Research Notes: Acupuncture and Migraines

Acupuncture for Migraine Headaches

Acupuncture as a therapeutic intervention is being embraced by the medical community. This is in part because it is a non-pharmacological therapeutic intervention that is simple to carry out, economical, and has very few side effects (Busse et al. 2017). One area that is being explored is the use of acupuncture to decrease the individual’s headache frequency, intensity, duration and acute medication requirements.

My first recommendation for those who suffer from migraines is to work with a physician to develop strategies to manage symptoms. Then treatment programs should be implemented based on patient-specific assessment findings and patient tolerance.

Acupuncture and Migraines

If a patient is interested in using acupuncture to manage migraine symptoms there is supporting evidence from The Cochrane Collaborative (Linde et al. 2016), Canadian Medical Association (Busse et al. 2017) and other high quality Systematic Reviews (Yang et al. 2016) and Randomized Control Trials (Zhao et al. 2017).

People often assume that acupuncture is synonymous with Traditional Chinese Medicine and that anyone who uses acupuncture does so based on 'qi' or 'meridians'. This is a misconception. Regardless of its theoretical basis, based on the traditional and official definition, the term acupuncture refers to the actual insertion of a needle into the body (Fan et al. 2016).

Acknowledging that traditional narratives outdated, medical acupuncture is an approach that is based upon a theory that is inline current scientific understanding of how the body works. Reframing acupuncture form of peripheral nerve stimulation technique in which acupuncture needles are inserted into anatomically defined sites, and stimulated manually or with electricity (White 2009).

Preferential sites for acupuncture stimulation are associated with areas rich in specialized sensory receptors such as muscle spindles, Golgi tendon organs, ligament receptors, Paciniform and Ruffini’s receptors (joint capsules), deep pressure endings (within muscle belly), and free nerve endings (muscle and fascia). All of these areas are highly innervated and as a result there are a number of physiological responses that help modulate the experience of pain.

Structures to be aware of when treating cervicogenic headaches

A treatment plan should be implemented based on patient-specific assessment findings and patient tolerance. Structures to keep in mind while assessing and treating patients suffering from migraine headaches may include neurovascular structures and investing fascia of:

  • Suboccipitals
  • Upper trapezius
  • Splenius Cervicis
  • Splenius Capitis
  • Levator Scapula
  • Rhomboids
  • Temporalis
  • Occipitofrontalis
  • Corrugator Supercilii
  • Masseter
  • Sternocleidomastoid
  • Temporomandibular Joint
  • Scalene Muscle Group
  • Trigeminovascular Nociceptive Pathway

Mechanism of Action

The British Medical Journal recently published a State of The Art Review looking at the evidence base surrounding acupuncture. It suggests that if you use Occam's razor, the insertion of an acupuncture needle is a form of novel stimuli, that functions by sending anti-nociceptive input to the neuroimmune system. This contributes to a number of physiological changes across different areas of the peripheral and central nervous systems, including peripheral receptors, dorsal horn of the spinal cord, brainstem, sensorimotor cortical areas, and the mesolimbic and prefrontal areas (Chen et al. 2017).

Is Acupuncture a Placebo?

The way we present ourselves and present our techniques is tied to clinical outcomes, the magnitude of a response may be influenced by mood, expectation, and conditioning. In any discussion on therapeutic effect it is important to acknowledge the placebo response.

It is also a within the realm of possibility that when acupuncture needles are inserted into anatomically defined sites, and stimulated manually or with electricity patients have a complex biopsychosocial response that INCLUDES but is not LIMITED to placebo. Several plausible theories attempt to explain how acupuncture works, this includes but is not limited to:
• The Gate Control Theory of Pain (Melzack & Wall 1984)
• The Release of Endogenous Opioids (Chen et al. 2017Yin et al. 2017)
• The Release of Endogenous Cannabinoids (McPartland et al. 2014Hu et al. 2017)
• Purinergic Signaling (Sawynok 2016Tang et al. 2016)
• Interactions Between Non-Neuronal Cells and Neurons (Ji et al. 2016Zhang et al. 2014)
• The Inflammatory Reflex (Chavan et al. 2014Lim et al. 2016Pavlov et al. 2017)
• Neuroplastic Changes Across Different Areas of the Peripheral and Central Nervous System (Chen et al. 2017)
• Sensory-Discriminative and Affective-Social Touch (Chae et al. 2017)
• Mesenchymal Stem Cells (Salazar et al. 2017
• Local Changes in Microcirculation (Kaneko et al. 2016)

More to Explore

Arendt-Nielsen, L., Castaldo, M., Mechelli, F., & Fernández-De-Las-Peñas, C. (2016). Muscle Triggers as a Possible Source of Pain in a Subgroup of Tension-type Headache Patients? The Clinical Journal of Pain.

Berchtold, V., Stofferin, H., Moriggl, B., Brenner, E., Pauzenberger, R., Konschake, M. (2017). The supraorbital region revisited: An anatomic exploration of the neuro-vascular bundle with regard to frontal migraine headache. J Plast Reconstr Aesthet Surg.

Bonaz, B., Sinniger, V., & Pellissier, S. (2016). Anti-inflammatory properties of the vagus nerve: Potential therapeutic implications of vagus nerve stimulation. The Journal of Physiology.

Borea, P. A., Gessi, S., Merighi, S., & Varani, K. (2016). Adenosine as a Multi-Signalling Guardian Angel in Human Diseases: When, Where and How Does it Exert its Protective Effects? Trends in Pharmacological Sciences.

Bove, G. (2013). Lending a hand to migraine. Pain.

Burstein, R., Noseda, R., Borsook, D. (2015). Migraine: multiple processes, complex pathophysiology. J Neurosci. (OPEN ACCESS)

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