HEADACHE AND MIGRAINE
Aproximately 25% of new referrals in my primary care clinics are for chronic headache and migraine – 100 new patients annually in an age range of 16-70
Acupuncture has been demonstrated in research trials to be an effective treatment reducing number and severity of headaches, reduction in medication, GP visits and time off work, (ref. 1).
DIFFERENT TYPES OF HEADACHE AND MIGRAINE
The International Headache Society classify headaches into 4 categories; migraine, tension type headaches, trigeminal cephalgias and other primary headaches . I normally see migraines and tension type headache with other facial and head pains associated with sinusitis, jaw clenching/grinding, and referred pain from the neck muscles.
A full history of the condition including any investigations and medication will be taken and an examination to exclude any signs of serious conditions such as brain tumours and neurological disease.
Migraines are divided into those with visual disturbances – aura- and those without aura. Visual disturbances can include, flashing lights and double vision and even loss of part of the visual field, ( hemianopia). Migraines without aura can be very disabling, involving sensitivity to light, intense pain and nausea and vomiting. Some migraines have a hormonal aspect and can occur in the menstrual cycle or be influenced by contraceptive pills or pregnancy. There are very effective migraine medications –Triptans- and also medicines that can prevent the onset of migraine – Pizotifen, Propranolol, Amitriptylline. There is some evidence that the herb Fever Few can help during episodes.
It used to be claimed that certain foods can trigger migraines, and although this may be the case in certain patients, migraines are more commonly caused by missing a meal, ( ‘fasting headaches’). Stress can trigger muscle tension headaches but characteristically migraines can occur when we relax at the weekend or even sleep longer than usual.
Tension type headaches are also called muscle tension headache and can affect 90% of us during our lives. Chronic recurrent tension type headaches can be very disabling and some patients have daily headaches. Ordinary analgesia like paracetamol , codeine and ibuprofen can help in the short term but repeated long term use can produce a rebound headache.
It has been suggested that tension type headaches and migraines are all part of the same spectrum despite the difference in symptoms, ( ref 2). Clinical experience also suggests that muscular trigger points can exist in a number of headaches and that treating the trigger points with acupuncture can produce sustained improvement. Benefit can usually become apparent after 4-6 weekly sessions. Chronic cases may require further monthly follow up treatments. The treatment is not usually uncomfortable or associated with side effects and will involve needling trigger points around the face, head, neck and shoulders
Ref 1. Vickers et al . BMJ. 2004; 328; 744
Ref 2. Lane. R, Davies. P “ Migraine”. 2006. New York, Taylor and Francis, pp 259-278