Acupuncture for Tension Type Headache and Migraine according to NICE

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.

Migraine

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.

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Medical Acupuncture for Irritable Bowel Syndrome - A Case Report

This case report is aimed to assist you with the clinical decision making and management of the condition known as irritable bowel syndrome. Particular emphasis is placed on the integrated use of Medical Acupuncture.

This case was selected from patients seen in an urban private physiotherapy practice.

Introduction

As a course of acupuncture for pain and dysfunction following a right hip replacement was coming to an end, Mrs. P (80 years old) mentioned she was suffering from an exacerbation of symptoms associated with irritable bowel syndrome (IBS). This exacerbation had begun a few days previously with IBS having been diagnosed by her general practitioner (GP) some years previously.

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Acupuncture For Chronic Knee Pain Relief

When discussing acupuncture for chronic knee pain we are referring, for the most part, to OA of the knee. Clinically there may be other forms of chronic knee pain such as that due to meniscal injury, patellofemoral maltracking/ chondromalacia patella which may also respond well to acupuncture when used as an adjunct.

What's the evidence?

A systematic review by White et al, 2007 concluded the following:

  • Acupuncture at traditional points in the vicinity of the knee (verum acupuncture) is superior to minimal, off point needling which avoided needling points which share the same segmental innervation as the knee (sham acupuncture)
  • Acupunctures benefits for pain and function last for more than 6 months
  • In view of acupuncture’s advantages, such as safety, and no need for a daily dose, it should be considered as a genuine alternative to NSAID’s

A more recent systematic review by Manheimer et al, 2010, also confirms efficacy of verum acupuntcure over sham and that providing Acupuncture is more effective with clincially relevant effects over leaving the patient on a waiting list i.e doing nothing.

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Acupuncture For Chronic Headache - Primary or Secondary?

A quick review of the NICE clinical guidelines for chronic headache tells us that when taking a history, be on the lookout for red flags.

If a headache sufferer presents with red flags they may have what is known as a secondary headache which may be a result of pathology, in which case further investigation is required.

If no red flags are present it is likely the headache is primary in nature. This would suggest a functional or physiological cause not related to specific pathology. Migraine and Tension Type Headache are typically primary headaches. When dealing with a primary headache, start treatment using an evidence based approach which may include Medical Acupuncture, unless your patient develops atypical features in which case refer on immediately.

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Part 3 - How To Manage Dose Using Dry Needling

This is part 3, the final post, in the series of: 

Session 1.

Identify the TrP/s, after explaining the needling process and referring to your information and consent form, answering any questions and then proceed to needling the points with consent.

Dose:

Start with the needle inserted into/ over the trigger point, not too deep with no added stimulation for 5 mins and remove. You could leave the needle in for less time eg 30 secs to im min a la Baldry. Reassess.

Session 2.

If there has been symptomatic improvement and better objective findings e.g a decrease in muscle tenderness, improvements in muscle length, power - maintain dose level for session 1. If an increase in dose is necessary, you can increase dose by leaving needle in situ for up to 10 mins with light stimulation (rotation) after 5 mins and remove. Reassess.

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