Ask an expert - neuro and psycho logical - headache

22 questions

As you might imagine we have been asked this question on several occasions and our answers have tended to be rather upbeat, as for example:

The evidence for the use of acupuncture to treat migraines and tension type 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 factsheet

provides details of a great deal of the research which has been undertaken. 

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.

The reply should probably point out that the evidence for cluster headaches per se is not quite as compelling, although the one study cited in the factsheet

comes from the GERAC trials in Germany in 2006 which are particularly interesting because the figures were gleaned from German medical doctors and were statistically significant by virtue of the sheer size of the trial.

Our advice from the earlier answers remains very apposite on one main point, though, and that is the fact that each person is unique and individual in their balance of energies, and for problems like cluster headaches which can arise from a number of systemic problems it is essential that someone has sight of a patient before blithely making any prognostications about what may be possible. Most members are happy to give up a little time without charge to prospective patients to enable them to make properly informed decisions about having treatment.

Q:  I have been recommended to have acupuncture for possible migraine. I have polymyalgia rheumatica and take steroids. Is it ok to have acupuncture ?

A:  There is no reason of which we are aware that suggests that acupuncture treatment was at all contra-indicated for someone taking steroids for PMR. In fact, a great many patients using steroids as a long term treatment for PMR seek treatment to see if over time they can reduce their steroid use. Clearly our members are very cautious in these situations and always advise the patient only to reduce a dose of medication with the knowledge and prior agreement of their doctor. As you are no doubt very well aware, a sudden reduction in a steroid dose can have serious consequences.

 As far as the treatment of migraine itself is concerned, you may well have looked at the details on our website, but if you haven't there is a fact sheet

 which provides some of best current research information about the treatment. In clinical practice migraine remains one of the more frequent reasons why patients seek acupuncture treatment. 

 As long as you are very clear about your situation when your practitioner goes through the initial interview there will not be a problem. Our members are all highly trained and take a full medical history to ensure that any and every factor in someone's health is taken into account.

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:

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:

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

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.

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