New Study Explains the Physiology of Acupuncture in Migraine Treatment

According to epidemiological research, severe headaches or migraines affect one in six Americans [1], and headaches in general were “reported to be the third-largest cause of years lost due to disability worldwide”[2]. For those of us who work as acupuncturists, we know that Chinese medicine can help reduce headache frequency and severity for patients who suffer from the condition. However, the physiological mechanisms of the effects of acupuncture are still being revealed.

 

The Connection Between Acupuncture and Brain Metabolites

A study published earlier this year in the Journal of Pain Research used brain imaging to draw a positive correlation between acupuncture and brain metabolites—which identifies a possible mechanism for the impact of acupuncture on migraines [3] and potentially indicates an effective way to measure the impact of acupuncture on other central nervous system (CNS) disorders.

The researchers in the study, which was conducted in Beijing, used proton magnetic resonance spectroscopy imaging (MRSI) to look at the levels of brain metabolites in regions of the brain associated with pain after five days of acupuncture treatments in patients suffering from migraines. The design of the study was interesting—45 subjects participated in the study and were broken into three groups: patients suffering from migraine without aura, patients suffering from cervicogenic headache, and a healthy control group of patients who didn’t suffer from headache. However, the cervicogenic group also acted as a type of control or “reference condition” by receiving a verum acupuncture treatment for migraine—not for cervicogenic headache. The healthy control group received sham acupuncture at non-acupuncture points on the body.

 

Liver Hyperactivity Acupuncture Protocol

Many acupuncture studies make the mistake of using a protocol of points designed for a syndrome due to a specific traditional Chinese medicine (TCM) diagnosis (e.g., points to treat low back pain due to Kidney Yang deficiency) to treat the syndrome regardless of TCM diagnosis (e.g., undifferentiated low back pain). This study, however, identified patients for the migraine without aura group that all fit into the diagnosis of “Gang Yang Shang Kang”—or “Liver meridian hyperactivity”—and used an appropriate treatment protocol to focus on that diagnosis, including DU20, GB20, and LV2. The cervicogenic group received the same points, which did not match their TCM diagnosis.

After five consecutive days of acupuncture treatment, the patients in the migraine without aura group reported a decrease in headache intensity. This decrease in pain level was backed up by significant increases in brain metabolite levels of N-acetylaspartate to creatine (NAA/Cr), particularly in the thalami regions of the brain—the part of the brain associated with the transmission of pain. Low levels of NAA are considered a potential contributor to the pain associated with migraines.

 

Research Findings Show Promise for Integrative Approach

As with any similar research, it’s important to take into account that this is a small study that has yet to be reproduced. But if the findings hold up, and acupuncture does show a positive impact on NAA levels in migraine patients, then an area of research to expand into might be what other CNS conditions are associated with low NAA levels—and whether acupuncture has a measurable impact on those conditions. Some of the conditions associated with low levels of NAA include post-ischemic stroke, dementia and Alzheimer’s disease, epilepsy, brain tumors, multiple sclerosis, Creutzfeldt-Jakob disease, traumatic brain injury, and schizophrenia[4].

Some Chinese medicine practitioners might wonder why we should place any importance on this type of research. If the patients are reporting a decrease in pain intensity, why do we need to also image the brain? What is the relevance of learning about NAA/Cr levels, when we can use the patient’s subjective experience of his or her condition as a better marker for clinical success? Because we are practicing integrative medicine! The reality is that studies on objectively measured physiological changes in the body that result from acupuncture strengthen the credibility of acupuncture in the eyes of Western medicine. It also creates a shared language of what acupuncture achieves, so that acupuncturists and medical doctors can collaborate creatively on how to use acupuncture alongside Western medicine to best heal our patients together.

 

Research & Writing by Dr. Stephanie Albert

Dr. Stephanie Albert holds a Doctorate of Acupuncture and Chinese Medicine from the American College of Traditional Chinese Medicine in San Francisco, CA. She runs a private practice out of the Lotus Center in the Mission district of San Francisco, where she works with patients to address stress, insomnia, pain, women’s health issues, and other health complaints through acupuncture, herbal medicine and lifestyle modification. www.stephalbert.com

 

References

  1. Burch, R., Rizzoli, P., & Loder, E. (2018). “The Prevalence and Impact of Migraine and Severe Headache in the United States: Figures and Trends from Government Health Studies.” Headache 58(4): 496–505.
  2. World Health Organization. (2016). Headache Disorders [Fact sheet]. http://www.who.int/news-room/fact-sheets/detail/headache-disorders
  3. Gu, T., Lin, L., Jiang, Y., Chen, J., D’Arcy, R.C.N., Chen, M., & Song, X. (2018). “Acupuncture Therapy in Treating Migraine: Results of a Magnetic Resonance Spectroscopy Imaging Study.” J Pain Res. 11: 889–900.
  4. Moffett, J.R., Ross, B., Arun, P., Madhavarao, C.N., & Namboodiri, M.A.A. (2007). “N-Acetylaspartate in the CNS: From Neurodiagnostics to Neurobiology.” Prog Neurobiol. 81(2): 89–131.
Contact Us