"Acupuncture is at least as effective, or possibly more effective [in the treatment of migraines] than prophylactic drug treatment, and has fewer side effects."
this is the conclusion of a highly respected scientific research study published in the Cochrane Review Database (the gold standard) in 2009.
Migraines are one of the 10 most disabling medical illnesses on earth (W.H.O.) with more than 90% of sufferers having to significantly change their lives because of them. In this post we will look at what migraines are according to western medicine (biomedicine) and discuss how we think of them and more importantly how we treat them in Chinese Medicine.
Two of the things that makes diagnosing and treating migraines difficult for western medicine are that 1) the causes are unknown and 2) the pattern of symptoms is highly individual to each patient. In Chinese Medicine we look at migraines not as a specific malady, but as a constellation of symptoms that point towards a pattern of disharmony. We treat to balance the pattern of disharmony and to unwind the knots of "symptom-trauma". Once balance has been established, the symptoms will resolve.
If you prefer to skip past the western medical information, scroll down ...
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BIOMEDICINE (western medicine)
Over 37 mil. Americans (12% of the population) and 1 out of every 7 people worldwide get migraines.
Women have migraines 2-3 times more frequently, and incidence is increased in people who have disturbed sleep, mood imbalances or epilepsy.
10% of children have migraines and "colic" may be an early sign of pediatric migraines.
If a parent gets migraines there is a 50% chance that the child will as well.
DIAGNOSIS / PRESENTATION:
Doctors of biomedicine will diagnose a migraine if, during their life, a person has 5 or more severe headaches that are without specific cause, that last between 4 and 72 hours and that are accompanied by nausea or light and sound sensitivity.
Migraine headaches are very often throbbing and one sided, but can include other patterns of headache. Occasionally migraines will occur without a headache at all.
Only 25% of migraine sufferers experience "aura" or a period of sensory disturbance that may include seeing zig-zags or dots in the visual field, tingling on the skin or decreased ability to form words and sentences. The prodromal (preceding) period may also include food cravings, mood changes, uncontrollable yawning, fluid retention or increased urination.
Often sufferers will experience a lengthy period of exhaustion, confusion or weakness after a migraine that can last a day or longer.
A diagnosis of Chronic Migraine means that there are headaches at least 15 days per month and that at least 8 of those are classic migraines or those which respond to medications used in acute migraine attacks (see below for medications).
Women may experience migraines that worsen during menstruation, menopause and menarche. Migraines may worsen or improve during pregnancy.
Though the cause of migraines is not known in biomedicine, there are some suggestions that a genetic component allows for hypersensitivity to changes in the internal environment (hormonal and neurological changes) or external environment (barometric pressure, travel, seasonal shift etc). It used to be thought that the vascular system was involved but recent research points to the brain as being the origin of migraine syndromes.
TRIGGERS & RISK FACTORS:
Certain triggers may increase chances of sufferers having a migraine:
red wine, certain foods and skipping meals
too much sensory stimulation, loud environments, weather and seasonal changes
hormonal changes such as fluctuating estrogen levels, HRT and oral contraceptives
head trauma, neck pain, TMJ
pain medications wearing off (rebound migraines)
Though migraines are not usually a medical emergency, there are some signs that need an immediate check from a doctor to rule out other problems.
Onset of head pain is sudden (within a few seconds) and extremely severe. This is a "thunderclap headache" and could indicate severe health concerns.
When migraines start after 50, there could be some issues that need an MD's attention.
When headaches are accompanied by fever and altered mental state or confusion you will want to see a doctor immediately to rule out Meningitis or other potentially deadly infections.
When cognitive or mental changes persist or are more severe than simple temporary confusion there could be something more serious going on.
There are two basic categories of drug therapies, Acute and Preventative:
ACUTE: This includes Triptans, Ergot Alkaloids and analgesics. PREVENTATIVE: The 3 classes of preventative medications are Anti-hypertensives, Anti-Convulsants and Anti-depressants. OTHER: Treatments may include Botox injections to paralyze related muscle tension systems and Aimovig which blocks one chemical pathway thought to contribute to migraines.
A note on the Chinese Medicine approach to diagnosis and treatment: We do not treat the "disease", we treat the "pattern." Each person will present differently and we treat each presentation with a different set of techniques, tools and prescriptions to counteract or balance the pattern of disharmony that leads to the symptoms.
There is a lot of good research coming out that suggests acupuncture as a treatment for migraines, but the two most important studies are these:
In 2009, a Cochrane Systematic Review (the gold standard) by Linde et al. concluded that "Acupuncture is at least as effective, or possibly more effective (bold added) than prophylactic drug treatment, and has fewer side effects."
In 2019, a follow-up review by Trinh et al. reinforced the original paper by Linde by stating that the effects of acupuncture on migraines should not be understood as placebo.
There are of course as many possibilities for patterns contributing to migraine symptoms as there are people suffering from them. However here are some of the most commonly seen examples along with suggestions for how we might treat each one.
Liver Qi Stagnation: One of the most common patterns in our modern culture, Liver Qi Stagnation is classically associated with stress and emotional tension and is additionally related to menstrual disharmony in women. Symptoms will very often include a frontal or temporal headache, or a dull aching band around the head. Headaches are sometimes more constant than throbbing and may develop into pain around or behind the eyes. Headaches will often start upon rising in the morning. There will often also be muscle tension, digestive upset, nausea or reflux, visual symptoms, PMS, sleep disturbances, exhaustion and/or irritability. This pattern is caused by a constraint and upset in one of the systems that benefits most from easy gentle movement (Gan - Liver) and that suffers from stress, lack of easy regularity and irritation. We treat this pattern with herbs that sooth the Gan (Liver system) and nourish the blood.
Liver Yang Rising: This is a commonly seen pattern in patients with migraine and can be seen as a development of the previous pattern. Symptoms may tend toward headaches at the top of the head, along the eyebrow ridge, behind the eyes or pulsing at the temples and will often be quite severe. There will often be visual zig-zags or dots, red bloodshot eyes, dizziness, night sweats, irritability and anger, insomnia and/or a sensation of heat in the head, chest or palms. This pattern is caused by an imbalance between the body information or energy (Qi) rising up to the head and the anchoring, nourishing substance that keeps that information grounded. Normally the uprising and the downward anchoring directions are balanced in the body and support each other, however if the nourishing substance of the body decreases and can no longer anchor the uprising of energy around stressful events, this pattern may emerge. We treat this pattern with points and herbs that help to nourish and stimulate the strong anchoring substance of the body, increase the quality of the blood and "Yin", and soften the uprising of un-moored energy.
Wind Dampness: One of the patterns that has a larger correlation with weather and seasonal shifts, especially rainy wet weather is Wind Dampness. Headaches are very often dull and frontal with a sensation of cloudiness or heaviness in the head. Very often there will also be heavy lethargic limbs, achey joints, sinus or nasal congestion, loss of appetite or nausea and a decreased sense of taste or smell. The treatment is to resolve Dampness by supporting the body's fluid metabolism. This approach focusses on points and herbs that treat the external protective layers of the body as well as the digestive system. Because Dampness will always inhibit movement of blood and "Qi", herbs and points that invigorate and course are often the key.
Blood Stasis: Another pattern that involves things being "stuck" is blood stasis. In Chinese Medicine the quality and movement of the blood are of prime importance to the health of the person. The movement of blood can be inhibited or blocked by long term illness, sedentary lifestyle, trauma or injury, a decrease in amount or quality of the blood and/or a weakness in the system that propels the blood. Symptoms may include headaches that are sharp and in a specific location that the sufferer can point to, often at the temple, above the eyebrow or behind the eyes. There may also be purplish dusky areas under the eyes or at the nail beds, irritability, dark spider veins on the lower legs and feet, and menstrual complaints. Famously it is said that with any chronic pain condition, or a condition that is resistant to treatment, blood stasis is involved. The treatment revolves around acupuncture points and herbs that move the blood. In cases where the stasis comes from deficiency it is also necessary to nourish the quality of the blood.
Again, there are many more patterns to consider when treating migraines and it should be noted that patterns may combine. You could, for example have a Wind Damp with Blood Stasis pattern that might start off with a dull heavy full sensation in the head, aversion to eating or nausea and fatigue that develops into a sharp or throbbing localized pain above the eyes. Treatment in this case would combine the techniques from the two patterns or would start with the treatment of one pattern and then change over time to the treatment of the other.
Acupuncture and Herbal Medicine will often form the base of the treatment of migraines, but GuaSha (a system of light skin scraping) has been demonstrated to be very useful. In cases where Blood Stasis is a factor "pricking the vessels" (where we gently prick to bleed, similar to a blood prick for a glucose test) is incredibly important. Cupping Therapy can be very useful as a preventative tool as it encourages circulation, disperses accumulation of toxins and relaxes the muscles and connective tissues.
To learn more about our approach to Acupuncture and Chinese Medicine, visit us online at www.uprightacupuncture.com
As always, if you have any questions or would like to suggest a topic for our monthly article series please write to firstname.lastname@example.org
Have a wonderful month!
Andrew & Marielle
Systematic Review of Episodic Migraine Prophylaxis: Efficacy of Conventional Treatments Used in Comparissons with Acupuncture; Trinh KV1, Diep D2, Chen KJQ1.; Med Acupunct. 2019 Apr 1;31(2):85-97. doi: 10.1089/acu.2019.1337. Epub 2019 Apr 19
Merck Manual; https://www.merckmanuals.com/professional/neurologic-disorders/headache/migraine?query=migraines ; sourced May, 2019
American Migraine Foundation; https://americanmigrainefoundation.org/resource-library ; sourced May, 201