A migraine is a type of headache often characterized by a throbbing, stabbing pain occurring on either one or both sides of the head. Migraines can become seriously debilitating for whoever has them and can also be a chronic, recurring condition. Migraines can occur when abnormal brain cell activities trigger the release of certain chemicals, causing changes of blood flow in the brain and surrounding tissues. CT’s or MRI’s do not show any organic changes in the brain.

The most prominent symptom of a migraine is a pulsating, throbbing pain that occurs on one side or both sides of the head (though it can be worse on one side). The pain usually lasts between 4 to 72 hours and can become worse with activities that require exertion, such as climbing stairs. Similarly, the pain can be reduced by relaxing and lying down.

Other symptoms that can accompany the pain include:

  1. Nausea and vomiting
  2. Chills
  3. Neck pain
  4. Increased urination
  5. Numbness and tingling
  6. Abnormal sweating
  7. Sleepiness and dulled thinking
  8. Vision changes that include seeing wavy lines or dots and flashing lights, blurry vision, and eye pain.

Causes of migraines:

  1. A changed sleep-wake cycle can cause an imbalance of chemicals in the brain. If cortisol, melatonin and other chemicals peak and drop at the wrong times, brain activity will change.
  2. Artificial light, such as computer and TV light, can reduce melatonin secretion, which is associated with the hyper-excitability of brain cells and increases of certain chemicals linked with pain sensation. Many teenagers develop migraines after prolonged screen time.
  3. Missing meals can cause a decrease in blood sugar, triggering adrenaline release and changing the activity of brain cells.
  4. Strong coffee or tea can over-stimulate the sympathetic nervous system and lead to an imbalance between excitatory and inhibitory chemicals in the brain.
  5. Taking medication for headaches daily can profoundly change the balance of the chemicals in the body.
  6. Hormone changes during puberty, menopause and menstruation can also influence brain blood flow. Women tend to develop migraines during menopause.
  7. Birth control pills not only dramatically change your chemical balance and brain activities but can also cause swelling in blood vessels, leading to migraines.
  8. Certain smells or perfumes can change blood vessel tone (constriction or dilation).
  9. Certain foods: any processed, fermented, pickled, or marinated foods, baked goods, chocolate, dairy products, foods containing monosodium glutamate (MSG), foods containing tyramine (including red wine, aged cheese, smoked fish, chicken livers, figs, and certain beans.), meats containing nitrates (bacon, hot dogs, salami, cured meats), nuts, onions and peanut butter.
  10. Stress can cause increases of cortisol, adrenaline and prolactin, causing migraines.
  11. Lyme disease can cause nerve damage.
  12. Dehydration induces histamine release, which generally causes inflammation and dilation of the blood vessels, thus causing migraines.
  13. Some medications, such as beta-blockers, can cause swelling in blood vessels.
  14. Excessive noise can over-stimulate the sympathetic nervous system, making you prone to developing migraines.
  15. Pregnant women may have migraine attacks during the last two trimesters due to high levels of progesterone and a certain type of estrogen (estriol) changing the activities of the blood vessels.
  16. Nicotine withdrawal can cause headaches.
  17. Weather changes may cause swelling of the blood vessels due to changes of humidity and air pressure.

What can you do to prevent migraines?

  1. Go to sleep and wake up at regular, consistent times in order to maintain normal brain cell activity. Healthy individuals typically maintain a proper circadian cycle.
  2. Avoid too much caffeine. If you currently have a migraine, you should gradually cut down the amount of caffeine that you take in. Technically, caffeine can constrict the blood vessels and help relieve headaches if you do not drink coffee regularly. Too much caffeine is always linked with frequent headaches, because caffeine can also overstimulate your sympathetic nervous system, causing overreactions to environmental changes. Moderation is key.
  3. If you want to quit smoking, do it gradually, because a sudden drop in nicotine can lead to hyper excitability of brain cells. Consider drinking some green tea when you want to light a cigarette, because theanine in green tea can help us relax but still stay alert.
  4. Cut down on alcohol consumption if you have frequent migraines, they interfere with the effectiveness of migraine medication.
  5. Stay away from foods you may be allergic to, such as nuts or onions. Abnormal levels of histamine due to allergies can change our brain cell activities causing migraine.
  6. Avoid intense exercise, which can trigger adrenaline release and cause migraines.
  7. Avoid artificial sweeteners, as they can have similar structures as certain brain chemicals such as aspartate or glutamate and thus can potentially change brain cell activities.
  8. Try to maintain proper blood sugar levels by eating at consistent times. Cut down on foods, such as sweets, that can cause your blood sugar levels to rise and drop rapidly.
  9. Apply a cool towel to your head during a migraine, which can help to reduce blood vessel swelling.
  10. Drink half your weight in fluid ounces of water at least three times a week. When you are dehydrated, your blood vessels tend to constrict to maintain your blood pressure. Furthermore, dehydration can induce histamine release.

Research about acupuncture and migraine:

As reported in 2009, in Military Medicine publication, researcher John P applied a set of standardized acupuncture points, over a predetermined time interval, on 26 subjects suffering from chronic daily headaches, the majority being migraines. John P observed a reduction in the frequency and intensity of headaches, after treatment, as reflected below: Headache calendars and validated measurements were compared 12 weeks before and 12 weeks after the acupuncture intervention. The outcome reflected continued improvements lasting beyond 12 weeks after the last acupuncture treatment. In another study published in Acupoints’ Dictionary of the People’s Republic of China, 275 migraine patients admitted to 3 hospitals were randomly divided into a treatment group treated by EA at Qiuxu (GB 40), and a control group treated by EA at Tian shu (ST 25). The indexes of the migraine symptoms and the 5-HT (serotonin) levels were observed in both groups before and after treatment. There was a significant difference in pain score between the two groups (P<0.01). The pain score was much lower in the treatment group than in the control group. Right after treatment and 3 months after the acupuncture treatment, the effective rates were 68.0% and 68.0% in the treated group (ES on GB40) and 24.0% and 32.0% in the control group, and the differences between the two groups were statistically significant. The evidence proves that acupuncture preventive treatments can effectively improve the quality of life of patients with migraine and reduce the frequency of migraine attacks.

Li Y published results in Headache 2009 reflecting how acupuncture can relieve the acute attacks of migraines. A total of 218 patients with migraine were recruited for the study; 180 met the inclusion criteria; 175 completed the callback process and were randomized into 3 groups. One group received true acupuncture, whereas subjects in the other 2 groups were treated with sham acupuncture. Each patient received 1 session of treatment and was observed over a period of 24 hours. The primary outcome measure was the differences in visual analog scale (VAS) scores for the pain level before treatment, and in intervals of 0.5, 1, 2, and 4 hours after treatment. VAS is used to measure the pain level from no pain to worse pain by making a handwritten mark on a 10-cm line. There was a significant difference in the change from baseline in VAS scores in the second hour after treatment among the 3 groups (P = .006), with only patients treated with real acupuncture showing a significant mean decrease in VAS score at this time. Significant differences were observed in pain relief, relapse, or aggravation within 24 hours after treatment as well as in the general evaluations among the 3 groups. Many patients in the acupuncture group experienced complete pain relief (40.7%) and did not experience recurrence or intensification of pain (79.6%). Using Positron emission computerized tomography, Li XZ observed the changes of glucose metabolism in the brains of patients suffering with migraine before and after acupuncture. Six cases of chronic migraine were treated with acupuncture at Fengchi (GB 20), Waiguan (TE 5), Yang-lingquan (GB 34) on the Shaoyang Channel. After acupuncture, the activities of brain regions associated with pain sensation, such as the brain stem and insula, were reduced, including both temporal lobes. When the neurons are not hypersensitive, the pain threshold can be elevated and the pain sensation can be lowered. Acupuncture achieves beneficial therapeutic effects possibly through coordination and redistribution of energy metabolism in the brain.

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Case Study:

A 53-year-old business woman had suffered with migraine headaches since she was 13 years old. Her last period occurred at the age of 52. The menopause symptoms were not bad. Patient did not use any hormones. However, 3 years before her last period, her migraines became more frequent and intense. Patient started taking Amitriptyline more often to relieve the debilitating migraines. Initially, after she took this magic pill, her migraine went away within a few hours, but she was exhausted and could hardly function. Therefore, she always delayed until the last minute to take this pill. Patient tried to cut down on her chocolate, wine and other possible triggers.

Interestingly, patient had a root canal two years ago. Since then, every time she had migraine, her toothache started. She noticed that all her problems were on her right side: right side migraine, back pain, varicose veins, breast cysts and ovarian cyst. One of the reasons is that she overused her right side, which became the weaker side. When there are imbalances, the right side cannot compensate anymore, all the symptoms show up on her right side.

When patient first came to see Boston Acupuncturist, she was having migraines every day. Patient is a very motivated businesswoman with four children. Patient does not drink coffee, is weight appropriate, and drinks red wine only once a week.  Despite patient follows a generally healthy diet, she was having some indigestion problems: bloating, gas and constipation. Together her acupuncturist in Needham revisited all her habits and diets. Boston Chinese acupuncturist discovered that she was drinking 3 to 5 cups of tea per day. With this much tea, her digestion would slow down, so that vitamins and minerals cannot be absorbed efficiently. Without sufficient vitamins and minerals, her nerves would become very sensitive to environmental changes: cold, heat, and humidity. After menopause, it is natural for our digestive and nervous systems to become very unstable, and we get stressed out easily. If we eat a little bit too much or too late, our blood sugar will go up too high or drop too low, and we may end up with indigestion and migraine. Plus, patient had ovarian cysts, varicose veins, and breast cysts, indicating that her estrogen was not balanced with progesterone before menopause. After menopause, the imbalance would become worse, with about a 70% decline in progesterone and 50% decline of estrogen. That is one of the reasons her migraine had become even worse.

Her Boston acupuncturist recommended that patient was to drink only one to two bags of tea every day, and drink more water instead. Patient had noticed that if she were dehydrated, her migraine started. On one occasion, after she drank a lot of wine without enough water, her migraine became so bad that even her magic pill could not stop it. She was rushed to an emergency room to get a morphine drip; patient was unable to attend to her business that day.

Patient had also noticed that if she became too busy and forgot to eat lunch or drink enough water, she might get severe migraines on the next day. Patient was aware that chocolate could trigger the migraines. After patient reduced chocolate consumption, drank more water, and cut down her tea intake, her sleep got deeper. With only two acupuncture treatments, the frequency of her migraines decreased to every other week.

Her migraines occurred around her right eye and temple area. Patient said that when she applied pressure on the right side of her neck or head, the migraine pain decreased indicating that neck muscle tightness can aggravate her migraine. After another two acupuncture treatments, patient only gets migraines once every 7 weeks.

On one occasion, after patient went out for a meal of pizza with diet coke in a restaurant, the salty food and sugar substitute induced a migraine the next day. The next treatment phase was to desensitize patient’s nervous system so that she would not get migraines so easily. Her Boston Acupuncturist checked her sublingual vein and found that the veins are enlarged and looked purple. She also had a lot of varicose veins removed surgically a few years ago. The above vein problems indicated blood stasis due to pregnancy and hormone imbalance. In this case, relying on acupuncture only once a week is not sufficient to get rid of migraines. In addition, her acupuncturist recommended that patient also take herbs. She stopped drinking wine except for minimal consumption at social events. Patient started with an herbal formula twice a day. Miraculously, she did not have any migraines for two months with just once-a-month acupuncture treatments. Patient then changed to once-a-day herbal intake. She also started eating every four hours, having fruit snacks in between the meals, and very little chocolate. Patient did not have migraines for 4 months.

With the onset of the winter holidays, patient came in with a severe migraine, and wanted to continue her Chinese herbs. Boston Chinese acupuncturist asked patient if she would like to try ES on her pain areas and certain gallbladder points, and she agreed to the recommendation.  Her acupuncturist connected GB8 and GV20 with intermittent frequency for 30 min. Patient reported to her Boston acupuncturist subsequently that this was the first time that the migraine stopped right before it became worse, without any medications.

In this case, low blood sugar, alcohol, dehydration, neck muscle tightness and indigestion are factors which can induce or make the migraine worse. Improving her digestion, circulation and balancing her hormones after menopause help her get rid of the migraine.

Questions for Acupuncturist and Herbalist

1. What is the mechanism of migraine?

    a. Abnormal activities of brain cells

    b. Imbalance of excitatory and inhibitory neurotransmitters

    c. Hyperactive sympathetic nervous system

    d. All of the above

2. What is the cause of migraine?

    a. Dehydration

    b. Histamine release

    c. Low blood sugar

    d. All of the above

3. How can histamine release lead to migraine?

    a. Histamine can cause fluids to come out of the blood vessels

    b. Histamine can cause constriction of blood vessels

    c. Histamine can induce the adrenaline release

    d. None of the above.

4. Why can low blood sugar cause migraines?

    a. Low blood sugar can cause dilation of the blood vessels

    b. Low blood sugar can induce the adrenaline release

    c. Low blood sugar can stimulate parasympathetic nerves

    d. None of the above

5. Why can cheese, nuts, wine, and fermented food cause migraine?

    a. They can induce GABA and progesterone

    b. They can induce the generation of aspartate, the excitatory neurotransmitter

    c. They can induce the generation of histamine

    d. They induce histamine release

6. Why teenager and menopause women tend to develop migraine?

    a. They have imbalance of estrogen and progesterone.

    b. They tend to have higher level of progesterone

    c. They tend to have fight or flight reaction

    d. None of the above

7. Regular coffee drinker tend to have less migraine?

    a. True

    b. False

8. Which of the followings are the symptoms of migraine?

    a. Throbbing or pounding headache in one or both sides

    b. Vision changes

    c. Nausea or sleepiness

    d. All of the above

9. Why certain medications such as beta-blocker can cause migraine?

    a. They tend to dilate the blood vessels, thus change the activity of the blood vessels

    b. They induce adrenaline release

    c. They can over stimulate the sympathetic nervous system

    d. None of the above

10. Why does regular wine drinker tend to have migraine?

    a. Wine induce histamine release

    b. Wine cause inflammation of the blood vessels

    c. Wine cause dehydration

    d. All of the above.

11. Why does BCP cause frequent migraine in teenagers?

    a. BCP causes swelling of the blood vessels

    b. BCP causes imbalance of the estrogen and progesterone because it stops the regular ovulation

    c. BCP makes people sleepy

    d. A and B

12. Why can Lyme disease lead to migraine?

    a. Lyme disease damage nervous system

    b. Lyme disease can cause inflammation in the blood vessels and joints

    c. A and B

    d. Lyme disease can cause release of histamine

13. How can we prevent migraine?

    a. Follow proper circadian cycle to optimize brain cell activity

    b. Cut down or quit alcohol

    c. Reduce the allergies

    d. All of the above

14. Which point on the ankle area can be used to treat migraine according to Military Medicine?

    a. ST25

    b. GB40

    c. ST31

    d. None of the above

15. According to the research in Military Medicine, how long the acupuncture effect could last for patients with migraine?

    a. 2 weeks

    b. 12 weeks

    c. 10 weeks

    d. 8 weeks

16. According to the research in Military Medicine, what were the effective rates of real acupuncture and sham acupuncture in controlling migraine?

    a. 68% vs 32%

    b. 90% vs 20%

    c. 60% vs 40%

    d. None of the above

17. Why can acupuncture reduce migraine effectively?

    a. Acupuncture can reduce the activity in the brain areas associated with pain sensation.

    b. Acupuncture can decrease the pain threshold

    c. Acupuncture can coordinate and redistribute energy metabolism in the brain.

    d. A and C.

18. In the case study, why did the patient have persistent headache even though she had healthy diet generally?

    a. The patient drank too much tea, so her digestion was not well

    b. The patient did not have her migraine medication regularly

    c. The patient drank too much wine

    d. None of the above.

19. Why can drinking too much tea cause migraine?

    a. Too much tea interferes with digestion, so vitamins and minerals cannot be absorbed efficiently.

    b. Too much tea can dehydrate the body

    c. Too much tea can stimulate the nerve cells

    d. All of the above.

20. How can acupuncture help the patient to reduce the intensity and frequency of the migraine?

    a. Acupuncture can relax the neck muscles to reduce the pressure on the nerves.

    b. Acupuncture can help digestion and thereby improve the absorption of vitamins and minerals

    c. Acupuncture can reduce the stress

    d. All of the above.

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