As we all know, headache is one of the most common disorders. Above all, headache is subjective and it may be a symptom of acute or chronic diseases.

If headache is a symptom of a disease (brain tumor, tonsillitis, myopia, acute otitis media etc.) it is necessary to remove the underlying cause before all. In this case headache ends when the cause disappears.

For what type of headache can acupuncture be performed?

1- All types of migraine and other vascular headaches,

2- Tension headache,

3- Sinusitis (acute or chronic); antibiotics may be added,

4- Headaches due to neck stiffness.

Migraine is a primary episodic headache disorder accompanied by various forms of neurological, gastrointestinal and autonomic changes. The results of neurological examinations, imaging and laboratory examinations are usually normal and these are useful in differential diagnosis. The migraine episode may be divided into four parts: the prodromal phase, which occurs before hours or days before the headache, the aura phase that occurs just before the headache, the headache phase and the postdrome phase.  

There is no mandatory stage for diagnosis of migraine.

1. Prodromal Phase

Prodromal phenomena tend to occur hours or days before the actual onset of headache. Patients often complain of typical mood or behavior shifts that appear suddenly. These symptoms vary from patient to patient but are quite consistent for every individual. Common symptoms are fatigue, difficulty in concentrating, neck stiffness, however symptoms such as depression, cognitive dysfunction and craving for some foods may also be seen.

2. Aura Phase    

Migraine aura is a mixture of focal neurological symptoms that accompany the migraine attack, or pre/post attack period.  

These symptoms usually develop within 5-20 minutes and last less than 60 minutes. Although headache often occurs within 60 minutes of the end of the aura, in some cases it may be delayed for several hours or may not occur. Most patients experience symptoms such as anxiety, physical complaints, mood changes, speech and thought disorders, or a feeling of abstraction, during the time between aura and headache.   

Auras can occur consecutively, and the frequency may vary from several hours to several times in one hour. 

Visual disturbances include blind spots, flashes of light, visualization of floaters of dots or geometric shapes (stable or moving in the visual field), fluctuations in vision. These visual disturbances are seen with the headache. Apart from these, visual deformations and hallucinations can also be seen. 

Non-visual disorders include those of perception and use of extremities, speech disorders, a state of nightmare and delirium.   

The second most common form of aura is numbness. It begins in the hand, disseminates to the arm and then passes to the face and affects the lips and tongue; rarely affects the legs.  

In half of the migraine patients, numbness begins on both sides or becomes bilateral. 

The auditory auras are rarely seen alone, they usually accompany a visual aura.

3. Headache Phase

The typical headache in migraine is unilateral, throbbing, moderate/severe and exacerbated by physical activity. For the diagnosis all of these characteristics do not need to be present. Pain may be bilateral from the beginning or may then become bilateral. Although the pain may occur any time during the day or night, often it starts between 5-12 am.

In 2 to 12 hours after the onset of pain, it reaches the peak and turns into an attack, of which, if not treated, average duration is 24 hours.  

It can range from 4-72 hours in adults and 1- 48 hours in children. Although the severity of the headache varies widely, it is usually described as between 7 and 8 on a 0-10 scale. 

Migraine pain is always present with other features. Even though anorexia is frequently present, the patient might crave for some foods (eg chocolate). Nearly all patients (90%) suffer from nausea, while 1/3 of them vomit. Photophobia (light sensitivity), phonophobia (sensitivity to sound), osmophobia (discomfort from odors) usually occur and the patient looks for a dark and quiet room.

4. Postdrome Phase

The pain gradually decreases and disappears. The patient may feel tired and indifferent, with remaining symptoms such as decreased concentration, tenderness on the scalp and mood changes. However, some patients may feel extremely well and refreshed contrarily to those feel depressed and sick.

Migraine Types

1. Migraine without aura (simple migraine)

2. Migraine with aura (classic migraine)

3. Other Types of Migraine:

Basilar Type Migraine

Confusional Migraine               

Ophthalmoplegic Migraine               

Hemiplegic Migraine               

Familial Hemiplegic Migraine               

Subcortical Infarcts and Leukoencephalopathy with Cerebral Autosomal Dominant Arteriopathy              

 White Substance Disorders               

Aura without headache         

Acupuncture and Migraine

The mechanism of action of acupuncture in migraine treatment can also be determined by orthodox medicine (western medicine) diagnostic methods. It is proved that the painkiller effect of acupuncture is increased through increasing the effect of opioidergic system. The superiority of acupuncture treatment for migraine to orthodox medicine techniques has been demonstrated by many studies conducted in recent years, in terms of higher efficacy, lower risk of side effects and lower cost. A study of Vickers eta. showed that acupuncture reduced the use of medication by 15%, decreased the number of visits to the physician by 25% and the number of painful days by 15%.