About migraines
Around 95% of the general population have experienced a headache at some stage. 12% of the population suffers from migraine. Migraine is a common health condition, affecting around one in every five women and around one in every 15 men. Migraines reduce the quality of life, including increased depression, anxiety and pain medication overuse. Although they have taken many painkillers, Frequent use of headache medication can cause medication-overuse. Rebound headaches are caused by regular, long-term use of medication to treat migraines. Acupuncture has been shown to be effective in treating migraines. It can clinically reduce symptoms and the frequency of attacks.
What are the symptoms of migraine?
Prodrome
One or two days before a migraine, some people may notice a few changes that an upcoming episode. Migraine prodrome symptoms vary from person to person and may include including:
- Constipation or diarrhoea
- Mood changes
- Cravings for specific foods
- Stiff neck
- Fatigue or unusually energetic
- Thirsty
Migraine attacks
The pain starts as severe fluctuating pain and then turns into a constant dull ache. It can strike at any time but is more frequent in the morning after waking up or after stress or irritation and can last from a few hours to a few days. Typical migraines have aura symptoms such as flickering dark spots in front of the eyes, visual field loss. Most people don't experience an aura, and some have both the aura and the headache simultaneously. Only about 4% of people with migraine have aura without headache. The pain may shift to another area during an attack and radiate to the neck and shoulders.
Some people also have other symptoms, including:
- sweating
- feeling hot or cold
- nausea
- vomiting
- abdominal pain
- diarrhoea
What are the causes of migraine?
From the Western medical point of view, apart from surgical headaches caused by brain injury (sometimes also in those with a concussion or traumatic brain injury). The most common migraines are caused by neurological and vascular dysfunction and are characterised by recurrent attacks of pain on one side of the head, even accompanied by nausea, vomiting or allergy to light and sound. There is a genetic component to the disease.
Migraine triggers
There are several migraine triggers, including:
- Stress at work or home may cause migraines.
- Hormonal changes in women, menstrual periods, pregnancy and menopause, seem to trigger many women's headaches. Attacks occur around the same time as their period. 75% of migraine sufferers are women, which may be related to hormonal changes, such as during pregnancy.
- Strong or intense lights, loud sounds or strong smells may trigger a migraine for some people. While everyone is sensitive to light to some degree, people with photophobia are hypersensitive.
- Sleep pattern changes can trigger migraines in some people.
- Intense physical activity exertion, including sexual activity, may also trigger migraines. Some people may notice a dull ache in the head and neck that builds up as sexual excitement increases.
- Change of weather or barometric pressure, Medications. Such as contraceptives and vasodilators.
- Foods and drinks can cause problems too, such as coffee, wine and cheese.
Chinese medicine believes that the disease is mainly related to irritation and emotional stress. The pathogenesis of the disease is usually due to inappropriate emotions, which turn into Fire. Or irritability, which leads to hyperactivity of Liver Yang and disturbance of the clear orifices. Sometimes it can be related to Spleen health, which leads to internal growth of phlegm and dampness and obscuration of the clear orifices; or the disease is prolonged, and the veins and ligaments are paralysed and obstructed, resulting in pain.
How is migraine treated in Acupuncture and Chinese medicine?
According to the Chinese medicine theory, a combination of internal organs and meridian identification is used to determine different treatment principles according to different evidence types. If the pain is caused by stagnation of Blood and Blood into the channels and paralysis of the veins and ligaments, then invigorate the Blood to remove stasis, move Qi and relieve pain.
Scientific research
The immediate analgesic efficiency of NRS (Numericrating Scales of Pain) score was 87.3%, and the treatment group was significantly better than the control group in terms of migraine recurrence rate of 12.70% 24h after electro-acupuncture.1 The treatment with electro-acupuncture at Qiu Xu(GB 40) point of the Shaoyang meridian was 70.3% effective, and the experimental group had better results with acupuncture.2 The treatment with electro-acupuncture at GB 40 of the Shaoyang meridian was 70.3% effective. The result was better than the control group.2
In one systematic review, researchers found
the high quality of evidence indicated that acupuncture's effective rate was
better. Besides, acupuncture reduced more headache days and the times of using
painkiller. It was more effective in reducing the frequency and degree of a
headache than western medicine and sham acupuncture.3
Effect of acupuncture on plasma vasoactive substances in migraine patients
Aetiology:
Mostly due to wind evil. The head is located at the highest part of the body, which is like a mountain peak. In Chinese medicine, it is said that "only the wind can reach the top of the mountain", meaning that headaches are caused mainly by wind evils, while other evil Qi, such as cold and dampness, need to "make use of wind evils" to "make waves" on our head. "This is why, in ancient times, it was often necessary to manage the headache.
For this reason, headaches were often called "head wind" or "migraine" in ancient times. Headaches are also similar to the unpredictable nature of wind, constantly hurting at one time and not at another, sometimes this and sometimes that, etc. If a person has a lot of mood swings, is angry, or has a depressed liver, it is easy to trigger the "internal wind" in the body, also known as "internal movement of liver wind", which is also a significant cause of headaches. This is also an important cause of headaches. Because the five internal organs are related to the five elements of nature, the Liver and gallbladder are related to wood, which corresponds to wind. Chinese herbal medicine treats headaches mainly by removing wind and removing cold dampness if there is cold dampness, soothing the Liver and quelling wind if there is liver wind, and activating blood stasis if there is blood stasis. Acupuncture is used to treat headaches by identifying the meridians according to their location and following the meridians to obtain acupuncture points.
Basic treatment
Acupuncture points commonly used in clinical practice: A-shi point, Shuai Gu(GB 8), Jiao Sun(SJ 20), Feng Chi(GB20), He Gu(LI 4), Tai Chong(LR3) and Wai Guan(SJ 5).
- Supporting acupuncture points: for hyperactivity of Liver Yang, add Si Shen Cong and Xing Jian(LR 2); for phlegm and dampness, add Feng Long(ST 40) and Zu San Li(ST 36); for blood stasis headache, add Xue Hai(SP 10).
- Ear acupuncture points: temporal, the tip of the ear, subcortical, sympathetic and diplomatic sense of the nervous system.
- At the same time, the treatment can be combined with Chinese herbal medicines that have the main effect of draining the Liver and relieving depression, promoting the flow of Qi and invigorating Blood, etc., to eliminate the persistent problems and treat both the symptoms and the root cause.
Dialectical treatment: There are three main types of headache: "identification of the meridians and following the meridians to take the points" is the core of acupuncture treatment in Chinese medicine, and headache treatment is no exception. When we use the yin and yang theory to understand the human body, the head is the yang on top, and the feet are the yin underneath. The head is the most important gathering place for yang energy in the body. According to the meridians, only the yang meridians can reach the head, namely the Yang Ming meridian at the front of the body, the Sun meridian at the back of the body and the Shao Yang meridian at the side of the body. So acupuncture points should be selected on the corresponding yang meridians when treating headaches. Another essential principle when selecting acupuncture points for headache treatment is "if the pain is in the head, take it from the feet". This is because there is a certain intrinsic correlation between parts that are far apart in Chinese acupuncture theory. If the body is folded in half from the waist, the head and the feet belong to the corresponding parts. In addition, some acupuncture points on the hands also work well.
Overall, most headaches' major acupuncture points are below the ankle and wrist joints except for the head. According to the headache location, we mainly classify headaches into the following three categories:
- Yangming headache. The main manifestation is forehead pain, mostly caused by rhinitis, sinusitis, gastrointestinal discomfort, etc. In acupuncture treatment, the most commonly stimulated acupoints are the Tou Wei(ST 8) point on the head (a finger's width up from the hairline point at the corner of the forehead, where the muscles are stretched when chewing). The He Gu(LI 4)point on the Yang Ming Large Intestine meridian, and the Chong Yang(ST 42) and Xian Gu(ST 43) points on the Yang Ming Stomach meridian. LI 4 and ST 43 are the most useful.
- Tai Yang headache. Tai Yang headache is caused by cervical spondylosis and wind and cold in the head. The most commonly stimulated acupoints are the Tianzhu point on the head, the Yang Lao(SI 6) point and Houxi(SI 3) point of the Hand Tai Yang and Small Intestine meridian, and the Jing Gu(BL64) point and Zhiyin(BL67) point of the Foot Tai Yang Bladder meridian.
- Shaoyang headache. It manifests as pain on both sides of the head and pain in the corners of the head, as in the common migraine. It is predominant in young and middle-aged women and often occurs a day or two before the onset of menstruation and the first three days of the menstrual period. The primary acupuncture points that are often stimulated are the head acupuncture points of Shuai Gu(GB 8), Feng Chi (GB 20)and Si Zhukong(SJ23). The hand Shaoyang San Jiao meridian acupuncture points of Zhong Zhu(SJ 3) and Waiguan(SJ 5) and the foot Shaoyang meridian acupuncture points of Qiu Xu(GB40) and Zu Lin Qi(GB 41).
In clinical practice, patients often say that they have chronic tightness in the head and feel drowsy and that the headache becomes more pronounced when they are under tension or stress. For this type of patient, we use the four diagnostic methods of "looking, smelling, asking and cutting" to identify the patient as a whole before applying acupuncture treatment. This is probably a sign of a deficiency of kidney essence, which needs to be tonified on Foot Shao Yin Kidney meridian and avoid overexertion. The treatment of chronic recurrent headaches with acupuncture needs to distinguish between the acute and intermittent phases (when the headache is not occurring).
During the acute phase of headache, acupuncture has to be used heavily; during the intermittent phase, the main focus is to adjust the imbalance of the internal organs and meridians in order to reduce the number of headache attacks and the intensity of the headache. Preventive treatment during the interval is even more important than pain relief during the attack. Prevention: Press these acupuncture points regularly. As the saying goes, "three parts cure, seven parts nourish". You can prevent or relieve headaches by rubbing the corresponding acupuncture points in your life. There is no particular time or number of times you should press, rub or pinch them when you want to.
How to locate Hegu(LI4) point?
Use the knuckle of the thumb on one hand to point the thumb at the middle of the edge of the tiger's mouth on the other hand.
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| Acupuncture point LI 4 |
How to locate Chong Yang(ST42)point?
It can be located at the highest point on the back of the foot, where the dorsalis pedis artery pulse can be palpated. The above two points are more useful for Yang Ming headaches.
Yang Lao(SI 6) point is helpful for people with shoulder and arm pain, restricted movement and blurred vision, as it is used for treating the elderly. With the palm down, press a finger against the high point of the most prominent bone on the little finger side of the wrist (the ulna), then rotate the wrist down 90 degrees so that the highest point of the bone becomes a pit and the finger slides into the bone.
Zhong zhu(SJ 3) point: located in the depression on the back of the hand between the 4th and 5th metacarpal bones.
Zu Lin Qi(ST 41)Point: located on the lateral side of the back of the foot, in the anterior depression between the 4th and 5th metatarsal bones. Shaoyang headache sufferers can press these two points regularly.
Foods that trigger migraines
Artificial sweeteners
Artificial sweeteners, commonly found in zero-sugar foods, aspartame in Coke Zero, sucralose in other foods, etc., have been shown to trigger type 2 diabetes and harm the gut, among other things. Also, artificial sweeteners can affect dopamine and serotonin levels in the brain, which may be a trigger for migraines.
MSG
Another substance that may trigger migraines is monosodium glutamate, MSG, which is a common food additive. Too much glutamate can be toxic to your brain & lead to migraine.
Nitrites
Nitrite is the most common preservative found in sausages, beef jerky, hot dogs, deli meats and other processed-meat products and has been shown to be a migraine trigger.
Wine
Wine contains a sulphite preservative that may trigger migraines. Sulphites can also be found in processed foods, including dried fruit.
Apples and pears
The tannins in apples and pears may trigger migraines. This natural plant substance can also be found in tea, black walnuts, red wine, chocolate, vanilla, raspberries and many herbal products. Studies have shown that reducing tannins in the diet may reduce the risk of migraine attacks.
Aged cheese
Aged cheese has an amino acid called tyramine, which has been linked to migraines. The longer a cheese ages, the more tyramine it has. It can also be found in other aged and fermented foods, such as Smoked fish, Cured meats, and some beers.
Leftovers
Leftovers contain high levels of tyramine, which can trigger migraines.
Alcohol
Alcohol can trigger headaches and hangovers, and studies have linked alcohol to migraines. You could get a headache within 30 minutes to 3 hours of drinking.
Caffeine
The effect of caffeine on migraines is more complex and depends on the individual. If you feel that caffeine intake triggers migraines, reduce your caffeine intake, but not everyone who drinks coffee will experience migraines. High caffeine foods and drinks include chocolate-covered coffee beans, coffee, energy drinks, espresso, green tea, black tea...
Dehydration
If you don't drink enough water, you risk becoming dehydrated, which is likely to cause a migraine.
Outlook
Migraines may severely affect your quality of life and stop you from carrying out your activities. However, some effective treatments are available to reduce the symptoms and prevent further attacks.
Reference
1. Zhang H, Hu Y, Wu J, Zheng H. [Timeliness law on the immediate analgesia on acute migraine treated with electroacupuncture at shaoyang meridian points]. Zhongguo Zhen Jiu. 2015 Feb;35(2):127-31. Chinese. PMID: 25854016.
2. Jia CS, Shi J, Ma XS, Zhang XJ, Wang YM, Yuan J, Li YF, Li M, Zheng LX, Gao JY. [Study on the therapeutic effect of electroacupuncture on migraine and influencing factors]. Zhongguo Zhen Jiu. 2007 Aug;27(8):557-61. Chinese. PMID: 17853749.
3. Li YX, Xiao XL, Zhong DL, Luo LJ, Yang H, Zhou J, He MX, Shi LH, Li J, Zheng H, Jin RJ. Effectiveness and Safety of Acupuncture for Migraine: An Overview of Systematic Reviews. Pain Res Manag. 2020 Mar 23;2020:3825617. doi: 10.1155/2020/3825617. PMID: 32269669; PMCID: PMC7125485.
4. LIANG Ruihua, ZHANG Suping, XIE Yonghong. Study about Influence of Brain Metabolism in Patients with Chronic Migraine after Acupuncture at Shaoyang Specific Acupoints. Chinese Archives of Traditional Chinese Medicine. 2016 4: 918-920.
5. Zhao, L., Liu, J.X., Qin, W., et al. (2014) Effects of Long-Term Acupuncture Treatment on Resting-State Brain Activity in Migraine Patients: A Comparative Study on Active Acupoints and Inactive Acupoints. Journal of Integrative Medicine, 9, 703. doi.org/10.1016/j.eujim.2014.09.044
6. Liu, H., Liu, M., Wang, Y., et al. (2011) Association of 5-HTT Gene Polymorphisms with Migraine: A Systematic Review and Meta-Analysis. Neurological Sciences, 305, 57-66. doi.org/10.1016/j.jns.2011.03.016
7. Pizza, V., Bisogno, A., Lamaida, E., et al. (2010) Migraine and Coronary Artery Disease: An Open Study on the Genetic Polymorphism of the 5, 10 Methylenetetrahydrofolate (MTHFR) and Angiotensin I Converting Enzyme (ACE) Genes. Central Nervous System Agents in Medicinal Chemistry, 10, 91-96. doi.org/10.2174/187152410791196404
8. Li, L., Liu, R., Dong, Z, et al. (2015) Impact of ESR1 Gene Polymorphisms on Migraine Susceptibility: A Meta-Analysis. Medicine, 94, e0976. doi.org/10.1097/MD.0000000000000976
9. Jia, C.S., Ma, X.S., Shi, J., et al. (2009) Electroacupuncture at Qiuxu (GB 40) for Treatment of Migraine—A Clinical Multicentral Random Controlled Study. Journal of Traditional Chinese Medicine, 29, 43-49.doi.org/10.1016/S0254-6272(09)60030-3
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