Migraine is a very painful headache. It is recurrent and it affects sufferer’s quality of life. It occurs in more than 10% of the world's population, afflicting more women than men by a ratio 3:1, and inflicts significant personal and socioeconomic costs. It was ranked eighth worldwide by the World Health Organization among the leading causes of disability in 2010. The exact causes are unknown, but it has genetic factor and change in the brain.
Migraine is featured as moderate or severe pulsating pain only on one side of the head which is deliberated by physical activity. It is recurring headache with duration 4-72 hours. It could accompany other symptoms including nausea, vomiting and increased sensitivity to light or noise. The diagnosis is based on clinical history and exclusion of other kind of headache, because there is no specific test for migraine. The cause of migraine is not fully understood. The current accepted theory of migraine is that the brain chemical called serotonin level is changing; this leads to blood vessels in brain contracting and then dilating, as a result, it causes symptoms of migraine. Migraine attach could be triggered by many factors, such as stress, tension, depression, not sleep well, tiredness, poor posture, neck or shoulder tension, hunger, caffeine products (coffee, tea), bright light , loud noise etc. Apart from headache, there could be other symptoms present, such as nausea, vomiting, fatigue, dizziness, blurred vision etc. Pain killers and anti-inflammatory drugs are mainly used to treat migraine attacks. Beta-blockers (e.g., propranolol, originally developed to treat high blood pressure), anti-seizure drugs (e.g., topiramate), or tricyclic antidepressants (e.g., amitriptyline), in combination with behavioral therapy or lifestyle adjustments are used to prevent migraine attack. Mauskop A from New York Headache Center USA summarised therapies proven (to various degrees) to be effective for migraine. These include aerobic exercise; other forms of relaxation training; dognitive therapies; acupuncture; and supplementation with magnesium, CoQ10, riboflavin, butterbur, feverfew and cyanocobalamin with folate and pyridoxine.
Recent research showed that acupuncture has effect to treat migraine. For example, Wang et al studied the effect of acupuncture in patients with migraine. This was a randomized controlled trial involving in 150 patients with migraine. They found that acupuncture has significantly better effect in relieving pain and reducing acute migraine attack than sham acupuncture. They also conducted another trial in 140 patients in 5 hospitals in China. They compared the effect of acupuncture with that of flunarizine, a drug used for migraine treatment. They found that acupuncture is more efficient in decreasing days of migraine attacks than flunarizine; acupuncture has similar effect as flunarizine in reducing pain and improving patient’s quality of life.
There are a few types of acupuncture and many acupuncture points applied for the treatments. Which points are more commonly used and which type of acupuncture is more effective? Wang JJ et al studied the optimized schemes for acupuncture treatment of migraine attack. They studied five types of acupuncture: manual acupuncture, electroacupuncture, auricular acupuncture and bloodletting therapies for migraine patients. There were 76 patients with migraine participated the study. Three groups of acupuncture points include group 1: local points including Sizhukong (TE23), Shuaigu (GB8), Taiyang (EX-HN 5), group2: local points plus distal points including Hegu L4 and Taichong LR3, and group3: local points plus distal points plus symptom points including Ganshu (BL18), Yanglingquan (GB34), Qiuxu (GB40) and Taixi (KI3). Different acupuncture types were type 1 no acupuncture stimulation, type 2 manual acupuncture stimulation, type 3 manual plus electroacupuncture, type 4auricular acupuncture, type 5 otopoint manual acupuncture, type 6 otopoint electroacupuncdture, type 7bloodletting. Within 24 hours after the treatment, the headache relief effects from greater to smaller were body-acupoints combination> manual acupuncture or electroacupuncture> bloodletting >auricular acupuncture. The pain relief effects were most stable in the manual acupuncture group with local acupoints plus distal acupoints. Manual acupuncture stimulation of the local plus distal body acupoints combined otopoint-EA and bloodletting at Taiyang (EX-HN 5) plus Ashi points is potentially the best option for relieving migraine during attack.
Why acupuncture is effective to migraine?
Acupuncture is recognised as effective treatment for migraine. It is as effective as drug treatments. Why can acupuncture treat migraine? It became commonly knowledge that acupuncture stimulates body releasing endogenous pain relief substances such as beta-endorphin. Recent research has shown that acupuncture can change response of the blood vessels in the brain. In migraine patients, their artery blood flow in the brain is increased excessively during migraine attack. After acupuncture treatments, the artery blood flow in the brain became normal. The reduction of blood flow reflexes the intensity of the headache.
Here are more examples of acupuncture for headache and migraine
There was a case report that acupuncture together with spinal manipulation was used to treat a patient with a chronic tension-type headache and episodic migraines. That was a 32 year old woman with headaches for 5 months. She also had a history of episodic migraine that started in her teens. She was diagnosed with mixed headaches: migraine and tension type. Her migraine had been controlled with medication. But she had severe gastrointestinal symptoms including vomiting, nausea and stomach cramping after a period of medication and she had to stop taking the medication. After stopping taking the medicines her headaches got worse and happened on a daily basis. To reduce the headache she started acupuncture treatment first. The points that were used for acupuncture were GB1, Tai Yang (M-HN-9), ST36, K3, K7, BL18 and BL19. After first acupuncture treatment, she had headache free for 2 hours and headache intensity was reduced; after the second treatment, her headache intensity was reduced about 90%. She received 5 treatments over 2 weeks: the first two treatments were acupuncture only and the following 3 treatments were acupuncture combined with chiropractic spinal manipulation treatments. After the 5 treatments, her headache had disappeared. Further four treatments were continued for 11 weeks. After 1 year follow-up, there was no recurrence of the headaches. This case report suggested that patient with headache could choose combined treatment methods in order to achieve best results.
Acupuncture is for migraine prevention
Acupuncture is used for migraine prevention. The effectiveness has been reviewed recently. Twenty-two trials including 4985 participants were analysed. Migraine frequency (migraine days, attacks or headache days if migraine days not measured/reported) was measured before and after treatment and at follow-up. The response (at least 50% frequency reduction) was also measured. Comparison with no acupuncture, acupuncture was associated with a moderate reduction of headache frequency over no acupuncture after treatment. After treatment headache frequency at least halved was found in 41% of participants receiving acupuncture comparing to 17% with no acupuncture. There is one trial with post-treatment follow-up found a small but significant benefit 12 months after treatment. Comparison with prophylactic drug treatment, acupuncture reduced migraine frequency significantly more than drug prophylaxis after treatment. Trial participants receiving acupuncture were less likely to drop out due to adverse effects than participants receiving prophylactic drugs. The conclusion from this study is that the available evidence suggests that adding acupuncture to symptomatic treatment of attacks reduces the frequency of headaches. The available trials also suggest that acupuncture may be at least similarly effective as treatment with prophylactic drugs. Acupuncture can be considered a treatment option for patients willing to undergo this treatment.
Acupuncture is effective for the treatment or prevention of migraine, tension-type headache
Recently a study summarizes the current evidence that evaluates the effectiveness of acupuncture for the treatment or prevention of migraine, tension-type headache, and chronic headache disorders. It demonstrate that acupuncture is associated with improved clinical outcomes compared to routine care only, medical management, and sham acupuncture 2 months after randomization. Cost effectiveness analyses conducted in the United Kingdom and Germany suggested that acupuncture is a cost-effective treatment option in those countries.
References
Wang LP et al (2012) Pain Med 13:623-630
Wang LP et al (2011) Pain 152:1864-71
Mauskop A Continuum (Minneap Minn) (2012) 18: 796-806
Wang JJ, et al Zhen Ci Yan Jiu (2013) 38:234-40.
Lo MY et al J Tradit Complement Med (2013) 3:213-220
Ohlsen BA J Chiropr Med (2012) 11:192-201
Linde K et al Cochrane Database Syst Rev 2016 Apr 19;4:CD007587. [Epub ahead of print]
Linde K et al Cochrane Database Syst Rev (2016) Jun 28;6:CD001218. doi: 10.1002/14651858.CD001218.pub3
Coeytaux RR & Befus D (2016) 56:1238-40
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