10 Jan How Acupuncture Treats Migraines & Tension Headaches
Acupuncture Treats Migraines & Tension Headaches
The following is an excerpt from a thesis written on the treatment of headaches with acupuncture. Headaches are complex and in the clinic there is much crossover between headaches (migraines & tension) and their symptoms. Modern medicine often time lacks the understanding that people are far more complex and due to a set of rigid guidelines many people are misdiagnosed and medicated for a condition they don’t have.
The Versatility of Acupuncture in Treating Cervicogenic Headaches
Dr. Philip Kish
“Neck pain and cervical muscle tenderness are common and prominent symptoms of primary headache disorders, less commonly head pain may actually arise from bony structures or soft tissues of the neck, a condition known as a ‘Cervicogenic Headache.’ Cervicogenic headaches a perplexing pain disorder that is refractory to treatment if it is not recognized. The condition’s pathophysiology and source of pain have been debated, but the pain is likely referred from one or more muscular, neurogenic, osseous, articular, or vascular structures in the neck” (Biondi, 2001). The current standard of treatment for Cervicogenic Headaches includes “a multifaceted approach using pharmacologic, nonpharmacological, manipulative, anesthetic, and occasionally surgical interventions. Medications alone are often ineffective or provide only modest benefit for this condition” (Biondi, 2001).
With such great depravity and debate on the cause and treatment of cervicogenic headaches it is important to provide a treatment modality that has the versatility to encompasses all of the potential causes and treat all the symptoms. The following article will give you a small glimpse at a few of the studies proving that acupuncture has the ability and versatility to treat the ever-elusive cervicogenic headache.
It’s important to diagnose the condition properly. “Patients with cervicogenic headache will often have altered neck posture or restricted cervical range of motion. The head pain can be triggered or reproduced by active neck movement, passive neck positioning especially in extension or extension with rotation toward the side of pain, or on applying digital pressure to the involved facet regions or over the ipsilateral greater occipital nerve. Muscular trigger points are usually found in the sub-occipital, cervical, and shoulder musculature, and these trigger points can also refer pain to the head when manually or physically stimulated. There are no neurologic findings of cervical radiculopathy, though the patient might report scalp paresthesia or dysesthesia” (Biondi, 2001).
Acupuncture Impacts Blood Flow:
The neck plays a critical role in nerve conduction and blood supply throughout the entire body and blockage of this arterial and neurogenic flow has been purported to cause cervicogenic headaches. Acupuncture (Chinese Medicine) looks at these blockages and or injuries as a stagnation of Qi and blood caused by trauma or overuse. As a result of our societies dependence on technology and unfavorable biomechanics these issues have become more prominent. Acupuncture aids in the alleviation of neck pain and headache like conditions including cervicogenic headaches by increasing cerebrovascular blood flow. Researchers measured increased blood flow of the middle cerebral artery (MCA) and anterior cerebral artery (ACA) during acupuncture. Although blood flow increased, the heart rate and blood pressure did not, which can be of concern to some people and conditions. “The data suggest that GV20 acupuncture treatment increases cerebral blood flow. The results of this small-scale study provide preliminary evidence for acupuncture effectiveness”(Byeon et al., 2011).
Cervical arterial circulation overlaps with point location of the Large Intestine (LI) and Stomach (ST) meridian points on the neck. In particular, LI 17 (Futu), LI 18 (Tianding), St 9 (shuitu), ST 11 (Qishe), Hou Tou Jia Ji (HTJJ), and Jing Ji cervical acupuncture points. Another study measured the impact of acupuncture on GB 20 (Fengchi) in treating disorders of posterior cerebral circulation and the study supports the idea that particular acupuncture points affect specific brain regions and cerebral arteries while increasing the activation of Myosin Light Kinase of the middle meningeal artery indicating acupunctures effectiveness at preventing Headaches (Peijuan, Aicheng, Bai, Chunyan, & Yu, 2015). Research clearly shows that Acupuncture causes increased blood flow to the brain which has a direct impact on different areas of the brain that control different sympathetic and parasympathetic events which directly impact the endocrine system, Blood pressure, heart rate,, etc., all of which could potentially have an impact on headaches.
Acupuncture Impacts Nerve Conduction
The Cleveland Clinic says that Headache pain results from signals interacting among the brain, blood vessels, and surrounding nerves. During a headache, specific nerves of the blood vessels are activated and send pain signals to the brain. (Cleveland Clinic, 2018) We know that acupuncture has an impact on the blood vessels. Now we will discuss how acupuncture interacts with the nerves. Acupuncture plays a role in the regeneration of damaged nerves. Findings published in Neural Regeneration Research show through an electromyography nerve conduction test of acupuncture patients with nerve injuries “an effective response” in 80% of the patients. Research was conducted utilizing the “Du” Meridian which happens to run over the spinal cord. “In conclusion, electro acupuncture on specific ‘Governing vessel acupoints’ appears to effectively promote functional repair after peripheral nerve injury. The mechanism may relate to the Governor vessel improving the local microenvironment and ensuring continuity between the peripheral and central nerve” (Ruan, et al., 2015).
Acupuncture Impacts Motor and Trigger Points:
Another way in which acupuncture helps to treat and prevent headaches is by relaxing muscles and treating ‘trigger points’ which may be causing headaches. “Trigger points are areas in muscle that are very irritable, show a band of tightness in the area of muscle itself, and, when pressed, produce a twitch within the affected muscle. A trigger point may produce not only pain in the affected muscle, but in a distant area, including locations in the head and neck, called referred pain.Trigger points may develop because of trauma, injury, inflammation, or other factors” (American Migraine Foundation, 2018). There are two types of Trigger Points; latent trigger points and active trigger point. A latent trigger point is a trigger point that is there but doesn’t caused referred pain during movement or palpation. An active trigger point is a trigger point that is physically prominent and when palpated causes referred pain to other areas of the body. “Trigger points located in the sternocleidomastoid sends referred pain to the supraorbital
area in the brow. Trigger points in the upper trapezius sends referred pain to the forehead and temples. Both of these Trigger Points can cause headaches. Other known muscles contributing to Headaches include the masseter, sub occipitals, splenius capitis, splenius cervicis, semispinalis, temporalis, frontalis, and middle trapezius. If treated properly with trigger point acupuncture the active trigger points will become latent trigger points. A “change in trigger point status is associated with a statistically and clinically significant reduction in pain. Reduction of pain is associated with improved mood, function, and level of disability” (Travell, Simons, & Simons, 1993).
Acupuncture Impacts the Neuroendocrine System
Some of the most exciting research coming out to date shows the connection between acupuncture and and how it impacts different brain networks which releases a multitude of neuropeptides and biochemicals responsible for pain relief. Acupuncture increases the bodies’ endorphins, the bodies innate, natural pain killers. The release of these endorphins can have an impact on the bodies serotonin levels which relaxes the autonomic nervous system. “Acupuncture therapy evoked short-term increases in MOR (Mu Opiate Receptor) binding potential, in multiple pain and sensory processing regions including the cingulate (dorsal and subgenual), insula, caudate, thalamus, and amygdala. Acupuncture therapy also evoked long-term increases in MOR binding potential in some of the same structures..” Long-term increases in MOR BP following Chinese Acupuncture were also associated with greater reductions in clinical pain. These findings suggest that divergent MOR processes may mediate clinically relevant analgesic effects for acupuncture and sham acupuncture.“Within 45 minutes of the needling session, the number of free opioid receptors in the patients’ brains didn’t fall; it surged. “I was completely floored,” he said. Whatever the acupuncture was doing, it wasn’t working as a placebo (Fleckenstein, Harris, Zubieta, & Scott, 2009).
Another study by Ji Shen-Han called Acupuncture and Endorphins shows that “Endogenous opioid peptides inhibit pain both in the central nervous system and in the periphery. Acupuncture triggers the release of opioid peptides at the level of the spinal cord and in the brain leading to activation of MOR and sometimes other opioid receptors. In the periphery, opioid peptide-induced antinociception seems to involve MOR, DOR and KOR at the site of pain. (Han, 2004)” Their is new research that extends “these findings by demonstrating that electroacupuncture stimulated the increased numbers of leukocytes (macrophages) containing the three opioid peptides END, ENK, and DYN and that all three opioid peptides mediated antinociception to thermal and mechanical stimuli..” What this means is that acupuncture releases numerous natural opioid receptors and or peptides which dull the nociceptive pain response which leads to relaxation of the muscles and other structures associated cervicogenic derived headaches.
It is important to note that acupuncture has a sophisticated system of pathology and diagnosis that is so complex that science is struggling to catch up to this intricate and ancient modality. Certain aspects of acupuncture and its effectiveness simply can’t be determined due to the complexity of acupunctures mechanism of action. With that being said, based on our current understanding and the ever increasing research it’s clear to see that the breadth of acupuncture is so great that you can’t deny it’s effectiveness regardless of its’ mechanism(s) of action. With acupunctures versatility it should be viewed as an efficacious non-pharmacological intervention in the fight against non-specific tension type cervicogenic headaches and shows great potential for many other conditions moving forward.
Philip Kish Owns Optimal Movement. He graduated from Metropolitan State University with a degree in Entrepreneurial Studies, completed his Master’s Degree in Acupuncture from Northwestern Health Sciences, and his Doctorate in Acupuncture from Pacific College of Oriental Medicine. Dr. Kish’s focus is in pain and performance, and everything in between.
American Migraine Foundation. (2018). The Basics of Trigger Point Injections for Headache and Migraine. Retrieved February 10, 2018, from https://americanmigrainefoundation.org/understanding-migraine/the-basics-of-trigger- point-injections-for-headache-and/
Biondi, D. M. (2001). Cervicogenic headache: Diagnostic evaluation and treatment
strategies. Current Pain and Headache Reports,5(4), 361-368. doi:10.1007/s11916-001- 0026-x
Byeon, H., Moon, S., Park, S., Jung, W., Park, J., Ko, C., . . . Bae, H. (2011). Effects of GV20 Acupuncture on Cerebral Blood Flow Velocity of Middle Cerebral Artery and Anterior Cerebral Artery Territories, and CO2Reactivity During Hypocapnia in Normal Subjects. The Journal of Alternative and Complementary Medicine,17(3), 219-224. doi:10.1089/acm.2010.0232
Cleveland Clinic. (2018). Headaches in adults. Retrieved February 10, 2018, from https://my.clevelandclinic.org/health/diseases/9639-headaches-in-adults-overview
Han, J. (2004). Acupuncture and endorphins. Neuroscience Letters,361(1-3), 258- 261. doi:10.1016/j.neulet.2003.12.019
Peijuan, Z., Aicheng, W., Bai, L., Chunyan, L., & Yu, W. (2015). Effect of acupuncture at Fengchi (GB 20) on the activity of myosin light chain kinase in the middle meningeal artery of migraine modeled rats. Journal of Traditional Chinese Medicine,35(3), 301-305. doi:10.1016/s0254-6272(15)30101-1
Ruan, J., Zhou, G., He, G., Zeng, Y., Zhou, X., & Ding, Y. (2015). Improvement in acupoint selection for acupuncture of nerves surrounding the injury site:electro-acupuncture with
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Fleckenstein, J., Harris, R., Zubieta, J., & Scott, D. (2009). Traditional Chinese acupuncture and placebo (sham) acupuncture are differentiated by their effects on μ-opioid receptors (MORs). Deutsche Zeitschrift Für Akupunktur, 52(4), 38-39. doi:10.1016/j.dza.2009.10.027
Wang Y, Gehringer R, Mousa SA, Hackel D, Brack A, Rittner HL. CXCL10 controls inflammatory pain via opioid peptide-containing macrophages in electroacupuncture. PLoS One. 2014;9(4):e94696. Published 2014 Apr 14. doi:10.1371/journal.pone.0094696
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