Acupuncture/ dry needling to break a migraine ?

Sep 26

7 min read

“Can acupuncture or dry needling break a migraine?”

This question was posed recently in a group that I follow, and it made me want to write about it because the answer isn't quite as simple as yes or no.

I treat a lot of people with migraine, and sometimes someone will come in during an attack and experience a significant change during or shortly after treatment.

But migraine is much more complicated than simply having a painful head.

And what we're trying to achieve with needling depends very much on why that particular person is experiencing migraine, what is contributing to it and whether we're treating an attack or trying to change a recurring pattern.

So, can you actually “break” a migraine with needles?

Sometimes, clinically, we see an attack settle considerably following treatment.

That doesn't mean I can promise to stop every migraine once it has begun. I can't.

What we can do is provide a very significant sensory stimulus to the nervous system — and needling has physiological effects on the way pain signals are processed.

This is where it becomes really interesting.

Needling isn't just happening where I put the needle

When I insert a needle into a muscle or acupuncture point, I'm obviously creating a local stimulus.

But that information doesn't remain at the needle.

Sensory information travels along peripheral nerves and into the central nervous system. Acupuncture analgesia has been associated with activation of the body's own pain-modulating systems, including endogenous opioids and descending inhibitory pathways.

In other words, we're giving the nervous system another piece of information to process.

And that can influence the way it processes pain.

The “gate” and pain

One of the classic explanations you'll hear in pain science is the Gate Control Theory of Pain.

The original theory was proposed in the 1960s and our understanding of pain processing has become considerably more sophisticated since then, so I wouldn't suggest that it explains everything acupuncture does.

But the basic concept is still incredibly useful.

Pain isn't simply a message travelling uninterrupted from an injured area to the brain.

Sensory information is constantly being modified, amplified and inhibited at different levels of the nervous system.

Think about what you instinctively do when you bang your elbow.

You rub it.

Why?

You're giving the nervous system additional non-painful sensory input. That input can alter the transmission and perception of the painful signal.

Needling provides a much more specific sensory stimulus. It activates nerve fibres and can engage spinal, brainstem and higher nervous-system mechanisms involved in regulating pain.

So rather than thinking:

needle goes in → pain switches off

it is more accurate to think:

needle goes in → sensory information enters the nervous system → pain-modulating systems respond → the way that pain is being processed can change.

This is one of the reasons acupuncture can sometimes have effects well beyond the tiny area immediately surrounding a needle.

And then there are the body's own painkillers

Needling can also engage our endogenous pain-control systems.

Research into acupuncture analgesia has found involvement of substances including endorphins, enkephalins and other endogenous opioid peptides, alongside neurotransmitter systems involved in descending pain inhibition.

These are part of the body's own mechanisms for turning the volume of pain signalling up or down.

This is important because pain is not a fixed signal.

The nervous system has its own internal braking system.

One of the things we're potentially doing with acupuncture is encouraging those inhibitory systems to become more active.

Migraine has another layer: the trigeminal system

Migraine isn't simply an especially bad headache.

It is a neurological disorder involving altered processing within the nervous system, with the trigeminovascular system playing an important role.

One chemical messenger you may have heard about is CGRP — calcitonin gene-related peptide.

CGRP is involved in migraine signalling, which is why an entire newer generation of migraine medications has been developed around blocking CGRP or its receptor.

There is research investigating acupuncture's effects on trigeminal pain pathways, neurotransmitters and CGRP-related mechanisms.

I think we need to be careful with the language here, though.

I wouldn't say that acupuncture simply “switches off CGRP”. The biology of migraine is far more complicated than that.

What the research does give us is a plausible biological framework for understanding why stimulating peripheral nerves with needles might influence systems involved in migraine and pain regulation.

What if the migraine is coming from the neck?

This is another important distinction.

Some people's headaches have a very obvious cervical component.

They might say:

“My migraine always starts in my neck.”

Or:

“I get that tight spot at the base of my skull and then it travels over my head and behind my eye.”

There is a fascinating anatomical reason why the neck and head can be so closely connected.

Sensory information from the upper cervical nerves and the trigeminal system converges within an area often referred to as the trigeminocervical complex.

In simple terms, information coming from the upper neck and information coming from the head meet within shared neurological processing pathways.

This means that for someone with a strong musculoskeletal component, I may use acupuncture alongside more direct needling or trigger-point work to muscles around the neck and shoulders.

In those cases, treating the muscular component may be an important part of reducing the input that is continually feeding into the headache system.

This is where dry needling and acupuncture can overlap, although they aren't identical treatment systems.

But not every migraine is a tight neck

This is really important.

I wouldn't treat a 28-year-old whose migraine predictably arrives just before every period in exactly the same way as someone whose headache begins after eight hours sitting at a computer and is accompanied by significant upper cervical and muscular dysfunction.

The symptom may be called “migraine”, but the factors contributing to it can be quite different.

Hormonal migraine is a good example.

Fluctuations in oestrogen — particularly falling oestrogen around menstruation — can affect the excitability of the migraine system. This is why some women experience extremely predictable menstrual migraine, and why migraine patterns can change dramatically during perimenopause.

Acupuncture doesn't simply “balance hormones”. You'll see that phrase everywhere, but physiologically it is far too simplistic.

Instead, I am interested in the person's whole migraine threshold: pain processing, sleep, stress, autonomic nervous-system activity, muscular input and, where relevant, the timing of attacks within the menstrual cycle.

And this is where Chinese medicine looks at it differently

I also practise Traditional Chinese Medicine, so I have another framework through which I assess migraine.

One pattern I commonly see clinically is Liver Qi stagnation.

It's important to explain what that means.

The Chinese medicine concept of the Liver is not simply the anatomical liver measured on a blood test, and Liver Qi stagnation is not a Western medical diagnosis.

Within Chinese medicine theory, the Liver is associated with maintaining the smooth movement of Qi throughout the body.

When that movement becomes constrained, we describe it as stagnation.

Clinically, I might be thinking about this pattern when someone tells me that their migraines are strongly associated with:

stress or frustration
feeling tense or “wound up”
tight shoulders, neck or jaw
PMS
irritability before menstruation
menstrual changes
digestive symptoms that worsen with stress
headaches that appear after periods of intense emotional or physical pressure.

But I don't diagnose Liver Qi stagnation simply because somebody has a migraine.

Chinese medicine is pattern-based.

Two people can walk into my clinic with the same Western diagnosis of migraine and receive quite different acupuncture treatments because the overall patterns presenting in those two people aren't the same.

Why might I want to see you more than once a week?

This brings me to something patients often ask.

If you have treatment and your migraine or headache improves for six hours, but then gradually returns, I don't necessarily see those six hours as a failure.

Quite the opposite.

Something changed.

The question becomes: can we make that change stronger and can we make it last longer?

If we then leave seven or ten days before providing another treatment, you may have completely returned to your previous baseline by the time I see you again.

We're effectively trying to climb the same hill again.

If I treat you again while some of that improvement is still present, we have the opportunity to build upon the response rather than continually starting again from the bottom.

Initially the improvement might last six hours.

Then perhaps a day.

Then three days.

Perhaps the headache is still there but instead of being an 8/10 it is a 5/10.

Perhaps you still experience the migraine but don't need to go to bed.

Perhaps you're having fewer migraine days.

Those are all changes I want to know about.

Chronic migraine is different again

If someone has experienced migraine for years, I don't expect their nervous system necessarily to change its behaviour after a single acupuncture treatment.

Repeated pain can involve changes in sensitivity and pain processing. The nervous system isn't a passive electrical cable; it adapts.

That is why I generally think about acupuncture as a course of treatment, particularly with chronic problems.

Interestingly, this isn't purely a traditional acupuncture idea. Current NICE guidance includes a course of acupuncture as one of the options that can be considered for migraine prevention in certain circumstances.

So after one treatment I am not only asking:

“Did your migraine disappear?”

I'm asking:

Was it less intense?

Did it last for less time?

Did it respond better to your usual medication?

Was the nausea different?

Was there less neck pain?

Did you sleep better?

Did you get an extra migraine-free day?

Was the next attack later than expected?

Those smaller changes can tell me that we're beginning to influence the pattern.

So, would I use acupuncture or dry needling to “break” a migraine?

Yes, I will sometimes needle someone during a migraine attack, and sometimes we see a very rapid response.

But that's only a small part of what I'm interested in.

I want to know why you're getting the migraines in the first place.

Is there a cervical component?

A hormonal pattern?

A significant stress relationship?

Muscular trigger points?

Is your nervous system becoming increasingly sensitised?

What does the migraine look like through a Chinese medicine pattern diagnosis?

And, very often, there isn't just one answer.

That is why treating migraine isn't simply about finding the magical “migraine acupuncture point”.

The needles are the stimulus. The nervous system is what we're actually talking to.

And sometimes, particularly when migraine has become established or chronic, that conversation needs to happen more than once before we begin to see the pattern change.