Tension Headache - Liver-Qi Stagnation Pattern

Dr. Li Wei, DACM

Tension Headache · Liver-Qi Stagnation Pattern

Updated: June 23, 2026

Reviewed by: Dr. Li Wei, DACM

Reading Time: 7 min

Body Area: Head

Pattern Overview

Liver-Qi Stagnation is the most common pattern in tension headache, characterized by sustained pericranial muscle contraction, central sensitization, headache worsened by stress, chest tightness, and frequent sighing. The core pathogenesis is emotional stress causing Liver-Qi stagnation, leading to muscle tension, central sensitization, and headache.

Key Symptoms and Differentiation Points

| Differentiation Dimension | Manifestations |

| :— | :— |

| Primary Symptoms | Band-like headache (bilateral, pressing or tight quality), worsened by stress |

| Associated Symptoms | Chest tightness, frequent sighing, irritability, depression |

| Tongue and Pulse | Pale red tongue with thin white coating, wiry pulse |

| Pathogenesis | Liver-Qi stagnation causing muscle tension and central sensitization |

| Etiology | Chronic stress, emotional distress, poor posture, sedentary lifestyle |

Acupuncture Point Prescription

| Point | Location | Function |

| :— | :— | :— |

| Fengchi (GB20) | Depression below the occipital bone, between the sternocleidomastoid and trapezius | Relaxes neck tension and clears the head |

| Taiyang (EX-HN5) | In the depression at the temple | Relieves headache and calms the spirit |

| Taichong (LR3) | Dorsum of the foot, between the 1st and 2nd metatarsals | Source point of Liver meridian; soothes Liver-Qi |

| Hegu (LI4) | Dorsum of the hand, between the 1st and 2nd metacarpals | Regulates Qi and relieves pain |

| Waiguan (TE5) | 2 cun above the wrist crease, dorsal side | Unblocks the Triple Energizer meridian; treats headache |

Clinical Recommendation: Filament needle, reducing method; combine with deep breathing and stress reduction techniques.

Herbal Formula

Base Formula: Chai Hu Shu Gan San (柴胡疏肝散)

Composition:

Bupleurum (Chai Hu), White Peony (Bai Shao), Immature Bitter Orange (Zhi Ke), Cyperus (Xiang Fu), Chuanxiong (Chuan Xiong), Tangerine Peel (Chen Pi), Licorice (Gan Cao)

Action: Soothes Liver-Qi, regulates Qi flow, and relieves headache.

Modifications

| Associated Symptoms | Additions/Subtractions |

| :— | :— |

| Pronounced depression | Add Yu Jin, He Huan Pi to relieve depression |

| Chest tightness | Add Zhi Ke, Hou Po to regulate Qi and relieve distension |

| Insomnia | Add Suan Zao Ren, Yuan Zhi to calm the spirit |

| Prolonged headache | Add Bai Zhi, Man Jing Zi to unblock collaterals and stop pain |

Western Mechanism Reference

Sustained pericranial muscle contraction with central sensitization, elevated EMG activity, and decreased pain threshold. Liver-Qi Stagnation corresponds to tension headache associated with stress, where sympathetic overactivity and sustained muscle contraction contribute to central sensitization and headache.

References

  1. Internal Medicine of TCM - Headache with Liver Depression.

  2. Xiong Jibai: Liver Depression uses Chai Hu Shu Gan San.

  3. WHO. (2023). Headache disorders. World Health Organization.

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