Headaches are among the most common complaints presented by patients seeking acupuncture treatments. Some cases respond well to acupuncture treatments, whereas others are rather challenging.
Although brain tissue does not ache, certain structures in the head and outside the skull are sensitive to pain. These include skin, muscles, arteries, the membrane that coats the skull, the eyes, the ears, and the nasal sinus cavities. Pain may result from tension or inflammation of the muscles or arteries of the scalp, or inflammation in the sinuses, ears, or gums.
Pain-sensitive structures inside the skull include arteries, venous sinuses and their tributary veins, parts of the outer membrane at the base of the brain, and cranial and cervical (sensory) nerves. Headache pain may result from dilation or contraction of the arteries, inflammation of brain membranes, or pressure from a tumor or hemorrhage.
The exact nature of headache pain is still unclear. It is believed that headaches occur as the result of an imbalance or changes in brain chemicals called neurotransmitters, such as serotonin and noradrenaline. The unbalanced levels of these brain chemicals cause inflammation of scalp arteries and irritation of the pain-sensitive structures mentioned above. The inflammation or irritation of these structures stimulates the trigeminal nerve, which sends pain impulses to the pain centers of the brain. The pain may be dull, sharp, or throbbing (pulsatile).
A headache is considered chronic if it cannot be relieved or improved after 6 months.
Medical professionals differentiate headaches into four types: migraine, tension, cluster, and organic. Each type of headache has its own pain pattern.
Of the four types of headache, the tension headache is the most common. This headache is characterized by a dull, squeezing knot or pressure pain that involves the forehead, scalp, temples, or back of the head and neck. The cause of this headache is muscle tension, especially the muscles on the neck and shoulder. When physical and/or physiologic tension or stress accumulates in the body, skeletal muscles and smooth muscles (muscles lining the internal organs and blood vessels) become contracted without spontaneous relaxation. This causes low oxygen supply and results in pain in both skeletal and smooth muscles. In such cases some people also feel pain in the stomach; some complain also of pain in the neck or shoulders; and others feel pain only in the head, possibly accompanied by raised blood pressure.
The tension headache responds very well to acupuncture treatments, and the Integrative Neuromuscular Acupoint System (INMAS) protocol proves to be very effective. As discussed in Chapter 3, muscle tension usually changes the homeostatic acupoints (HAs) from the latent phase to the passive phase, making them tender, and INMAS helps to locate these tender points. Locally, the process of needling tender points and the resulting needle-induced lesions effectively relax both superficial and deep muscles all over the body and restore their normal blood and oxygen supply. Systemically, needle-induced neurochemical substances such as endorphins are secreted into the blood stream and cause the relaxation of skeletal and smooth muscles as well as of other systems such as the cardiovascular system, thus normalizing the blood pressure. This combination of local and systemic effects brings about relief of tension headaches.
The underlying cause of migraine headaches is believed to be neurotransmitters, the communicating chemicals within the nervous system. Migraine headaches usually occur as moderate or severe pain on one side of the head, often accompanied by nausea or transient visual disturbance, intolerance to light or sound, or rainbow-like colors called aura in the field of vision. The incidence of migraine headaches is higher in females than in males. One of the reasons for the gender difference is that many female patients experience migraine just before or during their menstrual period, possibly due to fluctuation in the level of female hormones. Patients with a migraine headache may feel tightened scalp muscles just as do patients with a tension headache.
The medical history of patients with migraine headaches often shows that they have suffered for many years, and it may also show accompanying problems such as habitual constipation, insomnia, fatigue, or a food allergy. The chronicity of migraine headaches makes treatment challenging. In addition, physiologic problems, such as constipation, that often accompany migraines render the body resistant to any medical intervention. For example, if a migraine patient is also suffering from constipation, the toxins retained in the body as a result of the constipation may be supplementary triggers for the migraine.
A comprehensive approach is needed when treating patients with migraine pain. For example, during the course of acupuncture treatments the practitioner and the patient should work together to find solutions for contributing problems such as constipation, poor diet, fatigue, and lifestyle factors (e.g., lack of proper physical exercise). Acupuncture will not provide longlasting relief from migraine if these conditions are ignored or persist.
Cluster headaches are more common in male patients. The cluster headache is characterized by a steady stabbing pain around one eye or on one side of the head, sometimes with watering and redness of the eye and nasal stuffiness on the same side of the face. The pain episodes may recur at the same time of day or night.
The cluster headache is believed to be caused by a disorder in the hypothalamus, the part of the brain responsible for regulating hormones and physiologic rhythms such as the sleep-wake cycle. A specific chemical present in the brain and some cranial nerves may cause similar symptoms. This brain chemical binds to special receptors in the neck arteries to control the ratio of oxygen to carbon dioxide in the blood supply of the brain. Smoking, alcohol, or certain foods may trigger a cluster headache, especially in patients whose family history shows a similar pattern.
Acupuncture helps to relieve cluster headaches by similar means to those discussed in treating tension headaches. In addition to the local and systemic effects of acupuncture needling as discussed above, the needling stimulates peripheral nerves, which send impulses directly to the hypothalamus. Thus acupuncture stimulation helps the hypothalamus to restore its normal regulatory function and reduces the symptoms of cluster headache.
Organic headaches account for less than 1% of headache cases. These headaches are caused by problems such as inflammation around the brain, elevated blood pressure, brain edema (swelling), or a brain tumor. The underlying causes of organic headaches are life-threatening, and these patients should be examined by specialists. However, clinical evidence shows that acupuncture can be useful as a supplement to conventional approaches in treating such patients. Acupuncture induces the secretion of endorphins, which relaxes blood vessels, promotes blood circulation, and reduces peripheral resistance to blood circulation. By using INMAS and properly selecting symptomatic acupoints (SAs), an acupuncture practitioner can help to reduce tissue swelling and high blood pressure and to control inflammation.
7: The Psychology of Acupuncture Therapy: Placebo and Nocebo Effects in Acupuncture Pain Management
1: From Neurons to Acupoints: Basic Neuroanatomy of Acupoints
4: The Neural Bases of Acupuncture: Central Mechanisms
6: Quantitative Acupuncture Evaluation and Clinical Techniques
10: Upper Limb Pain: Shoulder, Elbow, Wrist, and Hand
