Headaches that occur around the time of menstruation are called menstrual headaches. If a headache occurs only occasionally during menstruation, it is not within the scope of this discussion.

bubble_chart Pattern Analysis

1. Blood Stasis︰It often occurs before or during menstruation, with fixed pain locations, stabbing pain like a cone, unsmooth menstrual flow, scanty flow with clots, lower abdominal pain, ecchymosis on the tongue edges, thin and greasy tongue coating, and wiry-tight pulse. It is caused by liver depression qi stagnation, static blood obstructing the collaterals, clouding the seven orifices, and pain due to obstruction. Its characteristics include fixed headache locations, stabbing pain like a cone, unsmooth menstrual flow, scanty flow often with clots, lower abdominal pain, and relief of both headache and lower abdominal pain when menstruation becomes smooth. The tongue texture is dark with ecchymosis on the edges, and the pulse is wiry-tight. Treatment should focus on invigorating blood and resolving stasis, using the formula Blood House Stasis-Expelling Decoction.
2. Ascendant Hyperactivity of Liver Yang︰Dizziness and distending pain before or during menstruation, irritability, restless sleep, soreness in the lower back, tinnitus, or hypochondriac pain, bitter taste in the mouth, advanced menstruation, heavy flow with bright red color, usually accompanied by excessive yellowish vaginal discharge, tongue texture tending to purplish-red, thin and greasy or yellow and greasy coating, wiry pulse. It is caused by deficiency of liver yin or kidney yin, where yin fails to nourish yang, leading to yang hyperactivity above. The characteristics include dizziness and distending pain before or during menstruation, irritability, restless sleep, soreness in the lower back, tinnitus, advanced menstruation, heavy flow with bright red color, tongue texture tending to purplish-red, wiry and tight pulse. The treatment should focus on pacifying the liver and subduing yang, using the formula Gastrodia and Uncaria Drink. If accompanied by flushed face, red eyes, bitter taste in the mouth, dry throat, migraine, prominent head veins, deafness, tinnitus, dysphoria, irritability, dark urine, constipation, red tongue edges and tip, wiry and rapid pulse with strong force, it indicates a pattern of liver yang transforming into fire. The treatment should aim to drain the liver and clear fire, using the formula Gentian Liver-Draining Decoction.
3. Blood Deficiency︰During menstruation or after menstruation, there is empty pain in the head, extending to the orbits and supraorbital ridge, accompanied by dizziness, blurred vision, photophobia, preference for quiet, palpitation, insomnia, dry mouth and throat, poor appetite, and a pale yellow complexion. The menstrual flow is scanty and light red in color. The tongue is pale with thin and peeling coating in the middle, and the pulse is thin. This is caused by blood deficiency failing to nourish the brain, insufficiency of brain marrow, and further depletion of the Sea of Blood during menstruation. Its characteristics include empty pain in the head during or after menstruation, pain extending to the orbits and supraorbital ridge, accompanied by palpitation, insomnia, dizziness, blurred vision, dull complexion, scanty and light-colored menstruation, pale lips and tongue, and a thin, weak pulse. The treatment should focus on nourishing blood and tonifying qi, using the modified Four Ingredients Decoction.

bubble_chart Documentation

1. 《Chinese Gynecology》menstrual headache: "For common cold type, aversion to cold with fever, without sweating, tight pulse. For internal heat, flushed face, irritability, thirst, purple lips, rapid pulse. For blood deficiency, palpitation, shortness of breath, spontaneous sweating, weak pulse. Treatment: For common cold type, use modified Chrysanthemum Flower Powder. For internal heat, use Jade Lady Decoction; for blood deficiency, use Angelica Blood-Tonifying Decoction or Ginseng Nutrient-Nourishing Decoction."