Chinese Herbs and Headache: Traditional Uses, Scientific Evidence, and Safety

Headaches  are among the most common health complaints, but they are not all the same. Migraine, tension-type headache, cluster headache, medication-overuse headache, and headaches caused by infections, injuries, sinus disease, high blood pressure, or neurological conditions may require very different treatments.

Traditional Chinese Medicine, commonly called TCM, has used herbal formulas for centuries to manage recurring headaches. Modern clinical research suggests that certain Chinese herbal medicines may help reduce migraine frequency and severity. However, the evidence is stronger for some multi-herb formulas than for individual herbs, and Chinese herbal medicine should not replace proper diagnosis or emergency medical care.

How Chinese Medicine Understands Headaches

In TCM, headache treatment is selected according to the person’s overall symptom pattern rather than the location of pain alone. Practitioners may consider the headache’s frequency, triggers, intensity, location, associated symptoms, digestion, sleep, menstrual cycle, stress level, and general health.

Traditional patterns associated with headaches may include:

• “Wind” affecting the head
• Rising “Liver Yang”
• Blood stagnation
• Phlegm or dampness
• Qi and blood deficiency
• Kidney deficiency

These are traditional diagnostic concepts and should not be considered equivalent to biomedical diagnoses. For example, a person described as having “Liver Yang rising” in TCM does not necessarily have liver disease. A qualified practitioner uses these patterns to determine which combination of herbs may be appropriate.

Chinese Herbs Commonly Used for Headaches

1. Chuan Xiong — Sichuan Lovage Rhizome

Chinese name: 川芎
English name: Sichuan lovage rhizome
Botanical name: Ligusticum chuanxiong

Chuan Xiong is one of the most frequently studied Chinese herbs for migraine. Traditionally, it is used to promote circulation, relieve pain, and address headaches associated with what TCM describes as wind or blood stagnation.

It is an ingredient in numerous classical and modern headache formulas, including Chuan Xiong Cha Tiao San and Chuan Xiong Ding Tong Formula. Importantly, most clinical studies have evaluated formulas containing Chuan Xiong rather than Chuan Xiong used by itself.

A 2018 systematic review examined 19 randomized controlled trials involving 1,832 participants. The review reported that Chuan Xiong-containing formulas were associated with reductions in migraine frequency, duration, number of headache days, and pain severity. Adverse events were reported as relatively uncommon, although the formulas and comparison treatments differed between studies.

2. Tian Ma — Gastrodia Rhizome

Chinese name: 天麻
English name: Gastrodia rhizome
Botanical name: Gastrodia elata

Tian Ma is traditionally used for headaches accompanied by dizziness, vertigo, muscle tension, tremors, or sensations described in TCM as internal wind.

Gastrodin is one of the main studied compounds found in Tian Ma. A 2022 meta-analysis reported that gastrodin treatment was associated with improvements in migraine pain, attack frequency, and attack duration. However, many included studies had methodological limitations, and gastrodin products used in research may not be equivalent to ordinary Tian Ma supplements or decoctions.

Tian Ma is also combined with Chuan Xiong in Tianshu Capsule, a standardized Chinese herbal product that has been studied for migraine prevention.

3. Bai Zhi — Dahurian Angelica Root>

Chinese name: 白芷
English name: Dahurian angelica root
Botanical name: Angelica dahurica

Bai Zhi is traditionally selected for frontal headaches, facial discomfort, nasal congestion, and pain around the forehead or eyebrow area. It is commonly included in formulas intended for headaches associated with sinus or upper-respiratory symptoms.

Laboratory research has identified potentially anti-inflammatory and pain-modulating compounds in Bai Zhi. Nevertheless, strong placebo-controlled human trials of Bai Zhi alone for headache are currently lacking. Its traditional use should therefore not be interpreted as proof that it can treat migraine, bacterial sinusitis, or other medical causes of head pain.

4. Gou Teng — Uncaria Hook

Chinese name: 钩藤
English name: Uncaria hook or gambir vine hook
Botanical name: Uncaria rhynchophylla

Gou Teng is traditionally used when headaches occur with dizziness, irritability, muscle tightness, or elevated blood pressure. It is frequently combined with other herbs rather than used alone.

Although its alkaloids have been investigated for neurological and vascular effects, clinical evidence directly supporting Gou Teng as a standalone headache treatment remains insufficient. Traditionally, Gou Teng is used in a formula, which is multi-targeted and has much sophisticated effect on the body.

5. Ju Hua — Chrysanthemum Flower

Chinese name: 菊花
English name: Chrysanthemum flower
Botanical name: Chrysanthemum morifolium

Ju Hua is traditionally used for mild headaches associated with eye strain, red or irritated eyes, seasonal discomfort, or a sensation of heat in the head. It may be included in teas and herbal formulas, but clinical research has not established chrysanthemum tea as a treatment for migraine or serious headache disorders. We can use Chrysanthemum flower to reduce the heat in the upper body in order to prevent the severe headache.

6. Bai Shao — White Peony Root

Chinese name: 白芍
English name: White peony root
Botanical name: Paeonia lactiflora

Bai Shao is traditionally used to nourish the blood, relax muscular tension, and relieve spasmodic pain. Practitioners may include it in formulas for headaches associated with neck tension, menstruation, fatigue, or deficiency patterns.

Research on its active constituents is promising, but evidence for treating headaches with Bai Shao alone is limited. Its role is generally supportive within a broader, individualized formula.

What Does Scientific Research Say?

Systematic review of placebo-controlled trials

One of the most relevant studies was a 2022 systematic review and meta-analysis of 18 randomized controlled trials involving 3,015 participants. Oral Chinese herbal medicine was compared with placebo.

At the end of treatment, Chinese herbal medicine was associated with:

• Fewer migraine attacks
• Fewer migraine days
• Lower pain severity
• A greater likelihood of achieving a meaningful clinical response

Some benefits for migraine frequency and pain severity remained during a four-week follow-up. The researchers graded the overall certainty of evidence as moderate and found that reported adverse-event rates were comparable between the herbal medicine and placebo groups.

Chinese herbal medicine compared with migraine medication

A 2020 systematic review included 35 randomized trials with 2,840 adults who had episodic migraine. It compared Chinese herbal medicines with flunarizine, a medication used for migraine prevention in some countries.

The combined results suggested that Chinese herbal medicine reduced migraine attack frequency at the end of treatment and during follow-up. However, variations in formulas, trial design, reporting standards, and blinding reduce the certainty with which these results can be applied to general clinical practice.

Chuan Xiong Ding Tong Formula trial

A randomized, double-blind, placebo-controlled study evaluated Chuan Xiong Ding Tong Herbal Formula Granule in 150 people with migraine. Participants received the herbal formula or placebo for 12 weeks, followed by a four-week observation period.

Compared with placebo, the herbal formula was associated with reductions in migraine days and attack frequency at week 12 and during follow-up. Pain scores and the proportion of people responding to treatment also improved during follow-up. However, the study did not find a significant difference in the use of acute pain medication.

Tianshu Capsule trial

Tianshu Capsule contains two herbs:

• Chuan Xiong — Ligusticum chuanxiong
• Tian Ma — Gastrodia elata

A multicentre, double-blind, placebo-controlled trial enrolled 1,000 adults with migraine, of whom 919 completed the study. Participants received Tianshu Capsule or placebo for 12 weeks. The study reported improvements in headache response rate, attack frequency, pain intensity, and some associated symptoms in the treatment group.

While this was a comparatively large trial, it evaluated a specific standardized product. Its findings cannot automatically be extended to homemade combinations or supplements with different concentrations.

How Might Chinese Herbs Influence Migraine?

Migraine is a complex neurological disorder involving altered pain processing, activation of the trigeminal system, inflammatory signalling, changes in neurotransmitters, and the release of substances such as calcitonin gene-related peptide, or CGRP.

Laboratory studies suggest that compounds found in Chuan Xiong and Tian Ma may influence:

• Neuroinflammatory signalling
• Oxidative stress
• Serotonin and other neurotransmitter pathways
• Vascular function
• Trigeminal pain processing
• The release or activity of pain-related neuropeptides

These mechanisms remain under investigation. Laboratory findings in cells or animals do not prove that an herb will produce the exact same effect in people at normally prescribed doses.

Why Professional Diagnosis Matters

Chinese herbal medicine may be considered as part of a preventive care plan for properly diagnosed migraine, particularly when it is prescribed by a qualified practitioner who can review the patient’s medications and medical history.

However, a headache can occasionally be a warning sign of a serious condition. Immediate medical evaluation is needed for:

• A sudden, extremely severe or “thunderclap” headache
• A first or worst-ever headache
• Headache with weakness, numbness, confusion, fainting, or difficulty speaking
• Headache with fever, stiff neck, seizure, or persistent vomiting
• A new headache after a head injury
• A new or changing headache during pregnancy or after childbirth
• Headache with significant visual loss or severe eye pain
• A progressively worsening or substantially different headache
• A new headache in someone with cancer, immune suppression, or another serious illness

These warning signs are included in evidence-based screening approaches for identifying potentially dangerous secondary headaches.

Safety and Herb–Drug Interactions

“Natural” does not always mean safe. Chinese herbs contain pharmacologically active compounds and may interact with prescription medicines.

Extra caution is needed for people who:

• Take anticoagulant or antiplatelet medication
• Use several migraine, blood-pressure, sedative, or psychiatric medicines
• Have liver or kidney disease
• Are pregnant, breastfeeding, or trying to conceive
• Are preparing for surgery
• Have allergies to medicinal plants
• Are purchasing products from unverified sources

Some classical headache formulas contain Xi Xin, or Asarum, species of which may contain aristolochic acid-related compounds. Aristolochic acids are associated with serious kidney toxicity and urinary-tract cancers. Only correctly identified, quality-controlled products supplied under professional guidance should be considered. In modern society, we have many kinds of mediation for debilitation migraine headache, herbalists do not have to use Asarum to help patients to stop the severe migraine, instead we use safe herbal formula to target root cause of headache/migraine.

Herb-induced liver injury and herb–drug interactions have also been documented. Patients should tell both their doctor and herbal practitioner about every medicine, supplement, tea, powder, and herbal product they use.

The Bottom Line

Scientific research suggests that certain standardized Chinese herbal formulas may help reduce the frequency, duration, and severity of migraine attacks. The best evidence currently supports multi-herb treatments, particularly formulas containing Chuan Xiong, rather than any single herb used independently. The formula will enhance the therapeutic effect and reduce unwanted side effects.

However, results vary between studies, and the evidence is not equally strong for tension-type headaches, sinus headaches, cluster headaches, or headaches caused by another medical condition. Product quality, accurate diagnosis, correct herb selection, and professional monitoring are essential.

Chinese herbal medicine may have a role as a complementary approach to migraine prevention, but it should be integrated responsibly with medical evaluation, headache tracking, adequate sleep, regular meals, stress management, hydration, and evidence-based conventional care.

References

1. Shan CS, Xu QQ, Shi YH, Wang Y, He ZX, Zheng GQ. Chuanxiong formulae for migraine: a systematic review and meta-analysis of high-quality randomized controlled trials. Front Pharmacol. 2018; 9:589. PMID: 30013473.
2. Zhou X, et al. Effectiveness of gastrodin for migraine: a meta-analysis. Medicine. 2022. PMID: 36090869.
3. Lyu S, Zhang CS, Guo X, et al. Efficacy and safety of oral Chinese herbal medicine for migraine: a systematic review and meta-analyses using robust variance estimation model. Front Neurol. 2022; 13:889336. PMID: 35873759.
4. Lyu S, Zhang CS, Guo X, et al. Oral Chinese herbal medicine as prophylactic treatment for episodic migraine in adults: a systematic review and meta-analysis of randomized controlled trials. Evid Based Complement Alternat Med.2020;2020:5181587. PMID: 33424985.
5. Fu C, Yu L, Zou Y, et al. Efficacy of Chuanxiong Ding Tong herbal formula granule in the treatment and prophylactic of migraine patients: a randomized, double-blind, multicentre, placebo-controlled trial. Evid Based Complement Alternat Med.2012;2012:967968. PMID: 23304233.
6. Yu S, Ran Y, Xiao W, et al. Treatment of migraines with Tianshu capsule: a multicentre, double-blind, randomized, placebo-controlled clinical trial. BMC Complement Altern Med.2019;19:370. PMID: 31842860.
7. Do TP, Remmers A, Schytz HW, et al. Red and orange flags for secondary headaches in clinical practice: SNNOOP10 list. Neurology.2019;92:134–144. PMID: 30587518.
8. Han J, Xian Z, Zhang Y, Liu J, Liang A. Systematic overview of aristolochic acids: nephrotoxicity, carcinogenicity, and underlying mechanisms. Front Pharmacol.2019;10:648. PMID: 31244661.
9. Ma ZT, et al. New insights into herb-induced liver injury. Antioxid Redox Signal.2023;38:1138–1149. PMID: 36401515.