acupuncture in therapy of migraine
DESCRIPTION
The article discusses the clinical issues about migraine, the incidence, causes, presentation and the therapy by using acupuncture as an effective approachTRANSCRIPT
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Acupuncture in Therapy of Migraine
What is Migraine? Migraine is a chronic neurological disorder characterized by moderate to severe
headaches, and nausea. It is about three times more common in women than in men.
A typical migraine headache is experienced as a pulsatile pain on one side of the head
and lasts from two to 72 hours with various symptoms that include nausea, vomiting,
photophobia (increased sensitivity to light) and phonophobia (increased sensitivity to
sound). These symptoms are generally aggravated by any routine activity. About one-
third of people who suffer from migraine headaches perceive an aura, a transient visual,
sensory, language, or motor disturbances that signals the oncoming bout of migraine.
Prodromal symptoms occur in 40–60% of those with migraines. This phase may consist
of altered mood, irritability, depression or euphoria, fatigue, yawning, excessive
sleepiness, craving for certain food (e.g. chocolate), stiff muscles (especially in the neck),
dizziness, hot ears, constipation or diarrhea, increased or decreased urination, and other
visceral symptoms. These symptoms usually precede the headache phase of the migraine
attack by several hours or days, and experience teaches the patient or observant family
how to detect a migraine attack is near.
About 20–30% of migraine sufferers who experience an aura that comprises focal
neurological phenomena that precede or accompany the attack. They appear gradually
over five to 20 minutes and generally last fewer than 60 minutes. Symptoms of migraine
aura can be sensory or motor in nature. Visual aura is the most common of the
neurological events, and can occur without any headache. There is a disturbance of vision
consisting often of unformed flashes of white and/or black or rarely of multicolored lights
or formations of dazzling zigzag lines. Some patients complain of blurred or shimmering
or cloudy vision, as though they were looking at an area above a heated surface, looking
through thick or smoked glass, or, in some cases, tunnel vision or partial temporary loss
of vision.
Pain of Migraine The pain of migraine is invariably accompanied by other features. Nausea occurs in
almost 90 percent of patients, and vomiting occurs in about one third of patients. Blurred
vision, delirium, nasal stuffiness, diarrhea, tinnitus, polyuria, pallor, or sweating may be
noted during the headache phase. There may be localized edema of the scalp or face,
scalp tenderness, prominence of a vein or artery in the temple, or stiffness and tenderness
of the neck. Impairment of concentration and mood are common.
Treatment of Migraine Initial treatment of migraine is with analgesics for the headache, an antiemetic for the
nausea, and the avoidance of triggers. Common triggers quoted for migraine are stress,
hunger, and fatigue (these equally contribute to tension headaches). Monosodium
glutamate (MSG) is frequently reported as a dietary trigger. Migraines are more likely to
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occur around menstruation. Other hormonal influences, such as menarche, oral
contraceptive use, pregnancy, perimenopause, and menopause, also play a role.
Cause of Migraine Although the cause of migraine headache is unknown; the most supported theory is that it
is related to hyperexcitability of the cerebral cortex and abnormal control of pain neurons
in the brainstem. Fluctuating hormone levels also have a relation to migraine as is known
that 75 percent of adult patients are women. Migraines were once thought to be initiated
exclusively by problems with blood vessels, but the vascular changes of migraines are
now considered by some researchers to be secondary to brain dysfunction
Migraines are underdiagnosed, and often are misdiagnosed. Migraine should be
differentiated from other causes of headaches, such as cluster headaches. These are
extremely painful, unilateral headaches of a piercing quality. The duration of the common
attack is 15 minutes to three hours. Onset of an attack is rapid, and most often without the
preliminary signs characteristic of a migraine. Medical imaging of the head and neck may
be used to rule out secondary causes of headaches.
Prevention of Migraine Preventive migraine drugs are considered effective if they reduce the frequency or
severity of migraine attacks by at least 50%. The major problem with migraine preventive
drugs, apart from their relative inefficacy, is that unpleasant side effects are common. So,
preventive medication is limited to patients with frequent or severe headaches.
Many medicines are available to prevent or reduce frequency, duration and severity of
migraine attacks. They may also prevent complications of migraine. However, there are
no drugs available to permanently cure migraine.
Medications are more effective if used earlier in an attack. The frequent use of
medications may, however, result in medication overuse headache, in which the
headaches become more severe and more frequent. These may occur with triptans,
ergotamines, and analgesics, especially narcotic analgesics. Also, long-term side effects
are known with all these drugs.
Complications of Migraine
The risk of stroke may be increased two- to three-fold in migraine sufferers. Young adult
sufferers and women using hormonal contraception appear to be at particular risk.
Migraine sufferers seem to be at risk for both thrombotic and hemorrhagic stroke as well
as transient ischemic attacks.
Incidence of Migraine Worldwide, migraines affect more than 10% of people. In the United States, about 6% of
men and 18% of women get a migraine in a given year. Based on the results of a number
of studies, one-year prevalence of migraine ranges from 6–15% in adult men and from
14–35% in adult women. In India, it has been reported that the prevalence of migraine is
9% among boys and 14% in girls. A rapid growth in incidence amongst girls occurs after
puberty, which continues throughout early adult life.
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Acupuncture in Migraine Acupuncture has been studied as a treatment for migraine headache for more than 20
years. Researchers do agree that acupuncture appears safe and that it may be effective for
many people. Results from a study published in 2003 suggest that receiving an
acupuncture treatment when migraine symptoms first begin is as effective as taking any
standard medication.
Many people who visit an acupuncturist's office come with a history of chronic headache.
While a headache may sometimes be a warning sign of a more serious medical condition,
most types of headache seen by an acupuncturist are either a tension headache, migraine,
or a combination of both.
For migraines, acupuncture treatment depends on whether the patient comes experiencing
acute pain or is seeking preventative treatment in between migraine attacks. Prevention
should be the long-term goal.
Acupuncture has been quite effective for managing the acute pain of mild to moderate
migraine attacks. A typical acupuncture treatment involves the insertion of fine needles
into acupuncture points on the body followed by gentle manipulation of the needles.
Minimization of activity of the blood vessels in the head and neck during a migraine
attack is beneficial and is done by limiting the acupuncture points selected to those on the
arms and legs. In certain situations, a high frequency (100 Hz) electrical current may be
used with the acupuncture needles to help constrict the blood vessels.
Acupuncture has been quite useful for migraine prevention also. Researchers have found
that people living in fast-paced business centers tend to have an imbalance in the
autonomic nervous system. This type of imbalance is associated with other health
conditions such as heart disease, insomnia, high blood pressure, and premenstrual
syndrome. In order to harmonize the autonomic nervous system, a special acupuncture
technique called SES is used.
Acupuncture can help in the treatment of migraine by:
1. Providing pain relief
2. Reducing inflammation in neural vesels
3. Reducing the degree of cortical spreading depression, an electrical wave in
the brain associated with migraine
4. Reduce plasma levels of calcitonin gene-related peptide and substance P.
5. Modulating extracranial and intracranial blood flow.
6. Affecting serotonin (5-hydroxytriptamine) levels in the brain thereby
influencing overall function.
7. Promoting homoeostasis and restoring normalcy
Acupuncture is a tried and tested system of traditional medicine, which has been used in
China and other eastern cultures for thousands of years to restore, promote and maintain
good health. Its benefits are now widely acknowledged all over the world and in the past
decade traditional acupuncture has begun to feature more prominently in mainstream
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healthcare in the UK. In conjunction with needling, techniques such as moxibustion,
cupping, massage or electro-acupuncture are also used. Traditional acupuncture takes a
holistic approach to health and regards illness as a sign that the body is out of balance.
The exact pattern and degree of imbalance is unique to each individual. The precise
nature of the underlying disharmony and selection of the most effective treatment leads to
a permanent cure. The choice of acupuncture points will be specific to each patient’s
needs. Traditional acupuncture can also be used as a preventive measure to strengthen the
constitution and promote general well-being.
From a biomedical viewpoint, acupuncture is known to stimulate the nervous system,
influencing the production of the body’s communication substances - hormones and
neurotransmitters. The resulting biochemical changes activate the body's self-regulating
homeostatic systems, stimulating its natural healing abilities and promoting physical and
emotional well-being.