Migraines

Migraine is a primary headache disorder manifesting as recurring attacks, usually lasting for 4 to 72 hours, and involving pain of moderate to severe intensity (IHS 2004). Migraine is thought to begin as an electrical phenomenon in the cerebrum that then affects blood vessels, and biochemistry, and causes neurogenic inflammation.

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/basic care for managing migraine and appears to be at least as effective as prophylactic drug therapy, with few contraindications or unpleasant side effects.  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.

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Acupuncture has been found to be cost-effective. As well as prevention it may also be used to alleviate symptoms in acute attacks. There is preliminary qualitative evidence from patients that acupuncture can increase coping mechanisms as well as relieve migraine symptoms.

Acupuncture can help in the treatment of migraine by:

  • Providing pain relief – by stimulating nerves located in muscles and other tissues, acupuncture leads to the release of endorphins and other neurochumoral factors and changes the processing of pain in the brain and spinal cord.

  • Reducing inflammation – by promoting the release of vascular and immunomodulatory factors

  • 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)

  • Modulating extracranial and intracranial blood flow

  • Affecting serotonin (5-hydroxytriptamine) levels in the brain. (Serotonin may be linked to the initiation of migraines; 5-HT agonists (triptans) are used against acute attacks.)