Recurrent migraine with visual aura
F, 36 years old. A 36-year-old woman with migraines two to four times a month for six years, right temporal in location, preceded by visual flashes and accompanied by nausea and light aversion.
The patient
- Age and sex
- 36 years · F
- Chief complaint
- A 36-year-old woman with migraines two to four times a month for six years, right temporal in location, preceded by visual flashes and accompanied by nausea and light aversion.
- Tongue
- Red edges, somewhat dry, with a thin yellowish coating at the root.
- Pulse
- A wiry (Xian) and somewhat rapid pulse, thin in the Chi (尺) position.
Symptoms
- Throbbing pain in the right temple, lasting twelve to twenty-four hours
- Flashes and bright lines twenty minutes before the pain
- Nausea and sometimes vomiting at the peak of the episode
- Episodes cluster in the days before menstruation
- Dizziness on standing and occasional blurred vision between attacks
- Insomnia and neck tension the night before an attack
Warning signs to rule out
- A change in the usual pattern: aura lasting over an hour, aura always on the same side, or a neurological deficit that does not resolve. → Neurological referral. A migraine with stable aura for six years that changes shape is no longer the same picture.
- Thunderclap headache peaking in seconds, or the worst headache of her life. → Emergency care. No migraine establishes itself in seconds.
- Migraine with aura in a patient who smokes and takes combined oral contraceptives. → She should discuss it with her doctor: that combination raises vascular risk and often requires changing the contraceptive.
Case resolution
Think through the pattern first, then expand the resolution
- Pattern
- Liver Yang Rising on a background of Kidney Yin Deficiency
- Meridians involved
- Liver, Gallbladder, Kidney
- Pathogenic factors
- Rising Liver Yang, Internal Wind, Kidney Yin vacuity
Kidney Yin is the anchor of Liver Yang. When Yin is depleted, Yang rises unchecked along the Gallbladder channel, which runs through exactly the temple that hurts. The visual aura is internal Wind, the nausea is Stomach Qi dragged upward, and the premenstrual clustering betrays the vacuous background: in the phase when Blood descends to the uterus, the anchor loosens further.
Differential diagnosis
Shares: Lateral headache worse with stress and before menstruation.
Sets it apart: Stagnation gives a dull, distending pain without aura, with breast tenderness and no heat signs. Here there is visual aura, throbbing pain and red tongue edges: the Qi is no longer merely stagnant, it has risen as Yang.
Shares: Headache with nausea, vomiting and dizziness.
Sets it apart: In Phlegm the head feels heavy and muddled, the coating is thick and greasy and the pulse slippery. Here the tongue is dry and the pulse wiry (Xian): the nausea comes from rebellious Qi, not from Phlegm.
Shares: Cycle-linked headache with dizziness and blurred vision.
Sets it apart: In Blood vacuity the pain appears during or after the period, is dull, and comes with pallor and a thin pulse without wiriness. Here attacks precede the period and the pain throbs.
Treatment
Principle: During attacks, descend Yang and unblock Shao Yang. Between attacks, nourish Kidney Yin and Liver Blood to restore the anchor.
| Point | Role | Technique |
|---|---|---|
| GB20 | Reference point for lateral headache: it descends Yang and releases the nape where the episode begins. | Oblique toward the opposite eye 0.5-0.8 cun, reducing during attacks. |
| LV3 | Liver Yuan-source: the point that brings down what has risen. | Perpendicular 0.5-0.8 cun, reducing. |
| KI3 | Kidney Yuan-source: it restores the Yin that holds Yang down, and it is what reduces attack frequency. | Perpendicular 0.5-0.8 cun, tonifying, between attacks. |
| GB43 | Gallbladder Ying-spring: it drains heat from the channel where the pain sits. | Perpendicular 0.3 cun, reducing. |
| TE5 | Opening point of the Yang Wei: the distal Shao Yang partner for the temple. | Perpendicular 0.5-1 cun. |
| SP6 | Nourishes Yin and Blood: between attacks, and above all in the premenstrual phase where the picture concentrates. | Perpendicular 1-1.5 cun, tonifying. Contraindicated in pregnancy. |
Formula: Tian Ma Gou Teng Yin. Calms internal Wind and descends Yang, the formula for the acute phase and for weeks of frequent attacks. For the background, between attacks, alternate with Qi Ju Di Huang Wan, which nourishes Liver and Kidney Yin.
- Frequency
- Two sessions weekly for the first three weeks, then one weekly, always reinforcing the week before menstruation. The measure of success is attacks per month, not how she feels on the day of the session.
Home care
- Keep an attack diary with date, duration and cycle day: without it there is no way to know whether treatment is working.
- A stable sleep schedule, weekends included; oversleeping triggers as many attacks as undersleeping.
- Sustained acupressure on LV3 at the first flash of aura.
- Cut back alcohol, aged cheeses and long fasts, which are frequent triggers in this pattern.
Progress
- Session 1 · cycle day 8, no attack Three attacks last month, two of them in the four days before menstruation. She sleeps badly the night before each episode. GB20, LV3, TE5 and KI3. The attack diary is opened, because without figures the follow-up is just an impression. No change in attack count that month, but the first one resolves in eight hours instead of twenty.
- Session 4 · day 24, premenstrual phase The diary confirms attacks concentrate between days 24 and 28 of the cycle. Sessions are reinforced in that window and SP6 is added with tonification: it is the phase when the anchor loosens. The next cycle goes from two premenstrual attacks to one, and without vomiting.
- Session 8 · week 6 A single attack in the past month and a five-minute aura instead of twenty. Dizziness on standing persists. Draining is reduced and the work centres on KI3, SP6 and BL23: the residual dizziness shows the underlying vacuity is not yet restored. Dizziness resolves within three weeks and no new attacks appear.
- Session 12 · week 12 Two consecutive months with a single mild attack, without aura. Sessions move to one a month, always placed in the premenstrual phase. She holds at one attack a month or none over the following six months.
- Discharge
- Treatment ends after three consecutive months with one attack or fewer, without vomiting and without rescue medication. With a six-year migraine, halving the frequency is already a clinical result, and it is worth saying so from the outset.
- Watch for relapses
- Periods of irregular sleep and weeks of heavy visual demand. The first warning is dizziness on standing, which returns before the attacks do.
Health notice. Educational and study content. It describes concepts of Traditional Chinese Medicine and does not replace diagnosis or treatment by a healthcare professional. Needling, medicinal herbs and invasive techniques must be applied by trained professionals. Safety guide.
