Migraine

By Jiang Liu, Diplomate of Oriental Medicine
AR Licensed Acupuncturist and Herbalist
Acupuncture & Chinese Medicine Clinic
2024 Arkansas Valley Dr., Suite 402
Little Rock, AR 72212

 

Migraine is a common type of chronic headache that may occur with symptoms of nausea, vomiting, diarrhea, facial pallor, cold hands, cold feet, and sensitivity to light and sound. Migraine headaches usually are described as an intense, throbbing or pounding pain that involves one temple. But sometimes the pain may be located in the forehead, around the eye or at the back of the head. The pain can be unilateral or bilateral and usually is aggravated by daily activities such as walking upstairs. Some migraine attacks are preceded by premonitory (warning) symptoms lasting hours to days.

Causes and triggers
The exact cause of migraine headaches is not clearly understood. There are different theories described by the scholars such as depolarization theory (neurological activity is depressed over an area of the cortex of the brain, which results in the release of inflammatory), vascular theory (blood vessels in the brain contract and expand inappropriately), serotonin theory (low serotonin levels in the brain may lead to a process of constriction and dilation of the blood vessels which trigger a migraine), neural theory (certain nerves or an area in the brain stem become irritated, a migraine begins), and unifying theory (both vascular and neural influences cause migraines).

Various factors can trigger migraine in certain people prone to developing migraine. They include 1) Environmental factors: bright lights, loud noises, and certain odors or perfumes; 2) Physiological factors: certain foods (chocolate, cheese, nuts, smoked fish, chicken livers, nitrates-containing food such as bacon, hot dogs and salami, and monosodium glutamate), alcohol, caffeine, cigarette, fasting, emotional or physical stress, sleep disturbances, hormone changes (birth control pills, menstrual cycle fluctuations or menopause), or allergic reactions.

Chinese Medicine
Chinese medicine has been used in the treatment and prevention of migraine for thousand years and it is natural, effective and no side-effects. In the western world, even though OTC medicine and prescription are useful and helpful for the migraine, more and more people suffered from migraine are seeking Chinese medicine for the cure, since migraine is a chronic condition and OTC medicine and prescription often have some side-effects. Multiple clinical studies have been performed and the results show the effectiveness of Chinese medicine on migraine. Since the complexity of Chinese herbal medicine, these clinical studies have mainly focused on acupuncture. The following are some of recent studies on migraine.

The effectiveness of acupuncture for chronic daily headache: an outcomes study (Plank S et al. Military medicine.174(12):1276-81, 2009):With the increased incidence of migraine headaches noted in the military population it becomes imperative to find safe and effective treatment options for soldiers. Acupuncture may be one of those options. This pilot study used a standardized set of well-known acupuncture points over a predetermined time interval on 26 subjects suffering from chronic daily headache, the majority being migraineurs, and found a reduction in the frequency and intensity of their headaches. Headache calendars and validated measurements were compared 12 weeks before and 12 weeks after the acupuncture intervention. Results showed continued improvements 12 weeks after the last treatment. Traditionally, acupuncture treatments are individualized at each visit. However the absence of a standardized treatment regimen obstructs data reproducibility across the discipline. A standardized approach may be useful. Variations of these acupuncture points have been used in recent research studies for migraines and acupuncture for headaches for the past 2,000 years.

Acupuncture at points of the liver and gallbladder meridians for treatment of migraine(Zhong GW et al. Zhongguo Zhenjiu. 29(4):259-63, 2009): in a multi-central, randomized and controlled trial, 253 cases of migraine were divided into an acupuncture group and a western medicine group. The acupuncture group was treated with acupuncture at points of The Liver and Gallbladder Channels with Taichong (LR 3), Yang-lingquan (GB 34), Fengchi (GB 20), Ququan (LR 8) selected as main points, and the western medicine group with oral administration of Flunarizine tablets for 4 therapeutic courses. The total therapeutic effects 3 and 6 months after the treatment, the scores of various symptoms of migraine before and after treatment, and the stability of therapeutic effect in one-year following-up survey were observed in the two groups. RESULTS: After treatment, mean times and duration of the headache attack were significantly improved in the two groups (all P < 0.01) with the acupuncture group better than the western medicine group (P < 0.05). The total effective rates for stopping pain after treatment, 3 months and 6 months after treatment in the acupuncture group were 93.0%, 93.0% and 87.7%, respectively, which were better than 85.6%, 86.5% and 69.2% in the western medication group (all P < 0.01). One year later, the stability of the therapeutic effect in the acupuncture group was better than that in the western medicine group (P < 0.05); the adverse reaction and the compliance in the acupuncture group were significantly superior to those in the western medicine group. CONCLUSION: Acupuncture at points of The Liver and Gallbladder Meridians for treatment of migraine is safe, effective, and with stable long-term therapeutic effect.

Effects of acupuncture preventive treatment on the quality of life in patients of no-aura migraine (Zhang Y et al. Zhongguo Zhenjiu. 29(6):431-5, 2009). In this randomized controlled, double-blind and double-dummy research, 60 cases were randomly divided into an observation group and a control group, 30 cases in each group. The observation group was treated with acupuncture combined with oral administration of Flunarizine Hydrochloride vacuity capsules, and Baihui (GV 20), Shenting (GV 24) and Benshen (GB 13) were selected as main points. The control group was treated with oral administration of Flunarizine Hydrochloride capsules combined with acupuncture at placebo-points, thrice each week, for 4 weeks. The SF-36 QOL Scale and effective rate were used for assessment of therapeutic effects before treatment, after treatment and 3 months later. RESULTS:There were significant differences in each dimension scores of SF-36 at 3 time points between the two groups (all P < 0.05). The dimension of the physiological function in the observation group was superior to that of the control group after treatment (P < 0.05). After treatment and 3 months later, the effective rates were 68.0%, 68.0% in the observation group and 24.0%, 32.0% in the control group, respectively, with significant differences between the two groups (all P < 0.05). CONCLUSION:Acupuncture preventive treatment can effectively improve the life quality of the patients with migraine and reduce the migraine attack and acupuncture is more effective in reducing the migraine attack days.

Acupuncture for treating acute attacks of migraine: a randomized controlled trial (Li Y et al. Headache. 49(6):805-16, 2009). A total of 218 patients with migraine were recruited for the study; One group received verum acupuncture while subjects in the other 2 groups were treated with sham acupuncture. Each patient received 1 session of treatment and was observed over a period of 24 hours. The main outcome measure was the differences in visual analog scale (VAS) scores before treatment and 0.5, 1, 2, and 4 hours after treatment. RESULTS: Significant decreases in VAS scores from baseline were observed in the fourth hour after treatment when VAS was measured in the patients who received either verum acupuncture or sham acupunctures (P < .05). The VAS scores in the fourth hour after treatment decreased by a median of 1.0 cm, 0.5 cm, and 0.1 cm in the verum acupuncture group, sham acupuncture group 1, and sham acupuncture group 2, respectively. Similarly, there was a significant difference in the change in VAS scores from baseline in the second hour after treatment among the 3 groups (P = .006). Moreover, at the second hour after treatment, only patients treated with verum acupuncture showed significant decreases in VAS scores from baseline by a median of 0.7 cm (P < .001). Significant differences were observed in pain relief, relapse, or aggravation within 24 hours after treatment as well as in the general evaluations among the 3 groups (P < .05). Most patients in the acupuncture group experienced complete pain relief (40.7%) and did not experience recurrence or intensification of pain (79.6%). CONCLUSION: Verum acupuncture treatment is more effective than sham acupuncture based on either Chinese or Western nonacupoints in reducing the discomfort of acute migraine. Verum acupuncture is also clearly effective in relieving pain and preventing migraine relapse or aggravation.

Electroacupuncture at Qiuxu (GB 40) for treatment of migraine (Jia CS, et al. Journal of Traditional Chinese Medicine. 29(1):43-9, 2009). In a clinical multicentral random controlled study, 275 migraine patients were admitted in 3 hospitals and randomly divided into a treatment group treated by EA at Qiuxu (GB 40), and a control group treated by EA at Tianshu (ST 25). RESULTS:There was a significant difference in VAS score between the two groups of the 3 clinical centers (P<0.01). The therapeutic effects of a 4-week treatment were much better in the treatment group than that of the control group. The 3-month follow-up survey showed that the long-term effects were in favor of the treatment group of the first and third clinical centers, though no significant difference was found in the treatment group of the second clinical center as compared with the control group. The results from the 6-month follow-up survey showed better effects in the treatment group of all the 3 clinical centers. CONCLUSION: EA at Qiuxu (GB 40) may show effect for migraine.

The design and protocol of acupuncture for migraine prophylaxis (Zhang Y , et al. Trials [Electronic Resource]. 10:25, 2009). In a multicenter randomized controlled trial, 140 migraine patients are randomly allocated to two different groups. The acupuncture groups (n = 70) is treated with acupuncture and placebo medicine; while the control group (n = 70) is treated with sham acupuncture and medicine (Flunarizine). Both Flunarizine and placebo are taken 10 mg once per night for the first 2 weeks and then 5 mg once per night for the next 2 weeks. Patients in both groups receive 12 sessions of verum/sham acupuncture in 4 weeks. DISCUSSION: The study design and the long term clinical practice of acupuncturists guarantee a high external validity for the results. The results of our trial will be helpful to supply the evidence on the efficacy of acupuncture for migraine prophylaxis in China.

Effect of ear point combined therapy on plasma substance P in patients of no-aura migraine at different stages (Yang DH, Zhongguo Zhenjiu. 29(3):189-91, 2009). In this study, thirty cases of no-aura migraine at different stages were treated with ear point combined therapy, including blood-letting at the ear back, injection of auto-blood into Fengchi (GB 20), Yanglingquan (GB 34), and pricking at ear points Nie (AT2), Yidan (CO11), Shenmen (TF4), etc. Their clinical therapeutic effects were evaluated at the end of one therapeutic course, and substance P (SP) contents were detected before and after treatment. RESULTS: The clinical effective rate was 86.7%, and the effective rate was 87.5% at the attack stage and 86.4% at the remission stage with no significant difference between the attack stage and the remission stage (P>0.05); after treatment, SP content had significant change as compared with that before treatment (P<0.05, P<0.01), and there was very significant difference in SP content between the attack stage before treatment and the remission stage (P<0.01). CONCLUSION: The ear point combined therapy can relieve pain possibly through decreasing plasma SP content, and the SP con tent possibly is one of main factors inducing migraine attack.

Etiology & clinical manifestations
There are multiple factors causing migraine and the following are the common causes of irregular period:

  • Wind invasion into meridian:
  1. Wind-cold evil into brain: headache with stiff neck and back, chilliness, general aching and stuffy nose with watery discharge. Tongue: thin, white coating; Pulse: floating and tense.
  2. Wind-heat evil into brain: severe distending headache in the whole head, aversion to wind, fever, stuffy nose with discharge, thirsty with desire to drink, constipation and dark urine. Tongue: thin, yellow coating; Pulse: floating and rapid.
  3. Wind-cold-damp evil into brain: head heaviness and head tightness, lassitude, tight chest, nausea, poor appetite and dry mouth with no desire to drink. Tongue: greasy coat; Pulse: soft and floating, or slow and floating.
  • Liver yang ascending: distending headache, irritability, easily angered, dizziness and blurred vision. Tongue: red tongue with thin coat; Pulse: rapid.
  • Wind-fire invasion into liver meridian: headache in one side with severer in the temple, red eye and red face, sensitive to light, bitter and dry month, anxiety and anger, nausea and vomit. Tongue: red with yellow coat; Pulse: string-like and fast.
  • Phlegm ascending: Severe headache with heavy, tight, muzzy feeling, foggy thinking, dizziness, lassitude, restlessness, paraphasia, oppressed chest, nausea, rapid breathing, excess salivation or drooling, and cold limbs. Tongue: thick, greasy coat; Pulse: wiry and slippery.
  • Blood stasis: Stabbing, splitting, localized intermittent but lingering headache, Tongue: purple spots, Pulse: choppy.
  • Deficiency of qi and/or blood: Dull pain at the vertex, or everywhere in the head with slight muscle spasms or twitching at the temples, dizziness, blurred vision, pale face, skittish or easily startled, and palpitations. Tongue: thin, white coat; Pulse: weak and thready.
  • Deficiency of kidney essence and blood: Dull headache in the whole head with empty feeling in the head, dizziness, tinnitus, soreness and weakness of the waist and knees, fatigue and amnesia. Tongue: red with little coat; Pulse: thready and weak.

Principle of treatment

  • Invasion of wind into meridian: Dispel wind, activate blood and stop pain.
  • Liver yang ascending: Pacify the liver, subdue rebellious yang, nourish water for normal wood function.
  • Wind-fire invasion into liver meridian: Pacify liver, suppress wind and extinguish fire.
  • Phlegm ascending: Resolve phlegm and suppress the ascending of phlegm.
  • Blood stasis: Activate blood and resolve blood stasis.
  • Deficiency of qi and/or blood: Tonify qi and nourish blood.
  • Deficiency of kidney essence and blood: Nourish kidney essence and tonify marrow, as well as supply qi and tonify blood.

Chinese medicine practitioners treat migraine patients according to patient’s initial cause, symptoms and signs, presentation of pulse and tongue. Acupuncture, herbal medicine and some other Chinese medicine modalities can be used alone, or combined, which depend on individual situation. Acupuncture, twice a week for 4 weeks, is a common practice. And herbal medicine, twice a day for 10 days, is often used in clinic practice. Responses to acupuncture or herbal medicine are different, so treatment course and modalities to be used are different.