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Ask an expert - neuro and psycho logical - headache

16 questions

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


Q:  When I had acupuncture for my permanent headache for the first time it was amazing and completely cured it for about 4 hours.
After that, however,  (17 visits) it never did anything. Other treatments have not even come close to that first time with acupuncture.
I have tried tablets,osteopathy, chiropractor, and many other treatments but none have come close to the first time with acupuncture.
Can you advise me on what if anything that signifies/ or acupuncture to relieve vagal nerve pressure.

A: This is not a frequent occurrence but most practitioners will be able to tell stories of similar outcome. This particular expert remembers treating a patient who had been hospitalised with neuropathy and was taking pethidine and other serious medications. After one session the pains disappeared, but then returned gradually over the next week, and were never amenable to any more change. There  is no agreed explanation for why this should occur. We suspect that the novelty of the intervention combined with the hope and expectation of the patient and practitioner can be a very powerful healing force but one which cannot be sustained. However this happens, it is clear that seventeen sessions is more than enough to establish that the treatment is not likely to work.

We have looked at the available research on vagal nerve stimulation and/or control, and by far the greater proportion involves the use of auricular acupuncture. This is a relatively modern development, as this rather dense but interesting study shows

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3523683/

and there are several others which seem to point to this form of treatment as an option. We think that your best bet may be to contact a practitioner who specialises in this form of treatment. Most of these are gathered on the register of the Complementary and Natural Healthcare Council (CNHC), a voluntary register which is accredited by the Professional Standards Authority and which subsumed the old Acupuncture Microsystems Group. There are thousands of practitioners who use the five point protocols for detox and addiction, but a smaller number who undergo extensive training in this modality. The CNHC register is where you will find most of them.

We wish you all the best. Cold comfort it may be but the fact that the condition could change at all does open the possibility that there may be something which will be able to effect the same sort of change on a more sustainable basis.



:

Q:  I suffer from very  bad headaches, have done for years but since having my total hysterectomy at the end of 2012 they are worse  on HRT. I tried Amitrypline but it is horrrible, made me like a zombie, can only use paracetamol but it doesn't  help much. I have  been looking on the internet and found out about acupuncture - can it help me? #

A: We tend to be very upbeat about treating migraines, cluster headaches and persistent headaches, and with good reason. The evidence for successful treatment is very encouraging, as our factsheets show


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

and 

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

and 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, based on what you describe, 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.

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