Patient Profile
Female, 55 years old, long-term mental worker. Twenty-year history of migraine.
Main Complaint
Recurrent migraine for 20 years, significantly worse in the last year, with several attacks each month.
History of Present Illness
For 20 years she had intermittent migraine, mostly unilateral and throbbing, often triggered by fatigue, stress, and poor sleep, and accompanied by light and sound sensitivity and nausea. Over the last year, attacks became more frequent, several times a month, and severe enough to keep her in bed, unable to work. She had repeatedly visited neurology and pain clinics and received many drugs and standard acupuncture/manual treatments. Relief was always short-lived. She came to my clinic, supported by family, feeling hopeless and exhausted.
Relevant History
No major cardio-cerebral vascular events, no epilepsy. Family history of migraine. Long-term poor sleep and high job stress, with prolonged computer use.
Examination
At first visit she kept her eyes half-closed, brows furrowed, speaking weakly, with strong pulsating pain in the temporal region. There was widespread tenderness over the forehead, temples, vertex, and occiput, and marked tightness and stiffness in the neck and shoulders. Numerous trigger bands and nodules were found in the upper trapezius, sternocleidomastoid, and cervical splenius muscles. Neck range of motion was slightly limited. Neurological exam showed no focal deficits.
Diagnosis
- Western medicine: Migraine.
- TCM: “Pian tou tong” (migraine), often from hyperactive liver yang and blood stasis blocking the collaterals.
- SNAN perspective: Multiple head and facial myofascial trigger points plus a high-tension neck–shoulder chain form the structural basis of her migraine. Nodules along the lower and upper nuchal lines, temporalis, occipitalis, and orbicularis oculi were prominent.
Treatment – Mini Ren-SNAN Acupuncture
Mini Blade Needle, 0.35 mm × 25 mm, insertion depth < 10 mm.
- Neck and cranial base (prone):
From the lower to upper nuchal lines, the suboccipital region and mastoid area were palpated and treated. Trigger nodules around the skull base, upper trapezius, and sternocleidomastoid were released with longitudinal shallow needling, reducing neck-origin tension. - Head and face (supine):
Then, trigger nodules in the temporalis, occipitalis, and around the orbicularis oculi were treated with shallow “解结” needling, adjusted to the patient’s tolerance.
Twice weekly, 4 sessions for the initial course.
Results
After the first treatment, she could sit up and open her eyes, and the pain dropped from severe to mild–moderate. The neck and shoulders felt much lighter. After 4 sessions, the frequency of migraine attacks dropped sharply and the pain intensity was markedly reduced. She regained the ability to manage daily life and work. Over 5 years of follow-up, she had only occasional mild headaches related to fatigue or cold; these resolved with rest or brief treatment. The previous disabling migraine did not recur.
Clinical Insight
This case shows how chronic migraine is deeply linked to widespread myofascial trigger points and high-tension fascia chains. Mini Ren-SNAN Acupuncture does not merely “regulate the brain or blood vessels.” It systematically releases nodules and tight bands from neck–shoulder to skull base to head and face, changing the underlying pain input pattern. Long-term follow-up suggests it can reduce attack frequency and medication dependence and should be considered a key structural intervention in migraine management.