Does acupuncture help headaches and migraines?

Migraines and headaches can be debilitating for many people and there are many treatments available, one of which is acupuncture. So does acupuncture help headaches and migraines?

Do you want to know if it is worth trying acupuncture for your migraines or headaches? That’s exactly what we are going to discuss in today’s article. Essentially, we will look at the current research for and against acupuncture for the treatment of headache and migraine.

To answer this question and we will find the most up to date and best evidence in the literature and discuss the common acupuncture points that can be effective for migraines and headaches.

Don’t worry if you can’t access acupuncture treatment. You can try acupressure for these points, which is simply applying pressure with your fingers to the points shown later in the article.

First, we need to learn a bit about headaches and migraines

Headaches are usually nothing serious at all, but in rare cases, they can potentially be more serious problems. It is important to look out for the following and get checked out:

If you have a worsening headache with a fever.

A new‑onset neurological deficit like weakness or sensation loss.

A sudden‑onset headache which quickly escalates to maximum intensity within 5 minutes.

A new‑onset cognitive dysfunction, like being unable to think or having confusion etc.

A reduced level of consciousness.

A personality change.

If you have had any head trauma within the past 3 months.

If you have a headache triggered by exercise.

A headache triggered by coughing, sneezing, essentially with the valsalva manoeuvre.

A headache that changes with posture changes, like going from sit to stand, also known as an orthostatic headache.

Any substantial changes to your headache characteristics.

(BASH 2010)

Signs and symptoms of giant cell arteritis, such as:

Having tenderness of the scalp or temples.

Temporary or sustained vision loss.

Jaw pain when moving the jaw.

Dizziness.

Coordination and balance problems.

Persistent sore throat.

Difficulty swallowing.

Occasional chest pain.

Double vision.

(BASH 2010)

Signs and symptoms of acute narrow-angle glaucoma, such as:

Rainbow-coloured circles around bright lights

Sudden loss of vision.

Sudden severe eye and head pain.

Hazy or blurred vision.

(BASH 2010)

If you have certain health issues past or present then it may be worth getting looked at with a new-onset headache:

Immune compromised individuals such as HIV or people on immunosuppressive drugs.

If you have had a history of malignancy and are under 20 years old.

If you have a history of malignancy known to metastasise to the brain.

If you start vomiting without an obvious cause.

(BASH 2010)

Outside of more serious headache causes, what are the main types of headache and migraine?

It is essential to rule out some of the above aspects before commencing any treatment, but once you are not serious then primary headaches are commonly categorised as follows:

Cluster headache

Migraine

Tension-type headache

Medication overuse headache

What is a Cluster headache?

A Cluster headache is an excruciating attack of pain in one side of the head, and eye. It is part of a group of disorders called the trigeminal autonomic cephalalgias. Daily occurrences of
headache are typical of a cluster headache. It affects mostly men at a 6:1 ratio to women. It is rare in children but most it is most common with people in their twenties and older and affects smokers more too. It comes in clusters, meaning in bouts for 6-12 weeks, once every year or two and strangely it tends to come at the same time of year each year. Cluster headaches are notorious for coming at night, often 1 to 2 hours after falling asleep.

Acupuncture treatment of Cluster headache

There is minimal evidence for using acupuncture on cluster headaches but a study by Fofi et al (2014) found that acupuncture did find short term relief in the cluster headache.

What is a Tension-type headache?

Tension-type headaches are sub-categorised as follows:

Infrequent episodic tension-type headache

Frequent episodic tension-type headache

Chronic tension-type headache

This is the most common type of headache and feels like a constant ache that often affects both sides of the head. It is also common to feel neck muscle tension and pressure behind the eyes.

As it sounds, an episodic tension-type headache comes in episodes. These episodes vary and are often not long-lasting at around a few hours, and they are relatively infrequent. A tension-type headache can be stress-related or can be associated with functional or structural neck or head musculoskeletal issues. For example postural strain or protective muscle tension around something like Cervical spondylosis.

A chronic tension-type headache basically means that it has lasted for a long time. This is considered at more than 15 days a month and they can even be every single day.

Acupuncture treatment of Tension-type headaches

As you would expect from the most common type of headache, there is lots of research into this area and overall it appears that acupuncture does help.

In a study by Linde et al (2016) they found that acupuncture was effective for treating frequent episodic or chronic tension headaches.

Another study found that 10 sessions of acupuncture over 5–8 weeks was best for the prophylactic treatment of chronic tension-type headaches (Carville et al 2012).

Santesso et al (2017) looked at 7 studies with a total of 795 people and they concluded that, in general, people who have frequent tension-type headaches will probably have slightly fewer headaches at 3-4 months after beginning a course of acupuncture. Specifically, people will probably have fewer ‘headache days’ per month, and even more people will have half as many headaches.

What is a Migraine?

A migraine is usually a moderate or severe headache felt as a throbbing pain on one side of the head. It can also have symptoms such as nausea, vomiting and increased sensitivity to light or sound.

There are several types of migraine, including:

Migraine with aura – Where there are specific warning signs just before the migraine begins, such as seeing flashing lights or visual disturbance.

Migraine without aura – The most common type, where the migraine occurs without the specific warning signs.

Migraine aura without headache, AKA: silent migraine – Where an aura or other migraine symptoms are experienced, but no headache.

To diagnose a Migraine without aura then you must exhibit at least 5 attacks fulfilling the following:

Firstly, an attack lasting between 4-72 hours

Secondly, it has at least two of the following characteristics:

1. Located on just one side

2. Pulsating in nature

3. Moderate or severe pain intensity

4.  Aggravated by usual daily activity or making these not possible

Thirdly, it has at least one of the following:

1. Nausea and/or vomiting

2. Photophobia and phonophobia

Finally, it is not attributed to another disorder

To diagnose a Migraine with aura:

This is diagnosed simply by the presence of the aura. A typical aura is progressive, it lasts for between 5 to 60 minutes before the headache starts. It is a visual disturbance in one eye, commonly described as a spreading blind spot that is like a jagged crescent. Occasionally, the aura can come with reversible focal neurological disturbances such as unilateral paraesthesia of the hand, arm or face or dysphasia.

Acupuncture treatment of Migraine

So as with tension headaches, there too, is plenty of research into acupuncture for migraines, and once again the evidence is positive. This Cochrane review found that adding acupuncture to the symptomatic treatment of migraine attacks reduces the frequency of headaches (Linde et al 2016).

Li et al (2009) found that acupuncture is clearly effective in relieving pain & preventing migraine relapse or aggravation. Also, this study concluded that current clinical evidence suggests that verum acupuncture is superior to sham acupuncture in migraine (Yang et al 2016).

What is a Medication overuse headache?

Medication overuse headaches occur in 1 in 50 adults at a ratio of 5 women to each man and even sometimes affecting children. These headaches are frequent or daily headaches that develop after taking painkillers for tension headaches or migraines over a long period of time.

Acupuncture treatment of Medication overuse headaches

Treatment is basically, withdrawal of the overused drugs, pharmacological and nonpharmacological support and prevention of relapse. So, in this case, acupuncture isn’t really used to cure this type of headache but can be used to help to prevent it. Basically, acupuncture can be used to manage the headache that the drugs were used for in the first place. (Kristoffersen & Lundqvist 2014).

What are the best acupuncture points to use for different headaches and migraines?

Cluster headache acupuncture points:

In a review by Fofi et al (2014), they found studies typically had 6 sessions given at least once per week and most studies left the needles in place for 20-30 minutes.

Here is an example of common points for acupuncture in this type of headache:
Ex HN-5, GB 14, GB 20, LI 4, LR 2, SP 6, ST 36.

Tension-type headache acupuncture points:

In a Cochrane review by Linde et al (2016), they found that it was typical to have 6 treatment sessions given at least once per week.

Here is an example of common points for acupuncture in this type of headache:
GB20, GB14, LI4, ST44, PC6, PC7, SP6, GB34, ST8, EX1 and EX2

Migraine acupuncture points:

In a Cochrane review by Linde et al (2016), they found that the number of treatment sessions in the studies reviewed was between six and 12 sessions in 13  trials and 16 or more sessions in 9 trials. Most studies left the needles in place for between 20 and 30 minutes.

Here are some commonly used points for Migraines:
BL 2, BL10, BL 60, GB 3, GB 20, GV 11, GV 20, LR 3, CV 13 EX1, ST 8

Summary

So, acupuncture seems to be a legitimate treatment modality option for headaches and migraines. That being said, a multi-modal approach will always be best so acupuncture should be part of the solution, not the only treatment performed. We do sometimes use acupuncture in our clinics but certainly not in isolation. It is still vital to see that acupuncture can be used as part of the solution and not the only one.