5 Important Things to Know Before Starting Acupuncture Treatment for Migraine

Hi everybody. Today we're going to talk about the five important things to know before you start acupuncture for migraine treatment. So my name's Nhu-Nhu Zang, Dr. Nhu-Nhu Zang. I'm a clinical assistant professor of neurology at Stanford University. I'm a headache specialist and a neurologist. So today we're gonna talk about acupuncture. So I've always been interested in complementary and alternative medicine. That's why a few years ago I trained in acupuncture at the Academy of Pain Research in San Francisco. So that training and also my own experience as an acupuncture patient has helped me answer a lot of the questions that my patients bring up during clinic. So what I want to share with you today is essentially the counseling I provide for my own patients when it comes to acupuncture. So for the first 15 minutes I'll cover the five important things to know about acupuncture and then I'll answer questions afterwards. So the first thing my patients usually want to know is how does acupuncture work? Or what exactly is it doing to the body? So there's two main ways to understand this. One is through the traditional Chinese medicine point of view where acupuncture is thought to help regulate and balance the flow of qi through the body. So in Chinese, qi literally means air but is usually translated as a vital force or energy that flows in our bodies. And this qi has an impact on our circulation, our nervous system, and all of our vital organs. And the analogy that I was taught which I find to be helpful is to envision the body as a New York City subway map. So all of the different colored subway lines are the meridians or energy channels in the body and the passengers in the subway cars are the qi or the energy that's being transported. So the goal is to make sure those subway cars are not too crowded and not too empty and that the whole system runs smoothly. And it's thought that needling is a way to add qi where there's a deficiency or to remove qi where there's congestion. The other way to understand how acupuncture works is through a more Western physiology perspective where micro-injury from needling can lead to increased blood flow and also healing. And there have actually been some studies that have shown that acupuncture can lead to changes in the levels of certain neurotransmitters like serotonin and dopamine and also changes in certain molecules like endorphins which affect how we sense pain. You know, the truth is there's still a lot we don't know about the mechanism of acupuncture so more research needs to be done. The second question that patients usually ask is what are the side effects of acupuncture and is it safe? So overall, acupuncture is actually very safe and it's low in side effects especially if it's performed by a competent certified acupuncturist who is using sterile single-use needles. Some common potential side effects can include bruising, bleeding, soreness and in some people, the needling can actually cause lightheadedness and fainting but that's exactly why acupuncture should be performed when a person is lying down. So there are three special groups of people though who should actually definitely consult with their medical doctor and let their acupuncturist know about their condition before starting acupuncture. The first is pregnant women. So if you're pregnant, then acupuncture should always be discussed with your OBGYN before you start acupuncture and if you decide to try acupuncture, you need to let the acupuncturist know that you are pregnant and this is because there are several acupuncture points that can actually induce labor when they are stimulated and if that's done before the baby's ready to be born, then it can potentially cause miscarriage. The second group is people with bleeding disorders or people who are taking blood thinners. So in that case, then you might expect more bleeding or bruising more so than the average person. The third group of people is those who have pacemakers. This is an issue if the acupuncturist decides to perform electroacupuncture where they apply electricity to the needle to get a stronger stimulation. The electrical pulses can sometimes affect the function of the pacemaker, so you gotta be careful. So this leads to the third important thing to know which is who then should be getting acupuncture and I think the simple answer is anyone who is open-minded about it, who has discussed it with their medical doctor and has the time and resources to do it. So number one is feeling comfortable with the treatment and believing in the treatment because it can actually affect the results that you get. And again, checking with your medical doctor is also important and in terms of time and resources, a good round of acupuncture is at least one to two sessions a week for about eight to 10 sessions. So it is a time commitment and it needs to be something that you're able to fit into your lifestyle. So at this point, many of my patients are thinking, okay, I may want to try this but what can I expect during the session? So on our list today, the fourth important thing to know is what to expect when you go to acupuncture for the first time. So for starters, you should always arrive wearing comfortable, loose clothing. I usually wear a T-shirt or warmups or pants that are easy to roll up to your knees. And the first session takes about an hour usually. It starts with the acupuncturist taking a medical history and this is the time to tell them what active issues are going on and what medical conditions they need to be aware of. Then you'll have a physical exam and two important parts of the exam is feeling your pulse and also looking at your tongue. So the tongue and pulse diagnoses are very important in guiding the acupuncturist treatment plan for you. So next for the needling, you'll lie on a padded bed usually and if you're cold, most offices will have heat lamps or warm towels or blankets to keep you warm. Then the acupuncturist will choose the points and start inserting needles. Once the needles start to go in, the acupuncturist may actually twist or thrust the needle until you feel a warm or tingling sensation which we call the T. Usually the average number of needles inserted in each session is about five to 20 or so. And once the needles are set, the acupuncturist will set a timer usually before leaving the room and the needles stay in for about 20 to 45 minutes. And during that time, your job is to breathe, relax and take a nap. And there's usually a call button placed beside your hand if you need help or if something needs to be adjusted. And then once the timer is up, the needles are removed and you're free to go. But I do think it's important to keep in mind that after the session, it is recommended that you avoid vigorous exercise, avoid sexual activity for that day and try to avoid alcohol and caffeine if you can. And the reason for this is that acupuncture is quite stimulating for the body so you don't want to overstimulate yourself that day. So the last thing on our list of five important things to know about acupuncture is also one of the most frequently asked questions. And that is, what kind of results can I expect from acupuncture? So overall, there is growing evidence that acupuncture is effective for episodic migraine prevention. And there are some studies that have compared acupuncture with some of the standard oral medications that we have, like topiramate and the beta blockers. Those have actually been shown to be helpful for migraine prevention and can cause less side effects than oral medications. However, there are many studies that show that sham acupuncture or stimulation acupuncture can be just as good as true acupuncture. So this brings up the question of, is acupuncture mostly placebo? So from a research perspective, there is growing evidence that acupuncture can be helpful for migraine, but we still need more and better quality studies to look further into this. When I'm in clinic with my patients, I always explain to my patients that just like in all other treatments, in acupuncture, you're going to have your super responders who do really well, and you're going to have your non-responders who don't get any benefit, and then most people fall somewhere in between. So I think one of the most important questions to ask yourself is, how severe is my disease? Because the severity of your disease can actually be an indicator of how effective the treatment will be and how long and how intense the treatment needs to be. So the less severe the disease, the easier it is to treat, pretty common sense, right? So for example, if you're someone who gets like one to two headache days a month, and it just started to increase in frequency a few months ago, then perhaps a round of eight to 10 sessions of acupuncture may make a big difference for you. Whereas someone who has daily headaches for the last 20 years, and going to a few sessions of acupuncture may not have a significant impact on how you feel. So, you know, most of my patients have chronic migraine, and it's been going on for many years, and they've tried many treatments already. And in their case, you know, I think that acupuncture can still be a good supportive or adjunctive treatment that may be helpful for other issues like sleep, anxiety, muscle tightness. And as you may know, all of those things can have a big impact on migraine and could ultimately be helpful for migraine. So if you're open to addressing those issues, then acupuncture may still be worth a try. So those are the five important things to know about acupuncture before you get started. My hope is that this information can help you make your own decision about whether or not to try acupuncture.