Migraines: Preventative Care with Acupuncture

Acupuncture is the technique of piercing the body with a solid needle for therapeutic purposes. Acupuncture was developed in China and the first textbook describing the use of acupuncture is thought to date back to about 200BC. Western interest in acupuncture grew in the 1970’s with President Nixon’s visit to China and has steadily increased since then. The majority of acupuncture treatment in the UK is provided in private practice by professional (lay) acupuncturists who are not from an orthodox medical background. However, acupuncture is provided in almost all NHS pain clinics and by increasing numbers of GPs and physiotherapists.

Types of acupuncture

Two main philosophical approaches are usually recognised. Traditional Chinese medical concepts describe illness and disease as a disturbance of qi (a form of energy or ‘vital force’) within the body. Qi is said to flow along fourteen meridians on the body surface on which the acupuncture points are situated (rather like stations on the lines of the London Underground map). Acupuncture aims to re-establish the correct flow of qi throughout the meridians. Diagnosis may include detailed examination of the pulse and tongue. Needle placement is individualised, so each patient with migraine might receive a different number and distribution of needles. This is often combined with dietary advice and Chinese herbal treatment.

Western medical acupuncture is a modern scientific approach which is based on the biological effects of needling and on clinical and laboratory research. Acupuncture has been found to have effects on the nervous system, including locally where the needles are placed, in the spinal cord and brainstem, where a ‘damping effect’ occurs on pain transmission, and in areas of the brain which regulate the emotional aspects of pain. This may explain beneficial effects from ‘distant’ acupuncture points of traditional practice. Western medical acupuncture uses both local points (for instance on the head and neck) and distant points (such as hands and feet). A related approach is ‘trigger point’ acupuncture, in which tender points in muscles are needled to release muscle spasm contributing to the condition, for example in the neck and scalp.

Evidence for acupuncture

A major problem in acupuncture research is that most clinical trials in headache are ‘randomised, double-blind placebo-controlled trials’, which means that the treatment (typically a drug) is compared with a ‘placebo’ or dummy tablet of identical appearance so that neither the patients nor the researchers know which is which. This is done to minimise treatment expectations affecting the outcome. However, it is much more difficult to devise a ‘placebo’ acupuncture technique with which patients and researchers can be ‘blinded’. One method is called ‘sham’ acupuncture, in which the needles are inserted less deeply into the skin and away from classic acupuncture points. This relies upon the patient not knowing where the true points are and works best in those who have never had acupuncture before. The second method is to use a special needle held in a sheath, which hides it from the patient. The needle can then be made to enter the skin as usual, or to ‘prick’ the skin but not penetrate it (placebo). This has been shown to mimic the sensation of acupuncture effectively. There is much controversy about whether either of these methods are truly inactive like a drug placebo or may have specific effects because they stimulate nerve fibres lying under the skin. The other issue is that practitioners can never be ‘blinded’; they always know which treatment they are giving. For this reason the results of treatment must be assessed by another researcher unaware of which patients got which treatment, or by the patients themselves.

Acupuncture studies in headache have concentrated almost entirely on the prevention of headache rather than acute treatment. A Cochrane systematic review first published in 2001 analysed 16 studies involving 1151 patients and concluded that ‘the existing evidence supports the value of acupuncture for the treatment of idiopathic headaches’, but called for further large-scale studies. Large, randomised controlled clinical trials involving several thousand patients have now been conducted, funded by German health insurance companies. These studies have compared acupuncture with standard treatment (drugs and advice given by physicians) and demonstrate persistent and clinically relevant benefits under real-life conditions and equivalence to specialist drug management. However, no convincing evidence of superiority to ‘sham’ acupuncture has been shown for headache. To skeptics, this suggests that ‘acupuncture doesn’t work’ (i.e. ‘it is no better than placebo’). To supporters of acupuncture, it suggests that while the studies show that it may not matter quite so much how the acupuncture is done, i.e. where the needles are placed or how deeply, acupuncture is much better than no treatment and equivalent to conventional treatment options, with considerably fewer side-effects.

In so-called ‘pragmatic’ studies, 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.

The National Institute for Health and Care Excellence (NICE) include in their headache guideline(2012, updated 2015) that a course of up to 10 sessions of acupuncture may be offered by a healthcare professional if neither topiramate or propranolol are suitable or work well for a particular patient. However, there is no mandate for health professionals to prescribe acupuncture. In practice its availability on the NHS is inconsistent.

Safety of acupuncture

Acupuncture is extremely safe if delivered by adequately trained practitioners. The most frequent side-effects are mild and include: minor bruising or bleeding, usually on needle withdrawal (3%), worsening of existing symptoms (1%) which usually lasts no more than two days and is sometimes associated with a good overall outcome; drowsiness, relaxation, or euphoria (3%) which is often experienced as pleasurable (and if so is not an adverse event!), and pain at the needling site (1%). Severe, extremely rare side-effects include a puncture lung or heart membrane (this is avoided by correct technique); transmission of blood-borne diseases (e.g. hepatitis C), avoided by using single-use, sterile, disposable needles, and skin infection (which is possible with ear acupuncture, particularly if indwelling studs are used).

Acupuncture at the Royal London Homeopathic Hospital

The Royal London Homeopathic Hospital, part of University College Hospital NHS Trust, introduced acupuncture into the NHS in 1977. It is the largest provider of acupuncture services to NHS patients, providing several thousand patient sessions per year. All treatment is provided by conventionally qualified doctors, nurses and physiotherapists who are additionally trained in acupuncture.  Both Western and traditional Chinese techniques are used. With increasing scientific evidence for the effectiveness of acupuncture, the RLHH has concentrated on the challenge of providing NHS acupuncture on the scale and frequency required to treat the large number of sufferers with chronic painful conditions including headache and migraine, facial pain, back and neck pain and knee osteoarthritis. It has set up a number of pioneering group treatment services, where patients are treated up to six at a time initially on a weekly or two-weekly basis, followed by monthly maintenance treatment for those who respond. Clinical audit has demonstrated that the results compare with those from clinical trials.

References

• Linde K et al. Acupuncture for migraine prophylaxis. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD001218.

• Diener HC. et al. Efficacy of acupuncture for the prophylaxis of migraine: a multicentre randomised controlled clinical trial. Lancet Neurol. 2006 Apr;5(4):310-6.

• Linde K, Streng A, Jurgens S, Hoppe A, Brinkhaus B, Witt C et al. Acupuncture for patients with migraine: a randomized controlled trial. JAMA 2005;293(17):2118-25.

• Vickers A. et al. Acupuncture for chronic headache in primary care: large, pragmatic, randomised trial BMJ 2004;328;744-9.

• Wonderling D et al. Cost effectiveness analysis of a randomised trial of acupuncture for chronic headache in primary care. BMJ 2004;328;747.

• National Institute for Health and Care Excellence.  Headaches in over 12s: diagnosis and management (NICE guidelines [CG 150]).  2012 (updated 2015).

this article originally appeared on migrainetrust.org, with contribution by Dr Saul Berkovitz MRCP

Acupressure Regions to Ease Migraine and Headaches

Headaches and migraines are two of the most common pains that people suffer form and although a headache may be mild or throbbing and last a few hours a migraine is a more serious condition where the pain may even last for days. In most cases common headache is caused by excessive stress, tension and emotional changes. But migraine is a more complex situation where the blood vessels of the brain enlarge to release chemicals from the nerve fibers that cause inflammation and hence the severe pain.

Causes of Migraine:

Although the precise cause of migraine in not yet known but there are certain specific triggers of migraines and the first and most powerful one is:

• Hormonal Change– That’s the reason two-third of women experience extreme headaches during the time or just before the onset of periods. Migraines become more common after the onset of puberty and gradually decrease after menopause.
• Eating Habits– Yet another major trigger of migraine is the food we eat. Most common triggers of migraine are alcohol, tobacco, caffeine and fermented foods.
• Other Causes– Stress, tension, work pressure, sleeping disorders and changed atmospheric pressure may also lead to severe headache and nausea.

Acupressure to Heal Migraine:

The benefits and helpful aspects of Reflexology are numerous and it can be used effectively for treating pains and aliments. A majority of the pains and irritations above the neck are caused by excess muscle tension and vascular imbalance and therefore can be healed effectively through acupressure and reflexology because the acupressure points in this area are easily accessible and can be triggered with very little pressure. While over the counter medicines can provide instant relief but in most cases it is a temporary one, but reflexology not only treats the problems externally but heals the ailment from within so that you can get over it completely.

6 Most Important Regions to Relieve Migraine and Headaches:

Applying pressure in these 5 specific regions of the body helps in clearing the blocked meridians so that energy may flow freely throughout the body releasing endorphins, the natural pain killer that our body produces.

Forehead Region:

All the points on the face and forehead are yang pints that are full of energy that generate from the head and face and flow downwards.

Third Eye Point– This point is located just between the two eyebrows where the bridge of the nose meets the forehead. Applying pressure on this region helps in improving concentration, reliving eye strain, headaches,  and ulcer pains. Apply pressure for 1 minute and then move to the next point.

Bright Light– This point is situated in the inner corner of the eyes just below the eyebrows. Applying pressure at these points works excellent in relieving sinus headaches and allergy symptoms. In addition, it also helps in improving vision. Apply pressure for 1 minute on both sides.

Temple Region:

In the temple region there are a chain of points that curl around the ear starting from the top of the ear and are situated just one finger width from the ear. All these points have to be worked simultaneously for effective results. Here we have numbered the pints as 1, 2, 3, 4 and 5 so that the points can be located in the image with ease. Point 1 is located near the tip of the ear and the rest of the points curl around the ear.

• Hairline Curve (1)
• Valley Lead (2)
• Celestial Hub (3)
• Floating White (4)
• Head Portal Yin (5)

Applying pressure on these points helps in relieving temporal headaches on the sides of the head and migraines.

Face Region:

Welcome Fragrance-This points are located both sides of the nostril. Applying pressure on these points helps in opening sinuses and reducing tension headaches.

Neck Region:

Wind Pool– This point is located at the back of the head, halfway between your ear and spine; between the two muscles that come together. Applying pressure at Wind Pool helps in unblocking nasal congestion, relieving  pain in eyes, ears, throat, headaches and migraines.

Shoulder Well– This point is located at the edge of the Shoulder halfway between the point of your shoulder and the base of your neck. Applying pressure on this point helps in reducing stiffness of neck and shoulders and relieving neck pain. It also helps in relieving other ailments like asthma and spasms.

Heaven’s Pillar– This point is located 2 fingers below the base of the skull on the rope like muscles present on both sides of the spine. Applying pressure on this point helps in relieving aches at the back of the head, neck pains, eyestrain, stress, insomnia and stiff neck. Stimulating the Heaven’s Pillar also helps in cough relief.

Hands:

Union Valley– This point is located in the web between you thumb and index finger. Applying pressure on this point helps in relieving back pain, frontal headaches, tooth ache and releasing tension from neck and head.

Foot:

Moving Between– This point is located in the valley between the big and the second toe. Applying pressure on this point helps in relieving headaches, tiredness of eye, arthritis and foot cramps.

Headaches may be a common problem but that does not mean it should be neglected. But instead of resorting to medicine and pills, know the reflexology zones and give reflexology and acupressure a chance to see the difference. Experiment with the pressure points you have chosen because specific pressure points work more effectively for specific type of headaches and some points might show strong results while others might take more time. Therefore try out each of the pressure points to know which points work best for you.

This article originally appeared on http://www.modernreflexology.com/6-effective-acupressure-regions-to-treat-migraine-headaches/ and was written by Bipasha Mukherjee