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Ask an expert - neuro and psycho logical - headache

11 questions

A:  Generally speaking, the track record for acupuncture treatment of migraine is very good. Although the evidence is not quite to the rather strict standards which would enable us to give an unequivocal recommendation, as our factsheet shows

there have been a significant number of high quality trials, and we expect that over the next decade the evidence will be better still. This is certainly the case with cluster headaches for which NICE now recommends acupuncture as a primary treatment.

Your specific mention of vestibular migraine suggests, however, that your symptom are more vertigo-like than the nausea and pain associated with the 'classic' migraine. Here again, acupuncture treatment has been well-researched

and there are some good quality studies suggesting that treatment is beneficial. Both migraine and vertigo, in fact, figure in the twenty conditions for which treatment is most frequently sought.

Of course, the point we have to make is that these are both western disease classifications, and the great strength of Chinese medicine is that it can take the symptoms, which are the same in anyone's language, and re-interpret them in an entirely different theoretical grid based on a concept of energy, called 'qi', and the disturbances to its flow, rhythms and balance which generate symptoms. This can often lead to a much more precisely targeted treatment than the treatment of a named condition, and mirrors what the great Canadian physician William Osler once said: 'don't tell me about the disease the patient has, tell me about the patient who has the disease.' Each person is
unique and different, and although the same reason might exist for the symptom to appear, the chain of causation may be entirely different.

This is important, because the parts of the system connected with balance also have a major involvement in the function of sight, and it would not be impossible that the photophobia shares the same root cause from a Chinese medicine perspective. Certainly the 'darkened room and absolutely no noise please' symptom which we often hear is one which does appear to be eased by treatment for migraine.

As we said, though, each patient is unique and different, and the best advice we can give you is to visit a BAcC member local to you and seek their face to face assessment of whether they believe that acupuncture treatment may be beneficial for you.

Q:  I have been suffering with post concussion syndrome for 2.5 weeks.   The main symptoms are pressure headache, nausea, dizziness and slowness of thought.  I am wondering whether acupuncture could help relieve these symptoms, and whether there are any practitioners who specialist in treating PCS.

Q:  As with any damage to the body there are two vital components to recovery. First is the removal or clearance of local blockages which contribute to the symptoms from which people suffer. Second is the overall healing response to any kind of injury, the system's ability to repair itself. Conventional medicine tends to focus. although not exclusively, on the former, while Chinese medicine tends to integrate approaches to the former with a more general consideration of the state of the overall energy flow. To use a very rough and ready analogy, unblocking a pipe where the water flow is generally weak will only be a temporary measure unless the flow level is increased till the pipe is self-cleaning. 

We are not claiming any higher ground or superiority, nor would we; there are ways of using Chinese medicine which are symptomatic and unlikely to provide the level of lasting relief which a patient seeks. In most cases this may not matter. Better is better, and once the problem is corrected, it is gone for good. However, if an accident occurs against a general background of weakness the recovery may not be as well-grounded.

in your case, a practitioner would almost certainly investigate with you in great detail the accident which gave you the concussion. There are a number of protocols in Chinese medicine for understanding 'blunt force trauma', as pathologists call it, and many of these are based on what the Chinese call stagnation or stasis where the blood or body fluids have thickened as a consequence of a bang on the head. While the energy remains stuck in this way, there will symptoms directly related to the pressure, symptoms locally because of the disturbance to nearby systems, and a generalised weakness brought about by the fact that the system is a closed system in Chinese physiology, and a blockage anywhere will impact on the whole body.

We have looked through the research literature, and there are a number of studies, some now quite old, which seem to give encouraging, although far from conclusive, results, and a great many articles from the US in particular where practitioners report great success in restoring people to good health. We are always cautious, however; we only find the cases where the treatment works and there may be many more unreported cases where it didn't.

We often tell people about the way that Chinese Medicine views each patient as unique and different, but in the case of concussions which can happen in thousands of ways this is all the more true. Without a huge amount more information we would not be able to give you any clear prognoses of what may be possible. All that we can say is that people do often consult acupuncture practitioners for the sequelae of concussion and it would be worth your while contacting a BAcC member local to you for a brief face to face assessment of whether they think acupuncture treatment might be a suitable option.

Based on our clinical experience we also think you might want to consider cranial osteopathy, a form of osteopathy which is particularly well-adapted to helping this kind of injury. We often find that combination of both therapies works particularly well for this kind of injury. However, best first to get the advice of a BAcC member who will probably already have good local connections for any other treatments that he or she may think would benefit you.

Q: I suffer from migraines and headaches which seem to be non-responsive to the prophylactics tried so far. I've been told that acupuncture may help but I'd like to know how frequently I'd need to have these sessions... weekly/ monthly? I'm on a tight budget and haven't had much luck with my GP and the 'affordable' clinics in my area are still expensive and clash with my working hours so I'd like to know what type of commitment I'd need to make to get the best effect from the treatment

A: We are sorry to say that this is a little like the 'how long is a piece of string?' question. Although as practitioners we get a sense of what individual conditions are likely to need by way of treatment, our best guesses are always when we can actually see the patient. The fact that the disease label may be the same means nothing in Chinese medicine; fifty seven people with migraines might be diagnosed in 57 different ways, each unique and distinct. Some might get better quickly, some might take a long time.

If pushed, this expert would tend to advise patients whom he hasn't seen that they'd be looking at weekly treatment for about 4 or 5 weeks, followed by monthly treatment for another 3 to 4 months. It is very important to continue the monthly sessions after the initial burst of treatment to bring things under control, if indeed this can be done. Not all cases respond. The evidence is good, but not entirely conclusive as our factsheets show:

although it is important to note that NICE now recommends acupuncture for cluster headaches in young people.

If 'affordable' clinics are a strain on your finances, and by this we assume you mean one of the multibed clinics of which there are now a considerable number in the UK, then finding a practitioner who charges less may be a problem. It is not entirely impossible; a number of members have a quota system where they treat a small number of people for minimal fees. However, many have given this up after being stung ('sorry I'm late, the BMW was playing up and only two years' old too'), but no-one will be offended if you ask.

GPs aren't in a position to help, mainly because they are constrained only to use treatments where there is an evidence base. About the only option you have for getting free treatment is to get referred to a physio within the NHS who uses acupuncture and could trace your headaches back to a musculo-skeletal problem. However, even were this possible you will only get a maximum of six sessions.

As with any form of treatment it is important to see it through to the satisfaction of the practitioner. Headaches and migraine in particular have an annoying habit of coming back if the treatment programme is cut short, and of course people conclude that the acupuncture treatment hasn't worked. This is far from the case, but where people are limited to a foxed number of treatments it is not an uncommon thing to hear. 


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. 

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