One interesting therapy for headaches, which generates a lot of questions from patients, is acupuncture. Acupuncture is a traditional Chinese therapy which has been around for centuries but only came around to wide spread use in the West (United States and Europe) in the 20th Century.
There are many misconceptions about acupuncture. One question I get regularly is “Do you think acupuncture works?” This is a difficult question to answer because acupuncture doesn’t lend itself to scientific inquiry. When we study pills, we can simply give one group of patients a placebo and another group of patients the actual medicine to document which group does better, thereby determining whether the medicine actually works or not.
One of the misconceptions we have in the West is that acupuncture therapy is somehow standardized. There seems to be a belief that some book or body of literature exists, that describes the “proper” method for placing needles to achieve the desired result of headache elimination or other therapeutic outcome. Indeed, there are a number books which have been published and seminars are given quite frequently that are designed to explain the “how to” of acupuncture. The problem with this is that it is not based upon real, traditional Chinese medicine.
Several years ago I journeyed to China to look into what therapies they had for headache management and of course acupuncture was one of those therapies. I was surprised to learn that there is absolutely no standardized way to do acupuncture. There are thousands of “schools” of acupuncture and unfortunately each school keeps their methods a closely guarded secret which they will not share with anyone. Of course, each school claims to be superior to all the other schools, claiming their techniques are better than the others. So what I found in China was just a lot of confusion. Chinese people tend to go to a “school” of acupuncture based upon word of mouth from their friends or family, indicating that a certain school was helpful for them. But exactly where each school places needles is highly variable and remains a closely guarded secret that is not to be shared with outsiders.
Neurologists in China are frustrated by the lack of standardization of acupuncture because this means there is no way to evaluate the procedure to determine its effectiveness. I did discover that Chinese patients who use acupuncture to treat their headaches also use Western medicines quite routinely. Truth is; headache sufferers in the East use whatever treatment they can access, that is affordable and seems to work. I did meet a couple of patients who only use acupuncture to treat their headaches but the vast majority used Depakote, Amitriptyline, Propranolol, or a triptan in addition to the acupuncture.
Circling back to my patients’ question, “does acupuncture work?” – I tell my patients that as long as disposable sterile needles are utilized and as long as the patient realizes that there is no proof that acupuncture works and it is likely that no proof of its effectiveness is forthcoming any time soon, and as long as the patient understands that there is no standardized way to perform acupuncture (a right way or wrong way to place the needles) then I have no objections to patients trying acupuncture, or any other safe procedure to treat their headaches.
Dana Winegarner is a neurologist and heads the Headache Center at MidAmerica Neuroscience Institute.
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