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Treating Migraines - Drugs, Acupuncture, Lifestyle Changes | East London Acupuncture & Massage Therapy
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East London Acupuncture & Massage Therapy

Treating Migraines with Drugs, Acupuncture and Lifestyle Changes

08 November 2011
9

This is an article that I wrote for the multibed clinic that I set up and run in South London. It discusses migraine headaches, the drugs used to control and treat them, acupuncture, and other ways of reducing their effect.
I thought I’d repost it here as it has some really good info on the type of dietary and exercise changes that can be effective, as well as an overview of the research that has been carried out into the effectiveness of acupuncture on migraine headaches

Treating Migraine Headaches

Contents

  • Summary
  • Introduction
  • What is a Migraine?
  • Treating Migraines: Drug Treatment
  • Treating Migraines: Acupuncture
  • What to Do as a Patient
  • Conclusion

Summary

  • Migraine is a widespread and debilitating illness, costly in both financial and social terms.
  • Drug treatments are effective both as acute remedies and as preventative treatments.
  • A significant proportion of migraine sufferers will not respond to drugs or will find the side effects intolerable.
  • Many well designed clinical studies have concluded that acupuncture is as effective or more effective than drugs as a preventative treatment for migraine.
  • The most recent studies on migraine and acupuncture show that treatments based on traditional theories produce significantly better results.
  • Other complementary therapies that may be useful to migraine sufferers include dietary and lifestyle changes, mind-body therapies and exercise.

Introduction

Migraine has a global prevalence of around 10%[1], and in the UK there are an estimated 5.8 million sufferers[2]. Its costs, both economic and social, are high. It is currently thought to be the most costly of the neurological disorders estimated to cost the U.S. economy $14.4 billion per year, and the European Union more than €27 billion per year[3]. The World Health Organisation rates it 19th on the list of leading causes of disability[4], migraines reduce the quality of life of individuals in all areas[5], affecting family and social life the most[6].

What is a Migraine?

Diagnosis of migraines are based on patient history. The International Classification of Headache Disorders, 2nd Ed. (ICHD-II) is used to define which headaches and accompanying symptoms constitute a migraine attack. Click the link below for details of the ICHD-II criteria. If you are unsure if you suffer from migraines or not, it is advisable to contact your Doctor. If you get a severe and unusual headache with recent onset, or following an accident, you should seek medical help immediately.

ICHD-II classification of migraine diagnosis

Treating Migraine Headaches

Drug Treatment

Drug treatments are the first option for many. As our understanding of migraine pathology has improved, so have the drugs used to treat it, and new and improved pharmaceuticals are being developed all the time.

Drug treatments can be divided into two categories; acute and prophylactic.

Acute Drugs:
These aim to reduce the severity and duration of a migraine attack, and thus hasten the return to normal life. Acute drugs include ‘non-specific agents’ such as Asprin, and ‘specific’ drugs, such as Triptans, which are designed to work only on the neurological cause of the migraine attack. Triptans are currently the most effective acute therapy available to migraine sufferers and should be considered if attacks are of moderate or severe intensity[7]. They should be taken early in the course of a migraine attack to maximise effect[8]. Although they are considered to have revolutionised acute migraine treatment, a significant percentage (about 30%) of patients will not respond at all to this type of drug[9] . Follow the link below for a summary of the current acute drugs available.

Acute drugs for migraine attacks

Prophylactic (Preventative) Drugs:
When migraine attacks are frequent and/or of moderate to severe intensity, preventative drugs should be considered[10]. The drugs of first choice are beta-blockers, flunarizine, valproic acid and topiramate[11]. These have been found to be consistenly effective in reducing the severity and frequency of migraine attacks. When starting a course of drugs for migraine, intake should be increased slowly over time to minimise side effects and to achieve optimum dosage. It may also take several weeks for effects to become noticeable[12]. A significant number of patients will, however, not find these drugs beneficial, or will not be tolerant of the side effects[13]. Click the link below for a table summary of these drugs.

Preventative Drugs for Migraine

Acupuncture and Migraine

Although around two thirds of patients will experience a 50% reduction in headache frequency after taking prophylactic drugs[14], a complete cure has proved elusive. As a result, the question of the effectiveness of acupuncture as a cure for migraine headaches is one that has been looked at in some depth over recent years. The evidence has been encouraging. A study of chronic headaches involving 401 patients suggested that acupuncture leads to persisting, clinically relevant benefits, particularly for migraine patients[15]. Large studies in both the UK and Sweden concluded that, for chronic migraine, acupuncture improves quality of life and is cost effective[16][17]. When compared to drug treatment, other studies have suggested that acupuncture may be a suitable alternative migraine prevention[18][19] and provides lasting improvements[20]. A study of 15,056 patients suffering from primary headaches concluded that acupuncture plus routine care provides marked and maintained clinical improvements when compared to routine care alone[21].

The general medical consensus, therefore, is that acupuncture may provide effective and lasting preventative treatment for migraine. The latest Cochrane Review looked at 22 studies and concluded that acupuncture is at least as effective and probably more effective than treatment with medication[22]. Controversy still exists regarding the exact mechanism by which acupuncture works. Some trials found that the locations of the needles were not important[23]. This has lead some to suggest that acupuncture works because of the high level of therapeutic intervention between practitioner and patient[24]. More recently, studies that have attempted to apply traditional Chinese acupuncture techniques more rigorously have found them to be significantly more effective and longer lasting than other forms of acupuncture[25][26].

What can you do if you suffer from migraines?

Acupuncture has been found to be as effective or more effective than medication, with fewer side effects. In addition, there are other therapeutic options that you can try as a migraine sufferer. Regular aerobic exercises may lead to a reduction in the pain felt during an attack[27]. It is however common for migraine headaches to worsen during vigorous exercise[28], so caution may be necessary. This not withstanding, aerobic activity is recommended as part of a regular lifestyle, with regular sleep, meals, and exercise[29]. Studies have also found that ‘mind-body therapies’ can significantly reduce the symptoms experienced during migraine attacks[30][31]. Mind-body therapies include meditation, tai chi, qi gong, yoga and relaxation techniques. Joining a local class could be an effective way of overcoming migraines, and most practitioners of acupuncture and Chinese Medicine will be able to advise you on these therapies. Diet is thought to play an important part in migraine, both in aetiology and prevention. Some migraine attacks are triggered by certain foods or categories of foods[32]. Common triggers include wine or chocolate, but they can vary from patient to patient. A physician or General Practitioner should be able to help you assess whether or not this is the case. Of greater importance, however, is regulation of diet – sufferes should eat regularly and avoid skipping meals. Additionally, certain supplements may help prevent migraines. The following have been recommended, in decreasing order of preference: magnesium, Petasites hybridus (Common Butterbur), feverfew, coenzyme Q10, riboflavin, and alpha lipoic acid[33]. All of these supplements are available in tablet form at health food shops and pharmacies, and manufacturers have begun to combine them into single products specifically aimed at the migraine market. Dietary changes can also be helpful to increase the amount of some of these compounds in the body. Magnesium rich foods include green leafy vegetables (such as spinach) and nuts[34]. Riboflavin (vitamin B2) is abundant in milk, eggs, rice and mushrooms[35], and alpha lipoic acid is found in foods such as red meat, organ meats (such as liver), and yeast (particularly Brewer’s yeast)[36]. Coenzyme Q10 sources include meat, poultry, fish, soybeans, and nuts[37].

Conclusion

Drug therapy for migraines has improved greatly over recent years, and provides relief from the pain of migraine headaches for many people. If you do not respond to medication, find that drugs produce unwanted side effects, or simply do not feel comfortable with taking pharmaceuticals regularly, then there are other options. Acupuncture has been used for centuries to treat migraines, and recent trials show that it is as effective, or more effective, than drugs. Some trials have shown that acupuncture based on Traditional Chinese Medical theory is the most effective form of acupuncture. Exercise, diet and mind-body techniques like meditation or qi gong can also help control the symptoms and frequency of migraine attacks. An acupuncturist trained in traditional techniques should be able to give advise on suitable mind-body relaxation therapies, as well as on appropriate dietary changes. Additionally, Chinese Medine understands the role of common triggers, such changes in weather conditions, hormonal changes, food types, lights or odours. An experienced practitioner will therefore tailor the treatment to you and your migraine sypmtoms specifically.

References

  1. ^ Jensen, R., & Stovner, L.J. (2008). Epidemiology and comorbidity of headache. Lancet Neurology, 7(4), 354-361.
  2. ^ Steiner, T.J., Scher, A.I., Stewart, W.F., Kolodner, K., Liberman, J., Lipton, R.B. (2003). The prevalence and disability burden of adult migraine in England and their relationships to age, gender and ethnicity. Cephalalgia, 23(7), 519-527.
  3. ^ Andlin-Sobocki, P., Jönsson, B., Wittchen, H., Olesen, J. (2005). Costs of Disorders of the Brain in Europe. European Journal of Neurology, 12(S1). http://www.sinapsa.org/Osnova/Materiali/Cost-paper-EBC.pdf
  4. ^ Mäki, K., Vahtera, J., Virtanen, M., Elovainio, M., Keltikangas-Järvinen, L., & Kivimäki, M. (2008). Work stress and new-onset migraine in a female employee population. Cephalalgia, 28(1), 18-25.
  5. ^ Lipton, R.B., Liberman, J.N., Kolodner, K.B., Bigal, M.E., Dowson, A., & Stewart, W.F. (2003). Migraine headache disability and health-related quality-of-life: a population-based case-control study from England. Cephalalgia, 23(6), 441-450.
  6. ^ Linde, M., & Dahlöf, C. (2004). Attitudes and burden of disease among self-considered migraineurs: a nation-wide population-based survey in Sweden. Cephalalgia, 24(6), 455-65.
  7. ^ Belvís, R., Pagonabarraga, J., Kulisevsky, J. (2009). Individual triptan selection in migraine attack therapy. Recent Patents on CNS Drug Discovery, 4(1), 70-81.
  8. ^ Rapoport, A.M. (2008). Acute and prophylactic treatments for migraine: present and future. Neurological Sciences, 29 (S1), S110-S122.
  9. ^ Deiner, H., & Limmroth, V. (2006). Specific Acute Migraine Treatment: Ergotamine and Triptans. In M.E. Bigal & R.B. Lipton (Eds.), Migraine and other headache disorders (pp. 289-310). New York: Taylor & Francis Group.
  10. ^ D’Amico, D., & Tepper, S.J. (2009). Key points in migraine prophylaxis: patient perspective. Neurological Sciences, 30(S1), S39-42.
  11. ^ Evers, S. (2008). Treatment of migraine with prophylactic drugs. Expert Opinion on Pharmacotherapy, 9(15), 2565-73.
  12. ^ Dodick, D.W., & Silberstein, S.D. (2007). Migraine prevention. Practical Neurology, 7 , 383-393.
  13. ^ Moschiano, F., D’Amico, D., & Bussone, G. (2009). Migraine prophylaxis: key points for the practising clinician. Neurological Sciences, 30(S1), S33-7.
  14. ^ Goadsby, P.J. (2006). Recent advances in the diagnosis and management of migraine. British Medical Journal, 332(7532), 25-29.
  15. ^ Vickers, A.J., Rees, R.W., Zollman, C.E., McCarney, R., Smith, C.M., Ellis, N., et al. (2004). Acupuncture for chronic headache in primary care: large, pragmatic, randomised trial. British Medical Journal, 328(7442), 744.
  16. ^ Wonderling, D., Vickers, A.J., & Grieve, R., & McCarney, R. (2004). Cost effectiveness analysis of a randomised trial of acupuncture for chronic headache in primary care. British Medical Journal, 328(7442), 747.
  17. ^ Witt, C.M., Reinhold, T., Jena, S., Brinkhaus, B., & Willich, S.N. (2008). Cost-effectiveness of acupuncture treatment in patients with headache. Cephalalgia, 28(4), 334-345.
  18. ^ Streng, A., Linde, K., Hoppe, A., Pfaffenrath, V., Hammes, M., Wagenpfeil, S., et al. (2006). Effectiveness and tolerability of acupuncture compared with metoprolol in migraine prophylaxis. Headache, 46(10), 1492-1502.
  19. ^ Allais, G., De Lorenzo, C., Quirico, P.E., Airola, G., Tolardo, G., Mana, O., & Benedetto, C. (2002). Acupuncture in the prophylactic treatment of migraine without aura: a comparison with flunarizine. Headache, 42(9), 855-861.
  20. ^ Melchart, D., Hager, S., Hager, U., Liao, J., Weidenhammer, W., & Linde, K. (2004). Treatment of patients with chronic headaches in a hospital for traditional Chinese medicine in Germany. A randomised, waiting list controlled trial. Complementary Therapy and Medicine, 12(2-3), 71-78.
  21. ^ Jena, S., Witt, C.M., Brinkhaus, B., Wegscheider, K., & Willich, S.N. (2008). Acupuncture in patients with headache. Cephalalgia, 28(9), 969-979.
  22. ^ Linde, K., Allais, G., Brinkhaus, B., Manheimer, E., Vickers, A., & White, A.R. (2009). Acupuncture for migraine prophylaxis. Cochrane Database of Systematic Reviews, (1).
  23. ^ Linde, K., Streng, A., Jürgens, A., Hoppe, A., Binkhaus, B., Witt, C., et al. (2005). Acupuncture for patients with migraine: A randomised controlled study. Journal of the American Medical Association, 293(17), 2118- 2125.
  24. ^ Moffet, H.H. (2008). Traditional acupuncture theories yield null outcomes: a systematic review of clinical trials. Journal of Clinical Epidemiology, 61(8), 741-7.
  25. ^ Facco, E., et al. (2008). Traditional acupuncture in migraine: a controlled, randomized study. Headache, 48(3), 398-407.
  26. ^ Li Y, et al. (2009). Acupuncture for treating acute attacks of migraine: a randomized controlled trial. Headache, 49(6), 805-16.
  27. ^ Dittrich, S.M., Günther, V., Franz, G., Burtscher, M., Holzner, B., Kopp, M. (2008). Aerobic exercise with relaxation: influence on pain and psychological well-being in female migraine patients. Clinical Journal of Sports Medicine, 18(4), 363-5.
  28. ^ Green, M.W. (2001). A spectrum of exertional headaches. Medical Clinics of North America, 85(4), 1085-92.
  29. ^ Schürks, M., Diener, H.C., Goadsby, P. (2008). Update on the prophylaxis of migraine. Current Treatment Options in Neurology, 10(1), 20-9.
  30. ^ Sierpina, V., Astin, J., Giordano, J. (2007). Mind-body therapies for headache. American Family Physician, 76(10), 1518-22.
  31. ^ Wahbeh, H., Elsas, S.M., Oken, B.S. (2008). Mind-body interventions: applications in neurology. Neurology, 70(24), 2321-8.
  32. ^ Kelman, L. (2007). The triggers or precipitants of the acute migraine attack. Cephalagia, 27(5), 394-402.
  33. ^ Sun-Edelstein, C., Mauskop, A. (2009). Foods and supplements in the management of migraine headaches. Clinical Journal of Pain, 25(5), 446-52.
  34. ^ http://www.eatwell.gov.uk/healthydiet/nutritionessentials/vitaminsandminerals/magnesium/
  35. ^ http://www.eatwell.gov.uk/healthydiet/nutritionessentials/vitaminsandminerals/riboflavin/
  36. ^ http://www.umm.edu/altmed/articles/alpha-lipoic-000285.htm
  37. ^ http://lpi.oregonstate.edu/infocenter/othernuts/coq10/

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