Migraine Awareness Week 2019 – How does acupuncture help?

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This week is Migraine Awareness Week. Despite migraine being the third most prevalent disease in the world, affecting 1 in 7 people, there is still a great deal of misunderstanding surrounding migraine. A migraine is more than just a bad headache.

For the majority of migraine suffers, attacks happen frequently. More than three-quarters of suffers experience at least one migraine a month, many so severe it causes severe physical impairment. Migraine is ranked globally as the 7th more disabling disease and the leading cause of disability among neurological disorders [1]. Symptoms include throbbing headache, sensitivity to light and noise, nausea, vomiting and fatigue. Some sufferers also experience auras (visual disturbances including but not limited to dark spots or flashing lights, dizziness, vertigo, numbness and tingling, confusion and weakness and sometimes partial paralysis), and some even auditory hallucinations. For some sufferers, attacks may not last even an hour, but for others is could be several days, with another couple of days of recovery [2]. Unsurprisingly, migraines can have an enormous detrimental effect on work, social and family lives.

Shockingly, despite the prevalence and severity of migraine, a mere 4 hours are committed to headache disorders in undergraduate medical training, and still only 10 hours for specialists worldwide [3]. Less than 50% of migraine sufferers are happy with their current treatment and the majority choose to self-medicate with over-the-counter medication rather than seeking medical help [4].

There is a growing body of research in recent years into the efficacy of acupuncture in both preventing and treating migraine [5,6,7,8,9,10]. Acupuncture has been found to be effective in both prevention and treatment, and in one study was found to be more effective than the current favoured medication Propranolol in reducing migraine episodes and caused fewer adverse events [6]. Other studies have shown acupuncture to be at least as effective as other interventions, and enhancing quality of life in migraine patients better than other medication [10].

The National Institute for Health and Care Excellence (NICE) recommends that patients are offered a course of up to 10 sessions of acupuncture to prevent migraine if the medications topiramate or propranolol are not working well for them [11].

So what can acupuncture do to help treat and prevent migraine? It provides pain relief, through the action of stimulating nerve fibres which leads to the release of endorphins and other neurohumoral factors, and changes the processing of pain in the brain and spinal cord [12, 13]. Acupuncture reduces inflammation by promoting the release of vascular and immunomodulatory factors [14, 15, 16]. It reduces the degree of cortical spreading depression (CSD), an electrical wave in the brain that is associated with migraine, and plasma levels of calcitonin gene-related peptide and substance P which are pain-signalling neuropeptides implicated in the pathophysiology of migraine [16]. Acupuncture also modulates extracranial and intracranial blood flow which contribute to migraine pain [17]. Serotonin levels in the brain are affected – serotonin may be linked to both the initiation of attacks and the relief of acute attacks [18], and there is an increase in local microcirculation which aids the dispersal of swelling [19].

 

 

[1] Steiner et al (2013) Migraine: the seventh disabler. The Journal of Headache and Pain, 14:1.

 

[2] Migraine Trust (2019) Symptoms and stages of migraine. www.migrainetrust.org.

 

[3] World Health Organization (2111) Atlas of headache disorders and resources in the world.

 

[4] All-Party Parliamentary Group on Primary Headache Disorders (2010) Headache Disorders – not respected, not resourced.

 

[5] Doll et al (2019) Acupuncture in adult and pediatric headache: A narrative review. Neuropediatrics.

 

[6] Chen et al (2019) Acupuncture versus propranolol in migraine prophylaxis: an indirect treatment comparison meta-analysis. Journal of Neurology.

 

[7] Kowacs et al (2019) Consensus of the Brazilian Headache Society on the treatment of chronic migraine. Asociacion Neuropsiquiatrica Argentina, 77(7): 509-20.

 

[8] Trinh et al (2019) Systematic review of episodic migraine prophylaxis: Efficacy of conventional treatments used in comparisons with acupuncture. Medical Acupuncture, 31(2): 85-97.

 

[9] Wells et al (2019) Complementary and integrative medicine for episodic migraine: an update of evidence from the last 3 years. Current Pain and Headache Reports, 23(2): 10.

 

[10] Jiang et al (2018) The effect of acupuncture on the quality of life in patients with Mmigraine: A systematic review and meta-analysis. Frontiers in Pharmacology, 9: 1190.

 

[11] National Institute for Health and Care Excellence (2015) Headaches in over 12s: diagnosis and management. www.nice.org.uk

 

[12] Zhao, C. (2008) Traditional and evidence-based acupuncture in headache management: Theory, mechanism, and practice. Headache: The Journal of Head and Face Pain.

 

[13] Pomeranz, B. (2001) Acupuncture analgesia – basic research. In: Stux, G., & Hammerschlag, R. (eds) Clinical Acupuncture, Berlin: Springer, 1-28.

 

[14] Kim et al (2008) Low-frequency electroacupuncture supresses carrageenan-induced paw inflammation in mice via sympathetic post-ganglionic neurons, while high-frequency EA suppression is mediated by the sympathoadrenal medullary axis. Brain Research Bulletin, 75(5): 698-705.

 

[15] Kavoussi, B. & Ross, B. (2007) The neuroimmune basis of anti-inflammatory acupuncture. Integrative Cancer Therapies, 6(3): 251-7.

 

[16] Shi et al (2010) Effect of electroacupuncture on cortical spreading depression and plasma CGRP and substance P contents in migraine rats. Zhen Ci Yan Jiu, 35(1): 17-21.

 

[17] Park et al (2009) Effect of acupuncture on blood flow velocity and volume in common carotid and vertebral arteries in migraine patients. Medical Acupuncture, 21(1).

 

[18] Zhong et al (2007) Effects of acupuncture on calcitonin gene-related peptide gene expressions in the brain of migraine rats. Modern Rehabilitation.

 

[19] Komori et al (2009) Microcirculatory responses to acupuncture stimulation and phototherapy. Anesthesia & Analgesia, 108(2): 635-40.

Mental Health Awareness Week: Depression according to Chinese Medicine

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A while ago I stumbled across a wonderful cartoon story that so perfectly describes the experience of depression.

While everyone will have a different experience, I think those of us who have suffered with depression can all claim to have felt apathetic, foggy and a distinct lack of joy. For many, the inability to feel anything at all really.

Acupuncture made a big difference for me, and now that I’m a qualified acupuncturist myself I am beginning to understand the hows and whys. Every case is different, the background to the illness, the experience of the illness vary with each individual. So diagnosis and treatment will be different for each individual. There is no “one pill cures all”.

Here is a brief and simplified overview of Depression and its relationship to the Five Elements in Chinese Medicine. Often patients fall clearly into one category, others are spread across several, but it is always interesting to recognise some of these characteristics within ourselves.

WoodWood

The root emotion of the Wood Element is anger. Anger is a positive and healthy emotion when felt and expressed appropriately and proportionately. The Wood Organ, the Liver, is profoundly affected by stress, frustration and unexpressed emotion. The function of the Liver in TCM is to maintain the free flow of Qi around the body, but when this function is damaged or interrupted Qi Stagnation occurs. Tension in body and mind, constriction of the chest, a lump in the throat, headaches, IBS, irritability are all symptoms of Qi Stagnation. An underactive Wood Element can result in someone lacking purpose and ambition, afraid to speak their feelings, burying everything deep inside. An overactive Wood Element creates rigidity, perfectionism and explosive emotions.

 

Fire

Fire

The root emotion of Fire is Joy. The Organ is the Heart, which in TCM houses the Shen (Spirit). When suffering from depression, there is usually at least a little Fire involvement. An imbalance of this Organ results in sadness, anxiety, low self-esteem, timidity, despondency and a general loss of joie de vivre. Insomnia is a common problem. When somebody looks dead behind the eyes, in TCM the Shen is said to have been extinguished. When over-active, Fire may cause over-excitement, excessive talking, self-centeredness, highly sensitive feelings and nervous exhaustion.

 

EarthEarth

Over-thinking is the root emotion of Earth. Its Organs are the Spleen and Stomach, which oversee both physical and mental digestion. When we start to obsess on something or find ourselves stuck in a cycle of negative thinking, Earth is often at the root. Earth is also the nurturing Element, and the disproportionate worry and anxiety felt by a parent results from this Element being out of balance. A weak Earth Element may manifest in difficulty concentrating, a fuzzy head, a lack of mental clarity, dependency and neediness. When it overacts, Earth may cause over-protectiveness, constant worry and mental churning.

MetalMetal

Metal is the Element of Grief. Its Organ, the Lung, takes in and lets go. Metal is imbalanced when we lose this ability to let go of something or someone, fail to accept reality and move on with our lives. It is no coincidence that following a great loss many people become ill themselves, feeling run down and often catch colds and other viruses very easily. When the Lungs are weak they are unable to provide Wei Qi, the body’s immunity and leave us vulnerable to infections. Metal is also the Element of connectedness. When it is imbalanced, we may find ourselves withdrawing from people and shutting ourselves off from friends and family.

WaterWater

Fear is the root emotion of Water. Again, this is a healthy emotion when felt at appropriate times – it keeps us safe after all. However, when Water is out of balance we can become too afraid to live our lives fully and lose our sense of Will. Loss of confidence and self-sufficiency, feelings of apathy and powerlessness are those of a weak Water Element. An over-active Water Element creates unsettled, workaholic personalities who demand far too much from themselves resulting in burn out. The Water Organ, the Kidney is the creator of our Yin and Yang and without this energy we become exhausted. We spend more energy than we create.

Tips for a healthy digestive system

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As April is IBS Awareness Month I am continuing this theme. Here are some simple tips that can be used by everybody to keep their digestive systems in good working order:

  • Eat regularly – don’t skip meals. Avoid eating too late in the evening to allow food to be digested before bedtime.
  • Try not to eat when feeling stressed or anxious. The mind has an intimate connection to the gut, hence why we often feel nauseous or in need of the toilet when under stress. When in a state of stress our sympathetic nervous system takes control, switching off unnecessary systems such as digestion in order to concentrate on muscles and respiration to help us escape the source of stress. Food will sit undigested in the gut until the stress has passed.
  • Concentrate on your meal. We process food better when we pay attention to what and how we are eating. There is also a tendency to over eat when watching the television or working as we do not notice the signals that we are full.
  • Don’t eat when in a hurry. Eating too quickly and not allowing some quiet time for digestion can add to digestive complaints.
  • Consider any negative emotional associations you may have with certain foods. These may be due to bad memories involving a meal, negative emotions or simple mental associations. Often eating these foods can trigger stress responses that can affect digestion. According to the IBS Network, a survey of IBS sufferers found the following common food associations:
    o Chocolate – guilt or a treat
    o Muesli – control
    o Meat – violence
    o Shellfish – sex
    o Milk – mother
    o Roast dinner – family arguments
  • Traditional Chinese Medicine (TCM) views the Stomach as a crockpot that processes the food. It sits above the Spleen which acts as the fire beneath. TCM dietetics advise avoiding cold and raw foods where possible as these douse the fire of the Spleen, making it difficult for the Stomach to “cook” and digest the food. Foods that are kind to the Spleen and Stomach are warming such as soups and stews.

abdominal-massage

  • Try gentle abdominal massage to keep things moving smoothly. Your colon runs up the right hand side of your abdomen (ascending colon), across below your ribs (transverse colon) and back down the left side (descending colon). Start by stroking down the descending colon 3 or 4 times. Then stroke across the transverse colon 3 or 4 times, and finally up the ascending colon. Then stroke all the way along, starting up the right, across the middle and down the left.
  • Essential oils of Aniseed, Basil, Black Pepper, Cardamom, Roman and German Chamomile, Fennel, Ginger, Nutmeg, Orange, Peppermint and Rose are carminative, providing local stimulation to the stomach lining which increases tone and contraction of the muscles. They increase stomach secretions thus improving digestion, relax the intestines to facilitate the passage of intestinal gas, have an antiseptic action on undesirable micro-organisms and promote the digestion and absorption of nutrients.
  • Herbal and fruit teas such as Chamomile, Ginger, Fennel and Peppermint are helpful in maintaining digestive health and calming an upset system.

For information and support for IBS visit The IBS Network

IBS Awareness Month: Can acupuncture help?

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For information and advice on managing IBS symptoms visit the IBS Network

The umbrella term Irritable Bowel Syndrome refers to a number of unexplained digestive disturbances including constipation, diarrhoea, abdominal pain and bloating, rumbling and wind. About a third of the British population are affected by IBS at some point in their lives and one in ten people are severely affected.

IBS is referred to as a ‘functional disorder’ of the bowel as tests and examinations find no structural abnormality or any obvious cause. IBS is commonly associated with stress and emotional tension, often triggered by difficult periods in our lives. There is a profound connection between our emotions and our gut.

Acupuncture, as a holistic medicine, takes your entire physical and emotional health along with lifestyle factors into consideration when forming a diagnosis and treatment plan. Every person is different and as such, every illness is different. There is also no use in merely trying to ease the symptoms without addressing its cause. This is why acupuncture has such long-term benefits.

Here are some recent studies into the efficacy and mechanisms of acupuncture and related Traditional Chinese medicine treatments for IBS.

A new acupuncture method for management of irritable bowel syndrome: A randomized double blind clinical trial
Conclusion: There was statistically significant difference between treatment groups in constipation and bloating. Differences that were statistically significant favoured acupuncture on pain and depression. The average of weight loss was 2 kg in acupuncture group.

Brain regions involved in moxibustion-induced analgesia in irritable bowel syndrome with diarrhoea: a functional magnetic resonance imaging study
Conclusion: Moxibustion can improve symptoms and quality of life in D-IBS patients. It can also decrease rectal sensitivity.

Effectiveness of acupuncture to treat irritable bowel syndrome: A meta-analysis
Conclusion: Acupuncture exhibits clinically and statistically significant control of IBS symptoms.