Guest guest Posted February 5, 2010 Report Share Posted February 5, 2010 I've been treating a patient for a year or so for migraine headaches. In my practice so far, usually headache cases aren't too complex... but this is one of them for me! My patient is about 29 years old, about 250#, headaches especially with weather changes and before her period. Occasionally her boyfriend will notice that her face will droop, and last week her co-workers saw her lower lip was blue, then it started to tingle and then run up the front of her face to the top of her head and she felt faint. Headaches vary in location and intensity. Typically they are splitting, exploding, stabbing. She's on a beta blocker, seroquel, maxalt, and lyrica. She went to the ER after the fainting spell (which started a few days after taking the seroquel) and after CT, EKG, blood work (glucose), she got the shoulder shrug, except she had tachycardia (strange considering the beta blocker). Pale purple puffy tongue with toothmarks, slippery pulse, doesn't seem like a type A person at all - also has a long term issue with onset insomnia (says she's tired but mind isn't racing, just doesn't fall asleep for a long time). Also has meralgia parasthetica in the right thigh. The most reliable trigger is onset of menses and weather changes. My diagnosis is Headaches due to Blood stagnation with Wind and Phlegm. We've settled on a combination of Ban Xia Bai Zhu Tian Ma Tang with Tong Qiao Huo Xue Wan. Generally she's better overall with the frequency of the headaches, and now 1 maxalt will halt the migraines where it used to take several. However, with the 'strokey' type of symptoms, I'm looking for a better direction to take! Any ideas? Geoff Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 6, 2010 Report Share Posted February 6, 2010 Sounds like you got the headache well taken care of. Has the blue lip issue changed at all with the herbs? How long has she been on the Ban Xia formula? Doug , " yingsuke2002 " <ozark.canuck wrote: > > I've been treating a patient for a year or so for migraine headaches. In my practice so far, usually headache cases aren't too complex... but this is one of them for me! > > My patient is about 29 years old, about 250#, headaches especially with weather changes and before her period. Occasionally her boyfriend will notice that her face will droop, and last week her co-workers saw her lower lip was blue, then it started to tingle and then run up the front of her face to the top of her head and she felt faint. Headaches vary in location and intensity. Typically they are splitting, exploding, stabbing. She's on a beta blocker, seroquel, maxalt, and lyrica. > > She went to the ER after the fainting spell (which started a few days after taking the seroquel) and after CT, EKG, blood work (glucose), she got the shoulder shrug, except she had tachycardia (strange considering the beta blocker). > > Pale purple puffy tongue with toothmarks, slippery pulse, doesn't seem like a type A person at all - also has a long term issue with onset insomnia (says she's tired but mind isn't racing, just doesn't fall asleep for a long time). Also has meralgia parasthetica in the right thigh. The most reliable trigger is onset of menses and weather changes. > > My diagnosis is Headaches due to Blood stagnation with Wind and Phlegm. We've settled on a combination of Ban Xia Bai Zhu Tian Ma Tang with Tong Qiao Huo Xue Wan. Generally she's better overall with the frequency of the headaches, and now 1 maxalt will halt the migraines where it used to take several. However, with the 'strokey' type of symptoms, I'm looking for a better direction to take! > > Any ideas? > Geoff > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 6, 2010 Report Share Posted February 6, 2010 Hi Geoff, Interesting patient here...Where are the phlegm signs? I don't see them from your description. I am interested in hearing what her menstruation is like. Since the headaches are related to the cycle, this is important. Pain, color of blood, clots, regularity, amount of blood, other symptoms. If there is pain, is it relieved by warmth? Better after passing a clot? What is her general body temperature? Also, I would like to know how you would diagnose her if you didn't know she had headaches - meaning - what is her constitution like, other signs and symptoms and her basic dynamic. If you could answer this form me, I could let you know my treatment thoughts. Until then - a couple of things I do.... With the paralysis issue and extreme pain I use Quan Xie and Wu Gong along with herbs like Tian Ma and Gou Teng. With the relationship with weather, I use Chuan Xiong unless she is thin and dry. I also use Fang Feng and Jing Jie. But we really need a bit more information ... Best Sharon Sharon Weizenbaum 86 Henry Street Amherst, MA 01002 www.whitepinehealingarts.com Topics in Blog sweiz Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 6, 2010 Report Share Posted February 6, 2010 Hi Geoff, Interesting case you have. Out of curiosity, just how frequent are her migraines currently? Once a week, once a month, every two months? My 2 cents on severe stabbing pain style headaches are as follows: I generally do not use Tian Ma anymore, as this is apparently an endangered species in the wild and there seems to be issues around how effective the cultivated types really are. Like, Sharon, I like to use insects in these cases to help clean out the channels and stop spasms. Quan XIe, Wu Gong, and Bai Jiang Can tend to be my favorites. I also like to use a large dose of Chuan Xiong. Perhaps you have heard the saying " when there is headache, use Chuan Xiong. " Plain and simple. I use this herb for pretty much every type of Headache that I encounter and have seen good results. For these intense stabbing types of migraines I will use it in doses up to 45 grams per days dose, and I generally do not go much below 24 grams as a starting dose. I find it works extremely well. To me there seems to always be an element of wind, qi stagnation, and blood stasis in these severe headaches, which needs to be addressed first off. The patient will usually see results within the first couple weeks (or first menses if they are cyclic.) As the headaches become less frequent and less intense, then I focus more on the underlining constitutional pattern/s to consolidate the treatment. I was taught to use the following 4 herb formula for migraines, and find it to be a good base for most migraines that are intense/ severe in nature. Chuan XIong 24-45 grams Jiang Can 10 Wu Gong 6 Shi Gao 24-30 I will often add to this: Bai Zhi Bai Shao Bai Ji Li Dang Gui Hong Hua Tao Ren Xiang Fu Huang Qin If the headaches are cyclic, I usually like to have patients take this type of treatment for roughly 3 cycles to see if they stabilize. (I usually use the wu gong in periodic doses, say 2 weeks at a time.) Best Trevor , sharon weizenbaum <sweiz wrote: > > Hi Geoff, > > Interesting patient here...Where are the phlegm signs? I don't see them from your description. > > I am interested in hearing what her menstruation is like. Since the headaches are related to the cycle, this is important. Pain, color of blood, clots, regularity, amount of blood, other symptoms. If there is pain, is it relieved by warmth? Better after passing a clot? What is her general body temperature? > > Also, I would like to know how you would diagnose her if you didn't know she had headaches - meaning - what is her constitution like, other signs and symptoms and her basic dynamic. > > If you could answer this form me, I could let you know my treatment thoughts. > > Until then - a couple of things I do.... > > With the paralysis issue and extreme pain I use Quan Xie and Wu Gong along with herbs like Tian Ma and Gou Teng. > > With the relationship with weather, I use Chuan Xiong unless she is thin and dry. I also use Fang Feng and Jing Jie. > > But we really need a bit more information ... > > Best > > Sharon > > > > > > Sharon Weizenbaum > 86 Henry Street > Amherst, MA 01002 > www.whitepinehealingarts.com > Topics in Blog > sweiz > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 6, 2010 Report Share Posted February 6, 2010 Thanks for the replies all: @Doug, your response is included below @Trevor - I use some similar approaches, and they do work well. Generally - we have a pretty good strategy to stop the headaches, but I am trying to move past this stage to get her more resilient to weather changes (frustrated by her lack of willingness to loose weight). , sharon weizenbaum <sweiz wrote: > > Interesting patient here...Where are the phlegm signs? I don't see them from your description. She is obese, has frequent nausea with the headaches, perfumes and many other smells trigger headaches (sorry, I forgot to mention that earlier) and can also break the headache. I've also come to conclude that considering her chronic sinusitis/allergies (also forgot to mention that) with the weather changes triggering the headaches, there is an element of stagnant phlegm in her head. Finally, her personality is 'phlegmy' - sorta laissez faire-ish. One other tidbit - when we use a heavy dose of Ban Xia Bai Zhu TMT - she expells phlegm in the stool. I've overdosed her before and she got dried out, so when the phlegm calms down, we switch to something like Xiang Sha Liu Jun Zi Wan. > I am interested in hearing what her menstruation is like. Since the headaches are related to the cycle, this is important. Pain, color of blood, clots, regularity, amount of blood, other symptoms. If there is pain, is it relieved by warmth? Better after passing a clot? What is her general body temperature? I don't have the details here, but it's not really remarkable. However, I finally convinced her to get off of the seasonelle ocp and I don't think her true menses will show up for a while yet. > > Also, I would like to know how you would diagnose her if you didn't know she had headaches - meaning - what is her constitution like, other signs and symptoms and her basic dynamic. See above. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 6, 2010 Report Share Posted February 6, 2010 > > I don't have the details here, but it's not really remarkable. However, I finally convinced her to get off of the seasonelle ocp and I don't think her true menses will show up for a while yet. Thanks for the information. I don't consider the breakout bleeding of the ocp an actual " period " and this makes me wonder why she is on the pill. What was her period like without it? Many women are on the pill to " regulate " their periods or to stop dysmenorrhea. To me, what her mense was like before this is important. Could you get those details? It should only take a month at most for her to get her true mense unless she has very late menses or amenorrhea - which would also be important. Thanks Sharon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 7, 2010 Report Share Posted February 7, 2010 I think it is also important to note that the birth control pill is not safe for women with migraines. It increases the risk of stroke. Sharon Sharon Weizenbaum 86 Henry Street Amherst, MA 01002 www.whitepinehealingarts.com Topics in Blog sweiz Quote Link to comment Share on other sites More sharing options...
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