Disease and Condition Overview
Headache is the intracranial pain felt due to stimulations of pain sensitive receptors. In Chinese medicine, the head is the meeting point of all things yang, the palace of clear yang, or the sea of marrow. The qi and blood of all five zang and six fu organs converge up at the head. If any external pathogenic factors invade the head or any internal injury occurs at the head. It can cause the mischanneling, disturbance of qi and blood, stagnation at the brain luo-connecting channels. As a result, the brain will lose its needed nourishment and generate headache. It is categorized as "head wind".
Clinically, vascular headache is very common, for example, migraines, followed by muscular/myogenic type of headache or tension headaches, then cervicogenic, traction and inflammatory headaches.

Pair-point Treatment Combinations

(1) Baihui (DU20), Fengfu (DU16)
Baihui (DU20) calms the mind and tonifies the brain. It pacifies liver and extinguishes wind. Fengfu (DU16) disperses wind. Both points combined regulate the qi in the brain, reviving the mind and opening orifices, dispersing wind, clam nerves and stop pain. Use for all types of headache and both the acute and latent stage of treatment.

Needling techniques:
1. Baihui (DU20) posterior oblique insertion l cun, or three edged needle prick for a few drops of blood or moxa using moxa stick 20 minutes.
2. Fengfu (DU16) perpendicular insertion 0.5-1 cun.

(2) Hegu (LI4), Quchi (LIll)
Hegu (LI4), Quchi (LIll) are the yuan-source point and he-sea point large intestine of hand-yangming channel respectively. The two points work in synergy, dredging the qi of the yangming channel, clearing the qi on all the orifices of the face. It is appropriate for use in yangming headaches caused by the uprising of wind and heat.

Needling techniques:
1. Hegu (LI4) perpendicular insertion 1 cun.
2. Quchi (LI11) perpendicular insertion 1 cun.
3. Use reducing method.

(3) Touwei (ST8), Lidui (ST45)
Touwei (ST8): on the lateral side of the head, 0.5 cun within the anterior hairline, 4.5 cun lateral to the midline.
Lidui (ST45): on the lateral side of the distal segment of the second toe, 0.1 cun proximal to the comer of the nail.
Touwei (ST8) dispels wind and reduces fire: it clears eye and head. Lidui (ST45), on the other hand, clears and reduces stomach fire: it invigorates the luo-connecting channels and stops pain. Both points combination one above and below, regulate the qi of the yangming channel, clear and reduce heat from the fire. It is great for use for headaches caused by wind heat.

Needling techniques:
1. Touwei (ST8) posterior horizontal insertion 1 cun.
2. Lidui (ST45) prick for a few drops of blood.

(4) Zusanli (ST36), Erjian (LI2)
Zusanli (ST36): on the anteriolateral side of the lower leg, 3 cun inferior to Dubi (ST35), one finger breadth (middle finger) lateral to the anterior crest of the tibia.
Erjian (LI2): on the radial side of the index finger, in the depression distal to the second metacarpo-phalangeal joint on the radial side. Slightly clench fist to locate the point.
Zusanli (ST36) tonifies spleen and stomach; lowers turbid and the inverse directed and dispels the pathogenic factors. Erjian (LI2) clears heat and stops pain, one point tonifies while the other reduces. Both points combined to keep each other in check. They possess the property of regulating the spleen and stomach, downing the inversed and clearing heat to stop pain. Appropriately used for headaches caused by yangming feverish heat, and inverted qi uprising.

Needling techniques:
1. Zusanli (ST36) perpendicular insertion 2 cun.
2. Erjian (LI2) perpendicular insertion 0.5 cun.

(5) Waiguan (SJ5), Zulinqi (GB41)
Waiguan (SJ5): on the dorsum of the forearm, on the line connecting Yangchi (S J4) and the olecranon, 2 cun proximal to the dorsal crease of the wrist, between the radius and the ulna.
Zulinqi (GB41): on the lateral side of the dorsum of the foot, posterior to the fourth metatarsophalangeal joint, m a depression lateral to the tendon of the m. extensor digitorum longus of the fifth toe.
Waiguan (SJ5) disperses heat obstruction at Sanjiao, Zulinqi (GB41) resolves and harmonizes shaoyang. One point above and one below, coordinating in synchrony, together, they clear and reduce the liver and the gallbladder. Appropriately use for shaoyang headaches caused by liver and gallbladder fire, uprising of wind and heat.

Needling techniques:
1. Waiguan (SJ) perpendicular insertion 1 cun.
2. Zulinqi (GB41) perpendicular insertion 1 cun.
3. Use dao-qi or the "guiding qi" method.

(6) Houxi (SI3), Shenmai (BL62)
Houxi (SI3): on the ulnar side of the hand, when the fist is formed, it is located at the end of the transverse crease proximal to the fifth metacarpo-phalangeal joint, on the junction of the red and white skin.
Shenmai (BL62): on the lateral side of the foot, in the depression directly below the lateral malleolus.
Houxi (SI3) connects to the Du channel and elevates yang. Shenmai (BL62) also connects to yang and relaxes the tendon and stops pain. Using these two points combined can clear the pathway to yang channel, elevate yang, relax the tendon, stop pains, and calm the mind. Appropriate for taiyang headache, or headaches accompanied by symptoms such as tense, tight neck.

Needling techniques:
1. Houxi (SI3) perpendicular insertion 1 cun.
2. Shenmai (BL62) perpendicular insertion 0.5 cun.

(7) Fengchi (GB20), Houxi (SI3)
Fengchi (GB20): on the nape, at the same level as Fengfu (DU16), in the depression between the origins of the sternocleidomastoid and trapezius muscles,
Houxi (SI3): on the ulnar side of the hand, when the fist is formed, it is located at the end of the transverse crease proximal to the fifth metacarpo-phalangeal joint, on the junction of the red and white skin.
Fengchi (GB20) dispels wind and extinguishes pathogenic factors, clears head and eyes. Houxi (SI3) connects to the Du channel and elevates yang, quiets the heart and calms the mind. Both points used together, up and down, they dispel wind to connect channels and to stop pain. Appropriate for taiyang and shaoyang headaches caused by wind disturbing the clear.

Needling techniques:
1. Fengchi (GB20) towards the tip of the nose oblique insertion 1 cun.
2. Houxi (SI3) perpendicular insertion 1 cun.

(8) Fengchi (GB20), Hegu (LI4)
Fengchi (GB20): on the nape, at the same level as Fengfu (DU16), in the depression between the origins of the sternocleidomastoid and trapezius muscles.
Hegu (LI4): on the dorsum of the hand, midway between the junction of the first and second metacarpal bones.
Fengchi (GB20) dispels and extingishes wind, Hegu (LI4) opens channels and invigorates luo-connecting channels, clears heat, opens orifices. The two points, one disperses and one clears, one elevates and one lowers, working in unison, they regular and harmonize blood and qi, dispel and extinguish wind. Appropriate for headaches caused by upward rising of wind and heat.

Needling techniques:
1. Fengchi (GB20) anteriorly towards the throat, perpendicular insertion 1 cun. Moxa using moxa stick 10-20 minutes.
2. Hegu (LI4) perpendicular insertion 1 cun. Moxa using moxa stick 10 minutes.|

(9) Hegu (LI4), Taichong (LV3)
Hegu (LI4) clears heat and opens the fu organ, tranquilizing and calming the mind, Taichong (LV3) soothing the liver and regulate qi, pacify liver and extinguish wind. These two points, one governs qi, one blood, one elevates while the other lowers. Used together, they promote qi and blood, both points in combination, open channels and invigorate luo-connecting channels, calm the mind and stop pain. It is appropriate for headaches caused by liver yang uprising.

Needling techniques:
1. Hegu (LI4) perpendicular insertion 1 cun.
2. Taichong (LV3) perpendicular insertion 1 cun.

(10) Yingu (KI10), Xingjian (LR2)
Yingu (KI10): on the medial side of the popliteal fossa, when the knee is flexed, it is located between the tendons of the semitendinous and semimembraneous muscles.
Xingjian (LR2): on the dorsum of the foot, between the first and second toe, proximal to the margin of the web, at the junction of the red and white skin.
Yingu (KI 10) tonifies kidney yin, clears empty heat, Xingjian (LR2) reduces liver fire and cools blood. These two points, while one tonifies, the other reduces. They work in synchrony to keep each other in check. Working in synergy, they tonify kidney and pacify liver, clear heat, extinguish wind, soothing and stop pain. Appropriate for headaches caused by kidney and liver yin deficiency.

Needling techniques:
1. Yingu (KI10) perpendicular insertion 1 cun.
2. Xingjian (LR2) perpendicular insertion 0.5 cun.

(11) Taixi (KI3), Taichong (LV3)
Taixi (KI3): on the medial side of the foot, posterior to the medial malleolus, in the depression between the prominence of the medial malleolus and the Achilles tendon.
Taichong (LR3): on the dorsum of the foot, in the depression distal to the junction of the first and second metatarsal bones, Taixi (KI3) tonifies kidney and reduces heat. Taichong (LV3) soothing the liver and regulate qi, invigorates blood and opens the Luo-connecting channels. These two points, while one tonifies, the other reduces. They work in synchrony to keep each other in check. Working in synergy, they tonify kidney, pacify liver and subdue liver yang. It is appropriate for headaches caused by yin deficiency and liver yang uprising.

Needling techniques:
1. Taixi (KI3) perpendicular insertion 0.5 cun.
2. Taichong (LV3) perpendicular insertion 1 cun.

(12) Baihui (DU20), Yongquan (KI1)
Baihui (DU20): on the head, 5.0 cun superior to the midpoint of the anterior hairline, at the midpoint connecting the apexes of both ears.
Yongquan ( KI1 ) : on the sole, in a depression formed when the foot is planter flexed, at the junction of the anterior third and posterior two- thirds of the line connecting the base of the second and third toes and the heel.
Baihui (DU20) calms the mind and tonifies brain, pacifies liver and extinguishes wind. Yongquan (KI1) clears heat and extinguishes fire. These two points, one elevates while the other lowers, tonify kidney pacify liver, clear heat and calm the mind. Appropriate for headaches caused by yin deficient fire.

Needling techniques:
1. Baihui (DU20) posterior oblique insertion 1 cun, or three edged needle prick and squeeze out a few drops of blood.
2. Yongquan (KI1) perpendicular insertion 1 cun.

Commentaries
The effects of acupuncture in treating headaches are notable, especially for headaches not caused by physiological changes. Most often, because of the persistence, recurrence of the disease, the patient may feel frustrated, depressed, worried, anxious and fearful. Therefore, while treating patients for headaches, it is important to focus on educating and counseling patients as well.
1. Baihui (DU20), Fengfu (DU16) combination, is the basic treatment method, appropriate for all types and stages of headaches.
Next, clinically, it's important to differentiate the location of headache and the affected channel.
2. Yangming headache caused by uprising of wind heat, select Hegu (LI4), Quchi (LI11) combination.
3. Uprising of wind yang, select Touwei (ST8), Lidui (ST45) combination.
4. Yangming dry heat, qi uprising headache, select Zusanli (ST3), Erjian (LI2) combination.
5. Shaoyang headache caused by liver and gallbladder fire or uprising of wind heat, select Waiguan (SJ5), Zulinqi (GB41) combination.
6. Taiyang headache, accompanied by stiff neck, select Houxi (SI3), Shenmai (BL62).
7. However. for taiyang headache and/or shaoyang headache caused by wind disturbing the clear orifices, it is more appropriate to use Fengchi (GB20), Houxi (SI3).
In addition, it is also essential to identify clinical manifestations.
8. For kidney and liver yin deficiency headache, one may select Yingu (KI10), Xingjian (LR2) combination.
9. For kidney yin deficiency and liver yang uprising headache, select Taixi (KI3), Taichong (LV3).
10. However, for usual yin deficiency and empty fire headaches, select Baihui (DU20), Yongquan (KI1). One can frequently moxa or massage Yongquan (KI1) as well.