Acupuncture & Migraines
Millions of Americans suffer from debilitating migraines with pain so intense that it affects their day to day lives and relief can seem impossible. Migraine is the third most common disease in the world affecting about one in seven people. Chronic migraine affects approximately 2% of the world population and three times as many women as men get migraines.
Migraine is a neurological condition that can be the source of intense throbbing pain that can last for hours or sometimes days. Not much is known about the disorder from a Western medical perspective but there is strong evidence that shows it can be a genetic disorder. Only about half of adults in the US who have migraines ever receive a formal diagnosis of such. Western medicine does offer migraine prevention therapies such as medications, electrical stimulation and injections such as Botox but they are not necessarily effective for all patients and most can cause serious adverse side effects. Over the counter medications provide little to no relief for chronic migraine sufferers and prescriptions to treat migraine pain can be costly or come with undesired life effects. Migraines can strike without warning and can interfere significantly in a patient’s life.
Acupuncture is a common therapy used for treatment and prevention of migraines in China and has been used for thousands of years. As more research is being done, we are finding that acupuncture treatments can reduce the frequency, intensity and duration of migraines - making it a great alternative or complementary therapy to Western medical options.
What Are Migraines?:
Migraine headaches are described as moderate to severe pain that can be pulsating or throbbing. They are typically concentrated to one side of the head and may be worsened with activity. Patients may experience light and noise sensitivity as well as nausea and/or vomiting. Some patients also experience auras which is a neurological symptom that develops gradually over a 5-20 minute period. Patients may see brief flashes or waves of light or changes in vision when experiencing auras. Other common features of migraine with aura include vertigo, imbalance, confusion and numbness. Pregnancy can have a significant impact on migraine symptoms and options for treatment are limited. 50-80% of migraine patients actually experience a reduction of migraine attacks during pregnancy. This is thought to be due to an increase in estrogen levels helping to reduce frequency and intensity. However, some women experience migraine for the first time or a severe increase in symptoms during pregnancy especially during the first trimester. Medications can be risky to take during pregnancy and some prefer to find alternative or complementary treatments to either decrease or eliminate the need for medication.
What Are the Treatment Options?:
There are two medication treatment options in Western medicine. These are pain relieving/abortive medications in order to stop symptoms during a migraine attack and/or preventative medications which are typically taken regularly, often daily, in order to reduce the frequency and severity of migraines.
Pain relieving medications include over the counter medications such as aspirin or ibuprofen or prescription pain relievers such as triptans which block pain pathways to the brain or dihydroergotamines. In cases where patients cannot take the other migraine medications available, opioid medications may be prescribed. In addition to pain relieving medications, anti-nausea drugs may also be prescribed especially in patients that suffer from migraine with aura.
Preventative medications are prescribed with the goal being to reduce how often patients experience migraine, how severe the attacks are and how long they last. These can include blood pressure lowering medications such as beta blockers, tricyclic antidepressants, anti-seizure drugs, Botox injections or a monthly injection of calcitonin gene-related peptide monoclonal antibodies.
As previously discussed, a lot of these medications do not work for people or they come with pretty significant side effects. Acupuncture is often considered for migraine preventions especially among people who want to avoid the side effects. There are a number of scientific studies that support the benefit of using acupuncture in migraine prevention. In fact, hospitals in London have been using acupuncture since 1977 and as more scientific evidence is proving the benefits and effectiveness of acupuncture, it’s use is being increased even more! The World Health Organization has also endorsed acupuncture as a promising treatment for pain since 1979.
How Does Acupuncture Work for Migraine?:
Migraine pain is believed to be associated with the dilation of blood vessels in the brain. Acupuncture promotes blood flow throughout the tissues in the body through a mechanism known in alternative medicine as the axon reflex. This mechanism dilates or widens the small vessels around the area that is being needled creating more blood flow and smoother blood flow. Acupuncture can reduce the frequency of migraine by altering the electrical activity in the brain and by smoothing the flow of blood through the blood vessels. Acupuncture also benefits the parasympathetic nervous system and promotes homeostasis throughout the body which allows for maintaining optimal heart rate, respiratory rate and blood pressure all of which can trigger a migraine if disrupted. Migraines can also be triggered by stress and muscle tension which can overstimulate the body’s pain response. Acupuncture is known to reduce stress levels and stop muscle tightness and spasms.
At the cellular level, acupuncture treatment changes the muscle cells as well as the fascia at the acupuncture point which influences and changes the expression of pain, stimulates the body’s healing process and reduces pain overall. By stimulating the nerves located in the muscles and other tissues, acupuncture treatment releases endorphins and other neuro-humoral factors which changes the processing of pain in the brain and spinal cord over time. Something that we have discussed in other blogs is acupuncture’s ability to reduce inflammation throughout the body. There is increasing scientific evidence that shows that inflammation is associated with migraine or pain in general. Acupuncture promotes the release of vascular and immunomodulatory factors that can counter inflammation. There is an electrical wave in the brain that is associated with migraine called cortical spreading depression. Acupuncture reduces the degree of this electrical wave in the brain which in turn reduces the frequency and intensity of migraine. The brain also holds a lot of pain signaling neuropeptides which could be the culprit in the pathophysiology of migraine. Acupuncture reduces the plasma levels of these peptides and the substance of the peptides which can be a factor in reducing the frequency of migraine.
Acupuncture has been shown to modulate the extra cranial and intra cranial blood flow. Although the changes in the cranial blood flow doesn’t necessarily initiate migraine pain, it could be a contributing factor to it. By using acupuncture treatments to change the cranial blood flow and pressure, the intensity of migraine pain can be decreased. Acupuncture also affects serotonin levels in the brain which can be linked to the triggering of migraine as well as can help to relieve acute attacks. The Western medication of triptans that is used often to reduce frequency of migraine works by promoting serotonin levels. Acupuncture also increases local microcirculation. When treating migraine pain locally, it is reducing the dispersion of swelling which can reduce migraine pain acutely in addition to preventing migraine attack with continual, regular treatments.
Migraines cause pain in theory because of constricting blood vessels which minimizes circulation including the circulation to the brain. Pain relief through acupuncture on a scientific level is thought to be due to a release of positive neurotransmitters through treatment such as endorphins, serotonin, norepinephrine, GABA and oxytocin. This flood of feel good brain chemicals over time are thought to be able to change the way that the body processes pain. By treating the whole body as opposed to just treating the pain specifically, acupuncturists are able to prevent migraine attacks and reduce the frequency and intensity in addition to treating the acute pain of a current attack. To do this, the goal is activate the parasympathetic nervous system, increase the blood flow and circulation and decrease muscle tension. Since headaches affect the head, a lot of patients assume that the acupuncture points for migraines and headaches will be located in the head and neck. This is not necessarily the case and in fact depending on the patient, using these points for migraines may cause the problem to worsen. Treatments are individualized based on the patient and the symptoms that they are experiencing.
When looking at specific studies looking at acupuncture’s effectiveness for migraines, it has been found that researchers have achieved 100% total effective rates with 88.6% complete recovery rates for the treatment of migraines with acupuncture and cupping. True acupuncture has been shown to be superior and have clinically relative benefits for at least 24 weeks in migraines prophylaxis including reducing the number of migraine frequency and days with migraine as well as decreasing the pain intensity. To see some of the studies that have been done looking at acupuncture effectiveness for migraine headaches, click the links at the end of this blog!
Other Suggestions for Migraine Treatment and Prevention:
In addition to acupuncture treatments, your acupuncture can work with you on lifestyle and dietary recommendations in order to treat and prevent migraines. It is known that certain foods tend to trigger migraine attacks. Your acupuncturist can work with you to discover what those triggers may be and ways to eliminate or decrease them from your diet. Your acupuncturist can also recommend foods that can be nourishing and help to prevent migraines or foods/drinks that may help when you are experiencing a migraine attack such as peppermint tea.
Essential oils can also be helpful during migraine attacks such as lavender essential oil or oils from the mint family which have been studied and found to be effective and safe for treatment of acute migraine pain.
Other suggestions that your acupuncturist can partner with you on are exercise routines, meditation practices and deep breathing exercises that can reduce stress levels, bring energy down from the head to reduce pain levels and improve circulation throughout the body.
Important lifestyle changes that are recommended to reduce the frequency of headaches include:
- Adequate sleep - 7-8 hours a day
- Avoiding physical or mental fatigue as much as possible. Listen to your body & rest when you need to.
- Avoid alcohol - especially red wine
- Avoid caffeine products
- Keep hydrated with WATER!!
- Keep a headache diary to be able to see if there is a pattern to when you get attacks
- Exercise regularly with mild aerobic activity such as walking, swimming or cycling - sudden, intense exercise can cause headaches.