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Acupuncture for Migraine Only a Placebo?

The American Headache Society supports that Traditional & “Sham” Acupuncture Both Effective for Migraine Relief. In contrast, after reviewing the studies mentioned in the AHS press release, Steven Novella of NeuroLogica Blog claims that the American Headache Society Recommends Placebos for Migraine. He writes,

Studies show that sham acupuncture is as effective as true acupuncture, and Dr. Dodick concludes from this that both work. The proper scientific interpretation of this result is that the treatment (acupuncture) is no different than placebo (sham acupuncture) and therefore has only a placebo effect.

Novella’s argument is sound and I agree with his conclusions. What intrigues me is why the American Headache Society and its president, David Dodick, are touting the benefits for acupuncture when the science is weak. Is it that there are so few effective treatments for migraine that even those without strong evidence are considered worthwhile?

It reminds me of when I was considering Botox injections and was surprised to find that studies only showed minor reductions in headache days of participants. From headlines, you’d think Botox had eradicated migraine, but studies have had only modest results.

The paltry options for treating migraine and the lack of funding for migraine research are disheartening. Urge Congress to take notice by signing the Alliance for Headache Disorders Advocacy’s petition.

 Thanks to reader C. Peterson for sharing NeuroLogica Blog’s post.

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Traditional & “Sham” Acupuncture Both Effective for Migraine Relief

I don’t normally republish press releases without further investigation, but I’m going to today because 1) It is from the American Headache Society and quotes my headache specialist, whom I trust immensely; 2) It provides a novel, scientific perspective on why acupuncture may help migraine (the focus is on endorphins and the effect they have on inflammation and pain signals, not the usual talk of meridians and energy flow); and 3) I have a killer migraine.

American Headache Society Supports the Use of Acupuncture in Migraine Treatment: Both Traditional Acupuncture and “Sham” Acupuncture Provide Relief

Mt. Royal, NJ (February 1, 2012) – When it comes to treating migraine, so-called “sham” acupuncture (where needles are inserted only to a superficial depth in the skin and not in specific sites) and traditional acupuncture where needles are inserted in specific sites, both are effective, according to the American Headache Society (AHS).

Citing publicity surrounding a recent Canadian study comparing the effectiveness of the two types of acupuncture, David W. Dodick, MD, AHS president, said both types of acupuncture, particularly when electrical stimulation is involved, may work to release endorphins that are important in controlling signals of pain and inflammation.

“How much of a benefit sham acupuncture can have on the release of these chemicals is unclear,” he said. “This suggests the benefits of treatment may not depend on the exact technique of acupuncture and needle positioning.”

There is ample evidence supporting the value of acupuncture in migraine treatment, Dr. Dodick noted, including four studies that compared acupuncture to standard migraine preventive medications. Acupuncture was found to be at least as effective and produced fewer side effects.  Further, he noted that a randomized clinical trial study published in November comparing acupuncture to topiramate in chronic migraine prevention showed that acupuncture was more effective than topiramate. Topiramate is an anticonvulsant often used in epilepsy.

Dr. Dodick said that needle positioning may be less relevant than acupuncturists believe, and acupuncture should be offered to patients as part of their options for migraine management.  “Further, the long-lasting effects of acupuncture, given that subjects continued to experience a reduction in migraine frequency two months after treatment, is also noteworthy and not a point to be ignored,” he said.

“Along with biofeedback training, cognitive-behavioral therapy, and lifestyle changes, acupuncture provides some migraine sufferers with a safe, non-pharmacologic treatment choice, and one that can also be used during pregnancy,” Dr. Dodick said.

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Yoga Isn’t Optional

It was 5:30 Saturday morning and I couldn’t sleep. Knowing I wouldn’t wake up early enough to go to the farmers’ market before yoga, I debated which one to go to. Images of the apple hatch chile cobbler I would make from my market spoils evaporated as I recognized that yoga is not optional. It was an astonishing revelation. The surprise wasn’t in the realization itself, but from the fact that it had never occurred to me before.

I usually feel better after yoga than I do after acupuncture, physical therapy or visits with my doctor, yet yoga doesn’t have the same priority as medical appointments, which are practically sacred. I schedule appointments for the time of day I’ve been feeling best, arrange back-up transportation in case I’m not up for driving, and only cancel if I am absolutely certain I will be miserable if I go. I’d never skip an acupuncture appointment to go to a baseball game, but I have chosen baseball over yoga before. Psychologically, I treated yoga as a fun (and thus optional) activity, not a health necessity.

Getting to class regularly was as simple as shifting yoga into the mental category of mandatory medical activity. I initially worried that medicalizing something I love would hinder my enjoyment of it, then the simple beauty emerged: Migraine allows me to spend 90 minutes a day in one of my favorite activities. If I were healthy, I’d be rushing to maximize 30-minute workouts, thinking that an hour and a half of yoga each day was a wasteful indulgence.

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Kerrie’s 2007: A Year to Forget

There was a theme consistently underlying my 2007 posts: My migraines were BAD. The year started with five months of being woken up by a migraine nearly every night and ended with more than two months of horrendous all-the-time migraines. I felt more beaten down than I have in the last three years.

Before you get discouraged by the following review, know that I am more optimistic about treating my migraines than I have been since I got my occipital nerve stimulator in December 2003. (Read more on that following the treatment review.)

Acupuncture
I revisited acupuncture, but my superhero acupuncturist told me that more sessions would be a waste of time and money.

Naturopathy/Homeopathy
Shedding tears in the naturopath’s office the first time was enough to keep me from seeing her again. Against my hard fast rule that I not take anything I can’t identify (which I also broke with the acupuncturist), I took the homeopathic remedy, vitamin D and magnesium supplements she suggested. They did nothing.

Chiropractic
I gave the chiropractor two months, which she said was the maximum time to see results. I went five times one week, four the next, three for a couple weeks and so on. Turns out I hold my adjustments very well. Unfortunately my migraines didn’t changed and having my neck adjusted freaked me out. Once she stopped asking about my headaches, I knew she had given up.

Sleep Specialist
Many people with treatment-resistant headache disorders become much more treatable once they have sleep problems resolved. Although my sleep seemed fine, I saw a sleep specialist with a background in neurology. Sadly, my sleep is practically perfect. I sleep eight hours, wake up rested, nap when I need to without having it interfere with that night’s sleep.

New Headache Specialist
I saw a new Seattle-based headache specialist in May. We hit it off immediately. Too bad we focused on my blog, headache patients in general and clinical trials. I left enrolled in a clinical trial for Lyrica (which I quit) and with a potential advertiser for The Daily Headache, but without having discussed any of my questions or other treatment options.

Food Trigger Diets
Food triggers were my obsession, even though I’ve always thought them to hog the spotlight in headache treatment (only about 25% of people actually have food triggers).

Although wheat and dairy aren’t considered headache triggers in the general sense, they were my target for months. My no-dairy foray lasted six weeks — until I discovered that I’d dropped 12 pounds in that time. Testing wheat lasted three months, yet I had no ill-effects when I reintroduced it.

After a couple years of avoiding them, I’m almost positive that beans, nuts and legumes are triggers for me. But berries, squash, sunflower and soy oil, barley, pineapple, onions. . . are all questionable.

I declared that I was going on a drastic food trigger elimination diet. A couple weeks later came this post: Drastic Elimination Diet for Migraine Triggers: What Was I Thinking? You get the point.

Myofascial Release
Finally some good news. In August I started myofascial release and noticed results quickly. The changes aren’t dramatic, but each treatment usually gives me some relief. The effects have never lasted more than two days — and sometimes only a couple hours — but I’m not complaining.

Craniosacral Therapy
Two sessions weren’t enough to judge if craniosacral will be effective. I’ll definitely try again, but it just didn’t work out this time. The woman I saw was wonderful and spent an extra 30 minutes with me each visit. Unfortunately, driving to her practice takes 30 minutes. After spending 20 minutes lost on the way there and another hour on the way home, the negative associations were too strong for me to go back.

What Now?
When the last migraine spell lifted in mid-December I remembered how good I could feel. Thinking about what I love about my life was no longer a reminder of what I couldn’t have, but of how wonderful it truly is. I am happy and getting out of the house more. I even get to see friends!

This year’s list of treatments to try is as long as it was last year. Its like I’ve spent the last 10 years whittling down possibilities and arrived at the most promising therapies. Having had this faith shattered in the past, I am cautious. Nonetheless, I’m positive a brighter path is ahead.

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Alternative and Complementary Medicine: Evaluating Success Rates

Evaluating any medical claim carefully is crucial, no matter the source. With so many false or overblown claims about alternative and complementary treatments, I’m pretty skeptical. Alternative Medicine: Evaluate Claims of Treatment Success from the Mayo Clinic can help sort fact from fiction.

The section on avoiding internet misinformation is a must-read. Other topics in the article beware of health care scams and fraud, looking for solid scientific studies, evaluating providers and dietary supplements, and integrating Western medicine with complementary treatments.

Related articles from the Mayo Clinic include: