Headaches and Migraines

Migraine
The cause and precise mechanism of migraine is unknown. Changes in brain and scalp blood flow occur, but whether vasodilation and vasoconstriction are a cause or an effect of the migraine is unclear. Irritation of sensory nerve endings near affected extra-cranial and meningeal arteries which surround the brain, along with vasodilation, result in the severe pain people experience.

Migraines are normally one sided and become worse with exertion. It is common to also experience nausea, vomiting, sensitivity to light and sound. Some people experience an aura prior to the migraine (classical migraine) with symptoms such as visual disturbance, speech difficulties, muscle weakness, nausea and vomiting. These normally occur 15 minutes - 1 hour prior to the migraine.

Some triggers have been recognised:

Tension Headaches
Tension headaches are caused by muscular tension in the neck, shoulders and jaw. When we are stressed or worried we often hold this in our shoulders as tension which then radiates to the head causing headaches. Grinding of the teeth during sleep (bruxism) can also cause tension headaches and is often due to stress. Poor posture, eyestrain and structural problems such as cervical spondylosis can contribute to tension headaches.

Cluster Headaches
These headaches come and go all day or over several days, the cause is unknown but thought to be similar to that of migraine. Men experience cluster headaches more often than women. Triggers include lack of sleep, alcohol and changes in barometric pressure. High blood pressure, low blood sugar, dehydration, sinusitis, noise and fumes can all cause headaches.

Traditional Chinese Medical Perspective
Headaches and Migraines can be caused by:

Additionally factors such as menstruation may play an important part in the cycle of headaches for women. Individual diagnosis is required in order to determine the most effective treatment. This is where Traditional Chinese Medicine differs from Western medicine. Rather than giving one type of treatment for all headaches or migraines we look at each person and determine which treatment is suitable for the individual based on diagnosis of their underlying pattern of disharmony.

Research on Acupuncture treatment of Headache and Migraine
In 2002, The Headache Journal, of the American Headache Society published a randomized control trial (RCT) comparing the use of acupuncture to Flunarizine in the prophylactic treatment of migraine in 160 women. Alias et al (2002) reported that whilst both acupuncture and Flunarizine were effective in migraine prophylaxis, specific results for acupuncture were

In 2004, the British Medical Journal (BMJ) published an RCT studying efficacy of acupuncture in treating chronic tension headaches and migraine. They found that
"Patients receiving acupuncture used less medication, made fewer visits to general practitioners, and took fewer days away from work or other usual activities" (Vickers et al, 2004).

In 2005, the BMJ published an RCT involving 270 patients with episodic or chronic tension-type headache. The objective was to investigate the effectiveness of acupuncture compared with minimal acupuncture and with no intervention in patients with tension-type headache. The results showed that acupuncture significantly reduced the amount of headaches experienced. They also found that minimal acupuncture had a good effect also (Melchart et al, 2005).

In 2005, The Headache Journal, of the American Headache Society reported an RCT studying acupuncture as an adjunctive therapy to medical management of chronic daily headaches. The researchers reported "findings demonstrate that a course of acupuncture treatments can improve clinical outcomes among patients with 'chronic daily headaches' beyond that which would be expected from headache-specialty medical management alone" (Coeytaux et al, 2005).

Nutrition & Herbs
It is important to establish any food triggers involved in headaches and migraines. Foods containing tyramine, phenyl ethylamine, histamine, nitrites and sulphites are involved in the mechanism of headache in sensitive people. At the complementary medicine practice we suggest keeping a symptom and migraine diary, and food diary to establish any relationship.

Several nutritional supplements and herbal medications may be useful in the treatment of headache and migraine, a consultation is required to make individualised and appropriate recommendations.

Self-help tips

• Unstable blood sugars play a causative role in headaches so eating regularly, including a small portion of protein with each meal, and having complex carbohydrates but avoiding sugar and high GI foods will help
  
• Fresh air, regular exercise, and balanced regular meals help to prevent headaches and migraines
  
• Keep a food diary alongside a record of your migraines to determine if there are any obvious links
  
• Avoid caffeine, alcohol, dairy produce, chocolate, cheese, red wine and additives, such as monosodium glutamate and nitrates, if these are found to trigger migraines
  
• Drink plenty of water (at least six glasses a day) to prevent dehydration
  
• Practice relaxation exercises, self-massage and deep breathing to ease tension
  
• Mix 2 drops of Melissa or Lavender essential oil in 2 teaspoons sweet almond oil and massage gently into your neck and temples to ease an attack
  
• Cold compresses can ease migraines
• Warm baths can relieve tension headaches
  
• Get a good night's sleep. It is important to establish regular waking and sleeping cycles as too little and too much sleep can trigger headaches.

References
Allais, G. De Loenzo, C, Ouirico, P. Airola, G, Tolardo, G. Mana O. Bendetto, C. 2002. Acupuncture in the prophylactic treatment of migraine without aura: A comparison with Flunarizine. Headache. 42: 855-861.
http://bmj.bmjjournals.com/cgi/reprint/331/7513/376.pdf

Coeytaux, R. Kaufman, J. Kaptchuk, T. Chen, W. Miller, W. Callahan, L, MANN, J. 2005. A Randomized, Controlled Trial of Acupuncture for Chronic Daily Headache. Headache. 45:1113-1123.

Linde, K. Streng, A. Susanne, J. Hope, A. Brinkhaus, B. Witt, C. Wagenpfeil, S. Pfaffenrath, V. Hammes, Weidenhammer, W. Willich, S. Melchart, D. 2005. Acupuncture for patients with migraine: randomized controlled trial. Journal of the American Medical Association. 293: 2118-2125.
http://jama.ama-assn.org/cgi/reprint/293/17/2118

Melchart, D. Streng, A. Hoppe, A. Brinkhaus B. Witt, C. Wagenpfeil, S. Pfaffenrath, V. Hammes, M. Hummelsberger, C. Irnich, D. Weidenhammer, W. Willich, S. Linde, K. 2005. Acupuncture in patients with tension-type headache: randomized controlled trial. British Medical Journal. 331.376-382. http://www.bmj.com/cgi/content/full/331/7513/376

Vickers, J. Rees, R. Zollman, C. McCarney, R. Smith, C. Ellis, N. Fisher, P, Van Haselen, R. 2004. Acupuncture for chronic headache in primary care: large, pragmatic, randomized trial. British Medical Journal.
http://bmj.bmjjournals.com/cgi/reprint/bmj.38029.421863.EBv2.pdf