Can acupuncture help chronic migraine?

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. 
 

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