I have successfully treated several dozen women for symptoms, including headaches, associated with perimenopause and here is my approach, ideas and suggestions. Headaches, in some circles of medical study, are considered a common symptom of perimenopause. Take, for instance, a common rating scale: the Blatt-Kupperman Index. This scale rates the severity of symptoms of the climacteric patient and includes headache as one of its weighted categories. On the contrary and based on my clinical research, I find that headaches should not be considered a common perimenopausal symptom. The reason being, commonly the sufferer has already had a history of headaches and often times it has been a chronic problem that started much earlier than perimenopause. If it were based on percentage, then according to my research, we would also have to include so many other common symptoms that the list would be endless. I suggest strictly using the signs of headache as a necessary diagnostic tool to confirm the TCM pattern of the patient. By questioning the patient about their headaches, the time of onset, duration and location, etc. it can give us a better and more accurate diagnosis of the true disharmony. So, with this in mind, I do not specifically focus my treatment on relieving the headaches, rather my focus is on the complete pattern. This allows the treatment of all of the indications simultaneously, including the headaches.

I have found a successful and eloquent acupuncture point prescription for the treatment of the common symptoms associated with perimenopause, which can also easily treat common patterns of headaches during this time. The following: RN4 (Guan Yuan), KI3 (Tai Xi), LI4 (He Gu), LR3 (Tai Chong), DU20 (Bai Hui), PC6 (Nei Guan), HT7 (Shen Men), ST36 (Zu San Li), RN6 (Qi Hai) and SP6 (San Yin Jiao) chiefly work to tonify and nourish the kidney essence and yin and boost the yang, as well as harmonize the functions of the heart, liver and spleen. These points used together also have the functions to calm the spirit, benefit the brain, regulate ascending yang, promote the smooth circulation of Qi and blood as well as nourishing the Qi and blood and regulate the digestion to treat a wide variety of TCM patterns causing headache. If the patient does suffer from a chronic or stubborn headache, it is easy to add or subtract points from this original prescription based on the patient’s pattern. For example, if a woman were suffering from a temporal headache, we could add SJ3 (Zhong Zhu) or even GB41 (Zu Lin Qi). If there were excessive liver fire or stomach fire, the ying spring points along the channels LR2 (Xing Jian) and ST44 (Nei Ting) can be needled to relieve the excessive heat. For dampness and phlegm obstruction headaches, ST40 (Feng Long) and SP9 (Yin Ling Quan) can replace ST36 and SP6. Even effective local points for the pain can be added with little effort such as the extra point Tai Yang, GB8 (Shuai Gu), GB14 (Yang Bai), GB20 (Feng Chi) or ST8 (Tou Wei).

In conclusion, it is not necessary to dramatically change an entire treatment protocol to address headaches during perimenopause. My clinical experience allows for slight modification to the prescription for effective treatment. Most headache patterns, by and large, should be relieved within twelve treatments. If there are no classical signs of climacteric and the patient complains of headaches, it would be a good idea to adopt another treatment protocol specifically targeting the headache only, which could be based an entirely different system of approach.

Brian Grosam, Ph.D., TCMD, L.Ac.