Migraines and Acupuncture

He has seen but half the universe who has never been shown the house of pain.   - Ralph Waldo Emerson

What do Thomas Jefferson, Vincent Van Gogh, George Seurat, Claude Monet, Virginia Woolfe, Freud, Nietzsche, Napoleon, and Whoopie Goldberg have in common?  MIGRAINES.  They were all Migraineurs.  Migraine is characterized by recurrent attacks of headache, usually one-sided with a locus of pain in the temple or behind an eye.  This pain is accompanied with nausea, vomiting, photophobia, and heightened sensitivity to sound. Migraine pain occurs most frequently in the morning after rising. Movement and activity make the pain worse.  The pain can last hours to days and can be disabling. An estimated 11 to 26 million Americans suffer from Migraine.  Migraine is a true organic neurological disease, whereas headache is a symptom according the Migraine Awareness Group, MAGNUM.  Migraineurs experience significant disability, lost work days and diminished quality of life, accounting for more than $13 billion a year in missed work days. There is no known cure, only treatment of symptoms.   No unanimous definitive cause of Migraine is agreed upon, but there is agreement that there are 2 main kinds of Migraine – Classic Migraine and Common Migraine.  Classic Migraine presents with flashing lights, blindness, numbness or aura in one eye’s field of vision.  The Seurat effect, named after the painter, is a medical term describing a visual phenomena (scotoma - aura) that occurs in Classic Migraine. Seurat's paintings were influenced by his migrainous visions.  If it were not for Classic Migraines and their accompanying auras, perhaps Lewis Carroll might not have dreamed up Alice's Adventures in Wonderland. Only about 20 % of migrainuers have Classic Migraines, the balance of migrainuers have what is called Common Migraine.

Who gets Migraines?

The majority of Migraine sufferers are women (three times more so than men, though it’s estimated that 6 % of men get Migraines)  and there seems to be a connection with the menstrual cycle and hormonal changes.  Heredity may play a role -  Dr. Stephen Peroutka, a research physician, claims that individuals with a migrainuer parent have a 50 % chance of developing Migraines.  MAGNUM claims that an international research team has identified a gene on chromosome 19 that causes familial hemiplegic Migraine with paralysis.  Migraines often occur during women’s menstrual period, presumably because of hormonal changes.  Frequently stress or emotional upset may precede an attack.

Acupuncture Physical Medicine, Trigger Points and Headache

One area of western medicine that seems to have been traditionally overlooked in Migraine management is that of myofascial trigger points [TPs].  According to Travell’s Trigger Point Manual, up to 80 % of patients in a chronic pain center have myofascial trigger points as a primary diagnosis and also up to 30 % of patients in a university based internal medicine practice had myofascial trigger points as the cause of pain.  Those with upper body pain and/or headache were even more likely to have trigger points implicated. Many muscles with active trigger points can refer pain, tingling, or other sensations to the temporal region of the head or to the eye and eyebrow area where Migraine pain typically presents.  The trapezius, sternocleidomastoid (sternal head), temporalis, splenius cervicis, suboccipitals and semispinalis capitis refer pain to the temple region.  The same muscles  minus the semispinalis muscles plus the masseter, occipitalis, and  orbicularis muscles refer pain to the eye/eyebrow region.  Evidence exists supporting a substantial role of TPs in Migraine headaches.  Overlapping pain referral patterns from the above muscle’s characteristic TPs can produce typical uni-lateral or bi-lateral pain patterns common to Migraine. It is not known whether the myofascial TPs are primary or whether the TPs are activated by central mechanisms.   In one study quoted by Travell, 60 % of Migraineurs who had tender pericranial muscle sites (TPs) referring pain  in patterns recreating their Migraine pain, and were injected with saline/lidocaine had their headaches completely erased.

In Traditional Chinese Medicine [TCM] the treatment of Migraines often involves the determination / diagnosis of a pattern of disharmony and subsequent treatment aimed at restoring balance, hopefully with care to not provoke side effects.  If, as noted neurologist Oliver Sacks asserts, Migraine represents a benign way for the [bodymind] to blow off accumulation of stress before it implodes and causes more tangible disease, then one might address Migraine management from the point of view of dissipating stagnant excess energies.

Clinically, I have noticed a strong correlation between the presence of trigger points in patients presenting with migraine or cluster headache.  In migraines, they often arise in tandem rather than as a cause and effect, as in tension headaches.  Interestingly, in one cluster headache patient I was able to stop the onset of an episode right as it was coming on by inserting 3 needles into the sternocleidomastoid muscle which fasciculated and released readily and dramatically.  While it’s possible for an aggressive treatment to trigger a headache, acupuncture is a powerful drug free complement to other therapies for headache pain with minimal risk of side effects.  Untying myofascial straitjackets and loosening myofascial constriction is an often overlooked and highly useful component to a patient’s pain regimen.  Treating the trigger points with acupuncture is advantageous for patients presenting with many trigger points, or with sensitivities to lidocaine, and also provides the beneficial effect of settling down the autonomic nervous system.


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