Pain Management – Migraine and Tension Headache

The most common types of headaches are:

Tension headaches: Also called chronic daily headaches or chronic non-progressive headaches, tension headaches are the most common type of headaches among adults and adolescents. These muscle contraction headaches cause mild to moderate pain and come and go over a prolonged period of time.

Migraines: The exact causes of migraines are unknown. A popular theory is that various triggers cause abnormal brain activity, which in turn causes changes in the blood vessels in the brain. This is called the neurovascular theory. Genetics plays a role in migraines and there are some forms of migraines that are associated with inherited abnormalities in certain parts of the brain. Typical migraine headaches are one-sided, pulsating or throbbing, and moderate or severe in intensity. Migraine headaches can last from four hours to three days and usually occur one to four times per month. Migraines are associated with symptoms such as sensitivity to light, noise, or odors; nausea or vomiting; loss of appetite; and stomach upset or abdominal pain.

Mixed headache syndrome: Also called transformed migraines, mixed headache syndrome is a combination of migraine and tension headaches. Both adults and children experience this type of headache.

Cluster headaches: The least common — although the most severe — type of primary headache, the pain of a cluster headache is intense and may be described as having a burning or piercing quality that is throbbing or constant. The pain is so severe that most cluster headache sufferers cannot sit still and will often pace during an attack. The pain is located behind one eye or in the eye region, without changing sides. The term “cluster headache” refers to headaches that have a characteristic grouping of attacks. Cluster headaches occur one to three times per day during a cluster period, which may last two weeks to three months. The headaches may disappear completely (go into “remission”) for months or years, only to recur.

Sinus headaches: Sinus headaches are associated with a deep and constant pain in the cheekbones, forehead, or bridge of the nose. The pain usually intensifies with sudden head movement or straining and usually occurs with other sinus symptoms, such as nasal discharge, feeling of fullness in the ears, fever, and facial swelling.

Here, we mainly discuss the most common primary headaches including tension-type headache and migraine headaches which can be treated effectively with acupuncture.

How many people choose acupuncture as treatment for pain today?

According to the 2007 National Health Interview Survey, which included a comprehensive survey of CAM use by Americans, 1.4 percent of respondents (an estimated 3.1 million Americans) said they had used acupuncture in the past year. A special analysis of acupuncture data from an earlier NHIS found that pain or musculoskeletal complaints accounted for 7 of the top 10 conditions for which people use acupuncture. Back pain was the most common, followed by joint pain, neck pain, severe headache/migraine, and recurring pain.

How does acupuncture work for pain?

Acupuncture is used in the West primarily for painful conditions, so the majority of research into the mechanism of acupuncture has been orientated towards this area. The gate control theory, developed by Melzack and Wall in 1965, states that the input of pain via small nerve fibres can be inhibited within the spinal cord by the stimulation of large nerve fibres. Acupuncture has been shown to stimulate large diameter nerve fibres, thereby ‘closing the gate’ to pain and blocking pain perception. The discovery of endorphins and enkephalins (the body’s own natural opiates) has also strengthened the position of acupuncture as a treatment for pain. It has been shown by a number of studies that acupuncture causes the release of these naturally occurring opiates into various areas of the central and peripheral nervous system. Therefore, there is good evidence for the mechanisms underlying the effect of acupuncture in both acute and chronic pain.


Acupuncture Helps Chronic Headache

About 10% of U.K. practitioners either refer patients for acupuncture or administer it themselves for various painful conditions, including headache. In a recent Cochrane review, data supported the value of acupuncture for headache, but the analysts questioned the quality and the amount of evidence, which prompted this randomized, controlled trial.

The researchers recruited 401 adult patients with at least two headaches per month. Patients were assigned to receive either usual care alone or usual care plus as many as 12 acupuncture treatments during 3 months; participants were followed for 12 months. At 12 months, headache scores on a Likert scale were reduced by 34% in the acupuncture group versus 16% in the control group — a significant difference. Acupuncture patients experienced the equivalent of 22 fewer days of headache yearly than did control patients; they also used 15% less medication, made 25% fewer general-practitioner visits, and took 15% fewer sick days. Finally, several measures on health-status questionnaires were significantly better in the acupuncture group than in the placebo group.

Comment: This is a pretty impressive result, although the benefit that is attributable to acupuncture itself (as opposed to a placebo effect) might have been exaggerated because of inability to blind patients to treatment. What is also impressive is the duration of the effect. At the very least, acupuncture should be considered as one therapeutic option for chronic headache.


Vickers AJ et al. Acupuncture for chronic headache in primary care: Large, pragmatic, randomised trial. BMJ 2004 Mar 27; 328:744-7.