Golden Needle Practitioner Library

abstracted & translated by

Honora Lee Wolfe, Dipl. Ac, Lic. Ac., FNAAOM

Keywords: Chinese medicine, acupuncture, migraine, vascular headache

Migraine headaches, also called vascular or neurovascular headaches, are one of the commonly seen complaints in the Western practice of acupuncture. Migraines are defined as paroxysmal headaches which last 4-72 hours, are throbbing in quality and moderate to severe in intensity, are typically worse with exertion, are commonly one-sided, and are associated with nausea, vomiting, or sensitivity to light, sound, or smell. Approximately 24 million Americans suffer at least occasionally from migraines, and more than 50% of these sufferers have a family history of migraine.  In addition, more women than men suffer from migraines, migraines commonly first appear around puberty and often disappear around menopause. However, in some cases, migraines can actually begin or worsen perimenopausally. According to Western medicine, the cause and pathophysiology of migraines is not fully known. Changes in brain ans scalp arterial blood flow occur, but whether vasodilation and vasoconstriction are the cause or the effect of the migraine is as yet unclear. The Western medical treatment of migraine is divided into three stages: prophylactic, abortive, and analgesic, and treatment primarily depends on the frequency of attacks. However, the Western medical treatment of migraine headaches is not ideal and, therefore, many sufferers of this condition search for alternative therapies. In issue #2, 2002 of Zhong Guo Zhen Jiu (Chinese Acupuncture & Moxibustion), Lei Jing-he et al. published an article titled, “Clinical Observations on the Treatment Efficacy of Acupuncture on 126 Cases of Vascular Headache Treated by Selecting Acupoints Via the Channels.” This article appeared on pages 87-88 of that journal, and a precis of it is presented below.

Cohort description:

All of the patients in this study were out-patients on their first visit to the Chinese authors’ hospital, and all  were diagnosed as suffering from migraine based on the International Criteria for Classification and Diagnosis of Headache published by the International Association of Headache in 1998. Blood analysis, liver function, electrocardiogram (ECG), electroencephalogram (EEG), CT scan of the head, and routine examination of the nervous system were carried out, and patients who test positive for neurological disorders were excluded. After testing and diagnosis, patients were randomly assigned to two groups, a so-called acupuncture group and a comparison group. There were 126 cases in the acupuncture group of whom 54 were male and 72 were female, aged 18.5-69 years with a median age of 38.9 ± 5.4 years. The shortest duration of illness was three months and the longest was 18.5 years, with an average disease duration of 5.8 ± 2.2 years. Ninety-one of these cases mainly suffered temporal pain, 13 cases mainly suffered frontal pain, four cases mainly suffered occipetal pain, while the other 18 cases experienced generalized head pain.

In the comparison group, there were 72 cases, 28 males and 44 females, 15.5-73 years of age, with a median age of  39.4 ± 3.9 years. These patients had suffered from migraines from five months to 21 years, with a mean disease duration of 5.2 ± 3.0 years. Fifty-two of these cases mainly suffered temporal pain, five cases mainly suffered frontal pain, three cases mainly suffered vertex pain, four cases mainly suffered occipetal pain, and eight cases suffered generalized head pain. Therefore, in terms of sex, age, disease conditions, and disease duration, there were no marked statistical differences between these two groups.

Treatment method:

In the acupuncture treatment group, acupoints were selected along the channel(s) which traversed the site(s) of pain. For temple pain, Jiao Sun (TB 20), Tai Yang (M_HN-9), Zhong Zhu (TB 3), and Zu Lin Qi (GB 41) were selected as the main points, while Wai Guan (TB 5), Yang Fu (GB 38), and a shi points were selected as auxiliary points. For frontal pain, Shen Ting (GV 24), Yin Tang (M_HN-3), Tou Wei (St 8), He Gu (LI 4), and Xian Gu (St 43) were selected as the main points, and Qu Chi (LI 14) and Jie Xi (ST 41) were chosen as auxiliary points. For occipetal pain, Yu Zhen (Bl 9), Tian Zhu (Bl 10), Hou Xi (SI 3), and Shen Mai (Bl 62) were selected as the main points, and Wan Gu (SI 4) and Kun Lun (Bl 60) were chosen as auxiliary points. For generalized head pain, Bai Hui (GV 20), Jiao Sun (TB 20), Tou Wei (St 8), Yin Tang (M_HN-3), and Tian Zhu (Bl 10) were selected as the main points, and Feng Chi (GB 20), He Gu (LI 4), Hou Xi (St 41), Zu Lin Qi (GB 41), and Jie Xi (St 41) were selected as auxiliary points. During the acute stage, strong manipulation was applied to create the strongest needling sensation the patient could bear. The needles were retained for 10_15 minutes, and treatment was given once or even twice each day for patients suffering severe pain. During remission, even supplementing-even draining method was applied, with treatment given once per day and the needles retained for 30 minutes. Six days equaled one course of treatment, and one day’s rest was allowed between successive courses. Treatment outcomes were assessed after four such courses.

Members of the control group mainly received oral administration of analgesics and Valium (diazepam) during the acute stage, and Prilue (?), 20mg T.I.D., and Nimotop (nimodipine), 30mg T.I.D., administered orally during remission. Six days equaled one course of treatment in this group as well, with an interval of one day between courses. Likewise, treatment outcomes were assessed after four courses.

Treatment outcomes:

Initial assessments of severity of pain and final outcomes were based on the Visual Analogue Scale which patients used to self-assess the degree of their pain. On a scale of 0_10, zero meant that the patient felt no pain and 10 meant that the patient felt the most severe pain imaginable. Cure was defined as a pain scale rating of zero after treatment. Some effect was defined as a pain scale rating which was decreased by more than three units or stages from before to after treatment. No effect meant that the pain scale rating was decreased by less than three units or stages from before to after treatment. Comparison of cumulative scores of pain between the two groups indicated that there was no statistically significant difference (P > 0.05) before treatment. However, after treatment, there was a significant difference (P < 0.01) between these two groups. Comparison of the cumulative scores before and after treatment in the two groups showed that both acupuncture and Western medicine were able to decrease the cumulative pain score but that acupuncture treatment was superior to Western medicine in analgesic effect. In the acupuncture treatment group, the cure rate was 61.11%, the rate for some effect was 25.40%, and the total amelioration rate was 86.51%. In the comparison group, the cure rate was 38.89%, the rate for some effect was 31.94%, and the total amelioration rate was 70.83%. Thus there were significant differences between these two groups in terms of the cure and the total amelioration rates (P < 0.01).

Discussion:

Unfortunately, it is not clear what the first prophylactic Western medicine is in the above study. Nimodipine is a calcium channel blocker which is sometimes used for migraine prophylaxis. Typically, in the West, it is used for at least two to three months before evaluating its effectiveness. It is also a clinical fact that no Western prophylactic therapy is effective until or unless the patient has effected a major reduction in analgesic use, but there is no discussion of this in this study. Therefore, it seems to me that there may be some shortcomings with the Western medical arm of this study. Nevertheless, the acupuncture arm of this study appears quite standard to me. A combination of local (or main) points are combined with distant (or auxiliary) points on the channel which traverses the primary area of pain. Such a combination of local and distant points is characteristic of contemporary Chinese acupuncture and should be familiar to every practitioner who has studied this style.

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