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The Migraine And Headache Program

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My reasons for distinguishing this pain from musculoskeletal pain is that migraine is a neurovascu-lar pain which manifests itself on the trigeminal territory and tends to relapse over time. Migraine is a disabling disorder with a high social and economical impact which requires a careful strategy of prophylaxis for reducing the number of attacks and preventing the chronic abuse of painkillers. Here acupuncture can gain ground with honor as an alternative treatment or for use in combination with pharmacological therapy.2-8

Besides body acupuncture, using formulae or personalized sets of points, ear acupuncture also seems to have an interesting role. Its main difference is that at every ear acupuncture session it is necessary to make a diagnosis and to find out which points to treat. Migraine requires a very accurate localization of the points; especially in the case of an attack, the algometer should be used with a light hand in order not to overly bother the patient.

In 15 patients with migraine attacks (13 female,

2 male) pain scoring with a VNS was repeated 1, 5, 15 and 30 minutes after NCT. Pain decreased about 26.4% after 1 minute and 47.4% after 5 minutes; in the succeeding time intervals the pain level remained unchanged (Fig. 8.2). The points identified with NCT were mainly distributed in the area of the forehead (AT1 e) and the temple (AT2 nie) on


Fig. 8.2 Reduction of pain in 15 patients with migraine attack in T1 (1 minute after NCT for 10 seconds); in T2 (5 minutes after); in T3 (15 minutes after) and in T4 (30 minutes after).


Fig. 8.2 Reduction of pain in 15 patients with migraine attack in T1 (1 minute after NCT for 10 seconds); in T2 (5 minutes after); in T3 (15 minutes after) and in T4 (30 minutes after).

the Chinese map and frequently also on the supero-internal surface of the antitragus overlapping partially with the Chinese subcortex area (AT4 pizhixia) (Fig. 8.3).

It has to be stressed that AT4 extends itself to the bottom of the medial wall of the antitragus and carries the generic indication 'painful symptoms'. The first documented application of NCT in a case of migraine attack was performed on one of these patients and a steady level of analgesia was maintained up to the 60th minute.9

In a still ongoing study with the collaboration of Dr Gianni Allais of the Women's Headache Center at Turin University, we treated a group of 40 females with an average age of 42.4 years affected by acute migraine pain. Our aim was to record the intensity of pain beyond the above-mentioned interval, adding a further recording at 120 minutes and 24 hours. The preliminary data show that the pain level drops from an average of 5.1 to 2.1 after 10 minutes and remains unchanged to the next day.

The application of NCT during a migraine attack is, however, a little different to that of mus-culoskeletal pain for the following reasons:

1. Pain relief is slower the greater the time lapse from the onset of pain. The patient often feels tired and weak and this may delay appreciation of any variation in pain intensity. To overcome

this the duration of needle contact can be protracted up to 30 seconds and the first measurement of pain level postponed to 3-4 minutes after NCT.

2. In the case of bilateral migraine it must be remembered that each half of the head is controlled by the auricle of that side. Therefore if NCT is begun on the right ear the patient needs to be instructed to consider, a few minutes after NCT, any difference of pain between the right and left side of his head. It is always surprising to witness how patients can be aware of the pain diminishing on the same side as the stimulated auricle and compare that sensation with the unchanged intensity in the pain on the opposite, as yet untreated, side. Obviously, once diagnosis and treatment have been accomplished on one side, the same operation has to be performed on the opposite side.

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