Last year’s NICE report recommends that healthcare professionals should consider offering patients a course of up to 10 sessions of acupuncture, administered over a period of from five to eight weeks, for the prophylactic treatment of chronic tension-type headaches.
The National Institute for Clinical Excellence (NICE) rigorously reviews the evidence from clinical trials to inform its recommendations. They found that patients with chronic headache who responded to acupuncture, reported a 50% improvement in their condition.
These new recommendations confirm the view – supported by positive evidence – that the use of acupuncture for tension type headaches achieves beneficial results.
Whilst there are effective conventional treatments for correctly diagnosed common headache types, patients can get into a vicious cycle by taking more and more medication to relieve their pain. Many people prefer not to use painkillers on a regular basis, as there are associated unwanted side effects. The report also reveals that one person in 50 experiences headaches as a result of overusing painkillers, so the drugs can cause the very problem they are being used to treat. This research showing that acupuncture is a viable alternative to medication, means that patients and their doctors now have a choice about how to treat headaches.
Paul Battersby, senior lecturer in acupuncture and director of the Acupuncture Association of Chartered Physiotherapists (AACP) suggests that acupuncture merited greater consideration for the treatment of headaches because it was associated with ‘fewer risks, fewer side-effects, and is also cost-effective’.
For more information, have a look at the NICE Guidelines on treating headaches.
Migraine is a more complex condition which causes severe pain and other symptoms like nausea and sickness. There have now been many controlled trials of acupuncture for migraine, with some large, high-quality ones in recent years.
The results of the latest reviews are quite consistent: acupuncture is significantly better than no treatment or basic care for managing migraine, and appears to be at least as effective as prophylactic drug therapy, with few contraindications or unpleasant side effects (Linde 2009, Wang 2008, Sun 2008, Scott 2008). Acupuncture has a similar or slightly better effect than sham procedures, which themselves can perform as well as conventional drugs, indicating that sham acupuncture is not an inactive placebo but a contentious alternative intervention.
Acupuncture has been found to be cost-effective (Witt 2008; Wonderling 2004). As well as prevention it may also be used to alleviate symptoms in acute attacks (Li 2009). There is preliminary qualitative evidence from patients that acupuncture can increase coping mechanisms as well as relieve migraine symptoms (Rutberg 2009).
Migraine is thought to begin as an electrical phenomenon in the cerebrum that then affects blood vessels, biochemistry, and causes neurogenic inflammation. Acupuncture can help in the treatment of migraine by:
- Providing pain relief – by stimulating nerves located in muscles and other tissues, acupuncture leads to release of endorphins and other neurochumoral factors and changes the processing of pain in the brain and spinal cord (Zhao 2008, Zijlstra 2003, Pomeranz, 1987)
- Reducing inflammation – by promoting release of vascular and immunomodulatory factors (Kim 2008, Kavoussi 2007, Zijlstra 2003).
- Reducing the degree of cortical spreading depression (an electrical wave in the brain associated with migraine) and plasma levels of calcitonin gene-related peptide and substance P (both implicated in the pathophysiology of migraine) (Shi 2010).
- Modulating extracranial and intracranial blood flow (Park 2009).
- Affecting serotonin (5-hydroxytriptamine) levels in the brain (Zhong 2007). (Serotonin may be linked to the initiation of migraines; 5-HT agonists (triptans) are used against acute attacks.)