Consider the article yesterday in the SF Chronicle "UCSF doctors see colic-migraine link."
And an elaborate study out of China looking at different acupuncture treatment approaches for migraine prophylaxis. Acupuncture for migraine prophylaxis: a randomized controlled trial (full text at link.)
What is of interest between the two? The UCSF study finds that mothers with migraines are more likely to have babies with colic. Of course, we still have no idea what causes colic, even though the name implies something to do with the GI system. But there is a link between migraines and abdominal pain in youths called "abdominal migraine." Some children suffer bouts of nausea or dizziness before developing more classic headache symptoms as adults. There clearly is some link between the gut and migraine.
Then consider the study out of China. It compares classic treatment for migraine using Shao Yang points (Gall Bladder, lateral points.) And Yang Ming or treatment using stomach points. Though Shao Yang had slightly better results, both showed a decrease in migraines compared to controls (sham acupuncture.)
So wouldn't it be fascinating, in light acupuncture's effect on the gut, to compare different electroacupuncture treatments using acupuncture points for the gut for migraine prophylaxis? (Too many studies to do, too little time.)
I would also like to mention a fascinating anecdote related to me by a patient. Her horse had a common type of colic in which they get distension, bloating and obstruction. An acupuncture veterinarian put some needles near the nostils of the horse (Large Intestine Meridian) and the horse was cured. Maybe a clue for migraine treatment??
(More on my practice here.)
Showing posts with label migraine. Show all posts
Showing posts with label migraine. Show all posts
Sunday, February 26, 2012
Friday, December 16, 2011
Acupuncture Vs Topamax for Chronic Migraine Prophylaxis
Cephalalgia. 2011 Nov;31(15):1510-21. Epub 2011 Oct 21.
Acupuncture versus topiramate in chronic migraine prophylaxis: A randomized clinical trial.
Yang CP, Chang MH, Liu PE, Li TC, Hsieh CL, Hwang KL, Chang HH.
Source
Kuang Tien General Hospital, Taiwan.
Abstract
Background: The aim of this study was to investigate the efficacy and tolerability of acupuncture compared with topiramate treatment in chronic migraine (CM) prophylaxis. Methods: A total of 66 consecutive and prospective CM patients were randomly divided into two treatment arms: 1) acupuncture group: acupuncture administered in 24 sessions over 12 weeks (n?=?33); and 2) topiramate group: a 4-week titration, initiated at 25?mg/day and increased by 25?mg/day weekly to a maximum of 100 mg/day followed by an 8-week maintenance period (n=?33). Results: A significantly larger decrease in the mean monthly number of moderate/severe headache days (primary end point) from 20.2±1.5 days to 9.8±?2.8 days was observed in the acupuncture group compared with 19.8?±?1.7 days to 4.1 days in the topiramate group Significant differences favoring acupuncture were also observed for all secondary efficacy variables. These significant differences still existed when we focused on those patients who were overusing acute medication. Adverse events occurred in 6% of acupuncture group and 66% of topiramate group. Conclusion: We suggest that acupuncture could be considered a treatment option for CM patients willing to undergo this prophylactic treatment, even for those patients with medication overuse.
Again, lots of treatments in this study. But, wow, that's a lot of side effects from Topamax!! I mean, 66%??
Do you treat patients this many times in your practice? I usually don't feel comfortable requiring this intensity of treatment.
Info on my practice here. More on acupuncture and migraine here.
Acupuncture versus topiramate in chronic migraine prophylaxis: A randomized clinical trial.
Yang CP, Chang MH, Liu PE, Li TC, Hsieh CL, Hwang KL, Chang HH.
Source
Kuang Tien General Hospital, Taiwan.
Abstract
Background: The aim of this study was to investigate the efficacy and tolerability of acupuncture compared with topiramate treatment in chronic migraine (CM) prophylaxis. Methods: A total of 66 consecutive and prospective CM patients were randomly divided into two treatment arms: 1) acupuncture group: acupuncture administered in 24 sessions over 12 weeks (n?=?33); and 2) topiramate group: a 4-week titration, initiated at 25?mg/day and increased by 25?mg/day weekly to a maximum of 100 mg/day followed by an 8-week maintenance period (n=?33). Results: A significantly larger decrease in the mean monthly number of moderate/severe headache days (primary end point) from 20.2±1.5 days to 9.8±?2.8 days was observed in the acupuncture group compared with 19.8?±?1.7 days to 4.1 days in the topiramate group Significant differences favoring acupuncture were also observed for all secondary efficacy variables. These significant differences still existed when we focused on those patients who were overusing acute medication. Adverse events occurred in 6% of acupuncture group and 66% of topiramate group. Conclusion: We suggest that acupuncture could be considered a treatment option for CM patients willing to undergo this prophylactic treatment, even for those patients with medication overuse.
Again, lots of treatments in this study. But, wow, that's a lot of side effects from Topamax!! I mean, 66%??
Do you treat patients this many times in your practice? I usually don't feel comfortable requiring this intensity of treatment.
Info on my practice here. More on acupuncture and migraine here.
Monday, January 24, 2011
Tension Myoneural Syndrome, A Theory
This is from an article in Anesthesiology News. You have to be registered to read the interview in its entirety and to register you have to be willing to have the ad replete glossy sent to your home every month, so I will assume that most will just take my word for it...
This is an interview with a physician named John Sarno, who makes a case for the underlying emotional issues, pain or rage, that can cause a patient to be under pressure to be a perfectionist, that leads to physical pain. He cites the study in the New England Journal of Medicine back in 1994 which shows that bulges and protrusions in discs in people with low back pain frequently may be coincidental. He believes that if you educate people as to the common psychogenic origins of of these pain syndromes, that he calls "tension myoneural syndrome," or TMS, they get better. He has seen more than 10,000 such patients over 30 years and that roughly 3/4 of them have gotten better.
His basic theory goes something like this. That the physical pain serves to distract the patient's attention from emotional pain or rage, which often derives from the pressure people put on themselves to be good or perfect. In this attempt to live up to these high standards, something in the unconscious, an inner child, becomes very, very angry. He tries to educate patients to the fact that the drive to be perfect angers the unconscious. Once the person recognizes that this is what is happening they no longer automatically react to pressure with anger and rage. They no longer need the distraction.
He says that in addition to musculoskeletal maladies, the most common illnesses are gastrointestinal. Migraines and other headaches are classic problems as well. Other conditions that can result are chronic or recurrent sinus infections, and "globus hystericus," the feeling of a lump in the throat. Allergic problems and frequent urination are others.
He postulates that the brain reduces the amount of oxygen to a given part of the body. He uses various physical therapeutic means to increase circulation, heat, exercise and deep massage. He sees increasing circulation as key, and that "the brain was causing all this through the autonomic nervous system, which controls blood flow."
(To read more about acupuncture and my practice, please click here.)
He goes on to cite a 1993 paper on neuroendocrine-immune interactions in the New England Journal of Medicine (NEJM 1993, 329:1246-1253) that concluded that "the central nervous sytem influences on the immune system are well-documented and provide a mechanism by which emotional states could influence the course of diseases involving immune functions."
I wanted to make a few points about this article since it touches on issues that are important in my practice and my view of Chinese Medicine.
1. The mind and body are not separate entities in Chinese Medicine. Indeed, each organ has its own emotional state that it is responsible for. That is one reason that I was interested in Chinese Medicine. It is a way to help heal the mind through the body without necessarily engaging the cognitive portion. This can be incredibly useful and healthy.
2. The example of migraine is classic Chinese Medicine doctrine. Migraine is often caused by a stagnation of liver qi from an underlying perfectionism and rage. We treat by dredging the liver and calming the Shen, as well as local points which increase circulation.
3. To the extent that I've done research it has been on the autonomic nervous system and it's pivotal role in the effectiveness of acupuncture. Dr. Sarno's theories do nothing to dispute that theory; though he seems to prescribe a slightly different remedy.
4. The increase in circulation has been clearly established with acupuncture treatment with infra-red documentation and the like.
5. I'd never considered that the brain would be selectively decreasing blood flow to an area of the body, but I find this hypothesis fascinating. I frequently will treat the spinal level involved in the nerves that feed an area that is in pain, and thought of the autonomic nervous system as a more general relaxation and restoration of function. More food for thought!
6. The increase in immune function with acupuncture is well documented, I've posted about it here, and here,and am heartened to see other practitioners accepting this link.
7. Globus Hystericus in Chinese Medicine is a common feature of the condition "running piglet" which is treated through the Chong Mai extra meridian and the liver meridian very effectively.
This is an interview with a physician named John Sarno, who makes a case for the underlying emotional issues, pain or rage, that can cause a patient to be under pressure to be a perfectionist, that leads to physical pain. He cites the study in the New England Journal of Medicine back in 1994 which shows that bulges and protrusions in discs in people with low back pain frequently may be coincidental. He believes that if you educate people as to the common psychogenic origins of of these pain syndromes, that he calls "tension myoneural syndrome," or TMS, they get better. He has seen more than 10,000 such patients over 30 years and that roughly 3/4 of them have gotten better.
His basic theory goes something like this. That the physical pain serves to distract the patient's attention from emotional pain or rage, which often derives from the pressure people put on themselves to be good or perfect. In this attempt to live up to these high standards, something in the unconscious, an inner child, becomes very, very angry. He tries to educate patients to the fact that the drive to be perfect angers the unconscious. Once the person recognizes that this is what is happening they no longer automatically react to pressure with anger and rage. They no longer need the distraction.
He says that in addition to musculoskeletal maladies, the most common illnesses are gastrointestinal. Migraines and other headaches are classic problems as well. Other conditions that can result are chronic or recurrent sinus infections, and "globus hystericus," the feeling of a lump in the throat. Allergic problems and frequent urination are others.
He postulates that the brain reduces the amount of oxygen to a given part of the body. He uses various physical therapeutic means to increase circulation, heat, exercise and deep massage. He sees increasing circulation as key, and that "the brain was causing all this through the autonomic nervous system, which controls blood flow."
(To read more about acupuncture and my practice, please click here.)
Migraines provide an excellent example of this process. The migraine is a condition of spasmodic narrowing of the blood vessels. The narrowing ususally takes place in one large blood vessel, such as the carotid. First you experience pain ,a nd if it persists long enough, you may have a stroke. Several studies support this oxygen-deprivation hypothesis.
He goes on to cite a 1993 paper on neuroendocrine-immune interactions in the New England Journal of Medicine (NEJM 1993, 329:1246-1253) that concluded that "the central nervous sytem influences on the immune system are well-documented and provide a mechanism by which emotional states could influence the course of diseases involving immune functions."
I wanted to make a few points about this article since it touches on issues that are important in my practice and my view of Chinese Medicine.
1. The mind and body are not separate entities in Chinese Medicine. Indeed, each organ has its own emotional state that it is responsible for. That is one reason that I was interested in Chinese Medicine. It is a way to help heal the mind through the body without necessarily engaging the cognitive portion. This can be incredibly useful and healthy.
2. The example of migraine is classic Chinese Medicine doctrine. Migraine is often caused by a stagnation of liver qi from an underlying perfectionism and rage. We treat by dredging the liver and calming the Shen, as well as local points which increase circulation.
3. To the extent that I've done research it has been on the autonomic nervous system and it's pivotal role in the effectiveness of acupuncture. Dr. Sarno's theories do nothing to dispute that theory; though he seems to prescribe a slightly different remedy.
4. The increase in circulation has been clearly established with acupuncture treatment with infra-red documentation and the like.
5. I'd never considered that the brain would be selectively decreasing blood flow to an area of the body, but I find this hypothesis fascinating. I frequently will treat the spinal level involved in the nerves that feed an area that is in pain, and thought of the autonomic nervous system as a more general relaxation and restoration of function. More food for thought!
6. The increase in immune function with acupuncture is well documented, I've posted about it here, and here,and am heartened to see other practitioners accepting this link.
7. Globus Hystericus in Chinese Medicine is a common feature of the condition "running piglet" which is treated through the Chong Mai extra meridian and the liver meridian very effectively.
Sunday, March 1, 2009
Acupuncture effective for migraine prophylaxis
The same authors as in my previous post also did a survey of the literature for migraine prophylaxis.
MAIN RESULTS: Twenty-two trials with 4419 participants (mean 201, median 42, range 27 to 1715) met the inclusion criteria. Six trials (including two large trials with 401 and 1715 patients) compared acupuncture to no prophylactic treatment or routine care only. After 3 to 4 months patients receiving acupuncture had higher response rates and fewer headaches. The only study with long-term follow up saw no evidence that effects dissipated up to 9 months after cessation of treatment.
The authors conclude that available studies suggest that acupuncture is at least as effective as, or possibly more effective than, prophylactic drug treatment, and has fewer adverse effects. Acupuncture should be considered a treatment option for patients willing to undergo this treatment.
Cochrane Database Syst Rev. 2009 Jan 21;(1):CD001218
Linde K, Allais G, Brinkhaus B, Manheimer E, Vickers A, White AR.
So, of course I'm biased because of my practice experience, but it seems to me that with the potential dangers of any medication, and the derivative benefits of acupuncture, the use of acupuncture treatment becomes more and more cost effective.
(For more information about my practice, please click here.)
MAIN RESULTS: Twenty-two trials with 4419 participants (mean 201, median 42, range 27 to 1715) met the inclusion criteria. Six trials (including two large trials with 401 and 1715 patients) compared acupuncture to no prophylactic treatment or routine care only. After 3 to 4 months patients receiving acupuncture had higher response rates and fewer headaches. The only study with long-term follow up saw no evidence that effects dissipated up to 9 months after cessation of treatment.
The authors conclude that available studies suggest that acupuncture is at least as effective as, or possibly more effective than, prophylactic drug treatment, and has fewer adverse effects. Acupuncture should be considered a treatment option for patients willing to undergo this treatment.
Cochrane Database Syst Rev. 2009 Jan 21;(1):CD001218
Linde K, Allais G, Brinkhaus B, Manheimer E, Vickers A, White AR.
So, of course I'm biased because of my practice experience, but it seems to me that with the potential dangers of any medication, and the derivative benefits of acupuncture, the use of acupuncture treatment becomes more and more cost effective.
(For more information about my practice, please click here.)
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