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Acupuncture in Therapy of Migraine

What is Migraine? Migraine is a chronic neurological disorder characterized by moderate to severe

headaches, and nausea. It is about three times more common in women than in men.

A typical migraine headache is experienced as a pulsatile pain on one side of the head

and lasts from two to 72 hours with various symptoms that include nausea, vomiting,

photophobia (increased sensitivity to light) and phonophobia (increased sensitivity to

sound). These symptoms are generally aggravated by any routine activity. About one-

third of people who suffer from migraine headaches perceive an aura, a transient visual,

sensory, language, or motor disturbances that signals the oncoming bout of migraine.

Prodromal symptoms occur in 40–60% of those with migraines. This phase may consist

of altered mood, irritability, depression or euphoria, fatigue, yawning, excessive

sleepiness, craving for certain food (e.g. chocolate), stiff muscles (especially in the neck),

dizziness, hot ears, constipation or diarrhea, increased or decreased urination, and other

visceral symptoms. These symptoms usually precede the headache phase of the migraine

attack by several hours or days, and experience teaches the patient or observant family

how to detect a migraine attack is near.

About 20–30% of migraine sufferers who experience an aura that comprises focal

neurological phenomena that precede or accompany the attack. They appear gradually

over five to 20 minutes and generally last fewer than 60 minutes. Symptoms of migraine

aura can be sensory or motor in nature. Visual aura is the most common of the

neurological events, and can occur without any headache. There is a disturbance of vision

consisting often of unformed flashes of white and/or black or rarely of multicolored lights

or formations of dazzling zigzag lines. Some patients complain of blurred or shimmering

or cloudy vision, as though they were looking at an area above a heated surface, looking

through thick or smoked glass, or, in some cases, tunnel vision or partial temporary loss

of vision.

Pain of Migraine The pain of migraine is invariably accompanied by other features. Nausea occurs in

almost 90 percent of patients, and vomiting occurs in about one third of patients. Blurred

vision, delirium, nasal stuffiness, diarrhea, tinnitus, polyuria, pallor, or sweating may be

noted during the headache phase. There may be localized edema of the scalp or face,

scalp tenderness, prominence of a vein or artery in the temple, or stiffness and tenderness

of the neck. Impairment of concentration and mood are common.

Treatment of Migraine Initial treatment of migraine is with analgesics for the headache, an antiemetic for the

nausea, and the avoidance of triggers. Common triggers quoted for migraine are stress,

hunger, and fatigue (these equally contribute to tension headaches). Monosodium

glutamate (MSG) is frequently reported as a dietary trigger. Migraines are more likely to

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occur around menstruation. Other hormonal influences, such as menarche, oral

contraceptive use, pregnancy, perimenopause, and menopause, also play a role.

Cause of Migraine Although the cause of migraine headache is unknown; the most supported theory is that it

is related to hyperexcitability of the cerebral cortex and abnormal control of pain neurons

in the brainstem. Fluctuating hormone levels also have a relation to migraine as is known

that 75 percent of adult patients are women. Migraines were once thought to be initiated

exclusively by problems with blood vessels, but the vascular changes of migraines are

now considered by some researchers to be secondary to brain dysfunction

Migraines are underdiagnosed, and often are misdiagnosed. Migraine should be

differentiated from other causes of headaches, such as cluster headaches. These are

extremely painful, unilateral headaches of a piercing quality. The duration of the common

attack is 15 minutes to three hours. Onset of an attack is rapid, and most often without the

preliminary signs characteristic of a migraine. Medical imaging of the head and neck may

be used to rule out secondary causes of headaches.

Prevention of Migraine Preventive migraine drugs are considered effective if they reduce the frequency or

severity of migraine attacks by at least 50%. The major problem with migraine preventive

drugs, apart from their relative inefficacy, is that unpleasant side effects are common. So,

preventive medication is limited to patients with frequent or severe headaches.

Many medicines are available to prevent or reduce frequency, duration and severity of

migraine attacks. They may also prevent complications of migraine. However, there are

no drugs available to permanently cure migraine.

Medications are more effective if used earlier in an attack. The frequent use of

medications may, however, result in medication overuse headache, in which the

headaches become more severe and more frequent. These may occur with triptans,

ergotamines, and analgesics, especially narcotic analgesics. Also, long-term side effects

are known with all these drugs.

Complications of Migraine

The risk of stroke may be increased two- to three-fold in migraine sufferers. Young adult

sufferers and women using hormonal contraception appear to be at particular risk.

Migraine sufferers seem to be at risk for both thrombotic and hemorrhagic stroke as well

as transient ischemic attacks.

Incidence of Migraine Worldwide, migraines affect more than 10% of people. In the United States, about 6% of

men and 18% of women get a migraine in a given year. Based on the results of a number

of studies, one-year prevalence of migraine ranges from 6–15% in adult men and from

14–35% in adult women. In India, it has been reported that the prevalence of migraine is

9% among boys and 14% in girls. A rapid growth in incidence amongst girls occurs after

puberty, which continues throughout early adult life.

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Acupuncture in Migraine Acupuncture has been studied as a treatment for migraine headache for more than 20

years. Researchers do agree that acupuncture appears safe and that it may be effective for

many people. Results from a study published in 2003 suggest that receiving an

acupuncture treatment when migraine symptoms first begin is as effective as taking any

standard medication.

Many people who visit an acupuncturist's office come with a history of chronic headache.

While a headache may sometimes be a warning sign of a more serious medical condition,

most types of headache seen by an acupuncturist are either a tension headache, migraine,

or a combination of both.

For migraines, acupuncture treatment depends on whether the patient comes experiencing

acute pain or is seeking preventative treatment in between migraine attacks. Prevention

should be the long-term goal.

Acupuncture has been quite effective for managing the acute pain of mild to moderate

migraine attacks. A typical acupuncture treatment involves the insertion of fine needles

into acupuncture points on the body followed by gentle manipulation of the needles.

Minimization of activity of the blood vessels in the head and neck during a migraine

attack is beneficial and is done by limiting the acupuncture points selected to those on the

arms and legs. In certain situations, a high frequency (100 Hz) electrical current may be

used with the acupuncture needles to help constrict the blood vessels.

Acupuncture has been quite useful for migraine prevention also. Researchers have found

that people living in fast-paced business centers tend to have an imbalance in the

autonomic nervous system. This type of imbalance is associated with other health

conditions such as heart disease, insomnia, high blood pressure, and premenstrual

syndrome. In order to harmonize the autonomic nervous system, a special acupuncture

technique called SES is used.

Acupuncture can help in the treatment of migraine by:

1. Providing pain relief

2. Reducing inflammation in neural vesels

3. Reducing the degree of cortical spreading depression, an electrical wave in

the brain associated with migraine

4. Reduce plasma levels of calcitonin gene-related peptide and substance P.

5. Modulating extracranial and intracranial blood flow.

6. Affecting serotonin (5-hydroxytriptamine) levels in the brain thereby

influencing overall function.

7. Promoting homoeostasis and restoring normalcy

Acupuncture is a tried and tested system of traditional medicine, which has been used in

China and other eastern cultures for thousands of years to restore, promote and maintain

good health. Its benefits are now widely acknowledged all over the world and in the past

decade traditional acupuncture has begun to feature more prominently in mainstream

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healthcare in the UK. In conjunction with needling, techniques such as moxibustion,

cupping, massage or electro-acupuncture are also used. Traditional acupuncture takes a

holistic approach to health and regards illness as a sign that the body is out of balance.

The exact pattern and degree of imbalance is unique to each individual. The precise

nature of the underlying disharmony and selection of the most effective treatment leads to

a permanent cure. The choice of acupuncture points will be specific to each patient’s

needs. Traditional acupuncture can also be used as a preventive measure to strengthen the

constitution and promote general well-being.

From a biomedical viewpoint, acupuncture is known to stimulate the nervous system,

influencing the production of the body’s communication substances - hormones and

neurotransmitters. The resulting biochemical changes activate the body's self-regulating

homeostatic systems, stimulating its natural healing abilities and promoting physical and

emotional well-being.