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

by David Mayor

Acupoints used for headache - general considerations
In the Journal of Chinese Medicine, there is a useful synopsis of the main acupoints used in TCM treatment of headaches (17 local points, 21 adjacent and distal ones) (Deadman, Al-Khafaji and Baker 1998). In the EA and other clinical studies for mixed headache types in the database, the most commonly used points are Fengchi (GB 20), Taichong (LIV 3) and Hegu (LI 4), with others such as Tianzhu (BL 10), Shuaigu (GB 8), Zusanli (ST 36) and Taiyang (M-HN-9) trailing behind and a scattering of other points used even less frequently. A number of authors emphasise TCM differentiation; others stress that local treatment is best carried out, at ashi points. Certainly in studies on experimental dental or other head pain local points have sometimes proved more effective than distal ones such as Hegu (LI 4).

However, most formula approaches to treating headache (as if it were a single condition!) do make use of Hegu (LI 4), either because it is traditionally indicated for headache (Shanghai College of Traditional Medicine 1981), or because of the dense innervation at the point (Mayor 1997), or because it lies within the C5 (Gagne and Walmsley 1996) (or C6 (Legge 1990) dermatome. Thus one EA device manual recommends Fengchi (GB 20) and Taiyang (M-HN-9) with Hegu (LI 4) (Anon e), whereas an Australian pTENS handbook advocates combining Hegu (LI 4) with Yintang (M-HN-3) (Richards 1991). For cranial electrotherapy stimulation (CES) using the Liss device, application at Hegu (LI 4) as well as over the area of pain is suggested (Anon a). Other recommendations may be more sophisticated. George Ulett gives a combination of Hegu (LI 4) with Fengchi (GB 20), Yamen (DU 15), Baihui (DU 20) and Taiyang, for example (Ulett 1992).

In the manual to the Chinese WQ-6F EA device (Anon c), points are grouped on the basis of headache location, although some of them also have a TCM rationale (the points recommended for EA by Fratkin (1984) for the WQ-10 are shown in parentheses):

  • Frontal: Yangbai (GB 14), Hegu (LI 4), Touwei (ST 8), Neiting (ST 44), Shangxing (DU 23), Yintang(GB 14-, Yintang+)
  • Temporal: Waiguan (SJ 5), Shuaigu (GB 8), Zulingqi (GB 41), Taiyang
  • Occipital: Houxi (SI 3), Tianzhu (BL 10), Kunlun (BL 60), Fengchi (GB 20), (GB 20 bilateral)
  • Vertex: Tongtian (BL 7), Taichong (LIV 3), Hegu (LI 4), Baihui (DU 20), (GB 20-, Du 20+)
  • Whole head: (Hegu LI 4 bilateral)

In another EA device manual (Anon b), points are given more on the basis of TCM syndrome differentiation:

  • Exogenous (Cold) type: Sanyangluo (SJ 8), Fengchi (GB 20), Hegu (LI 4), Dazhui (DU 14), Taiyang
  • Upward disturbance of Liver Fire: Taixi (KID 3), Hanyan (GB 4), Xuanlu (GB 5), Taichong (LIV 3)
  • Phlegm blocking upper orifices: Fenglong (ST 40), Zhongwan (REN 12), Baihui (DU 20), Yintang
  • Hyperactivity of yang due to yin deficiency: Yongquan (KID 1), Hegu (LI 4), Sanyinjiao (SP 6), Yintang.

When it comes to distal points, Joseph Wong has a very clear and useful exposition of points to use for different sorts of headache (Wong 2001). His suggestion that distal Yangming points are used for anterior head pain, Shaoyang for lateral pain and Taiyang for posterior pain is in line with the list of points according to headache location given in the manual to the WQ-6F device.

An interesting approach for 'most headaches', deriving ultimately from nineteenth-century electromedicine but using very low ('polarised microcurrent') levels of stimulation, has been described by Starwynn, with one (handheld) electrode applied on the head, the other on a distal extremity. He claims that this 'works more quickly than needle acupuncture in many cases' (Starwynn 2002). A somewhat similar method, with 1 mA direct current (DC) TENS applied between the forehead and interscapular area has been claimed to give more prolonged benefits for chronic headache than standard TENS, although with adverse skin effects in a considerable proportion of patients (Annal, Soundappan, Palaniappan and Chandrasekar 1992).

Acupoints for migraine

Traditionally, acupoints for migraine treatment are selected according to TCM syndrome differentiation (Ben), along with local or meridian points (Biao) (Blackwell 1991). Thus, in one Chinese MA study, selection of acupoints according to TCM syndrome differentiation improved results (Gao, Zhao and Xie 1999), and in one uncontrolled high frequency (HF) TENS study the use of tender local points alone (not acupoints) was of little benefit for migraine (or indeed various other types of headache) (Woods 1975), although Omura reported good results with bilateral frontal TENS alone in one case report (Omura 1983). However, the Chinese reviewer of a large number of headache studies noted that the use of local points appears particularly prevalent in the treatment of migraine (as opposed to headache of neurogenic origin, for example) (Chen 1995). Huatuojiaji points are also often used, for example in patients whose 'improper' sleeping position - prone, with the head turned to one side – was considered partially responsible for their condition (Hu 1998).

One often-quoted author on EA recommends the combination of Shuaigu (GB 8) with Fengchi (GB 20) (Zheng 1998), in line with a Korean suggestion that in migraine tender or tight scalp points may be found predominantly along the Gall Bladder meridian (Park and Yoo 2002).

Fratkin has a different recommendation for local EA, at Xiaguan (ST 7) and Taiyang (Fratkin 1984). Meeran used unilateral stimulation at Zanzhu (BL 2), Sizhukong (SJ 23), Tongziliao (GB 1) and Sibai (ST 2), with bilateral EA at Hegu (LI 4), and auricular points such as Nogier's 'Anti-aggression' point, the Trigeminal zone and Shenmen (Meeran and Meeran 1990). Others have focused on distal stimulation. Andrew Oliver, a physiotherapist, has found that LF EA at Taichong (LIV 3) and Xiaxi (GB 43) can even be helpful for acute migraine, for example (Oliver 2007), while Schvallinger applies local stimulation only at Fengchi (GB 20) (linked to Hegu LI 4) on the side of the pain and MA at points selected according to aetiology. For auricular treatment, he combines EA at Liver and/or Gall bladder with points selected according to headache location, together with Shenmen (Schvallinger 1986).

In the pTENS migraine studies, the majority carried out by Heydenreich, local points were selected according to the region affected (for instance, 'vertebral artery' or 'carotid sinus' points (Wang and Ma 1989), and stimulated in combination with distal/constitutional points such as Shenmen (HE 7), Houxi (SI 3), Waiguan (SJ 5), Hegu (LI 4) or Zusanli (ST 36). In one Russian report, once pain was stabilised using local stimulation, distal points were selected according to whether the patient’s blood pressure was high (Neiguan P-6, Sanyinjiao SP-6), low (Yanglingquan GB-34, Zulingqi GB-41, Juque REN 14?) or indifferent (Quchi LI 11?, Zusanli ST 36) (Vesnina and Dubovskaia 1983).

For acute migraine, TEAS has been recommended at Hegu (LI 4), Baihui (DU 20) and Taiyang (for unilateral pain, with positive polarity locally, negative at Hegu LI 4) (Hiranandani 1989). Local points such as Xuanlu (GB 5), Xuanli (GB 6), Yangbai (GB 14) and Taiyang, with distal points like Waiguan (SJ 5), Zulingqi (GB 41), Hegu (LI 4), Quchi (LI 11), Neiting (ST 44) or Sanyinjiao (SP 6) have also been recommended for TEAS (King 1999).

Schvallinger considers it important to use TENS immediately if the migraine sufferer is experiencing an 'aura' prior to an attack. His TENS protocol for all migraines appears to be with electrodes applied bilaterally at the temples and sub-occipitally (Schvallinger 1986). As with EA, he will use distal TEAS according to aetiology: Ganshu (BL 18) to Zhangmen (LIV 13) and Taichong (LIV 3) to Ququan (LIV 8) for a 'digestive' migraine, Shenmai (BL 62) to Gongsun (SP 4) with Leique (LU 7) or Qichong (ST 30) on one side linked to Guanyuan (REN 4) or Qichong (ST 30) on the opposite side for 'menstrual' migraine.

Acupoints for Tension-type headache

It has been suggested that in TTH tender or tight scalp points may be found predominantly along the Bladder meridian (Park and Yoo 2002). Points such as SI-17 are less likely to be helpful (Zhang, Li, Ren, Kuang, Wu, Zhang and Liu 2000).

For TEAS/TENS, Schvallinger suggests points either side of C7 if there is cervical involvement, along with Hegu (LI 4) linked to Quchi (LI 11) (Schvallinger 1986). Starwynn, although also an advocate of bilateral cervical stimulation, reports less good results when this is applied to the head itself, preferring his longitudinal, head-to-limb, approach (Starwynn 2002).

Table 2 below, shows the acupoints most commonly used for migraine and tension-type headache.

Table 2 Points commonly used in EA treatment for migraine and tension-type headache, from the clinical studies database at




(a) migraine


BL 10



SJ 23

P 6, SJ 5

Gall bladder, Liver

GB 8, GB 14, GB 20

GB 34, LIV 2, LIV 3

Large intestine

LI 4


ST 8

ST 36, ST 44


DU 15

Extra points

Yintang, Taiyang

(b) tension-type headache

Gall bladder

GB 20, GB 21

Large intestine

LI 4


Myofascial trigger points

Notes: (1). Points which only appear once or twice in the database are not listed in this Table. Points that occur five times or more are indicated by bold type.

Despite the paucity of precise information on TTH in the database, there are obvious differences between the points most commonly selected for the two types of headache considered here:

Those most commonly used points for migraine are Shuaigu (GB 8), Fengchi (GB 20), Xingjing (LIV 2), Taiching (LIV-3), Hegu (LI 4), Touwei (ST 8), Yintang(M-HN-3) and Taiyang (M-HN-9), whereas trigger points, Fengchi (GB 20), Jianjing (GB 21) and Hegu (LI 4) are the most frequently used points in EA protocols for TTH.

Gall bladder meridian points are used for both migraine and TTH, but the focus in migraine treatment is on head points, and that in TTH on occipital and shoulder points.

Hegu (LI 4) is frequently used for both headache types.

Stomach meridian points, both local and distal, are more commonly used for migraine.

Whereas the extra points Yintang and Taiyang are commonly used for migraine, myofascial trigger points occur most often in protocols for TTH.

The Korean differentiation between migraine and TTH in terms of tender points along the Gall bladder and Bladder meridians does not appear to be supported insofar as such points are selected for treatment: Gall bladder points are used for both types of headache, Bladder points much less commonly and possibly hardly at all for TTH.

Incidentally, Heydenreich noted, in an unpublished discussion of his results with pTENS, that changes only became significant after stimulation of distal points, with little difference between vascular headache (such as migraine) and TTH (Heydenreich).

However, more data is really needed to consolidate these conclusions.

Parameters used for headache - general considerations


In one Chinese review of a number of MA headache studies, it was observed that continuing to manipulate the needle once deqi is obtained gives better results than simple needle retention (Chen 1995). This could be used to justify the stronger stimulation possible with EA. However, strong stimulation to head points may actually result in headaches (Anon d).

Frequency and mode

Low frequency (LF) or 'dense-disperse' (DD) EA is used more than HF EA in clinical studies on uncategorised or mixed headache types.

Starwynn, in his book on microcurrent EA, suggests 10 Hz for 'some types of headaches', but also 80 Hz for acute or shi headache and 0.6 Hz for chronic headache. These suggestions may not be generalisable to other types of stimulation. Polarity.

DC or 'polarised microcurrent' stimulation linking the head and a distal point has been mentioned above.

Parameters for migraine


Information in the database on stimulation amplitude is sparse. Fratkin (1984) recommends EA of 'medium intensity' at local points, Hiranandani TEAS at high intensity (at Hegu LI 4, Baihui DU 20 and Taiyang) during an attack (Hiranandani 1989). Others have advised that strong local stimulation at hypersensitive points or at many points should be avoided, at least initially. In keeping with this, Pontinen has warned that exacerbation due to hyperstimulation is more likely with EA than with MA.

Frequency and mode

There is little consistency in the parameters used in the EA migraine studies. LF, HF and DD have all been employed. Both HF and LF CES have been used for migraine.

Voll (1975) recommended 9.4 Hz, or 9.5 Hz for migraine with nausea and Fratkin (1984) 10 Hz for migraine in general. Similarly, Schvallinger uses 8 Hz with both EA and TENS (Schvallinger 1986), and Meeran 6-8 Hz EA (Meeran and Meeran 1990). Tukmachi (2000) has suggested that LF EA should be used for acute migraine, but HF if it is chronic. This is in direct contrast to Starwynn's recommendations for headache in general (Starwynn 2002), and to Hiranandani's advice that TEAS at 12-30 Hz and high intensity be used during a migraine (at points detailed above) (Hiranandani 1989).

Duration and spacing

For 'vasomotor' headaches, 10 EA sessions daily or every other day have been recommended, for 15-20 minutes at auricular points or for 30 minutes at points such as Geshu (BL 17) (Zhang 1990). Even though he focuses on using distal points, Schvallinger recommends a basic duration of 20 minutes only for both EA and TENS treatment of migraine (Schvallinger 1986), while Meeran suggests 20-30 minutes (as against 30 minutes for tension-type headache) (Meeran and Meeran 1990).

Parameters for tension-type headache

LF EA, pTENS and TENS appear to have been used in the various clinical studies more than HF stimulation, but data are sparse in this respect. Meeran advised 8/30 Hz DD EA for 30 minutes for the condition (Meeran and Meeran 1990).

Summary of electrical parameters most commonly used for migraine and tension-type headache

Table 3 below, attempts an analysis of the electrical parameters applied in practice.

Table 3 Electrical parameters most often used in treating migraine and tension-type headache, from the clinical studies database at





(a) migraine



LF (for example, 1-10 Hz distally, but >25 Hz locally (Heydenreich 1988a)

HF (in 1 report, preventively, with LF during attack (Pothmann, Goepel and Buhl 1990)


CW or DD


CW monophasic

(also intermittent monophasic, for example (Vesnina 1980; Vesnina and Dubovskaia 1983)



'to tolerance'

little consistency (e.g. 'strong' distally, 'low intensity' locally (Heydenreich 1988a)

to induce local muscle twitch

Treatment duration

15-45 mins

(usually 20 mins)

10 secs - 7 mins per point

10-60 mins

(b) tension-type headache



2.5 Hz(2)








or motor level

to patient's tolerance (2)


Treatment duration

5 mins - 2 hrs (usually 20-30 mins)(1)

30 secs per point (2)

20-30 mins

Notes: (1) Lundeberg et al found that 2 Hz EA required applications of 30 minutes or longer for maximal duration of pain relief (Lundeberg T, Hurtig T, Lundeberg S, Thomas 1988).(2) Insufficient data to draw meaningful conclusions.

As so often in the field of electrotherapy, it is hard to draw any useful conclusions on the most useful parameters to use for migraine and TTH.

However, it would seem that LF CW is likely to be useful for both types of headache when using EA or pTENS, with quite a number of authors recommending frequencies of around 8-10 Hz for migraine.

To improve results, it might be worthwhile exploring suggestions that different parameters should be used at local and distal points, or between and during migraine attacks.

Longer treatments may be more appropriate for TTH than for migraine.


1. Distal points should be used in addition to local points. Bilateral stimulation of the head should be undertaken only with proper precautions.

Hyodo, in his textbook on Ryodoraku, recommends using Zusanli (ST 36) in addition to head and arm points, 'to avoid over-stimulation of the upper body' (Hyodo 1975). In keeping with this is Starwynn's observation that using two microcurrent probes on the head may be effective, 'but may be more likely to aggravate sensitive patients' than if they are applied at local and distal points (Starwynn 2002).

More specifically, bilateral electrical treatment of the head should not be undertaken with standard EA and TENS equipment, but only with devices (such as CES) designed for safe cranial electrotherapy stimulation.

2. Strong or prolonged local stimulation should be avoided, at least initially, to lessen the risk of exacerbating symptoms.

3. Individuals may differ in their responses to stimulation at different frequencies. From the information here, you may wish to restrict stimulation to three 'windows' - around 2 Hz, 8-10 Hz, and 25-30 Hz - testing each carefully before trying one of the others.

One author, for example, has suggested that frequencies of more than 10 Hz should not be used in (microcurrent) headache treatment, as 'this may increase agitation' (Manley Teahen 1994).

4. Advise headache sufferers to avoid coffee (and possibly strong tea as well).

Although caffeine is used as a treatment for headache, in part because of its autonomic and vascular effects, it should not be forgotten that overuse of caffeine as well as withdrawal from it can contribute to headache/migraine (Sawynok 1995). Caffeine may also reduce the effectiveness of some forms of electrostimulation (Mayor 2007).

Discussion and conclusion

EA and associated non-traditional methods have been used for both migraine and TTH, more frequently for the former.

Comparisons by various authors suggest that EA may be more helpful than MA for migraine (and perhaps for TTH as well). They also hint at the possibility that non-invasive acupoint stimulation, whether with pTENS, TEAS or LA, may also be helpful for those who do not find needling an acceptable treatment.

On the basis of the clinical studies database, it can be stated with a fair degree of confidence that the acupoints most commonly used for migraine are Shuaigu (GB 8), Fengchi (GB 20), Xingjian (LIV 2), Taichong (LIV 3), Hegu (LI 4), Touwei (ST 8), Yintang(M-HN-3) and Taiyang (M-HN-9), whereas trigger points, Fengchi (GB 20), Jianjing (GB 21) and Hegu (LI 4) are the most frequently used points in EA protocols for TTH.

Matters are less clear when it comes to the electrical parameters to be used in treatment, partly because historically individual researchers have had to develop their own protocols, partly because of a paucity of studies (particularly for TTH), and partly because authors have been peculiarly reticent about the protocols they have in fact used, whether because they were not thought worth recording or for other reasons.

Nonetheless, it does seem that LF CW (at about 2-4 Hz) is likely to be useful for both types of headache when using EA or pTENS, with several authors recommending frequencies of around 8-10 Hz for migraine. However, individuals differ in their responses to stimulation at different frequencies. A third frequency 'window' - around 25-30 Hz - may also be worth exploring.

To improve results, distal points should be used in addition to local points, possibly with different parameters at distal and local points, or between and during migraine attacks.

In particular, strong or prolonged local stimulation should be used with caution.

Somewhat unexpectedly, there is less certainty about the protocols derived from the extracted data for TTH than those for migraine, although no doubt more information relevant to the treatment of TTH could be obtained by trawling through studies on cervical myofascial pain.

Further research is still needed to clarify which procedures are most likely to benefit patients who suffer from migraine and TTH. Hopefully, if funding can be found, continuing updates to the clinical studies database at will permit this.


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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