August 2014

A new study concludes that acupuncture combined with herbal medicine is more effective than drugs for the treatment of headaches. This confirms similar results found in a prior study wherein acupuncture was found comparable to drugs for the treatment of migraine headaches. The new study finds acupuncture combined with herbal medicine is effective for the treatment of vascular headaches whereas the prior study found acupuncture, as a standalone procedure, effective for the treatment of migraines. The results agree that acupuncture and/or acupuncture combined with herbs produce positive patient outcomes for headaches.

The prior study concluded that acupuncture is “of comparable efficiency to several proven drug therapies for the treatment and prevention of migraine(s).” The meta-analysis examined 25 randomized controlled trials involving a sample size of 3,004 patients. True acupuncture significantly outperformed simulated sham-acupuncture. In addition, true acupuncture was comparable to drug therapy for the treatment and prevention of migraines.

The new acupuncture continuing education research increased the strength of clinical care by adding herbal medicine to the Traditional Chinese Medicine (TCM) protocol. By combining acupuncture with the modified herbal medicine formula Huo Xue Qu Feng Tong Luo Tang (Blood Activating Wind Dispelling Meridian Unblocking Decoction), the TCM treatment was significantly more effective than nimodipine. Also referred to by its brand names Nimotop and Nymalize, this drug is a calcium channel blocker that increases blood flow to the brain by widening blood vessels. Originally developed to reduce high blood pressure, this drug is commonly used to prevent complications due to cerebral vasospasm.

Acupuncture combined with modified Huo Xue Qu Feng Tong Luo Tang is more effective than nimodipine for relieving vascular headaches. These headaches include cluster headaches, migraines and toxic headaches. Migraines involve unilateral or bilateral head pain and may combine with nausea, vomiting, sensitivity to light and sound, and visual auras. Toxic headaches occur during fevers. Cluster headaches are focal and recur in severe episodes.

The researchers conducted a randomized acupuncture continuing education investigation of 92 patients with vascular headaches at the College of Traditional Chinese Medicine (TCM) in Chongqing Medical University (Sichuan). Group #1 received oral administration of nimodipine at 40 mg per dose, three times per day. Group #2 received acupuncture and a TCM herbal formula based on Huo Xue Qu Feng Tong Luo Tang. A course of treatment for both groups consisted of two weeks and the entire treatment lasted for two courses. After the two courses of treatment, patients in both groups made considerable progress. However, patients in the acupuncture group significantly outperformed those in the drug group.

The Herbs
The primary ingredients in the modified version of Huo Xue Qu Feng Tong Luo Tang for patients in the acupuncture group were:
Tao Ren 12g
Hong Hua 12g
Dang Gui 15g
Chuan Xiong 15g
Chi Shao 12g
Sheng Di Huang 20g
Chai Hu 12g
Zhi Ke 12g
Xiang Fu 12g
Yu Jin 12g
Niu Xi 15g
Jie Geng 6g
Shi Jue Ming 30g
Zhen Zhu Mu 30g
Raw Mu Li 30g
Wu Gong 2 pieces
Quan Xie 10g
Gan Cao 5g

Modifications were made according to TCM differential diagnostics:
Add Di Long 12g for severe cases of stasis blocking collaterals.
Add Raw Long Gu 30g, Gou Teng 15g and Ci Shi 30g for cases of hyperactivity of liver yang.
Add Chen Pi 12g and processed Ban Xia 10g for cases of phlegm dampness.
Add Shan Zhu Yu 20g, Gou Qi Zi 15g and Nu Zhen Zi 15g for yin deficiency in the liver and kidneys.
Add Ren Shen 15g, Dang Gui 15g and Shu Di Huang 20g for cases of qi and blood deficiency.

The Acupuncture Points
The acupoints for acupuncture needling were chosen according to the locations of the headaches, i.e. near the affected regions and along the meridians:
For headaches primarily on the top of the head add Baihui (DU20), Sishencong (EX-HN1), Taichong (LR3), Neiguan (PC6) and Yongquan (KI1).
For headaches primarily on the forehead add Yintang (EX-HN3), Touwei (ST6), Yangbai (GB14), Zanzhu (BL2), Hegu (LI4) and Quchi (LI11).
For temporal headaches add Shuaigu (GB8), Taiyang (EX-HN5), Fengchi (GB20), Zhukong (SJ23), Waiguan (SJ5) and Yangfu (GB38).
For occipital headaches add Tianzhu (BL10), Fengchi (GB14), Fengfu (DU16), Yuzhen (BL9), Kunlun (BL60) and Houxi (SI3).

Modifications were also made based on differential diagnostics:
Add Hegu (LI4) and Lieque (LU7) for cases of external infection due to wind cold.
Add Xuehai (SP10), Geshu (BL17) and Sanyinjiao (SP6) for cases of stasis.
Add Taichong (LR3) and Yanglingquan (GB34) for cases of liver yang hyperactivity.
Add Fengrong (ST40) and Yinlingquan (SP9) for cases of wind phlegm invading upwardly.
Add Shenshu (BL23), Taixi (KI3) and Xuanzhong (GB39) for the cases of kidney deficiency.
Add Zusanli (ST36), Ganshu (BL18), Pishu (BL20) and Sanyinjiao (SP6) for cases of qi and blood deficiency.

Acupuncture Techniques
Acupuncture was applied in either the seated or lying posture. Quick insertion of filiform needles was applied with twirling reinforcing and reducing manipulation methods to acupoints on the head. Lifting and thrusting was used for reinforcing and reducing methods at limb acupoints. Manual manipulation was applied every 10 minutes. The retention of needling was 20 minutes for minor cases and 30 minutes for severe cases. Acupuncture needling was applied once daily with 10 days comprising one course. There was a two day break after the first course and the entire treatment consisted of two courses of care.

After two courses of treatment, both groups achieved varied degrees of curative effects in terms of reducing headache attacks, duration of each attack and the intensity degree of headaches. The acupuncture group outperformed the drug group in all of the aforementioned indices. As a result, the researchers conclude that acupuncture combined with Huo Xue Qu Feng Tong Luo Tang is superior to nimodipine for the treatment of vascular headaches.

References:
Zhou, Ping, Huali Luo, Oula Chen, et al. “Clinical Research on Huoxue Qufeng Tongluo Decoction Combined with Acupuncture in Treatment of Vascular Headache.” Chinese Journal of Experimental Traditional Medical Formulae 20.2 (2014).

Scott SW, Deare JC. Acupuncture for migraine: a systematic review. ‘Aust J Acupunct Chin Med’ 2006;1(1):3-14)

From Health CMI: http://www.healthcmi.com/Acupuncture-Continuing-Education-News/1342-acupuncture-herbs-best-pharmaceutical-for-headaches