Complementary and integrative medicine in the management of headache

acupuncture and headaches

Acupuncture Research Has Matured

A recent State of the Art Review published in The British Medical Journal (Chen et al. 2017) takes a critical look at cupping, massage, acupuncture and yoga, but does not throw the baby out with the bathwater. This review along with recent recommendations from The American College of Physicians (Chou et al. 2017Qaseem et al. 2017) and Center for Disease Control (Frieden et al. 2016) represent a monumental shift in pain management.

Physicians, now more than ever are recommending conservative treatment including massage, acupuncture and exercise for patients suffering from pain.

Acupuncture for Headaches

Along those line, The British Medical Journal just published a State of the Art Review looking at the evidence base surrounding massage and acupuncture for patients who suffer from headaches (Millstine et al. 2017). It found that acupuncture and massage has been shown to be a therapeutic intervention that may lower headache frequency and intensity. 

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.

If a patient is interested in using acupuncture to manage headache symptoms there is actually a larger body of scientific evidence for acupuncture than most people are aware of. There is supporting evidence from The Cochrane Collaborative, Canadian Medical Association and other high quality systematic reviews:
• Chronic pain (MacPherson et al. 2017Vickers et al. 2012)
• Acute pain (Murakami et al. 2017)
• Tension-type headaches (Busse et al. 2017Linde et al. 2016)
• Migraines (Busse et al. 2017Linde et al. 2016Yang et al. 2016)

Mechanism of Action:

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).

More to Explore

There is a  growing body of evidence to support the use of acupuncture for people who suffer from migraines, so in this post I have taken the time to organize some of the recent research on the topic.

Migraine Brains and Bodies: C.M. Shifflett
Migraines: More than a headache Elizabeth Leroux
The Migraine Brain- Carolyn Bernstein

Related Research
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.

Busse, J.W., Craigie, S., Juurlink, D.N, ... Guyatt GH. (2017). Guideline for opioid therapy and chronic noncancer pain. CMAJ.

Chae, Y., Olausson, H. (2017). The role of touch in acupuncture treatment. Acupunct Med.

Chen, L., Michalsen, A. (2017). Management of chronic pain using complementary and integrative medicine. BMJ.

Coeytaux, R. R., & Befus, D. (2016). Role of Acupuncture in the Treatment or Prevention of Migraine, Tension-Type Headache, or Chronic Headache Disorders. Headache: The Journal of Head and Face Pain.

Frieden, T. R., & Houry, D. (2016). Reducing the Risks of Relief — The CDC Opioid-Prescribing Guideline. New England Journal of Medicine.

Jacobs, B., & Dussor, G. (2016). Neurovascular contributions to migraine: Moving beyond vasodilation. Neuroscience.

Ji, R.R., Chamessian, A., Zhang, Y.Q. (2016). Pain regulation by non-neuronal cells and inflammation. Science.

Linde, K., Allais, G., Brinkhaus, B., Fei, Y., Mehring, M., Shin, B., . . . White, A. R. (2016). Acupuncture for the prevention of tension-type headache. Cochrane Database of Systematic Reviews.

Linde, K., Allais, G., Brinkhaus, B., Fei, Y., Mehring, M., Vertosick, E. A., . . . White, A. R. (2016). Acupuncture for the prevention of episodic migraine. Cochrane Database of Systematic Reviews.

Langevin, H. M. (2014). Acupuncture, Connective Tissue, and Peripheral Sensory Modulation. Critical Reviews in Eukaryotic Gene Expression.

MacPherson, H., Vickers, A., Bland, M., Torgerson, D., Corbett, M., Spackman, E., ..., Watt, I. (2017). Acupuncture for chronic pain and depression in primary care: a programme of research. Southampton (UK): NIHR Journals Library.

Millstine, D., Chen, C., Bauer, B. (2017). Complementary and integrative medicine in the management of headache. BMJ.

Murakami, M., Fox, L., Dijkers, M.P. (2017). Ear Acupuncture for Immediate Pain Relief-A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Pain Med.

Nahin, R. L., Boineau, R., Khalsa, P. S., Stussman, B. J., & Weber, W. J. (2016). Evidence-Based Evaluation of Complementary Health Approaches for Pain Management in the United States. Mayo Clinic Proceedings.

Sawynok, J. (2016). Adenosine receptor targets for pain. Neuroscience.

Salazar, T.E., Richardson, M.R., Beli, E., ... Grant, M.B. (2017). Electroacupuncture Promotes CNS-Dependent Release of Mesenchymal Stem Cells. Stem Cells.

Schwedt, T. J. (2014). Chronic migraine. BMJ.

Tang, Y., Yin, H., Rubini, P., & Illes, P. (2016). Acupuncture-Induced Analgesia: A Neurobiological Basis in Purinergic Signaling. The Neuroscientist.

Vickers, A. J., Cronin, A. M., Maschino, A. C., Lewith, G., Macpherson, H., Foster, N. E., . . . Collaboration, F. T. (2012). Acupuncture for Chronic Pain. Archives of Internal Medicine.

Volkow, N.D., McLellan, A.T. (2016). Opioid Abuse in Chronic Pain--Misconceptions and Mitigation Strategies. N Engl J Med.

Yang, Y., Que, Q., Ye, X., Zheng, G.h. (2016). Verum versus sham manual acupuncture for migraine: a systematic review of randomised controlled trials. Acupunct Med.

Zhang, R., Lao, L., Ren, K., & Berman, B. M. (2014). Mechanisms of Acupuncture Electroacupuncture on Persistent Pain. Anesthesiology. (OPEN ACCESS)

Zhao, L., Chen, J., Li, Y., ... Liang, F. (2017). The Long-term Effect of Acupuncture for Migraine Prophylaxis A Randomized Clinical Trial. JAMA Intern Med.