Bulletin of Clinical Acupuncture & Natural Healing Volume VII Issue 109 Nov 2011

DR. HOLMES KEIKOBAD MBBS, DPH, Dip Ac NCCAOM, LAc Editor in Chief & Clinical Director
CAROL ANDRADE PHD LAC
Editor & Creative Director

Migraine
A Photo-Study of Migraine with a Diagnostic Discussion

Part II

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In this Series of which this Issue is the second, following the dream, we present a photo study of Migraine, which carries color images of cases with diagnostic parameters which can be discussed and dilated upon. Clinical methods can be approached best from point of view of fine diagrams, images of cases and explanatory charts. This is the first of many Issues which incorporate this methodology. Each photo carries invaluable clinical information and incorporates a discussion. Study each carefully and you may even find more signs than have been mentioned here.

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With best wishes Dr. Holmes Keikobad Editor in Chief

A Photo-Study of Migraine with a Diagnostic Discussion

Dr. Holmes Keikobad
MBBS DPH DIP AC NCCAOM LAC Bachelor of Medicine & Surgery. Diplomate in Public Health. Diplomate in Acupuncture National Board Certified. Licensed Acupuncturist Scope of this discussion is entirely educational. COPYRIGHT ACU-FREE.COM LLC ALL RIGHTS RESERVED

You can classify any case of Migraine you see by its location:
LOCATION Temples LOCATION Forehead Channel GB Channel ST Treat GB & LV

Treat ST & LV

LOCATION Vertex

Channel LV

Treat LV

LOCATION Occiput LOCATION All 4 locations Cluster Migraine

Channel UB

Treat UB & LV

Channels All 4

Treat LV Wind

Q. Why treat LV in all type of Migraine? A. Because Migraine is a LV based illness.

Q. Why treat LV Wind in a Cluster Migraine and in no other? A. Because in all other conditions there is a Disharmony of LV Yin & Blood. In Cluster Migraine there is predominantly, in addition, LV Wind Rampant. One still treats LV Yin & Blood but looks to containing the Wind as a priority. Q. Does any other element come into the picture in Migraine? A. Yes, Metal does. Q. How so? A. Metal is natural controller/aggressor of Wood. Often in a pronounced Wood illness you will find signs of a Metal in serious disharmony. Q. Would the treatment approach change? A. Yes, if you find pronounced Metal signs together with Wood signs, treat Metal, then treat Wood.

Image of migraine

On following pages are a series of photographs of actual patients with migraine. These give startling insight into what a patient feels or perceives, and become a basis for projecting type of migraine and treatment which can benefit. This is Part II of the series.

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Image One Pain of Migraine is so much a Wood element disharmony that the patient will often unconsciously place fingers on the actual GB 1 point at temple. As often the patient is withdrawn, with eyes shut.
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There is usually aversion to light, photophobia. As also visual disturbances.

This image is adapted from its original emphasize the pain of Migraine.

Image miss_rogue.tara hunt.. http://www.flickr.com/photos/missrogue/551044890/

Image Two Pain of Migraine is often preceded by visual phenomena These are of many types and vary widely Rarely the patient will be able to reproduce what they see as in the example below It is good practice to have a visual record of what they see even if it is an approximation; this is because in time the pattern may change, signaling a shift in the status of the patient

Image eliZalO. http://www.flickr.com/photos/elizaio/5983297828/

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Image 3
Chronic pain. Patients often typify these with images which are vivid. In this case the patent chose this image of a gnarled and twisted tree [see inset]

The other image is derived from the first and uses photo enhancement technique to try to emphasize what patient goes through

With conventional Western Medicine intervention the pain may be temporarily relieved but not the root cause This makes the condition last over years with no permanent relief in sight Traditional Medicine in the hands of an adept offers both pain relief and a cure

Image carulmare. http://www.flickr.com/photos/8545333@N07/2300681412/

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Image Four
When pain is severe patients withdraw to a darkened room They often cover their eyes as light aggravates pain Lying still they weather the attack till it wanes away Photophobia or aversion to light is due to LV Wind Rising into the eyes, which are the organ where LV opens
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Image Brian makelessnoise http://www.flickr.com/photos/makelessnoise/2450239227/

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Image Five
Again, a clearly half sided headache, a hemicrania Eyes covered, patient withdrawn As often there is nausea and at times frank vomiting This is because LV is the natural controller of ST and can cause ST Qi Ascending In your work always remind yourself that however distressing migraine is locally, its remedy is somewhere away from the head.
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In terms of Extraordinary channel points, two which are indicated in most cases of migraine are GB 41 and SJ 5, particularly when the pain is on the temple and side of head.

Q. How to work the points? A. First palpate points bilaterally. One side will seem soft, stiff, heated, cold, gummy, discolored, painful, tender. Use the point on that side, first needle the GB 41, and then the SJ 5 on opposite side. In Extraordinary point usage needle direction and depth do not matter. Also these are not stimulated, just left in place for 20 m, then removed.

Image fifikin Fiona Hendersen http://www.flickr.com/photos/fifikins/5827856372/sizes/m/in/photostream/

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Image Six Again, note the almost exact pressure of left hand on point GB 1 Migraine can disrupt life and interrupt social and job related activities Note the dark glasses to ward of bright light Ask patient to point where it hurts the most with one finger and if GB 1 is pointed out, this is a good indication this can be a Temporal type Migraine
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Image Chris Baranski cbb4104 http://www.flickr.com/photos/chrisandbabs/5564617699/

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Image Seven and Eight

By now you have seen many images of Migraine and have a good idea what indicators these show. Keeping that in mind we are exhibiting these images, encouraging you to find signs, such as where is a hand or finger pressing, is there an attempt to ward of light, the expression, any other sign which adds to the possibility this is a Migraine:
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Image Doug Belshaw http://www.flickr.com/photos/dougbelshaw/4099210308/

Image Sasha Wolff - SashaW http://www.flickr.com/photos/sashawolff/3108464695/

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The Migraine patient checklist = the more signs check positive the greater the likelihood you are dealing with a case of Migraine:

chronic disorder moderate to severe headaches nausea &/or vomiting a women patient headache is unilateral pulsating in nature lasting from 4 to 72 hours photophobia phonophobia (increased sensitivity to sound) symptoms aggravated by emotional overload perception of an aura, a transient visual disturbances signaling the migraine
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The diagnosis of Migraine in Western Medicine terms can also be made by items in following Table. Study signs and symptoms in first column and apply to patient. If
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positive check the YES column, if not, then check the NO column.

SIGNS & SYMPTOMS Have there been 2 attacks with aura? Have there been 5 attacks without aura? Has pain lasted from 4 hours to 3 days in duration?

YES

NO

PLUS any 2 of the following Is pain unilateral? Is it pulsating? Moderate or severe pain intensity? Aggravated or caused by avoidance of routine physical activity? PLUS any 1 or more of the following Nausea and/or vomiting? Sensitivity to both light and sound? Add checks in YES column and read RESULTS. Ignore No column

RESULTS: if in YES column there are 6 or more checks this is very likely a case of Migraine. Ignore the results in the NO column, simply decide on basis of checking total in YES column.
Source: Courtesy of Wikipedia Table and artwork: acu-free.com LLC

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Image Mountain. CA wooden Bodhisattva from the Song Dynasty (9601279 AD). Courtesy Wikipedia

Origin of Qi

Not from this Earth, for it pervades far heavens. Perhaps, when a child playing on a far star With magical beams, grew tired And put it to one side And fell asleep And it fell off And landed Here *

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