky, Dan and Randall Barolet.  Chinese Herbal Medicine:  Formulas and Strategies. Seattle, Washington:  Eastland Press, 1990.

Chen, John K. and Tina T. Chen.  Chinese Medical Herbology and Pharmacology. City of Industry, California:  Art of Medicine Press, 2001.

Granella, F. “et al”.  “Treatment of Menstrual Migraine,” Cephelalgia, 17 Suppl 20:35-8, 1997.

Hsu, PhD., Hong-Yen and associates.  Oriental Materica Medica:  A Concise Guide. Long Beach, California:  Oriental Healing Arts Institute, 1986.

Johannes, C. B. “et al”.  “Relationship of headache to phase of the menstrual cycle, among young women: a daily diary study,”  Neurology, Vol 45, Issue 6: 1076-1082, 1995.

Sarrel, P.M.  “The differential effects of oestrogens and progestins on vascular tone.”Human Reproduction Update, May-June: 5 (3): 189-190, 1999.

Silberstein, S. and G. Merriam.  “Sex hormones and headache 1999 (menstrual migraine),”  Nuerology, 53 (4 Suppl 1):  S3-13, 1999.

Stewart, W. F. “et al”.  “Menstrual cycle and headache in a population sample of Migrainers,”  Neurology.  55: 1517-1523, 2000.

Lichten, E.M. and J.B. Lichten, A. Whitty, D. Pieper.  “The confirmation of a Biomedical marker for women’s hormonal migraine:  The depo-estradiolChallenge test,” Headache, Jun; 36 (6): 367-71, 1996.

Loder, E.  “Menstrual Migraine,” PubMed, 1092-8480 Mar; 3 (2): 189-200, 2001.