Acupuncture Deep Needling Points to Greater Headache Relief

Acupuncture deep needling offers significant, long-lasting relief from chronic tension headache (TTH), new research suggests.

The result of a randomized study showed that although the majority of participants reported some relief from TTH after 8 weeks of acupuncture treatment, those who received needles at a depth of 12.5-20.0 mm had the greatest reduction in the frequency and severity of reported the headache.

At this depth, acupuncture promotes deqi sensation, a feeling of numbness, pain, heaviness, or irritating pain at the needle site which is considered the key to successful acupuncture treatment in traditional Chinese acupuncture theory.

Ying Li, MD, PhD

“Our study showed that deqi sensation could enhance the effect of acupuncture in the treatment of chronic TTH, and the effect of acupuncture persisted for at least 6 months when treatment was discontinued,” study co-author Ying Li, MD, PhD, The Third Hospital/Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China, told: Medscape Medical News

The findings were published online on June 22 in Neurology

deqi Sensation Key

TTH is the most common form of headache, with a lifetime prevalence of up to 78% in some studies. The pain is often described as throbbing or a mischievous tightness on both sides of the head. TTH is considered chronic if it occurs at least 15 days a month.

Previous studies have suggested that acupuncture may provide relief from headache pain, but specific information on TTH, especially chronic TTH, was lacking.

To address the issue, researchers designed a parallel-designed, patient-and-evaluator blinded randomized controlled trial involving 218 individuals with a history of chronic TTH. All were untreated with prophylactic treatment in the previous 3 months.

The treatment group (n = 110) received 20 sessions of true acupuncture (TA) over 8 weeks. This included three sessions per week in the first 4 weeks and two sessions per week in the last 4 weeks. The needle depth at each point ranged from 12.5 to 20mm, which is required to achieve deqi feeling.

The control group (n = 108) received superficial acupuncture (SA) on the same schedule as the TA group and at traditional acupuncture points. However, this is done at a maximum depth of 2 mm, which is not deep enough for deqi feeling.

At week 16, 68.2% of participants who received TA reported a greater than 50% reduction in monthly headache days compared with 48.1% of those who received SA (odds ratio, 2.65; p < .001).

Mean monthly headache days decreased from 20.38 days at baseline to 7.48 days at week 32 in the TA group versus 22.6 days at baseline to 11.94 days in the SA group.

Headache intensity and severity decreased in both groups, although those who achieved this deqi sensation reported the most improvement.

Only four patients reported side effects, all of which were mild and required no treatment.

Patients in both groups reported some pain relief, suggesting that those who are uncomfortable with deqi sensation may still benefit from superficial acupuncture, although to a lesser extent, Li said.

“We assume that the point-specific effect and the placebo effect were combined to give the patients relief from headaches,” Li added. “Furthermore, the effect of deqi sensation added more treatment effect. This could be explained by gate-control theory or other unknown mechanisms.”

Deeper understanding?

Respond Medscape Medical NewsJennifer Bickel, MD, a senior member of neurology at the Moffit Cancer Center and professor of oncology sciences at the University of South Florida in Tampa, said the study provides a deeper insight into the efficacy of acupuncture for chronic TTH, which could help clinicians. help those unfamiliar with therapy or when and how to refer treatment.

“This study provides a more descriptive overview of what type of acupuncture treatment and duration may be effective for patients so that doctors can prepare patients for what to expect and so doctors can better assess whether patients have received appropriate acupuncture for their headaches,” Bickel said, he was not involved in the investigation.

However, she noted that the acupuncture sites and techniques did not vary during the trial. While that makes sense for a controlled study, it may not reflect real clinical practice, she added.

“The downside is that the study did not fully reflect that most acupuncturists in clinical practice would change treatments during the 20 sessions based on the patient’s response and associated symptoms or comorbidities,” Bickel said.

The study also missed information about drug overuse headaches or patients’ history of TTH treatments.

“This could be helpful in understanding which patient will benefit most from treatment in clinical practice,” Bickel said.

Authors of the study received funding from the Department of Science and Technology of Sichuan Province and the National Natural Science Foundation of China. Li, Bickel and Vickers report no relevant financial relationships.

Neurology. Published online June 22, 2022. Full text

Kelli Whitlock Burton is a reporter for Medscape Medical News

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