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Ask an expert - neuro and psycho logical - headache

24 questions

Q. I have been suffering from migraines for a few years and have just started acupuncture in the hope it will help. Could you kindly advise how often I should have a treatment and for how long should I plan to continue to have the sessions to fully see if it is successful?

A. It is surprising how infrequently we are asked about the treatment of migraines, since it is one of the more common referrals we get. The evidence, which you can see from our factsheet

is pretty good.

Of course, the one thing that we always have to say is that each person is unique and different, and the standard treatments used in these trials are not always indicative of the way that we actually work. Twenty people presenting with the same named condition might be treated twenty different ways.

This also means that each individual presentation, the problem and the context in which it lies, can profoundly affect how much treatment and for how long. Most of us would regard a good routine as four or five sessions at once a week, and then stretching the gaps to a fortnight and up to a month over the next three to four months. We have found that simply treating weekly until the symptoms abate is not always successful, and that without later follow-up there is a danger that the migraines will return. Patients then conclude that the treatment didn't work, which is probably not the case.

Of course, this routine can vary tremendously. If someone has three migraines a week then treatment might be more than once a week to bring things under control. In other cases, where the migraines are related to specific patterns like the menstrual cycle a practitioner might target particular times of month for a few months.

All we ask that our members do is that they review treatment at regular intervals to ensure that there really is some progress, and to ensure that the patient is happy to give continuing consent. What we try to avoid is a treatment 'habit' where someone books week after week without realising that they've run to ten or fifteen sessions without result. This can sometimes make patients unhappy.

However, most people appear to benefit from treatment, and we hope that this is the case for you.

Q. Can it help with tension headaches and TMJ?

A. These are both problems of which we see a great many cases in practice. There is a certain amount of research, as you can see from our two factsheets

but it has to be said that the quality of trials is not that great and as ever the conclusion from any trial will always be that more and better research is needed.

The predominant reason for this is that there are so many precipitating causes for both problems that even researchers fight shy of testing whether the symptom can be relieved by treatment. This is rather ironic, because this is precisely the way that Chinese medicine looks at every symptom, not as a problem in itself but as a problem which has emerged against a backdrop which is unique to each individual. That means that twenty people with the same problem may end up being treated twenty different ways because the underlying patterns were different.

Obviously there are going to be some cases where you can pinpoint the cause. We often come across TMJ syndrome which has been caused by rough dentistry when the jaw has been pushed wide for some time and slightly dislocated. It's not a fantastically stable joint, and once it is slightly out of alignment it can cause facial pain and sometimes headaches too. If we suspect that this is the case we sometimes refer people to cranial osteopaths who can go straight after the problem. This doesn't mean that we aren't interested in why this happened in this particular patient, but it could take a great deal longer to get the same change by restoring better function.

As far as headaches are concerned, though, there are literally dozens of differentiations in the more syndrome orientated acupuncture styles which can define precisely what kind of headache it is and alongside that several very long established styles of treatment aimed at restoring the overall balance. That is why we would never venture a view on a specific question because so much depends on the individual presentation. That is why we invariably say that a brief visit to a local BAcC member for a chat is a great idea. Most will offer a small amount of time without charge to prospective patients to give them a better view of what might be possible, and help them to make an informed choice. It has to be said, though, that headaches remain one of the more common presentations we see in clinic, and many are referrals from people who have been successfully treated themselves.

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.

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