For chronic migraine sufferers, acupuncture for migraines can provide an excellent alternative to complement their medical treatments. Acupuncture, a component of traditional Chinese medicine (TCM), may be effective in managing certain pain conditions, including migraine headache. Dr. Robert F. Lenahan offers acupuncture for migraines to help patients find their own balance between lifestyle adjustments, medical therapies and alternative treatments. If you have been struggling with headaches, acupuncture for headaches may provide an excellent supplement to the existing medical therapies you have tried.
Acupuncture is used to effectively treat primary headaches, namely tension and migraine, which are the most common. A primary headache is a clinical condition, not a symptom of another disorder. Primary headaches include tension headaches, migraines and cluster headaches.
Types of Headaches
There are a variety of different types of headaches, both primary and secondary. These include the following:
- Tension Headaches
- Tension headaches, which occasionally affect most people, are the most common type of headache. They are recurrent headaches, and can last anywhere from minutes to days. These headaches are experienced as a dull pressure, mild or moderate in severity.
- Migraines
- Migraine headaches are usually one-sided, pulsating or throbbing, and moderate or severe in intensity. They can be worsened with activity and may be associated with nausea and/or vomiting, as well as sensitivity to light or noise. Some patients also experience auras, a neurological symptom that develops gradually over 5-20 minutes. The patient may see brief flashes or waves of light, or changes in their vision. Other common features of auras include vertigo, imbalance, confusion and numbness.
- Chronic Headache
- Headaches occurring every day or almost every day are referred to as chronic daily headaches or rebound headaches. Sometimes they resemble tension headaches, and at other times, migraines. The overuse of pain medications can result in aggravating headache patterns.
- Dangerous Headaches
- Some headaches may be signs of a serious medical condition. These include headaches after trauma, headaches in the elderly, or headaches with any of the following symptoms:
- Vomiting without nausea
- Severe dizziness
- Fever
- Extreme neck pain
- Sudden onset
- Hypertension
Evidence for acupuncture
Web MD reports that Acupuncture May Be Effective for Migraines describing 3 studies that concluded that acupuncture is more effective than no acupuncture in the treatment of migraine. They also report that another study of nearly 800 people showed that 11 acupuncture treatments over six weeks were at least as effective as the blood pressure drugs called beta-blockers — often used for migraine prevention — taken daily for six months.
MigraineTrust.org talks about ‘pragmatic’ studies, where the real-world effectiveness of acupuncture has been assessed when given in addition to usual treatment. Patients are randomized to ‘acupuncture’ or ‘no additional treatment (standard GP management) without the use of a placebo. In one such study, patients suffering with chronic headache (80% with migraine) were given 12 sessions of acupuncture over 3 months. This resulted in 34% fewer headache days, 15% less medication, 15% fewer days off work and 25% fewer GP visits after one year. The cost-effectiveness, expressed per ‘quality-adjusted life year’ (QALY), the recommended measure, was £9000 per QALY, well under the threshold of £20-30 000 per QALY) required by the National Institute of Clinical Effectiveness (NICE). These results have been repeated in Europe.
How acupuncture can help
There have now been many controlled trials of acupuncture for migraine, with some large, high-quality ones in recent years. The results of the latest reviews are quite consistent: acupuncture is significantly better than no treatment/basic care for managing migraine, and appears to be at least as effective as prophylactic drug therapy, with few contraindications or unpleasant side effects (Linde 2009, Wang 2008, Sun 2008, Scott 2008). Acupuncture has a similar or slightly better effect than sham procedures, which themselves can perform as well as conventional drugs, indicating that sham acupuncture is not an inactive placebo but a contentious alternative intervention. Acupuncture has been found to be cost-effective (Witt 2008; Wonderling 2004). As well as prevention it may also be used to alleviate symptoms in acute attacks (Li 2009). There is preliminary qualitative evidence from patients that acupuncture can increase coping mechanisms as well as relieve migraine symptoms (Rutberg 2009). acupuncture.org.uk
Migraine is thought to begin as an electrical phenomenon in the cerebrum that then affects blood vessels, biochemistry, and causes neurogenic inflammation.
Acupuncture can help in the treatment of migraine by:
- Providing pain relief – by stimulating nerves located in muscles and other tissues, acupuncture leads to release of endorphins and other neurochumoral factors and changes the processing of pain in the brain and spinal cord (Zhao 2008, Zijlstra 2003, Pomeranz, 1987)
- Reducing inflammation – by promoting release of vascular and immunomodulatory factors (Kim 2008, Kavoussi 2007, Zijlstra 2003).
- Reducing the degree of cortical spreading depression (an electrical wave in the brain associated with migraine) and plasma levels of calcitonin gene-related peptide and substance P (both implicated in the pathophysiology of migraine) (Shi 2010).
- Modulating extracranial and intracranial blood flow (Park 2009).
- Affecting serotonin (5-hydroxytriptamine) levels in the brain (Zhong 2007). (Serotonin may be linked to the initiation of migraines; 5-HT agonists (triptans) are used against acute attacks.)
The Treatment of Headaches in Traditional Chinese Medicine
Traditional Chinese Medicine (TCM), acupuncture has been used to treat headaches for thousands of years. The greatest advantage of acupuncture over western medicine is that it does virtually no harm. Unlike synthetic drugs, acupuncture has virtually no side effects, and the procedures for treating headaches are much less invasive.
We also recommend some important lifestyle changes to reduce the incidence of headaches:
- Sleep adequately (7-8 hours per day)
- Avoid physical or mental fatigue
- Avoid alcohol (especially red wine)
- Avoid caffeine
- Eliminate foods that trigger migraines: dairy, chocolate, spices, wheat and corn
- Avoid any triggers that cause your headaches
Additional studies demonstrating the affect of acupuncture on patients who suffer from migraine headaches:
http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2603492
http://www.cochrane.org/CD001218/SYMPT_acupuncture-preventing-migraine-attacks
The skill of the practitioner lies in knowing how a symptom relates to and derives from the overall pattern of balance. This might mean that someone treated without regard to this may show very limited or even no progress, and it would be unfortunate to draw conclusions about the efficacy of acupuncture based on this. The treatment of headaches and migraines is an area where there is a large body of evidence of acupuncture being beneficial, and although the designs of some of the studies have fallen short of the standards of acceptance in the west, the sheer volume of positive trials suggests that acupuncture will have a continuing role to play in the management of this condition.