Headaches and Migraines

For both migraines and headaches, there are several areas that we can consider in order to determine the cause and then find the solution. We have have very good success in reducing the frequency and severity of migraines and headaches or eliminating them.  Most patients come to us with a combination of factors that may be contributing to their headaches or migraines.  Through the initial evaluation, we will go over the patient's medical history and get other diagnostic information that will lead us to the cause or causes of their head pain.  Even though patients may come in with the same diagnosis, we will provide an individual evaluation that takes into account factors that may not seem related to the headaches. Our evaluation will consider the following major areas of possible involvement:

1. stress

2. weather sensitivities

3. neck and/or shoulder tension or pain

4. menstrual cycle

5. gastrointestinal reaction

 

Acupuncture Superior to Drug Therapy for Migraines
Study Highlights the "Exceptional Usefulness" of Treatment
According to the National Headache Foundation, as many as 28 million Americans suffer from migraine headaches each year.1 Migraines can be caused by a variety of physical and environmental factors, including diet, stress, allergens, menstruation, and changes in the weather. They can last from a few minutes to several days, which in some cases may completely incapacitate the person suffering an attack.

Migraine headaches are also one of the leading causes of time missed from work. It is estimated that migraine sufferers lose more than 157 million workdays each year, leading to a loss of approximately 50 billion dollars per year due to absenteeism and medical expenses caused by headache. An additional four billion dollars a year is spent on pain relievers for migraines and other headaches, but many of these remedies either do not work as needed, or simply mask an underlying condition.

In one of the largest studies of its kind to date, a team of investigators in Italy examined the effectiveness of acupuncture versus a variety of pharmacological therapies in treating migraines. Their results, published in a recent issue of the Journal of Traditional Chinese Medicine,2 revealed that patients given acupuncture experienced fewer migraine episodes, missed fewer days from work, and suffered no side effects compared to patients on conventional drug therapy. They also found acupuncture to be more cost-efficient, estimating a savings of hundreds of millions of dollars in private and social health expenditures if it were used to treat headaches alone instead of drugs.

A total of 120 subjects with a history of migraine headaches (without aura) were divided into two treatment groups of 60 patients each. The first group was treated with acupuncture (a maximum of three courses of 10 treatments twice a week, with a one-week break between each course). Acupuncture needles were applied to five points -- ST8; GB5; GB20; GV14; and LU7 -- with practitioners using the reducing method.

 

The second group of patients received drug therapy consisting of two or three treatments using a variety of pharmaceutical products (flunarizine; nimodipine; dihydroergotamine; lisuride; sumatriptam; or amitriptiline). A subgroup of pharmaceutical patients received a drug called longastatine, along with electrical stimulation.

All patients received a 30-minute medical examination at the beginning of the study, with 15-minute examinations at intervals of three, six and 12 months. For the month prior to the start of care, and for 12 months following the first course of treatment, patients were also given a set of monthly time-sheets and asked to track several criteria, including the duration and severity of symptoms; general psychological and physical condition; side-effects; and work absences.

To measure the daily impact of migraines, the researchers assigned values to the frequency, duration and severity of migraine symptoms. One unit of value was noted for each hour a patient had a migraine. If the migraine caused moderate pain, another unit was added; if the pain was intense, two units were added. Another unit was added if the migraine lowered the patient's quality of life during that hour; two units were added if the patient became bedridden because of the condition. At the end of each month, the units were totaled and expressed as a negative number, indicating the extent to which a patient's quality of life had been affected by migraine attacks.

Statistical analysis of the groups found that acupuncture improved the symptoms of migraine without aura "more significantly" than any type of pharmacological therapy. Total symptom scores in the acupuncture group dropped more than 7,800 points from the start of study to six months after the first treatment; in comparison, scores in the drug therapy group dropped less than 4,500. Twelve months after the start of the study, total symptoms scores for patients using drug therapy were still nearly twice those compared to subjects treated with acupuncture

(see Figure I).

 

These variations were also seen on an individual patient basis (see Figures II and III). Six months after receiving their first treatment, the average migraine value for a patient in the drug therapy group was 65.45, a reduction of nearly 46% from the start of care. For those in the acupuncture group, however, the results were even more dramatic: the average acupuncture patient's migraine values decreased nearly 80%, from 163.72 at the start of the study to just 33.17 six months later. Acupuncture patients also experienced considerably fewer absences from work in the second six months of treatment compared to drug therapy patients.

 

One of the most significant aspects of the study was that even though patients were asked to document any side-effects from treatment, none were reported by participants in the acupuncture group. According to the investigators, "no negative sign was highlighted" by subjects receiving acupuncture, leading to the conclusion that "the total absence of side-effects after acupuncture treatment can be affirmed."

 

Patients in the drug therapy group did not appear to fare as well (see Figure IV). Of the 60 patients given pharmaceuticals, over three-quarters - 47 - reported side-effects ranging from nausea and diarrhea to flatulence and burning sensations. For instance, 16 of the 19 patients given flunarizine reported an unwanted weight gain of 3-4 kilograms; all 19 patients taking supatriptam, meanwhile, complained of difficulty breathing, nausea, stuffiness in the chest, and occasional vomiting.

Acupuncture Clinical Studies

Ahonen E, Hakumaki M, Mahlamaki S, Partanen J, Riekkienen P and Sivenius J (1983) Acupuncture and physiotherapy in the treatment of myogenic headache patients: Pain relief and EMG activity, Adv Pain Res Ther 5: 571-576

 

Type of Study: Acupuncture was compared to standard physiotherapy for the treatment of tension headaches.

 

Research Design: Twenty-two patients with chronic tension headaches of various etiologies (mean duration 5.9 years) were randomly assigned to receive acupuncture or physiotherapy.  Acupuncture was administered in 4 sessions at 16 loci on the neck and shoulders.  Physiotherapy, consisting of a combination of ultrasound, massage and parafango (a mixture of paraffin and mud) was administered in 8 sessions.  Pain was assessed using a 10 cm visual analogue scale.  Pain medication usage, duration of treatment effects and frequency of headaches were also assessed.  Surface electromyographic (EMG) activity was recorded from muscles of the forehead.  Each endpoint was assessed during a 2 week pre-treatment phase, during the 3 weeks of treatment and at 3 and 6 month follow-ups.

 

Results:  Patients were comparable at baseline except that pain levels and EMG activity were slightly higher in the physiotherapy group.  By the end of treatment, both groups had shown significant improvements in pain levels.  These improvements, that were maintained at the 3 and 6 month follow-ups, were statistically significant for acupuncture at both time points and significant for physiotherapy at the 6 month follow-up.   Use of medication, duration of treatment effects and frequency of headaches were comparable in both groups after treatment.  EMG reading levels improved during and after treatment, being significant for acupuncture at both the 3 and 6 month follow-ups and significant for physiotherapy at the 6 month follow-up.

Importance of the Study:  Four acupuncture sessions produced roughly the same level of improvement in the tension headaches as 8 sessions of physiotherapy. This suggests that acupuncture provided therapy that was as treatment-effective and more cost-effective than physiotherapy.

 

 

 

Loh L, Nathan PW, Schott GD and Zilkha KJ (1984).  Acupuncture versus medical treatment for migraine and muscle tension headaches, J Neurol Neurosurg Psychiat 47:333-337.

 

Type of Study:  Acupuncture was compared to standard drug therapy for treatment of migraine and muscle tension headaches.

 

Research Design:  Forty-eight patients with chronic migraine and muscle tension headaches (mean duration 19 years), were randomly assigned to receive either acupuncture or standard drug therapy.  After 3 months of treatment, each was asked to cross-over to the other therapy for an additional 3-month period, but only 29 agreed.  Acupuncture was administered at a minimum of 6 needle sites per treatment session, with variation of treatment point selection based on examination of the patients.  Patients in the drug therapy group were asked to continue taking the medications they had been using prior to entering the study.  Patients assessed their headaches at the end of each 3-month treatment phase according to whether there was no, slight, moderate or great benefit from their treatment.  Patients kept a log of medications consumed throughout the study.  At the end of the study, they were asked which treatment they preferred.

 

Results: Twenty-four of 41 patients (59%) who received acupuncture reported benefits from treatment, with 16 (39%) reporting moderate or great improvement.  Nine of 36 patients (25%) who received drug therapy benefited from treatment, with 4 (11%) reporting moderate or great improvement.  Of the 29 patients that received both treatments, there was a greater preference for the acupuncture treatment.  A greater decrease in use of pain medication was reported by the acupuncture group.

 

Importance of the Study:  These findings indicate that a relatively simple course of acupuncture can produce better relief than standard drug therapy in patients with long-term histories of chronic headaches.

 

 

 

Carlson J, Fahlcrantz A, Augustinsson LE (1990) Muscle tenderness in tension headache treated with acupuncture or physiotherapy, Cephalagia 10: 131-141. 

 

Type of Study:  Acupuncture was compared to standard physiotherapy for the treatment of chronic tension headache.

Research Design:  Sixty-two female patients with chronic tension headaches (mean duration 7 years) were randomly assigned to receive either acupuncture or physiotherapy.  Acupuncture was administered in 4-10 sessions, with needles inserted in at least 6 points on each occasion.  Electrical stimulation of needles was also used after the first treatment session.  Physiotherapy was administered for 10 treatment sessions, with techniques tailored to suit the condition of each patient.  Intensity of headache pain was assessed on a five point scale before and after the treatment series.  Six pericranial muscles were palpated bilaterally for tenderness.  The pain on palpation of each muscle was assessed before and after the treatment series on a four point scale.  Use of analgesic medications was assessed before and after each course of treatment.

 

Results:  Patients in the two groups were comparable at baseline.  The intensity of headache pain decreased significantly with both treatments. Tenderness of the palpated muscles improved in both groups.  This was significant for each of the 6 muscles tested in the physiotherapy group and for 3 of the 6 muscles tested in the acupuncture group.  Post-treatment use of analgesic medication declined to a slight extent in both groups, with only minimal change in the acupuncture group.

 

Importance of Study:  Acupuncture resulted in a similar level of  improvement of tension headache and associated muscle soreness as physiotherapy despite the use of a limited course of acupuncture treatment in comparison with relatively normal course of physiotherapy.  These findings suggest that acupuncture can be at least as cost-effective as physiotherapy for tension headaches.

 

 

 

 

Hesse J, Mogelvang B, and Simonsen H (1994) Acupuncture versus metoprolol in migraine prophylaxis:  a randomized trial of trigger point inactivation, J Internal Med 235: 451-456.

 

Type of Study: Acupuncture plus placebo medication was compared to active medication plus placebo needling for treatment of chronic migraine headaches.

Research Design:  Seventy-seven patients with chronic migraine headaches (mean duration over 20 years) were randomly assigned to receive a course of acupuncture treatment with placebo medication or a course of active medication with “placebo stimulation”.  The acupuncture group received 4-6 needles at selected trigger points for 6-8 treatments over a 17 week period, as well as daily doses of placebo medication.  The medication group received the beta-blocker, metoprolol, on a daily basis during a 17 week period.  They also received “placebo stimulation”, consisting of pressure with the blunt end of the acupuncture needle at 4-6 randomly selected sites with the same frequency and duration of treatments as received by the acupuncture group.  Patients kept a daily headache diary for 1 month prior to the onset of the study period and during the 17 weeks of treatment, in which they recorded the frequency, severity, duration and global rating of their migraine attacks, tension-type headaches and consumption of analgesics.  Severity of attacks and global ratings were each scored on a 3-point scale.   Side effects were also recorded.

 

Results:  Both treatment groups were comparable for the 1 month baseline assessments.  During the 17 week treatment period, both groups showed a significant reduction in frequency of migraine attacks, with no significant between-group difference.  Both groups showed non-significant reductions in duration of attacks and a significant difference in global rating was found in favor of metoprolol.  Considerably fewer side effects were reported in the acupuncture treatment group than in the medication treatment group.

 

Importance of the Study:  These findings indicate that a relatively simple course of acupuncture can approach the effectiveness of a standard medication for treatment of migraine headaches.  Acupuncture was at least as effective as metoprolol in reducing frequency and duration, but not severity, of attacks and it was superior in terms of negative side-effects.  The findings imply that acupuncture can be considered as a safe and effective treatment for chronic migraine headaches, especially for patients that do not tolerate standard migraine medication.