Acupuncture for Cervicogenic Headaches

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Acupuncture for Cervicogenic Headaches

Acupuncture for Cervicogenic Headaches

Acupuncture as a therapeutic intervention is being embraced by the medical community. This is in part because it is a non-pharmacological therapeutic intervention that is simple to carry out, economical, and has very few side effects. One area that is being explored is the use of acupuncture to decrease the individual’s headache frequency, intensity, duration and acute medication requirements.

A Biopsychosocial Model: Many clinicians explain the mechanism of action in neurophysiological terms.

Evidence based acupuncture is an approach grounded in neuroscience that is based upon a theory that is inline current scientific understanding of how the body works. Using occam's razor the insertion of an acupuncture needle is a form of novel stimuli, that functions by sending anti-nociceptive input to the neuroimmune system. Stimulating endogenous opioid release, purinergic signaling and modulation of the endocannabinoid system.

Preferential sites for acupuncture stimulation are associated with areas rich in specialized sensory receptors such as muscle spindles, Golgi tendon organs, ligament receptors, Paciniform and Ruffini’s receptors (joint capsules), deep pressure endings (within muscle belly), and free nerve endings (muscle and fascia). 

Based off the biopsychosocial model, all of these areas are highly innervated and as a result there are a number of physiological responses that help modulate the experience of pain. An observed favorable outcome may be explained by a number of overlapping mechanism in the periphery, spinal cord, and brain including represented in the image below.

Structures to be Aware of When Treating Cervicogenic Headaches

My first recommendation for those who suffer from headaches is to work with a physician to develop strategies to manage symptoms. Then a treatment plan can be implemented based on patient-specific assessment findings and patient tolerance. 

proposed mechanism of action for acupuncture

Structures to keep in mind while assessing and treating patients suffering from migraine headaches may include neurovascular structures and investing fascia of:
• Upper Trapezius
• Splenius Cervicis
• Splenius Capitis)
• Suboccipitals
• Levator Scapula
• Rhomboids
• Temporalis
• Occipitofrontalis
• Corrugator Supercilii
• Masseter
• Sternocleidomastoid
• Temporomandibular Joint
• Scalene Muscle Group

More to Explore

Arendt-Nielsen, L., Castaldo, M., Mechelli, F., & Fernández-De-Las-Peñas, C. (2016). Muscle Triggers as a Possible Source of Pain in a Subgroup of Tension-type Headache Patients? The Clinical Journal of Pain.
https://www.ncbi.nlm.nih.gov/pubmed/26550960

Bendtsen, L., Ashina, S., Moore, A., Steiner, T.J. (2016). Muscles and their role in episodic tension-type headache: implications for treatment. Eur J Pain.
https://www.ncbi.nlm.nih.gov/pubmed/26147739/

Coeytaux, R. R., & Befus, D. (2016). Role of Acupuncture in the Treatment or Prevention of Migraine, Tension-Type Headache, or Chronic Headache Disorders. Headache.
https://www.ncbi.nlm.nih.gov/pubmed/27411557

Fernández-de-Las-Peñas, C., Courtney, C.A. (2014). Clinical reasoning for manual therapy management of tension type and cervicogenic headache. J Man Manip Ther. (OPEN ACCESS)
https://www.ncbi.nlm.nih.gov/pubmed/24976747

Fernández-de-Las-Peñas, C.. Myofascial Head Pain. (2015). Curr Pain Headache Rep.
https://www.ncbi.nlm.nih.gov/pubmed/26049772

Fernández-De-Las-Peñas, C., Arendt-Nielsen, L. (2017). Improving understanding of trigger points and widespread pressure pain sensitivity in tension-type headache patients: clinical implications. Expert Rev Neurother.
https://www.ncbi.nlm.nih.gov/pubmed/28745080

Ishiyama, S., Shibata, Y., ... Matsumura, A. (2018). Clinical Effect of C2 Peripheral Nerve Field Stimulation Using Electroacupuncture for Primary Headache. Neuromodulation.
https://www.ncbi.nlm.nih.gov/pubmed/29566284

Linde, K., Allais, G., Brinkhaus, B., Fei, Y., Mehring, M., Shin, B., . . . White, A. R. (2016). Acupuncture for the prevention of tension-type headache. Cochrane Database of Systematic Reviews.
https://www.ncbi.nlm.nih.gov/pubmed/27092807

Linde, K., Allais, G., Brinkhaus, B., Fei, Y., Mehring, M., Vertosick, E. A., . . . White, A. R. (2016). Acupuncture for the prevention of episodic migraine. Cochrane Database of Systematic Reviews.
https://www.ncbi.nlm.nih.gov/pubmed/27351677

Luedtke, K., Boissonnault, W., Caspersen, N., Castien, R., Chaibi, A., Falla, D., . . . May, A. (2016). International consensus on the most useful physical examination tests used by physiotherapists for patients with headache: A Delphi study. Manual Therapy.
http://www.ncbi.nlm.nih.gov/pubmed/27183831

Luedtke, K., Starke, W., May, A. (2017). Musculoskeletal dysfunction in migraine patients. Cephalalgia.
https://www.ncbi.nlm.nih.gov/pubmed/28641450

MacPherson, H., Vickers, A., Bland, M., Torgerson, D., Corbett, M., Spackman, E., ..., Watt, I. (2017). Acupuncture for chronic pain and depression in primary care: a programme of research. Southampton (UK): NIHR Journals Library.
https://www.ncbi.nlm.nih.gov/pubmed/28121095

Millstine, D., Chen, C., Bauer, B. (2017). Complementary and integrative medicine in the management of headache. BMJ.
https://www.ncbi.nlm.nih.gov/pubmed/28512119

Murakami, M., Fox, L., Dijkers, M.P. (2017). Ear Acupuncture for Immediate Pain Relief-A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Pain Med.
https://www.ncbi.nlm.nih.gov/pubmed/28395101

Nahin, R. L., Boineau, R., Khalsa, P. S., Stussman, B. J., & Weber, W. J. (2016). Evidence-Based Evaluation of Complementary Health Approaches for Pain Management in the United States. Mayo Clinic Proceedings.
https://www.ncbi.nlm.nih.gov/pubmed/27594189

Vickers, A.J., Vertosick, E.A., Lewith, G., ... Linde, K. (2018). Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis. The Journal of Pain.
https://www.ncbi.nlm.nih.gov/pubmed/29198932

Yang, Y., Que, Q., Ye, X., Zheng, G.h. (2016). Verum versus sham manual acupuncture for migraine: a systematic review of randomised controlled trials. Acupunct Med.
https://www.ncbi.nlm.nih.gov/pubmed/2671800  

Zhao, L., Chen, J., ... Liang, F. (2017). The Long-term Effect of Acupuncture for Migraine Prophylaxis A Randomized Clinical Trial. JAMA Intern Med.
https://www.ncbi.nlm.nih.gov/pubmed/28241154