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Ask an expert - neuro and psycho logical - headache

18 questions

A:  We are not quite sure whether your question relates to the age of the patient or to the problem she has.

Let us be clear straight away that age itself is not a factor in treatment. We have seen treatments given to new born babies and to 100 year olds, and there is always something which can be done to improve the balance of the system and the flow of energy within it. The only factor which may change is the ability to respond to treatment and even here there are no set rules. This 'expert' used to treat a lady in her 90s whose energy responded better than most to very simple treatments.

As far as migraines are concerned, these are one of the more frequent problems with which we have to deal on a regular basis. As our factsheet shows in a rather matter of fact way

  http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/migraines.html


there is a gathering body of evidence which shows that acupuncture is at least as good at conventional treatments with the added advantage that the body does not have to deal with the relatively strong medications which are routinely prescribed for the problem.  Of course, all migraines are different, and one of the great strengths of Chinese medicine is its concern to establish why this person gets this migraine, which means understanding not only what the whole picture of the system presents but also what counts as a migraine. This is a very flexible definition, and although there are family resemblances between all migraines, not everyone experiences every feature.

The best treatment patterns, in our experience, often involve a number of weekly sessions followed by a series of subsequent visits at longer intervals. Getting migraines under control is not the same as getting rid of them altogether, and the risk of stopping treatment too soon when they appear to have stopped is that when they return people conclude that the acupuncture did not work.

The best advice that we can give, however, is to visit a local BAcC member for an informal chat and face to face assessment of what may be possible. This is likely to give a much better idea of what benefits there may be and will also offer someone a chance to meet the practitioner and see where they work before committing to treatment.

Q:  My 92 year old mother has been suffering with what she has been told by a GP with tension headaches. These headaches start as soon as she is upright but not when she is laying down. She has them everyday. She has severe osteoporosis in her spine and arthritis in her neck.  My question is "is it safe for her to have acupuncture"

A:  There is nothing in what you have told us to give any hint that acupuncture would be at all unsafe. The only problems might be associated with mobility and visiting a clinic, but we are sure that you have had to address these already in getting your mother to various appointments, so your systems are probably well geared to this.

There is a growing body of evidence to suggest that acupuncture can have a very positive effect on tension headaches, as our factsheet shows:

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/headache.html

With the elderly patient we usually start with relatively gentle treatment and needle rather more conservatively, using less needles and less needle manipulation, until we have assessed how well they can handle treatment. Most are probably more hardy than us younger ones, but there is no reason not to start slowly. Older people can also be slightly more prone to bruising and slight bleeding after needle insertion, so we always near this in mind when treating.

Overall, though, it is always a pleasure to treat the elderly. They often respond very well, and they have usually reached the stage where they tell people exactly what is happening, which can make feedback very direct on occasion. We wish you luck finding a good practitioner for her.

Q:  Please can you suggest the best type of acupuncture for vestibular migraine? I have no headache but daily vertigo/dizziness symptoms.

A:  Acupuncture has a surprisingly good record with treating the different varieties of vertigo/dizziness/Menieres kinds of problems, as our factsheet on vertigo shows:

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/2599-vertigo.html

The evidence is not quite robust enough for us to be able to make claims for success, but this is more a reflection of the type of evidence sought, by which acupuncture treatment is not, in our view, appropriately tested. We treat many people with these types of problem, and we have to presume that the fact we keep getting referrals indicates that we must be doing some good.

We think we are probably helped by the fact that there are some clearly defined functional elements as defined within Chinese medicine which are responsible for the sense of balance in the body, and this makes tracking the pathways of imbalances a great deal easier. This means that there are some short term treatments which one can apply in a slightly less holistic way to bring things under control while spending time on the underlying patterns of imbalance from which the balance problems usually emerge as a secondary phenomenon. You have probably read that twenty people presenting with the same  symptom might be treated in twenty different ways because each has a unique balance which needs to be adjusted. This holds true, but doesn't preclude direct help to one of the secondary manifestations if we need to help someone as best we can.

You ask about types of acupuncture, and we have to be honest and say that within traditional acupuncture any of the systems will be equally effective in addressing your problems. Seen from the perspective of balancing the system as a whole, there have been dozens of variations on the basic themes in the 2500 year history of the tradition, and all are equally valid ways of elaborating the core concepts. We would be less optimistic about modern traditions, as you could imagine from what we have already said. Treating the symptom as the source of the problem will obviously work in cases where there is nothing else out of kilter, but our experience is that there usually is, and just using formula treatments for problems often leads to short term gain followed by a return to the status quo.

We have checked our database by using the online search facility and have found a number of people working very close to where you live. The postcode facility is even more precise, so we have no doubt that you will be able to find a well trained and qualified practitioner near to where you live. Most offer a facility of dropping in for a chat before committing to treatment, and this might be a good route to pursue, giving you a chance to meet them and see where they work.

Q:  I have been seeing things on the internet that a daith ear piercing helps with migraines. Is there any truth in this?

A:  It is a fair bet that everything will work for someone. The real issue is finding something that will work for everyone.

Ear acupuncture is a relatively modern phenomenon, developed largely by a French neurologist called Paul Nogier in the late 1950s. There are some classical and traditional antecedents, but it is a mainly modern practice. From our understanding of the sections of the ear where the Daith piercings are inserted have no direct connection with points as understood after Nogier which might have an impact on migraines. That said, we would be the first to say that there are no specific points for migraines, and if an imbalance in the system which was the root cause of a migraine-causing imbalance happened by chance to be treated by the Daith piercing it is possible that it may have an effect.

We have borrowed this short section of text from the website of an American practitioner who has researched this practice thoroughly because we believe that this is about the best that you can say:

  • The daith does not come anywhere close to stimulating points that acupuncture experts use to treat migraine headaches.
  • Clinical experience suggests that body piercings offer temporary (1-2 weeks) therapeutic benefit at best. They definitely do not represent a long term cure for any condition, including migraines.
  • The daith is an advanced piercing that is often done incorrectly and with inappropriate jewelry. A bad piercing and/or the wrong jewelry is likely to result in excessive pain and serious problems with healing, including the formation of unsightly (and sometimes permanent) bumps around the piercing, as well as potentially serious infections.
  • All cartilage piercings require diligent aftercare (including daily washing and soaking with saline) for the entire six month period of time that it takes to heal. During the healing period ear buds and swimming must be avoided.

Most of this is not exactly unfamiliar territory to those having normal ear piercing. Ear infections are not only painful but far too close to the brain and other delicate structures to be allowed to develop. However, we understand that this type of piercing in this area is slightly more dangerous, although for a professional assessment you might have to talk to someone who specialises in this kind of work.

We would be remiss if we did not mention that traditional acupuncture has a good record in treating migraines, as our factsheet shows

  http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/migraines.html

and as the recommendation by NICE for acupuncture in the treatment of chronic headaches shows. If you are a migraine sufferer you might want to seek the advice of a BAcC member local to you about what treatment may be able to offer. 

A:  The evidence for the use of acupuncture to treat migraines, tension type headaches and cluster headaches is encouraging enough that NICE, the National Institute for Health and Clinical Excellence has recommended it as a treatment for many types of headache. Our two factsheets#

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/migraines.html

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/headache.html

provide details of a great deal of the research which has been undertaken.

As you can imagine we are asked this question quite frequently, and a recent answer included the following paragraphs:

When we conduct online surveys of the main reasons why people consult a BAcC member headaches in one form or another appear in the top ten reasons. The evidence has been good enough for NICE to recommend acupuncture for the treatment of cluster headaches.

However, we have to be a little cautious. The great strength of Chinese medicine is that it understands the symptom within its overall context, and that does mean that while the majority of people will experience some benefit there will always be those whose overall balance means that short term success is less likely. On the other hand, the majority of research trials tend to be undertaken with formula acupuncture in order to meet the criteria espouse in the West, where the outcome is the only variable, and we have long argued that this is not the best way to test a system which is geared to the individual and where treatment evolves as the patient progresses. In many cases this refinement of treatment generates much better results than the orthodox trials suggest are likely, but until we come up with ways of preserving the integrity of what we do in a research setting we are where we are.

The best advice we can give you is to visit a BAcC member local to you for a short face to face assessment. Most of us are happy to give up a few minutes without charge to assess whether acupuncture is the best treatment for what troubles you, and this will also give you a better idea of what we do, who you might see and the surroundings in which they work. We find that this means prospective patients feel more empowered in making their choices rather than simply being booked in sight unseen.

We think that it is important to add riders like this. Research very often uses formula treatments, and this goes against our ethos of treating the person, not the condition, of seeing symptoms in their overall context. Just as there are occasions when an individualised treatment will exceed formula treatment in effect, there are equally occasions when formula treatment will not be appropriate, nor will individualised treatment be much better. Talking to a practitioner before committing to treatment is a wise move.

On the whole, however, headaches of all kinds tend to be a major element of day to day practice, and most of us approach treatment with quite a great deal of confidence


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