As with mental disorders and DSM classification, the broad spectrum of headaches also needed to be classified with a symptom-oriented classification. The second edition of the International Classification of Headache Disorders (ICHD-2) published in 2004 maintained the three main categories of primary headaches described in the edition of 1988: migraine, TTH, cluster headache and other trigeminal autonomic cephalalgias.
It is important for the practitioner trying to treat these disorders with acupuncture to be familiar with this classification in order to make a differential diagnosis between the first two categories because of their prevalence in the general population. The custom of maintaining the common term 'headache' in acupuncture textbooks is still widespread, even today. This results in auricular charts not reporting different points or areas for treating the two different types of headache. In the Chinese standardized map, for example, the term
'migraine' has been reported only once for the pancreas-gallbladder area (CO11 yidan), whereas the indication 'headache' was preferred for other points or areas such as the forehead (AT1 e), temple (AT2 nie), occiput (AT3 zhen), central rim yuanzhong and brainstem naogan. Moving upwards we find the same indication for Darwin's tubercle (HX8 jiejie) and the medial surface of the heart (P1 erbeixin), kidney (P5 erbeishen) and lower ear root (R3 xiaergen). There is no mention on the Chinese map of points to be used for TTH. However, the neck (AH12 jing) and cervical vertebrae (AH13 jing zhui) areas, with their indication 'neck stiffness', may be part of the sensitive areas in the case of tension headache, for which previously synonyms such as 'muscle contraction headache', 'psychomyogenic headache', 'stress headache', etc. were used (Fig. 5.25).
Western maps better differentiate between the principal types of primary headaches and several authors report separated sets of points for treating them.15,46-48
Raphael Nogier49 reported a specific set of points aimed at diagnosing particular co-factors to be checked in every patient with migraine, such as the oculomotor point pertaining to movements of the eye; the interference of active scars and dental foci according to the principles of neuralther-apy; the irritation due to the so-called 'first rib syndrome' and possible allergy and intolerance to food negatively influencing frequency and intensity of migraine attacks (Fig. 5.26).
My contribution to the issue of differentiating the auricular areas associated with either migraine or TTH was conducted on 90 subjects pertaining to three groups of 30 randomly selected patients; two groups were composed of patients with migraine and TTH; the control group was composed of subjects without these types of headache.
If we look at the sensitized sites of the auricles in the first two groups, at first glance we may have the impression of an overlapping of clusters which is apparently not justified by the different mechanisms on which migraine and TTH are based. If, however, we consider the relative size of the identified clusters, we can see that migraine (on the left of Fig. 5.27) causes a higher sensitization of the antitragus, which is in my opinion the representation of the cerebral vascular system. This area has at least two sectors (3 and 5) which are more significantly sensitized with respect to the control group (P<0.01); the first can be correlated with the forehead and the second with the temple area according to the Chinese map. It is interesting to note the fourfold sensitization of the liver-gallbladder, the threefold sensitization of the elbow and the bigger area of the large intestine compared to the TTH group (on the right of Fig. 5.27). These three areas may be considered correlated, assuming that some of the patients have allergies or food intolerance negatively influencing the normal functions of the liver and the colon.
If we consider the TTH group we can see relatively larger clusters of points on the Chinese occiput, neck and spleen area than in migraine patients; these areas have two sectors in common (8 and 9) which are more significantly sensitized with respect to the control group (P<0.05). This sensitization presumably represents the tension of the cervical muscles and, in the observed group, also the tension of the thoracolumbar muscles (on the medial surface of sectors 17-20). It is possible, however, that several factors besides anxiety and depression may cause an increased tension of the cervical muscles, as for example bruxism, dental and sinus foci, after-effects of a whiplash, etc.
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