You have a patient who you have diagnosed with primary tension type headache or who has possibly been a referred migraine sufferer with a view to providing prophylactic treatment - so what next?
Assuming the correct diagnostic criteria have been met, and there are no red flags suggesting further medical evaluation may be needed, the NICE guidelines now suggest that Medical Acupuncture has a role to play in both scenarios.
Abortive treatments of migraine are non specific for example Paracetamol and NSAIDS. Specific treatment includes triptans which may be used concurrently with prokinetics such as domperidone or metoclopramide for associated nausea.
Preventative treatments in migraine include antidepressants, B blockers, anticonvulsants and Acupuncture with 10 sessions over 5 weeks recommended.
Tension Type Headache (TTH)
Currently Acupuncture is the only treatment recommended for this condition by NICE.
Interestingly there is no evidence for Amitriptyline but clinically this may still be useful for certain patients. For TTH there may also be a role for manual therapy although the evidence does not support this. Therapeutic exercise and certainly lifestyle modification are important in my clinical experience.
Hopefully those practising Acupuncture in a medical setting will be further utilised to assist in the management of headache sufferers, particularly given the growing evidence base for this type of treatment.