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Ask an expert - neuro and psycho logical - headache
A:We think there are two elements to this question. The first is whether it is safe to treat someone who is thirteen weeks pregnant. The answer is that when the treatment is offered by a properly trained and qualified practitioner, as all our members are, then acupuncture in the first trimester is perfectly safe. There are a number of points which are forbidden during pregnancy as a whole and during specific stages of pregnancy, but all practitioners are well aware of these and either avoid their use or find safe alternatives which have the same function. It is fair to say that very few western-trained practitioners use needle techniques vigorous enough to cause any problems, but we have always erred on the side of caution.
There is an increasing number of members who now focus their time and practice on treating women through pregnancy and undertake postgraduate training in all aspects of fertility, conception and childbirth. We are just in the final stages of a process which will define the qualifying standard for laying claim to expertise in this area, after which we may be able to make specific recommendations. In the interim most members who have this treatment focus usually make this very clear in their website materials. The reason we say this is that while all members can safely treat migraines in pregnancy, the later stages can present some interesting energetic changes, and if treatment does continue over the nest few months, there may be some advantage in seeing a practitioner with additional expertise in this field.
As far as migraines themselves are concerned, there is now a considerable body of evidence suggesting that acupuncture treatment may have a beneficial effect. As out factsheet shows
there have now been a large number of trials which show that acupuncture treatment does have an effect greater than no treatment or conventional treatment, and once you look at the wider picture of the treatment of all headaches even NICE has now accepted that acupuncture is in some circumstances a frontline treatment. From a Chinese medicine perspective there is actually a comprehensive list of types of headache where the headache/migraine itself will be a part of a wider picture of imbalance in the system, and this will enable the practitioner to do what we think is the real strength of Chinese medicine, treat the person with the illness rather than simply treat the illness as defined by a broad label. There are as many different headaches as there are people suffering from them.
The best advice that we can give is that you look at the websites of BAcC members local to you to see which ones have a focus in their practice on treating the pregnant woman. This may be your daughter's best option, but at this stage of the pregnancy it is highly likely that the problem will be brought under control long before the beginning of the third trimester, and any of our members will be able to offer effective treatment at this stage.
Q: My husband is suffering from cluster headaches; severe headaches the cause is unknown to medicine. Every 3-4 months he wakes up in pain in the early morning for a period of 1-2 weeks. Then they go as suddenly as they came. We have done all tests but there is nothing wrong with him physically. Do you think acupuncture can help?
A: The evidence for the use of acupuncture to treat cluster headaches is improving but still a long way short of a quality which could allow us to make an unequivocal recommendation. However, the current NICE guidelines for the treatment of cluster headaches in young people, which have slightly different criteria for inclusion, make a good case for recommending up to 10 sessions of acupuncture as a treatment
Much of the research for the use of acupuncture treatment for headaches focuses on migraine, maonly because it is easier to define and therefore easier to set clear outcome measures. As you say, cluster headaches are not so well understood from a conventional medical perspective, and the relatively small number of treatment options reflects this.
Acupunture treatment is based on the principles of Chinese medicine which have been developed over 2000 years, and there are many different ways of understanding headaches based on their location, frequency, and severity. A skilled practitioner will often find other signs and symptoms which underpin a specific diagnosis, and the fixed point and severe nature of the pain suggest a few very specific alternatives within a Chinese medicine understanding.
However, each patient from a CM perspective is regarded as unique and different, and so with conditions like this which are not so well understood, it is always best to seek the advice of a BAcC member local to you based on a face to face assessment of what is going on. This will give you a very much clearer sense of what could be achieved.
It is very important that if your husband goes ahead there are very clear review periods and where possible a clear outcome measure to help assess what progress has been made.
Q: I believe some research has been done on treating hemi-crania with acupuncture. How effective is this? Are there any practitioners within a reasonable radius of SY7?
A:We are not aware of any research specifically on the treatment of hemicrania continua as a named condition. Obviously we have factsheets about migraine
Having said that, the very specific symptoms of hemicrania do possibly have significance within the systems of Chinese medicine. As you are probably aware Chinese medicine operates from an entirely different theoretical perspective, and understands the body, mind and spirit as a movement of energy, called 'qi', whose flow and balance determine the state of a person's health. Symptoms, however, what someone actually experiences, remain the same whatever system of medicine one uses, and the advantage that eastern medicine sometimes has over western medicine is that it can offer ways of understanding specific pains such as those associated with Sjaastad Syndrome and with that treatment possibilities. There are dozens of ways of classifying headaches in Chinese medicine according to location and types of pain, and repeated stabbing pains in a fixed location are often attributed to a specific kind of blockage.
The best advice we can give, however, is to go to a BAcC member local to you and seek their advice on what may be possible. There are at least 16 within a reasonable radius of where you are, and you can generate a list by using the practitioner search function on our home page. Most are only too happy to give up a little time without charge or commitment to assess whether acupuncture is the best treatment option for someone or to recommend alternatives if they think it may not be. We have heard of people using cranial osteopathy as another possible modality for treating this problem, but believe, naturally, that acupuncture is worth exploring first.
It is always gratifying to be able to say very positively that it has been accepted that acupuncture can be used to treat regular/chronic tension-type headaches. The latest NICE guidelines recommend a course of up to 10 sessions to deal with the problem.
Although we are very pleased with the acceptance of acupuncture for another 'condition', as our Research Officer Mark Bovey writes in an article here
we treat a little cautiously, even with such encouraging news. The kinds of research which are accepted by the conventional medical establishment favour trials of a design which we would not use to look at acupuncture. The more the treatments fit the protocol, the less they resemble what a skilled practitioner would do in clinic. Chinese medicine is dynamic and evolutionary; when someone has treatment, the treatment is adjusted for how things progress, whereas in research trials people use the same points formula over and over again.
What this means from our perspective, though, is, to use the quote from George Orwell's famous novel Animal Farm, 'two legs good, four legs better'. If sub-optimal treatment, i.e. formula treatment has been shown to work for treating headaches, specifically designed treatment is likely to be more effective still. The match between western named conditions and Chinese medicine diagnosis is often not a precise one. A single symptom like a headache could result from dozens of different causes as understood by Chinese medicine, and the skill and art of the practitioner lies in assessing the unique balance of the patient to determine how to deal with this unique presentation.
Our factsheet on headaches
also gives some useful background on headaches and research, but our advice remains the same as we would give for any condition for which the evidence was not necessarily as strong: visit a BAcC member local to you and ask for a brief face to face assessment of whether acupuncture treatment may be beneficial to you. There are occasions, for example, where someone may feel that cranial osteopathy or another form of treatment was more appropriate, and we trust our members to do what is best for the patient, not simply to book patients in willy-nilly.
Q: My 15 year old daughter has had chronic migraine for a year. She has constant symptoms. She is under Great Ormond Street Hospital who agreed with our suggestion to try acupuncture as prophylactic treatment as she prefers not to try further medication. She has now had six sessions of medical acupuncture, once weekly, from a GP who specialises in this. She has not had any beneficial response yet, and the GP thinks there is no point in having further acupuncture sessions as there is no chance of benefit now. If it might be helpful we could continue with a different acupuncturist. Looking at the trials that were assessed for the relevant Cochrane review and NICE guidelines, most of these involved at least 10 treatment sessions. Before we stop a potentially useful treatment, we wondered whether in your experience with a chronic condition, benefit can sometimes be seen after more sessions even if no initial response.
A: The short answer is 'yes'!
We were heartened by the fact that the NICE guidelines on the treatment of headaches were based on an assessment of trials using traditional chinese acupuncture rather than medical acupuncture, and that one of our members was on the expert panel. This has two consequences. First, it may be the case that the treatments administered by the doctor did not use the same acupuncture points as those used in Chinese medicine, which would clearly affect the outcome. Second, some of the trials will almost certainly have tailored the points used to the specific constitutional balances of the individual patients. While there may be considerable overlap in the points used for treating all headaches most point 'prescriptions' allow sufficient flexibility for tailoring the treatment to the individual's needs.
We are not demeaning the work done by medical acupuncturists, most of which we believe to be very good when practised within scope and on the basis of good evidence. The great strength of Chinese medicine, however, is that a symptom by itself, however well differentiated, does not point automatically to a diagnosis and treatment, and ten patients with identical symptoms from a western point of view may have ten different diagnoses and treatments from a Chinese perspective. 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. This is why we occasionally become disheartened when trials 'prove' that acupuncture has no effect when the treatment is not one which a traditional practitioner would ever do, the same points over and over again without any assessment and refinement.
Although we believe it would be worth your daughter's while to have further treatment, we have to remain realistic and say that not all patients respond positively to treatment. There are occasions when treatment can take a long time to achieve change, but even when the symptom does not shift the practitioner can often tell from their diagnostic work that there is progress and change will happen. Equally, BAcC members are responsible enough to tell someone that in their view a course of treatment has done little and is not worth pursuing. Most BAcC members review progress after four or five sessions to discuss with the patient what has happened and to agree together how to proceed.
Even before the NICE announcement, however, the treatment of headaches and migraines is an area where there is a large body of evidence of acupuncture beign 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.