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Is Electroacupuncture a Useful Approach for Migraine and Tension-Type Headache? Using the Clinical Studies Database at - Part One

by David Mayor

Electroacupuncture and the database

Electroacupuncture (EA), defined as the electrical stimulation of acupuncture points (acupoints) through needles, is applied at the same points as traditional or manual acupuncture (MA), and has been used for most conditions for which MA is indicated, especially when manual stimulation has not brought a response, or when strong reduction is appropriate (eg, for severe or acute qi and/or Blood stagnation). It is less commonly used in deficiency conditions.

The clinical studies database at was compiled from clinical studies on EA, pTENS, TEAS, TENS, LA, LILT and other associated treatments. For a full list of abbreviations used in this article, please refer to appendix A.

The database was designed to

  • Make data from the many existing clinical studies easily accessible at one location
  • Include information from studies carried out in China, the former USSR and other non-English-speaking countries that until now has been published in English – if at all – only in scanty (and sometimes inaccurate) abstracts
  • Enable researchers to decide rapidly which studies merit further investigation, and which not
  • Act as a springboard to further research
  • Speed up literature review
  • Prevent needless duplication of effort
  • Lead to more effective treatment.

Using studies located from databases such as MEDLINE, EMBASE, the Science Citation Index, AMED and the MARF online database at, and hand-searching runs of periodicals held in specialist libraries (such as the Needham Research Institute, Wellcome Institute and British Library), data have now been entered from well over 8000 studies originally published in English and other Western European languages, Chinese, Russian, Ukrainian and other languages, by 23 different individuals (acupuncture practitioners and students, researchers, translators).

The resultant database concentrates on what conditions are treated with EA and other nontraditional forms of acupuncture (although some MA studies are included), and on which acupoints and treatment parameters are used. Other data types include study type, numbers and subgroups of subjects, endpoint measures used, and outcome. Statistical detail is not usually included. When appropriate, traditional Chinese medicine (TCM) syndrome differentiations are mentioned.

The results are analysed in detail in the associated textbook and CD-ROM on electroacupuncture published by Churchill Livingstone earlier this year (Mayor 2007).

This article, based on the textbook, demonstrates how the database can easily be used to develop treatment protocols for migraine and tension-type headache (TTH), conditions frequently treated with EA.


Migraine has been defined by the International Headache Society as a unilateral and intense head pain that may last several days, typically accompanied by nausea or vomiting, visual disturbances and extreme sensitivity to light, with a variety of other accompanying symptoms (sometimes some of those of a cold, for instance). It is not just a headache but a systemic condition, occurring more in women than men. Schvallinger, a French author, differentiates between ‘digestive’ and ‘menstrual’ migraine, for instance (Schvallinger 1986). There is even a headache-free type of migraine, in which other migraine symptoms are experienced without the actual headache (Anon 2001b). Migraine often goes unrecognised and is underdiagnosed (Dowson 2001).

Conventionally, migraine is generally understood as a form of vascular headache, and is usually classified as ‘classical’ (paroxysmal in quality with a preceding aura) or ‘common’ (without the aura, more reactive in nature and generally longer lasting). The latter is more frequent. Sometimes a third type, ‘complicated’, is added, associated with neurological symptoms that persist after the migraine attack (Blakley and Siegel 1997). Although migraine is usually episodic, it can become chronic, occurring almost daily.

The vascular nature of migraine can be seen in those (the majority) who turn a deathly pale during an attack, shivering and cold (what Sacks calls ‘white’ migraine (Sacks 1985), or yang deficiency (Xu) in TCM language), whereas others become flushed and hot (‘red’ migraine, perhaps Yin Xu or Liver Yang rising).

Neurological involvement is evident in the frequency of the scintillating visual scotoma and the paraesthesiae that can precede or accompany migraine – both around 8–12 Hz, in the EEG α range (Sacks 1985). Disturbances, even hallucinations, may occur in any of the senses, and in most people are accompanied by cutaneous allodynia (increased or extreme sensitivity to normally innocuous temperature or touch stimuli). Once allodynia is established during an attack, neither the migraine nor the allodynia itself is likely to respond to tryptan medication such as sumatryptan (Imigran) (Silberstein 2002). Thus early treatment while the migraine is still mild would seem advisable (Klapper, Rosjo, Charlesworth, Jergensen and Soisson 2002). Whether this is also true for acupuncture is an important question.

Tension-type headache (TTH)

Tension-type headache is a steady, non-throbbing bilateral pain of the head, back of the neck and face. It may last up to several hours, and occur several times within a week. Usually episodic (< 180 days per year), but can become chronic (> 180 days/year). Although the autonomic symptoms typical of migraine are absent or mild, both types of headache may occur in the same patient (Pfaffenrath, Brune, Diener, Gerber and Gobel 1998), and one may possibly lead to the other (Flaws 1990).

As many as 90% of adults have had a tension headache at some time (Anon 2001a), while around 3% of the population suffer chronic TTH (Pfaffenrath, Brune, Diener, Gerber and Gobel 1998). Like most varieties of headache, these can be aetiologically multifactorial, and so may require a correspondingly catholic approach to treatment. They are usually muscular in origin (with ensuing ischaemia contributing to the pain), often with a stress-related component, but may also result from degenerative arthritis of the neck or be drug-induced (headache patients not infrequently become dependent on medication) (Kunkel 1991), or both. There may be considerable overlap between TTH and myofascial pain. Although antidepressant drugs are frequently prescribed initially, it appears that none of the currently available treatments for TTH, such as drugs, EMG or other biofeedback methods (Budzynski, Stoyva, Adler and Mullaney 1973; Epstein, Hersen and Hemphill 1974; Hutchings and Reinking 1976), or psychotherapy, demonstrates clear superiority over the others (Biondi and Portuesi 1994).

Acupuncture and headache

At one time, it was claimed that around a third of patients receiving acupuncture in the West suffered from some form of headache (Stux and Pomeranz 1991). In one very large, recent German survey of some 40,000 acupuncture patients with previously diagnosed migraine, TTH, low back pain or knee or hip arthrosis, around 26% claiming relief from pain were headache sufferers (Anon 2002). However, some reviewers have considered as equivocal the evidence that acupuncture has any effect beyond that of a placebo in the treatment of headache (ter Riet, Kleijnen and Knipschild 1990; White 1998/1999), or as inconclusive when acupuncture for headache is compared with other forms of treatment (Ernst 2001). It also appears from some MA studies that this form of acupuncture may reduce headache frequency and analgesic consumption, rather than headache duration or pain severity (Hester 1998).

Nonetheless, the 1997 US NIH Consensus Development Conference panel concluded there was good evidence that acupuncture can benefit headaches, although this does require further substantiation (NIH 1997). Indeed, in a more recent systematic review of acupuncture – including EA and LA – for chronic headache (24 RCTs, 35 non-randomised studies), acupuncture appeared to have a positive effect, although better quality studies produced lower response rates, as is often the case (Linde, Scholz, Melchart and Willich 2002).

Migraine and acupuncture

‘The placebo effect in migraine is so marked that virtually any form of treatment administered with sufficient aplomb, as for example, acupuncture, will produce a remission in a high proportion of patients’

WB Matthews (1983)

Despite the bias evident in such remarks by some diehard orthodox medical practitioners, a variety of non-pharmacological methods, including acupuncture and TENS, continues to be used in migraine treatment (Pryse-Phillips, Dodick, Edmeads, Gawel, Nelson, Purdy, Robinson, Stirling and Worthington 1998; Ringel and Taubert 1991). In one German TCM hospital, for example, migraine was one of three conditions most frequently treated with acupuncture and Traditional Chinese Herbal Medicine (TCHM) (Melchart, Hager, Liao and Weidenhammer 1998).

Flaws (1990), in his very readable book on migraine from a TCM perspective, considers that acupuncture may help more than 50% of migraine sufferers. Nevertheless, it has not always been considered useful for migraine even by its protagonists (Pomeranz and Stux 1989), and evidence for acupuncture’s efficacy in this condition is still unclear in the minds of some reviewers (Lewith and Vincent).

Lewith has made the interesting observation that acupuncture can make patients more responsive to medication: ‘someone with migraine may find that while powerful analgesics did not help at all, after acupuncture, one aspirin does the trick’ (Lewith 1992). Hu has commented that the causes of migraine in TCM terms may well differ in different countries, with acupuncture treatment needing to be adjusted accordingly (Hu 1998). Reviews of the TCM differentiation and treatment of headache, including migraine, have been given by Scott (1984) and Sun (2002), among others.

Tension-type headache and acupuncture

Acupuncture has been used for TTH (Rose 1993; Vincent 1990; Zhang 1992; Karst, Reinhard, Thum, Wiese, Rollnik and Fink 2001),with some trials indicating MA as only equivalent to placebo in effect and others suggesting that MA may be more useful, or as effective as standard treatment. Some reviewers consider neither acupuncture nor TENS of proven benefit (Pfaffenrath et al. 1998), and others that when acupuncture appears to benefit non-migraine headaches, this may be just because tension headache sufferers tend to be more responsive to non-specific effects (Richardson and Vincent 1986). Placebo considerations still lurk beneath the surface in many orthodox medical discussions of acupuncture!

The treatment of migraine with electroacupuncture and its variants

EA has frequently been used for migraine. Some authors consider that EA may be particularly helpful for the condition (Cheung 1985). However, in one American study, although good results were reported initially; a second course of treatment was less effective (Frost, Hsu and Sadowsky 1976).

Heydenreich was the great protagonist of pTENS both for headache and migraine, and his studies, a mixture of well-performed clinical trials and general reviews, are some of the most convincing of its benefits for the latter condition, prophylactically (Heydenreich 1990) as well as therapeutically (Heydenreich and Thiessen 1989; Heydenreich 1991; Heydenreich 1988b; Heydenreich 1989).

Ulett used what he terms ‘neuroelectric acupuncture’ (TEAS) together with imagery conditioning in the treatment of a woman with schizoaffective disorder and migraine who was on a veritable cocktail of eight different medications. After only four sessions, once each month, she was able to reduce to two drugs (risperidone and lithium), with the migraines mostly controlled by her imagery work (Ulett 1996). It is unclear from his report whether the migraines resulted from or preceded her use of so many different drugs. TEAS for migraine has been investigated by other authors too (Goepel, Buhl and Pothmann 1985; Lapeer 1986).

TENS does not appear to have been used that frequently for migraine, although there are some positive reports on this application (Omura 1983; Winnem and Staff 1982; Saini, Talwar and Arora 1979). It gave quite good results in one uncontrolled study, but (as for other conditions) was not found helpful if patients were also severely depressed (Appenzeller and Atkinson 1976). It has been utilised for children with migraine (Pothmann 1984). The Skenar device, a variant of TENS, has also been used for migraine (Meizerov, Chernysh and Dubova 2002).

The treatment of tension-type headache with electroacupuncture and its variants

Given that electrotherapy appears to be helpful for TTH and cervicogenic headache (Vernon, McDermaid and Hagino 1999), there are surprisingly few studies on EA for TTH. In one mixed retrospective study it gave good results (Waylonis 1974), but in a series of controlled studies by Jane Carlsson and colleagues standardised symptomatic EA appeared to be less helpful than causally and individually adapted physiotherapy, for example.

In one small crossover pTENS trial, a single treatment resulted in greater increases in pressure pain threshold at stimulated trigger points than sham stimulation. It is unclear how clinically significant this would be (Airaksinen and Pöntinen 1992).

TENS (both with and without physical therapy) was superior to biofeedback-enhanced neuromuscular re-education in one CT of TTH (Jay, Brunson and Branson 1989). TEAS/TENS was found helpful in several uncontrolled studies as well (Fargas-Babjak, Pomeranz and Rooney 1992). For instance, in one interesting report of over 5,000 patients suffering from headaches of which 39.5% were cervicogenic in origin, manipulation of the cervical spine benefited 91% of those whose symptoms appeared to be due to vertebral displacement (67% of the cervicogenic group), whereas electrical nerve block using a monophasic (interrrupted direct current) variant of TENS benefited 80–90% of those whose symptoms were apparently caused by narrowing of the intervertebral foramina (33% of the cervicogenic group) (Jenkner 1994). TENS has also been found helpful for tension-type headache in children (Pothmann 1991), alleviating symptoms in around 80% of sufferers (Pothmann 1992).

Acupoint injection has been used for both migraine (Mikamo, Takao, Wakutani and Nishikawa 1994) and TTH (Sternfeld, Finkelstein, Hai and Hod 1986).

Database studies on EA and related modalities for migraine and tension-type headache

Table 1 below, shows the distribution of study types for the different interventions included in the EA clinical studies database for these conditions.

Table 1. Database studies on EA and related modalities for migraine and tension-type headache

The first figure in each pair is the number of studies on migraine, the second figure is the number of studies on tension-type headache.





Case series

Case report























1 (r)/0





















1 (d)/0















Other methods





















Note: ‘Other methods’ include heat, acupoint injection, application of magnets and pulsed magnetic fields, ‘Gigahertz TENS’ and Koryo hand acupuncture; (d) = descriptive study; (r) = review.


David F Mayor is the editor of Electroacupuncture: A practical manual and resource (Elsevier/Churchill Livingstone 2007), the online clinical studies database at and the Clinical Application of Commonly Used Acupuncture Points by Li Shizhen (Donica 2007). He lectures on electroacupuncture at CICM and is an honorary member of the UK Acupuncture Association of Chartered Physiotherapists (AACP) as well as being a member of the British Acupuncture Council. He practises acupuncture in Welwyn Garden City, Hertfordshire, UK.

This article is based on material published in the textbook Electroacupuncture: A practical manual and resource (CD version), edited by David Mayor andcopyright Elsevier (2007).



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