Ask an expert - neuro and psycho logical - headache

24 questions

A:  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 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.

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.



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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.

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

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

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

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

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.

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