"I've had this headache for years. A painkiller sorts it out, then it comes back a few days later." Headaches are something readers raise often, and they are among the easiest things to self-medicate and carry for years without ever having looked at properly.

This article is not about what to take for the pain. It is about what a practitioner asks — set out as 5 things — and which headaches should not wait.

I. First: "headache" is not a diagnosis

"Headache" is the name of a symptom, not a disease. Two people saying "I have a headache" may be describing completely different things:

• A band-like tightness around the whole head, worst after work.
• A throbbing on one side, with light and noise hard to tolerate, and nausea.
• The back of the head running into the neck, tugging when you turn.
• Pressure behind the eyes after a long stretch at a screen.

In Western medicine these fall under different diagnoses and are handled differently. So a practitioner's first step is not to relieve the pain — it is to work out which kind you are describing.

As for how headache is categorised within TCM theory, that belongs to the framework of channels and qi-blood, which is not the same as the modern medical classification of headache.

II. The 5 things a practitioner asks about

• Location — the whole head, one side, the back of the head into the neck, or around the eyes.
• Character — pressure, tightness, throbbing, or sharp.
• Timing — present on waking, building through the afternoon, around your period, or with no pattern.
• Triggers and relief — what brings it on (too little sleep, sun, coffee, menstruation, stress) and what settles it (rest, pressure, water, a dark quiet room).
• Painkiller use — how often, for how many years, and whether you are needing them more frequently than you used to.

The fifth is the one most often skipped, and the most important. Frequent long-term painkiller use can itself make headaches harder to manage. That is something for a doctor to assess — not something to fix by quietly cutting down on your own.

III. How to describe it usefully

This table deliberately does not say what any answer "means". TCM is not a self-matching exercise — the assessment is the practitioner's, after the consultation.

IV. Headaches that need medical attention now

These headaches cannot wait:

• Sudden onset, reaching maximum pain within seconds, and the worst headache of your life — call 999 or go to the nearest emergency department immediately.
• Headache with slurred speech, weakness or numbness down one side, a drooping face, or a sudden change in vision — call 999 immediately.
• Headache with persistent high fever, a stiff neck, or discomfort with light — call 999 or go to the nearest emergency department.
• A headache that follows a head injury, particularly with vomiting, drowsiness or any change in alertness — call 999 or go to the nearest emergency department immediately.
• A new type of headache appearing after the age of 50, or a clear change in your usual pattern — see a doctor first.
• Waking you at night, worst in the morning, or worse when you cough or strain — see a doctor for assessment first.
• Accompanied by unexplained weight loss — see a doctor first.
• A headache during pregnancy, particularly with visual changes or swelling of the hands, feet or face — seek medical attention promptly.

Separately, if your blood pressure is raised and you also have a headache, see a doctor to have it measured and assessed. Hypertension is a condition for a doctor to diagnose and treat.

A note: this section is general information only. For conditions like these, follow your doctor's diagnosis and treatment, and seek medical attention when you need it.

V. Fitting it into life in Malaysia

• Whether you are drinking enough — in this climate, a day spent in air-conditioning drinking mostly coffee or tea often adds up to less water than you think.
• How much kopi and teh tarik — how many a day, at what times, and whether the days you skipped them were noticeably worse. Both the pattern and a sudden stop are worth mentioning.
• Afternoon sun and heat — headaches that start after outdoor work or a midday errand are a pattern worth describing.
• Screens and posture — how long at a stretch, and whether the neck and shoulders tighten with it. Neck-shoulder trouble and headaches often arrive together — see stiff, aching neck and shoulders.
• Sleep — too little brings headaches on, and so can too much. A headache after a weekend lie-in is a common description.
• Days when the air is bad — changes during the haze are worth noting.

For how pain is approached in a consultation generally, see how TCM approaches pain. If dizziness often comes with your headaches, see why do I keep feeling dizzy?

In closing

✅ Worth remembering:

1. "Headache" is a symptom, not a diagnosis — the kind matters.
2. A practitioner asks about location, character, timing, triggers and relief, and painkiller use.
3. How often and how long you have taken painkillers is key information, not a side issue.
4. Worst headache of your life, weakness or slurred speech, high fever with a stiff neck — call 999.
5. A new headache after 50, a changed pattern, or one that wakes you at night — see a doctor first.

❌ What not to do:

1. Do not treat years of frequent painkiller use as the problem being handled.
2. Do not start with TCM when a red-flag sign is present.
3. Do not stop or adjust medication a doctor prescribed on your own.

👉 If you would like to set out your headaches properly for a practitioner, you are welcome to book an online consultation with HansMed, where a practitioner registered under the T&CM Act 2016 can assess it with you. In-person consultations are coming soon.

Sit with a licensed TCM practitioner from wherever you are.

HansMed Modern TCM

「医师，我这个头痛很久了，吃止痛药就好，过几天又来。」头痛是不少读者常提起的情况之一，也是最容易自己买药解决、拖上好几年的一个。

这篇不谈「吃什么可以止痛」。这篇讲的是医师在问诊时会了解哪些事，整理成 5 件事——以及哪些头痛不该等，要立刻处理。

一、先分清楚：「头痛」不是一个诊断

「头痛」是一个症状的名字，不是一个病名。同样说「我头痛」的两个人，情况可能完全不同：

• 有人是整个头像被箍住的紧绷感，下班后特别明显。
• 有人是单侧一跳一跳，怕光怕吵，想吐。
• 有人是后脑连着脖子，转头会牵动。
• 有人是眼睛后面发胀，看屏幕久了就来。

这些在西医里分属不同的诊断，处理方式也不一样。所以医师第一步不是止痛，是先分清楚您说的是哪一种。

至于头痛在中医理论里怎么归类，属于经络与气血的理论框架，与现代医学对头痛的分类不是同一回事。

二、医师会了解的 5 件事

• 位置：整个头、单侧、后脑连颈、还是眼睛周围。
• 性质：胀、紧、跳动、还是像针刺。
• 时间规律：早上起床就有、下午累积、经期前后，还是没有规律。
• 诱因与缓解：什么会诱发（睡不够、太阳、咖啡、月经、压力），什么会缓解（休息、按压、喝水、黑暗安静的房间）。
• 止痛药的使用：多久吃一次、吃了几年、有没有越吃越频繁。

第五项最常被略过，也最重要。 长期频繁使用止痛药本身可能让头痛变得更难处理，这是需要由医生评估的情况，不是自己减量就能解决的。

三、一张表看懂：怎么描述才有用

这张表刻意不写「哪一个答案代表什么」。中医不做自我对号入座——分辨是医师问诊后的判断。

四、这些头痛请立刻就医

以下几种头痛不能等：

• 突然发作、几秒内就到最痛，而且是您这辈子最痛的一次——请立刻拨打 999 或前往最近的急诊部。
• 头痛伴随说话不清、单侧手脚无力或麻痹、嘴角歪斜、视线突然改变——请立刻拨打 999。
• 头痛伴随持续高烧、颈部僵硬、怕光——请立刻拨打 999 或前往最近的急诊部。
• 头部受伤之后出现的头痛，尤其伴随呕吐、嗜睡或意识改变——请立刻拨打 999 或前往最近的急诊部。
• 50 岁以后第一次出现的新型头痛，或头痛的模式明显改变——请先就医。
• 夜间痛醒、早晨最重、咳嗽或用力时加重——请先就医评估。
• 伴随不明原因的体重下降——请先就医。
• 怀孕期间出现头痛，尤其伴随视力变化，或手脚、面部水肿——请尽快就医。

另外，若血压偏高又同时头痛，请先就医测量与评估。高血压属于须由医生诊断与治疗的情况。

小提醒：本段仅为一般知识说明。相关情况请以西医的诊断与治疗为主，并在需要时及时就医。

五、大马生活里怎么安排

• 水喝得够不够：在这个气候里，一整天在冷气房、喝的又多是咖啡或茶，实际水分往往比自己以为的少。
• Kopi 与 teh tarik 的量：每天几杯、什么时段、有没有突然停掉的那几天特别痛——咖啡因的规律与突然中断都值得讲。
• 午后的太阳与热：户外工作或中午外出后才发作，是值得说明的规律。
• 屏幕与姿势：连续看屏幕多久、有没有连着肩颈一起紧。肩颈与头痛常一起出现，可参考：肩颈僵硬酸痛。
• 睡眠：睡太少会痛，睡太多也可能会痛——周末补眠后的头痛是常见的描述。
• 空气品质差的日子：烟霾期间症状变化值得记录。

关于疼痛问诊的整体顺序，可参考：中医怎么看疼痛。若头痛常伴随头晕，可参考：常常头晕，是什么问题。

结语

✅ 记住这几点：

1. 「头痛」是症状不是诊断，先分清楚是哪一种。
2. 医师会了解位置、性质、时间规律、诱因与缓解、止痛药的使用。
3. 止痛药吃多久、多频繁，是关键资讯，不是题外话。
4. 最痛的一次、伴随无力或说话不清、伴随高烧与颈僵——立刻拨 999。
5. 50 岁后新出现的头痛、模式改变、夜间痛醒——先就医。

❌ 不要这样做：

1. 不要把长期频繁吃止痛药当成「已经处理好了」。
2. 不要在出现红旗信号时先找中医调理。
3. 不要自行停用或调整医生开立的药物。

👉 如果您想把头痛的情况完整说给医师听，欢迎透过汉方中医的线上问诊，由依 2016 年 T&CM 法令注册的医师为您评估。亲诊服务即将推出。

无论身在何处，与持证中医师对坐。

汉方现代中医