Patient: Ms. Ting, 34 years old
Date: 13 April, 2022. First visit
Chief complaint: Migraine for more than ten years, with the last three years occurring during menstruation

Ms Ting has experienced migraines for more than 10 years; typically, stress or lack of sleep triggers an attack. For nearly 2-3 years, the headache worsens in the first two days before menstruation, starting every afternoon, with a focus on the right side of the head and neck. This affects sleep, necessitating the use of Panadol, which can provide temporary relief before the drug effect wears off. The pain will last until the next evening and will go away when menstruation occurs.

At the time of treatment, Ms Ting was nearing the end of her menstrual. Her headache, which started yesterday afternoon and lasted for hours, first affected her right side of the head and neck before spreading to her entire head and causing her to wake up in the morning with a tight pain in her right eye socket. This month has seen a significant increase in blood clots. Her tongue is reddish-purple, with a slightly thick tongue coating and purple distended veins on the underside. Her pulse is deep and wiry on both sides. She was diagnosed with liver qi stagnation and blood stasis, and her treatment primarily focuses on dispersing liver Qi and Blood and relieving pain. Scientific Chinese medicine is prescribed, along with tuina to relax her stiff neck muscles. Her headache subsided immediately following the muscle relaxation treatment.

5 May, 2022. Second visit

The day before her period, Ms Ting started to experience a tingling headache in the afternoon. The pain was similar to what she had experienced previously; it still started on the right side of her head and neck and spread throughout her entire head, ending in her right eye socket.After taking painkillers last night, she was able to sleep for a while, but she woke up in pain this morning. She was currently on the first day of her period, but her tongue and pulse did not significantly differ from when she had visited earlier. I gave her scientific Chinese medicine to take at home in addition to an acupuncture treatment for immediate pain relief. I suggested she come before her period to reduce the symptoms of her menstrual headaches.

13 June, 2022. Third visit

Due to her busy schedule, Ms Ting did not visit a few days ago. When she visited, she was nearing the end of her period and said that the day after her last treatment and medication, her headache had subsided. She experienced a headache last night, but it was much less severe than it had been during her previous two visits. She could rest soundly until dawn. Her pulse is now thready instead of wiry. Despite the fact that her tongue is dark purplish, the coating is thin and white, and the distended purple veins on the underside are improving. Then she was given acupuncture treatment and a scientific Chinese medicine to invigorate the blood and relieve pain.

Pathological analysis

Menstrual headaches are headaches that happen during the menstrual cycle, typically before or during the period until the end, when the symptoms go away. The pain site can be classified as headache in the forehead, headache in the back of head, or headache at one side, but one-sided headaches are typically the most common.

Due to the demanding nature of her work, Ms Ting has been experiencing tension and anxiety for a considerable amount of time. This has caused her liver qi to become stagnant, which affects the body’s blood flow and causes stasis, which in turn causes meridians to block and become obstructed. The pressure in the blood vessel wall and the increase in blood flow during menstruation cause areas of stagnant qi and blood to become more serious, which makes the headache worse and causes it to spread from one side of the head to the other.

Methods of headache relief during menstruation

【1】One week before your period, soak your feet in warm water.

The week before menstruation, ladies with or without menstrual headaches can soak their feet in warm hot water before bed.

• Soak your feet until you are warm and perspiring for 15 minutes.
• Warm and hot foot soaks can stimulate blood flow and increase blood circulation throughout the body, which not only effectively relieves a variety of premenstrual discomforts but also relaxes the entire body and enhances sleep.
【2】Exercise in moderation

Exercise in the proper volume is the simplest and most efficient way to reduce blood stasis formation in the body. Regular exercise helps to improve menstrual blood flow and stress relief while also strengthening blood circulation. Of course, because the body is in a unique state during menstruation, intense exercise is not advised; instead, menstrual women should engage in low-intensity exercise, like yoga and jogging.

【3】Prior to and throughout menstruation, maintain a positive attitude, prioritise rest, and balance work and leisure.

Menstrual discomfort is caused by a variety of factors, including stress and anxiety, a spicy or stimulating diet, and a lack of sleep. You must pay attention to maintaining adequate sleep during menstruation, not overworking, and avoiding being too emotional if you want to avoid the physical discomforts during menstruation.