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Ask an expert - neuro and psycho logical - headache
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.
Q: Please could you tell me if acupuncture can prevent hormonal migraines which occur during ovulation? I suffer from migraines with aura every month at the end of the ovulation time. Can acupuncture be used to prevent these types of migraines and how would it do so?
A: As you may have seen in the press recently with the announcement of the NICE Guidelines for tension headaches, acupuncture is being increasingly recognised as a worthwhile option for treating headaches, and is certainly high on the list of conditions for which patients seek treatment with BAcC members. As our factsheet shows. Please click here
the evidence is encouraging and migraine is one of the conditions where we believe the evidence is good enough to allow us to claim so in our marketing,and for which we continue to make our case regularly with the ASA.
Migraines are differentiated in many ways, however, a medical term meaning they can arise from a number of different causes. This is equally the case in Chinese medicine; one old but influential article in the Journal of Chinese Medicine outlines 57 varieties of migraine, which sounds uncannily like a famous advertising slogan of the time. The key thing which would engage the practitioner's interest in your case is the fact that the migraine occurs mid-cycle, where the great majority of cycle-related migraines tend to occur just before or just after the period.
The Chinese understanding of the physiology of the body is entirely different from the western one, based as it is on the flow of 'qi', the Chinese term for energy, and a functional understanding of the internal Organs, not simply physical things which work in their precise location but functional units which can carry on working even when the physical organ has gone, like the Spleen or Gall Bladder. This means that the physiology of the menstrual cycle, when expressed and understood in these terms, identifies various peaks and flows during the cycle which can help to make sense of some of the symptoms which occur. A skilled practitioner may be able to make sense of your specific presentation and adjust the balances of your energy accordingly. Even where the symptom may not relate directly to a specific physiological understanding of the problem it is important to bear in mind that there is a very powerful strand in Chinese medicine which regards symptoms as merely alarm bells which, if the whokle system is in balance, will resolve.
How does it work? Well, from a Chinese medicine perspective it is all about ensuring a good flow and supply of qi to all of the body, and the needles are used to re-balance everything, adjusting excesses and deficiencies, and removing blockage and stagnation. Of course, this presupposes that you buy into the Chinese medicine understanding of the body, which most western medical practitioners don't. Their research often looks to identify changes in body chemistry achieved by needles, or to neuriphysiological effects, and there is no doubt that there will be changes in these - it's all one body after al.
The key thing is to ensure that acupuncture treatment is worth pursuing, and if not, to look at what else may be of benefit. The best advice we can give is that you visit a BAcC member local to you for an informal assessment of whether they think acupuncture may be of benefit.
Q. I have suffered from severe migraine my entire life. I take daily medication which reduces attacks to 1-2 a year. When an attack begins, I haven't found any tablets that help. By chance I received acupuncture by my GP when I happened to see her whilst in the middle of an attack, which instantly ended the attack.
Would it be possible to be trained to give myself acupuncture (on the back of the hand) so I could use this as a first aid treatment if/when I suffer my next migraine?
A. Although it's great to hear of people having dramatic results from having treatment we do not encourage people to needle themselves. There are two main rasons. First, acupuncture involves piercing the skin and safely disposing of needles, and a professional practitioner spends a considerable time learning the skills and knowledge necessary to remove any risk of infection or cross-infection from the process. Our main complaint about very short training courses is that while they may train people in useful adjunctive skills they cannot hope to ensure that the person taking them is sufficiently well trained in safe needle practice and all the cautions that go with being a professional acupuncturist.
Second, although the treatment of symptoms has its place in Chinese medicine, symptoms are regarded as only a part of the picture, and are usually indicators of imbalances within the system which need attention. The risk is that using acupuncture in a first aid way, the underlying pattern is deteriorating, but the alarm bell which the symptom represents keeps getting turned off.
The fact that this works so well for you, however, is perhaps something you could discuss with your GP. Our members would possibly fall foul of our Codes of Professional Conduct if they taught people self-needling techniques, and our insurers would probably be less than happy with the practice. There have been one or two trials within the NHS which used self-needling, however, and it may be that your GP can authorise and delegate care in this way. If not, acupressure using the same points should offer a similar kind of relief.