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Ask an expert - neuro and psycho logical - headache

20 questions

Q:  I have chronic headaches as a long term after effect of viral meningitis 15 months ago. Drugs reduce the severity but do not cure the pain completely. Could acupuncture help?

A: We always tread a little cautiously around the treatment of headaches which arise from distinct pathologies like post-viral conditions. In general, the use of acupuncture treatment for headaches is both well-researched and promisingly so, as our two factsheets on headaches and migraine show:

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

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

This has even led to acupuncture being recommended in one set of NICE guidelines for cluster headaches.

 However, post viral conditions often present greater difficulty when they generate specific symptoms, as you can clearly see when you look at thee evidence for the treatment of the various chronic fatigue/post viral/ME style of problems. What would be a relatively straightforward 'fix' for some of the symptoms here does not always seem to 'take'.

 Two factors, however, predispose people to have a go at acupuncture treatment for these types of headache. First, acupuncture treats the person, not the condition, and is aimed at much on the overall recovery of balance in the system as it is in simply reducing the effects of the symptoms. I many cases the body's ability to correct its own imbalances is severely impaired by viral infections, and anything which helps the whole system to function better is likely to have great impact in retaining any benefits a treatment may have.

 Second, the Chinese medicine practitioners have looked at all of the different types of headaches for over 2500 years through an entirely different conceptual structure centred on the flow of energy. The exact nature of the presentation will point to specific types of imbalance for which there will probably be considerable secondary diagnostic information available to the practitioner. This might be in the form of changes to routine patterns which someone has just grown used to over the years, or in some cases signs from pulse or tongue diagnosis of which the patient would not be aware. This would probably give the practitioner some confidence that they could help.

 The best advice we can give, and which we invariably give with problems like this, is to visit a BAcC member local to you for an informal assessment of the situation based on what they find. In most cases they may well see an immediate set of signs and symptoms which will enable to say with confidence that they think they might be able to help. In some cases they may decide that other forms of treatment may be more suitable, and we have certainly heard of people using herbal medicine, cranial osteopathy and homoeopathy to good effect.

 In summary, we think that there may well be some benefit to be gained from acupuncture treatment, and for us the issue with headaches is usually the extent of the improvement and how sustainable this is. We hope that in your case this proves to be considerably so.

Q:  My GP is referring me for acupuncture for my neck.  I have a partial fear of needles and a low pain threshold . I am suffering with bad headaches and my gp thinks it's coming from my neck.

A: The GP may well be correct; a considerable number of headaches arise from problems in the neck, often to do with gradual changes in the vertebrae which can impinge nerves and affect blood flow. There is quite a great deal that acupuncture for both problems, as our factsheets show:

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/4076-neck-pain.html

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/1581-headache.html

Obviously we have to qualify these kinds of sheet with the statement that traditional acupuncture treats the person, not the condition, so we treat a person with a headache, not just a headache. This can make a profound difference to the treatment. Twenty different patients with the same presenting symptom might be treated in twenty entirely different ways as the practitioner sought to balance their own specific patterns of energy. This is one reason why we believe that acupuncture can be more successful than some conventional treatment because it is tailored to the unique needs of the patient.

As far as needles are concerned, there is no reason to fear them. The majority of members use needles which are 0.18mm ot 0.25mm and usually only an inch long, of which the top 3mm-5mm is actually inserted. The use of guide tubes helps even more, the pressure of the tube deadening most of the sensation in the area. Most of us have treated people who are needle phobic, and the simple expedient of showing someone what is going on, perhaps on an area where they can see what's happening, and talking through the process is usually more than effective. There are very few cases where the needling itself has stopped people having treatment, and most of us know how to start as gently as possible in order to keep people happy!

The best thing to do is to visit a local BAcC member for a pre-commitment chat to be reassured about them, where they work and what needles look like. You will also get the benefit of a straightforward assessment of how well acupuncture may be able to help you.

 

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.

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