Chinese Medicine For Headache (A 2025 Comprehensive Guide)

Migraine is a debilitating condition affecting millions worldwide, and many individuals seek relief through complementary and alternative therapies like Traditional Chinese Medicine (TCM). TCM, with its long history, offers a range of treatments, including acupuncture, massage, and herbal remedies, to manage migraine. This article reviews the key findings from recent studies focusing on the use of chinese medicine for headache relief, drawing from both classical literature and modern research.

Migraine is a recurrent neurological disorder that significantly impacts individuals and society. It is considered a major type of primary headache. The condition is characterized by:

• Unilateral or bilateral pulsatile headache
• Accompanied by autonomic nervous system dysfunction, including nausea, vomiting, photophobia, and phonophobia

Migraine is a common condition, with approximately 1 billion cases worldwide and is considered the second leading cause of disabilities worldwide. Epidemiological studies show a prevalence of 14.9% in the United States and 8.4-12.7% in Asia.

The exact cause of migraine are not fully understood. However, it is known that genetic predisposition, inflammatory processes, and central sensitization play significant roles. The pathogenesis of migraine primarily involves the activation of trigeminovascular pain pathways.

This activation is believed to mediate the occurrence of migraine through the release of neuropeptides such as calcitonin gene-related peptide (CGRP), substance P, and pituitary adenylate cyclase-activating polypeptide.

In the theory of Traditional Chinese Medicine (TCM), migraine is classified as a “head wind”. The onset of migraine is often due to wind pathogen invasion, deficiency of Qi and blood, damage to the meridians, and malnutrition of the brain.

Current conventional treatments for migraine include acute and preventive medications and non-pharmacological therapies. Medications such as paracetamol, non-steroidal anti-inflammatory drugs, beta-blockers, anticonvulsants, tricyclic antidepressants, and calcium channel blockers are used. 

However, due to their suboptimal efficacy, adverse effects, and contraindications, they do not fully meet the needs of all migraine patients. This leads many patients to seek complementary and alternative therapies like TCM.

International Classification of Headache Disorders (ICHD-3) identifies over 250 different types of headaches, including:

• Migraine without aura: This subtype accounts for up to 80% of migraine cases. Diagnostic criteria for this type were used to score citations in classical Chinese literature.
• Migraine with aura: Some individuals experience an aura, which is a neurological phenomenon that precedes the headache. Single-pulse transcranial magnetic stimulation (TMS) is an FDA-approved treatment specifically for acute migraine with aura.
• Chronic migraine: This is mentioned as a condition that is sometimes treated with occipital nerve stimulation (ONS) and for which repetitive transcranial magnetic stimulation (rTMS) has been explored as a preventive measure, with mixed results. A pilot study of daily vagal nerve stimulation (VNS) for prevention of chronic migraine was completed in 2014.
• Menstrual migraine without aura: Acupuncture has been studied as a treatment for this specific type of migraine.
• Episodic Migraine: rTMS has been investigated as a preventative treatment for episodic migraine with mixed results. Oral Chinese herbal medicine has been studied as a prophylactic treatment for episodic migraine.
• Refractory migraine: This is mentioned in the context of ONS and other neurostimulation therapies, indicating that some migraines do not respond to typical treatments.
• Cluster headache: Although not a type of migraine, it is mentioned alongside migraine as a condition for which neurostimulation therapies are being investigated. Cluster headaches are characterized by severe pain and are often considered one of the most painful conditions.

Migraine attacks have been classically divided into four phases: prodromal, aura, headache, and postdromal.

• Prodromal Phase: This is the initial phase that occurs before the headache.
• Aura Phase: Some migraine sufferers experience an aura, which is a neurological phenomenon. Single-pulse transcranial magnetic stimulation (TMS) is presumed to abort attacks of migraine with aura via inhibition of cortical spreading depression. TMS is FDA approved for the acute treatment of migraine with aura.
• Headache Phase: This is the phase characterized by head pain, which is often described as a throbbing or pulsing sensation. Migraine headaches are typically unilateral but can be bilateral. They are also often associated with autonomic symptoms, such as nausea, vomiting, photophobia (sensitivity to light), and phonophobia (sensitivity to sound).
• Postdromal Phase: This final phase occurs after the headache subsides, and can be characterized by fatigue, difficulty concentrating, and muscle aches.

Modern research is beginning to unravel the mechanisms through which these traditional herbs work, revealing a complex interplay of biochemical and neurological effects.

Neuropeptide Modulation

Chinese herbs are noted to reduce levels of neuropeptides such as calcitonin gene-related peptide (CGRP), which plays a significant role in migraine pathogenesis.

• Da Chuan Xiong prescription has been shown to improve the metabolism of glutamate, thus reducing CGRP production.
• Wu Zhu Yu decoction is thought to increase serotonin (5-HT) levels and decrease CGRP.
• Chuan Xiong and Xiang Fu have been shown to increase cerebral blood flow and reduce CGRP expression.

Anti-inflammatory Effects

Many of the herbs have anti-inflammatory properties, which help to address the neuro-inflammation involved in migraine.

• Du Liang soft capsule decreases plasma CGRP and serum NO levels and reduces pro-inflammatory cytokines.
• Gan Cao exhibits anti-inflammatory effects by regulating NF-kappaB pathways and tumor necrosis factor, and can also have neuro-protective effects by protecting the blood brain barrier permeability.

Blood-Brain Barrier (BBB) Regulation

Some herbs and formulas impact the permeability of the BBB, which can be compromised in migraine.

• Chuan Xiong and Tian Ma reduce BBB permeability by regulating MMP-9 and suppressing glutamate.
• Shao Yao Gan Cao decoction inhibits the NGF/TRPV1/COX-2 signaling pathway, which is involved in pain transmission.

Neurotransmitter Balance

Herbs can help to balance neurotransmitter levels, including increasing serotonin and reducing glutamate, which are important in pain perception.

• Components of Cha, such as L-theanine and epigallocatechin-3-gallate, offer neuroprotective benefits and neuropathic pain alleviation.
• The active compound of Gan Cao, glycyrrhizic acid, may have antidepressant effects, which could be beneficial for migraine since depression is a common comorbidity.
• Bo He (Peppermint) has shown some efficacy for migraine relief when applied intranasally or cutaneously.
• Sheng Jiang (Ginger) is effective for migraine pain and nausea.

A comprehensive data-mining project of classical Chinese medicine literature identified several frequently used herbs and formulas for migraine.

• Chuan xiong: This herb stands out as the most frequently used single herb for migraine. Its analgesic properties are believed to be related to its influence on neurotransmitters and nitric oxide.
• Chuan Xiong Cha Tiao San (CXCTS): This formula is the most frequently cited formula for migraine in the classical literature. The formula’s ingredients have demonstrated anti-migraine effects by regulating the inflammatory response, vasoconstriction, and endocrine-neurotransmitter metabolism.
• Dietary Medicinal Herbs: Several herbs commonly used in the Chinese diet were also identified as having therapeutic potential for migraine, including:
  • Gan Cao (Licorice): This herb is frequently used and has both anti-inflammatory and neuroprotective effects.
  • Bai Zhi (Angelica Dahurica): This herb is known for its ability to modulate vasoactive substances and is often combined with Chuan Xiong.
  • Bo He (Peppermint): While often used in beverages, more research is needed on the oral use of Bo He for migraine relief.
  • Tian Ma (Gastrodia): This herb is often paired with Bai Zhi, and is thought to modulate nitric oxide levels and CGRP.
  • Sheng Jiang (Ginger): This herb is recognized for its effectiveness in managing migraine pain and nausea.
  • Cha (tea): This common beverage is noted for its anti-inflammatory properties and neuroprotective components.
  • Other Herbs: Fang Feng, Qiang Huo, and Jing Jie are traditionally used to dispel wind and cold, addressing the root causes of some headaches.

Yes, Chinese medicine for headache can be combined with other therapies for migraines, and many patients seek complementary and alternative medicine (CAM) approaches like TCM when conventional treatments are not fully effective or cause unwanted side effects. There are several ways in which TCM can be integrated with other treatments:

• Acupuncture: Acupuncture is widely used to manage migraine in both China and Western countries and is considered to have unique advantages in efficacy, compliance, and safety. Clinical trials suggest that acupuncture is more effective and provides longer-lasting relief for migraines compared to sham acupuncture and standard care.
• Massage (Tuina): Massage is used to treat migraine and is effective in alleviating the frequency, intensity, and duration of migraine attacks. It is considered a non-pharmacological option for patients who prefer to avoid needles or medications.
• Conventional Therapies: Conventional therapies for migraine include acute and preventive medications, such as paracetamol, non-steroidal anti-inflammatory drugs, beta-blockers, anticonvulsants, tricyclic antidepressants, and calcium channel blockers. However, these treatments often have suboptimal efficacy, adverse effects, and contraindications, leading some patients to seek CAM.
• Neurostimulation: Neurostimulation therapies are also explored for migraine treatment, including Transcranial Magnetic Stimulation (TMS). Single-pulse TMS is FDA-approved for acute treatment of migraine with aura. Repetitive TMS is explored for migraine prophylaxis, though with mixed results.
• Transcutaneous Supraorbital Nerve Stimulation (tSNS): This is FDA-approved and available commercially for migraine prevention.
• Occipital Nerve Stimulation (ONS): ONS has been investigated for treatment-refractory chronic migraine, sometimes in combination with supraorbital nerve stimulation.
• Vagal Nerve Stimulation (VNS): VNS is being studied as both a prophylactic and acute treatment for migraine and cluster headaches.

Traditional Chinese Medicine (TCM) is a popular complementary and alternative medicine (CAM) therapy that is often sought out for migraine relief. While the sources suggest that TCM can be effective for migraine management, safety is an important consideration.

General Safety of TCM

• TCM therapies, including acupuncture, Chinese herbal medicine (CHM), and massage, are generally considered safe when administered by qualified practitioners.
• It’s important to note that while TCM is used worldwide and has obtained sufficient evidence, the specific mechanisms of TCM for migraine have not been fully clarified. More research, including multi-omics data analysis and neuro-imaging, is needed.
• Previous systematic reviews suggest that CHM is effective and safe for migraine management.
• While many herbs used in TCM are considered safe, some have specific safety considerations. For example, Xi Xin is a natural analgesic but has raised safety concerns regarding nephrotoxicity. However, it is considered relatively safe when consumed with controlled doses and duration.

• The combination of Chuan Xiong and Bai Zhi in the formula Du Liang Wan is considered safe and effective for migraine.

Potential Risks and Considerations

• Herb-Drug Interactions: Dietary supplements and herbal products can have side effects and may interact with other medications.
• Lack of Standardization: One limitation is the considerable heterogeneity in CHM prescriptions across various studies, which can make it difficult to evaluate effectiveness and safety.
• Need for Qualified Practitioners: It is crucial to seek treatment from qualified and experienced TCM practitioners to ensure safety and efficacy of these treatments.

You can alleviate migraine symptoms at home by preparing herbal teas. Here are some recipes to try:

1. Chrysanthemum and Goji Berry Tea

This tea helps clear heat, calm the liver, and improve circulation, making it effective for migraines caused by tension or stress.

Ingredients:

• Chrysanthemum flowers (Ju Hua): 1 tablespoon
• Goji berries (Gou Qi Zi): 1 tablespoon
• Honey (optional): To taste

Instructions:

1. Rinse the chrysanthemum flowers and goji berries with water to remove impurities.
2. Place the chrysanthemum and goji berries in a teapot.
3. Pour 2 cups of boiling water over the herbs.
4. Let the tea steep for 5–10 minutes.
5. Strain the tea into a cup and add honey if desired.

Tip: Drink this tea warm, 1–2 times a day.

2. Ginger and Green Tea

This combination soothes the stomach, relieves nausea, and improves blood flow, which can help alleviate migraine symptoms.

Ingredients:

• Fresh ginger (Sheng Jiang): 3–4 slices
• Green tea: 1 teaspoon or 1 tea bag
• Lemon juice (optional): 1 teaspoon

Instructions:

1. Boil 2 cups of water and add ginger slices.
2. Simmer for 5–7 minutes, then remove from heat.
3. Add the green tea and let it steep for 3–5 minutes.
4. Strain into a cup and add lemon juice if desired.

Tip: Ginger can be particularly helpful for migraines accompanied by nausea.

3. Peppermint and Schisandra Berry Tea

This blend cools the body, relaxes the liver, and helps with migraines triggered by emotional stress or heat.

Ingredients:

• Peppermint leaves (Bo He): 1 teaspoon
• Schisandra berries (Wu Wei Zi): 1 teaspoon
• Honey (optional): To taste

Instructions:

1. Rinse the Schisandra berries and peppermint leaves.
2. Add them to a cup and pour boiling water over them.
3. Cover and steep for 8–10 minutes.
4. Strain the tea and sweeten with honey if desired.

Natural migraine prevention can be approached through various methods, including lifestyle adjustments, and relaxation techniques.

Lifestyle Adjustments and Identifying Triggers

• Migraine Diary: Keeping a migraine diary is helpful for identifying potential triggers. This diary should include what happened before the migraine, what you ate and drank, the time the migraine started and ended, how severe it was, and what medication was taken and when.
• Avoid Common Triggers: Common triggers include too little or poor sleep, irregular or skipped meals, stress or winding down after stress, weather changes, lack of exercise, and hormonal changes in women. Some foods and drinks, such as red wine, can also trigger migraines.
• Stress Management: Because stress is often unavoidable, the aim of non-medication treatments is to help you cope with stress.
• Relaxation Techniques: Techniques such as progressive muscle relaxation and autogenic training can help with stress management and can be learned through classes, books, videos, or apps.
• Cognitive Behavioral Therapy: If migraines significantly impact your life, cognitive behavioral therapy can help you understand how your behavior, thoughts and feelings affect pain and how to better cope with pain.
• Exercise: Endurance sports like brisk walking, swimming, or aerobics are often recommended for migraine prevention.

Traditional Chinese Medicine (TCM)

• Dietary Herbs: Herbs such as gan cao (licorice), bai zhi, bo he (peppermint), tian ma, cha (tea), and sheng jiang (ginger) can be incorporated into the diet. These herbs have anti-inflammatory and neuroprotective properties.
• Specific Formulas: The herbal formula CXCTS is recommended for migraine prevention. Additionally, du liang wan (a combination of chuan xiong and bai zhi) has anti-migraine effects by reducing neurogenic inflammation and adjusting neurotransmitter levels.
• Acupuncture: Acupuncture inhibits the release of CGRP, reduces inflammatory factors, modulates neurotransmitters, and changes brain structure and function.
• Massage (Tuina): Massage inhibits pain signal transmission, reduces substance P, increases 5-HT levels, improves local blood flow, accelerates the metabolism of pain-causing substances, reduces cortisol levels, and relieves muscle tension.

Dietary Supplements and Herbal Products

• A number of herbal products and dietary supplements are available for migraine prevention. These include coenzyme Q10, magnesium, feverfew, butterbur, vitamin D and riboflavin (vitamin B2).
• There is a lack of conclusive evidence regarding the efficacy of these products for preventing migraines.
• Some studies suggest that magnesium and a certain feverfew extract can reduce the number of migraine attacks. However, the quality of these studies isn’t good enough to prove that these products have a preventative effect.
• Dietary supplements and herbal products can have side effects and may interact with other medications. For example, feverfew extracts can cause gastrointestinal problems.

Chinese medicine for headache offers a variety of treatment options, with herbal remedies playing a central role. Herbs like Chuan Xiong, Gan Cao, Bai Zhi, Bo He, Tian Ma, Sheng Jiang, and Cha, along with formulas like CXCTS, are frequently used in clinical practice.

Modern research is beginning to validate the effectiveness of these treatments, with their mechanisms involving the modulation of neuropeptides, inflammation, the blood-brain barrier, and neurotransmitter levels. While neurostimulation offers another promising avenue, the traditional use of Chinese herbal medicine continues to be a valuable approach for migraine management. Further research into both traditional and modern approaches will help refine treatment strategies and improve outcomes for those suffering from migraines.