头痛是指枕骨大孔及眉弓以上部位发生的疼痛。常见于各种急、慢性疾病。95％的就诊病人属于“原发性头痛”。我们就此讨论其针灸治疗方法。
第一部分 按照中医分类
1． 无论何种证候，阿是穴都是针灸治疗头痛所必须选择的穴位。
2． 根据经络分布取穴是针灸治疗的特点，“经脉所过，主治所及”是它的理论基础。局部取穴是针灸治疗头痛的重点。
巅顶痛：百会或四神聪、行间、阿是穴
额部头痛：上星、印堂、阳白、三间、阿是穴
颞部头痛：率谷、太阳、侠溪/中渚、阿是穴
枕部头痛：后顶、天柱、后溪、束骨、阿是穴
3． 辨证取穴可以增强疗效
（1） 风邪袭络：加风池、合谷、外关等。
（2） 肝阳上亢：加风池、太冲、太溪等。
（3） 气血不足：加气海、脾俞、足三里等。
（4） 痰浊闭阻：加丰隆、阴陵泉等。
（5） 瘀血阻络：加血海、合谷、三阴交等。
4． 适当的刺灸法可以增强疗效
（1） 气血不足型头痛需采用补法，风邪袭络型、肝阳上亢型、瘀血阻络型头痛均采用泻法。风邪袭络型、肝阳上亢型、瘀血阻络型头痛可采用皮肤针叩刺及拔罐（若病人同意），除“肝阳上亢”外，灸法是其它各型头痛治疗中非常重要的手段。
（2） 电针广泛应用于针灸治疗中。气血不足选用低频率、弱刺激，其他各型可选用高频率、可耐受的强刺激。
5． 耳针
取穴：枕、额、脑、神门
每次取2～3穴。留针20～30分钟，每十分钟行针一次。病程较长的头痛可在耳背静脉放血。
第二部分：按疾病分类
一、偏头痛
1． 发作期的治疗：在前驱期或先兆期的治疗可以阻止偏头痛的发作或减轻发作时疼痛的程度。可以取百会、太阳、内关、合谷、太冲等穴.
2． 头痛期可以在局部（太阳穴、率谷穴）梅花针叩刺后拔罐令出血，常可迅速终止发作，也可以给予针刺强刺激（取穴参照前一节）。
3. 对于其他类型的偏头痛，如：基底型偏头痛，偏瘫型偏头痛等，可在治疗典型偏头痛的基础上参照眩晕、中风的针灸方法进行治疗。
二、紧张型头痛
由于紧张型头痛主要表现为双侧枕、颈部或全头部的紧缩或压迫性疼痛，同时伴有焦虑、抑郁、失眠等症状，所以针灸治疗除了要缓解肌肉紧张外，还要调整精神状态。取穴太阳、风池、肩中俞、内关、神门等。采用中等强度刺激，头部穴位的温和灸亦能明显提高疗效。推拿治疗有效。
三、颈椎病所致头痛
常表现为枕部头痛、伴颈部僵硬、疼痛，查体可见颈椎棘突旁的压痛。X片或CT检查可提供诊断依据。针灸取穴主要取阿是穴及夹脊穴，远端取后溪穴，并予颈部穴位5～10分钟/每穴温和灸。
枕神经痛是由于C2、3神经病变引起。可由于受凉或颈椎病变引起。针刺取风池穴（相当于枕大神经压痛点）、天柱穴（相当于枕小神经压痛点），最好针刺时能获得放射感，予中等强度刺激，并予足量温和灸，疗效非常好。
HEADACHE
Headache refers to pain,a subjective symptom,on the part of head which is above aperture of occipital bone,up to supraorbital ridge.It can be induced by various acute or chronic disease. In clinic,the propertion of primary headache reach up to 95%,Here today,we’re going to have a discussion on the Acupuncture and Moxibustion treatment of the Primary headache.
Part I Classificaton according to TCM Theory
1. No matter which syndrom it is,A-shi point is always effective.
2. Slecting point along meridian is characteristic.which selecting local point is the key.based on the theory that”The disease can be cured when the affected meridian or the affected Zhangfu organs are cleared.”
Vertex Headache:Baihui(GN20).Sishengchong(EX-HN1).Xingjian(LR2).A-shi point
Frontal Headache:Shangxing(GN23).Yingtang(EX-HN3).Yangbai(GB14).Sanjian(LI3).
A-shi point
Temporal Headache:Shuaigu(GB8).Taiyang(EX-HN5).Xiaxi(GB43)/Zhongdu(SJ3).A-shi point
Occipital Headache:Houding(Du19).Tianzhu(BL10).Houxi(SJ3).Sugu(BL65).A-shi point
3. Slecting points under the guide of differentiation will strengthen the effect.
① Wind evil invading callateral: Fengchi(GB20).Hegu(LI4).Waiguan(SJ5)etc.
② Liver yang flaming up:add Fengchi(GB20).Taichong(LR3).Taixi(K13)etc.
③ Qi and Blood deficiency:add Qihai(RN6).Pishu(BL20).Zusanli(ST36)etc.
④ Turbid phlegm obstruction:add Fenglong(ST40).Yinglingquan(SP9)etc.
⑤ Blood staglation:add Xuehai(SP10).Hegu(LI4).Sanyingjiao(SP6)etc.
4. Proper methord of needling will enhance the effect of Acupuncture.
① Under the condition of Qi and Blood deficiency,reinforcing is the right way.But for the rest four types,reducing methord should be taken.When Wind evil invades collaterals,Liver Yang flames up,and Blood stagnates,usually cutaneous needle would be used.As well as cupping,tapping is another good way.If patient permit.Usually,we tap on acupoints with a relative strong force. Until slight bleeding appear companied with pain.moxbustion is very import,except the case of Liver-Yang flaming up.
② Electro-acupuncture is widely used too.Low frequency,soft stimulation is suitable deficiency syndrome,while high frequency strong stimulation fit for indeficiency syndrome.Take care! The intensity of electro-acupunture should be within the limitation patient could endure.
5. Auricular Needling
Priscription:Occiput,Forehead,Cerebral.Shengmen.
Choose 2~3 points one time,retaining needles for 20~30 minuts,manipulate needles every 5 minuts.If patient suffer from headche for a long time,bleeding tapping should be used.
Part Ⅱ Classification according to disease
1. Migraine
Treatment given in prestage or aua stage may prevent migraine from seizuring or alleviate pain when it occurs.Acu-points:Baihui(Du20),Taiyang(EX-HN5),Neiguan(Pc6),Hegu(LI4),Taichong(LR3),
etc.Cuping local place after tapping until slight bleeding with plum-blossom needle can stop migraine seizuring rapidly.And,strong stimulation electro-acupuncture possese the same function.
2. Tonic Headache
Main manifestation:Pain on double occiput,nape or all over the the head,companyed with anxiety,depression,insomnia,So,Taiyang(EX-HN5),Fengchi(GB21),Jianzhongshu(SI15),
Neiguan(PC6),Shenmen(HT7) are choosing to regulate emotion and mentality, as well as loosing local muscles.
3. Headache induced by Cervical Spondylosis
Main manifestation:Pain on occiput, stiff nape, body excurination.Pressing pain on the side of cervical spinal process.X-ray,CT could prove the dignoses.
Key points:A-shi points,Jiaji points
Remote points:Houxi(SI 3).
Mild moxibustion 5~10mins.every point.
Occipital neuralgia is caused by nerve pathologic changes of C2.3, Get cold or pathological chang of the cervical vertebrae is the clue.Punture Fengchi,Tianzhu point with mid-stimulation.It’s better to get the radiate sensation when needling, add mild moxibustion.
