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Acupuncture
For The
Management Of Cluster Headaches
Gaston Dana, DO
ABSTRACT
Background Cluster headaches are often seen in conventional medicine.
They can be treated with conventional modalities, but these therapies
(including corticosteroids) have adverse effect profiles.
Objective To determine if medical acupuncture can be used in
the management of a patient with chronic cluster headaches.
Design, Setting, and Patient A single case report in a patient
seen from January 2000-May 2002 in a private practice setting in Indiana.
Intervention Initial treatment with n–n+1 acupuncture energetics
and auricular acupuncture; a special acupuncture formula was then included
in the treatment regimen to wean corticosteroid use by stimulating cortisone
production. Two-year follow-up was conducted, including treatment with
acupuncture energetics, auricular acupuncture, and Yamamoto New Scalp
Acupuncture.
Main Outcome Measures Resolution or reduction in the frequency
and severity of the patient’s headaches, and decrease or discontinuation
in medications.
Results The patient was able to discontinue all her medications
and experienced a cluster headache-free interval of 8 months. The headaches
recur sporadically, but respond to treatment with acupuncture and rofecoxib.
Conclusions Acupuncture can be used to provide sustained relief
from cluster headaches and to stimulate adrenal cortisol to aid in discontinuing
corticosteroids.
KEY WORDS
Cluster Headache, Acupuncture, Cortisone Production
INTRODUCTION
Cluster headaches affect less than 0.5% of the U.S. population.1 Approximately
80% of those affected are male, and the headaches commonly begin in
the 3rd or 4th decade of life. Early in the course of cluster headaches,
attacks can occur once or several times a day followed by long symptom-free
intervals. Typically, the attack happens at the same time each night,
often awakening the patient during a REM phase of sleep. The pain is
usually unilateral and occurs in a given cluster on the same side of
the face. An initial dull discomfort behind the eye is rapidly replaced
by an intense deep pain which may spread to the temple and malar region.
The headache usually subsides after 1-2 hours. Associated symptoms include
nasal congestion, coryza (acute rhinitis), lacrimation, conjunctival
injection, and facial flushing. Ptosis and miosis may occur, but visual
disturbance, characteristic of migraine headaches, is usually absent.1,2
Cluster headache episodes can become recurrent with longer periods of
pain and shorter intervals between attacks. Over time, 10%-15% of patients
with typical cluster headaches develop a chronic form in which daily
attacks become more frequent and persist unremittingly for months or
years.1
In conventional medicine, prophylactic and abortive therapies are often
included as monotherapy or combination therapy. Some of the prophylactic
therapies include calcium channel blockers, lithium, ergotamine, neuroleptics,
and corticosteroids. Some of the abortive therapies include oxygen inhalation,
sumatriptan, intranasal lidocaine, non-steroidal anti-inflammatory drugs,
ergotamine, and corticosteroids. Surgical approaches have also been
used such as radiofrequency tri-
geminal rhizotomy.
CASE REPORT
A 59-year-old woman presented with a 10-year history of cluster headaches.
When she first experienced the headaches, they were easily managed with
oxygen therapy and short courses of prednisone. Symptom-free intervals
of 1 year occurred during the first several years but over the last
4-5 years, the patient’s headaches were more severe with increased
frequency and duration. She expressed interest in medical acupuncture
in an attempt to alleviate her headaches.
On presentation in January 2000, the patient had been taking prednisone
continuously for 2 years, verapamil, and oxygen therapy. She was experiencing
multiple daily cluster headaches that were disabling. The neurologist’s
attempts to wean her prednisone usage were futile. The patient was concerned
about the adverse effects of prednisone such as osteoporosis, muscle
weakness, impaired wound-healing, and fluid retention. Patient consent
was obtained.
TREATMENT
The initial acupuncture approach was weekly treatments with an n–n+1
therapeutic input involving Jue Yin-Shao Yang principal meridian subcircuits
with movement through Jue Yin.3 Acupuncture points included LR 3, PC
6, KI 3, SP 6, TE 5, GB 20, and GB 40. I also included a auricular points
on the side of the headache: Shen Men, Autonomic Point, Thalamus Point,
and Tranquilizer.4 Moxibustion was included with each treatment. Although
the response was good regarding her daily cluster headaches, each attempt
at reducing the prednisone dosage resulted in a headache exacerbation.
Therefore, included in her treatment protocol was a focus on stimulating
the adrenal glands to produce cortisone.
Various experiments have been performed to evaluate the effect of stimulation
of specific acupuncture points on cortisone production.6-8 Several of
the acupuncture points produced even higher cortisone levels then the
administration of adrenocorticotropic hormone. I used KI 2, SP 2, GB
39, GB 25, BL 23, and a special point at C2/C3 (between 2nd and 3rd
cervical vertebrae) in bilateral tonification to effect cortisone production
by adrenal stimulation.5 Biweekly treatments included 30 minutes of
the above approach for adrenal stimulation, followed by 30 minutes of
the prior treatments with the n–n+1 therapeutic input and auricular
acupuncture.
RESULTS
Within 7 weeks of starting this treatment regimen, the patient was weaned
off all her medications and remained headache-free for 8 months. Over
the following 2 years, cluster headaches began to recur, at first mildly
and infrequently and responding to ibuprofen. On follow-up with a neurologist,
the headaches were more frequent (sometimes daily) and severe. Her neurologist
prescribed topiramate, titrated to 75 mg twice daily, and rofecoxib
as needed.
The patient also began acupuncture treatment. Four 30-minute treatments
over a 2-month period were performed. She appeared to have good results
with this approach although it was difficult to tell if the topiramate
was helping. Yamamoto New Scalp Acupuncture was also tried. When she
presented with a headache, she usually felt alleviation after a 30-minute
treatment and she experienced increasing days of relief with each treatment.
For breakthrough headaches, the patient took rofecoxib and obtained
relief within an hour.
After a vacation during which the patient took rofecoxib daily for headache
prophylaxis, she discontinued rofecoxib and developed severe rebound
headaches. Her neurologist discontinued her use of topiramate after
a 1-year trial due to apparent lack of efficacy. Over a 3-month period,
she had 12 acupuncture treatments once weekly. I tried a combination
of acupuncture energetics, auricular acupuncture, and Yamamoto New Scalp
Acupuncture. The patient eventually obtained relief from her daily cluster
headaches.
Over a 5-month period, the patient received 3 acupuncture treatments
for her headaches (which were under control). The occasional headache
was controlled with rofecoxib, carefully taken to avoid a rebound headache.
The combination of acupuncture and rofecoxib appears to work well for
this patient.
DISCUSSION
Conventional medicine offers multiple prophylactic and abortive therapies
for cluster headaches. Many of these are effective but the adverse effects
often complicate the situation. The two concerns in this case were the
cluster headaches that had become disabling and the adverse effects
of steroid use.
Although cluster headaches commonly follow symptom-free intervals, the
favorable outcome in this patient likely can be attributed to acupuncture
treatments. Given the progressive nature of her disease, the cumulative
favorable response to the treatments was evident with a decrease in
severity, frequency, and finally, an 8-month
symptom-free period.
Both concerns were addressed once a treatment protocol was introduced
to discontinue prednisone. Acupuncture appears to be a safe alternative
to the use of prednisone in the management of cluster headaches.
No studies were found when MEDLINE was searched for literature on the
same adverse effects of prednisone use as compared with cortisone production
by adrenal stimulation using acupuncture. Acupuncture appears to be
a regulatory therapy that creates a change toward homeostasis.5
CONCLUSION
Cluster headaches are a disabling form of headache. Many of the therapies
in conventional medical practice are often effective, but their adverse
effect profiles can create other problems. Acupuncture can offer an
attractive integrative approach in the management of cluster headaches.
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Barrett J. Cluster headache. In: Gale Encyclopedia of Medicine.
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Cutler RWP. Headache. New York, NY: Scientific America Inc; 1996:4-5.
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Helms JM. Acupuncture Energetics: A Clinical Approach for Physicians.
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Oleson T. Auriculotherapy Manual: Chinese and Western Systems of
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Low RH. The Secondary Vessels of Acupuncture: A Detailed Account
of Their Energies, Meridians, and Control Points. Northhamptonshire,
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Cheng R, McKibbin L, Roy B, Pomeranz B. Electroacupuncture elevates
blood cortisol levels in naive horses; sham treatment has no effect.
Int J Neurosci. 1980;10:95-97.
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Liao YY, Seto K, Saito H, Fujita M, Kawakami M. Effect of acupuncture
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AUTHOR
INFORMATION
Dr Gaston Dana practices Emergency Medicine, Internal Medicine, and
Medical Acupuncture at Johnson Memorial Hospital in Franklin, Indiana.
Gaston Dana, DO, DABMA*
1101 W Jefferson St, Ste S
Franklin, IN 46131
E-mail: GLCWZdana@juno.com
*Send all correspondence and reprint requests regarding this article
to Gaston Dana, DO, at the address above.
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