Researchers in China have conducted a meta-analysis of 22 randomised controlled trials of acupuncture as a treatment for chronic spinal pain. A meta-analysis involves combining the results, in this case of the 22 trials, thus giving a much better insight into the effectiveness of treatment than would be the case with just looking at one trial alone. This meta-analysis, including 2588 patients over the 22 trials, concluded that for pain control acupuncture is significantly better than medication. Considering the problems associated with long-term use of pain-killers, this is good news.
Acupuncture also improved physical function (i.e the ability to move around, bend over etc,), and this improvement persisted at long-term follow-up, and was not, therefore, just a temporary effect of the treatment.
Can Acupuncture Improve Chronic Spinal Pain? A Systematic Review and Meta-Analysis. Global Spine J. 2020 Oct 9;2192568220962440.
Sometimes people assume that acupuncture treatment will involves putting needles where the problem is – in the knee if the problem is a painful knee, in the head to treat dizziness, and so on. But this isn’t always how it works.
The traditional Chinese understanding of acupuncture involves a fairly sophisticated system of about 360 acupuncture points distributed all over the body, from the top of the head to the sole of the foot. Many of these points have a number of functions, not all of which are obviously related to the actual location of the acupuncture point. But we can also invoke a western scientific understanding of the various effects the insertion of an acupuncture needle has to help us understand why needles go where they do - and not always in the location of the problem.
i) GENERAL EFFECTS
Our skin and muscles contain many different kinds of nerve endings or receptors, which respond to different kinds of stimulation. For instance, there are receptors which detect heat and ones that detect pressure – so that we can become aware for example of hot objects on or near our skin, or of something pressing against our skin. One of the most important kinds of nerve which seems to be involved in acupuncture treatment are called Aδ nerves (or type II/III nerves in muscles), which amongst other things convey a feeling of heaviness which will perhaps be familiar to acupuncture patients.
Once an Aδ nerve has been stimulated by an acupuncture needle entering the skin in its vicinity, information travels along the nerve to the spinal cord, and from there up towards the brain, where it can initiate a number of different subtle changes in the almost infinitely complex activity within the various parts of the brain. One of these changes involves triggering a number of ‘descending inhibitory pathways’. These refer to different pain relieving substances which are released from the brain and descend down the spinal cord (and in some cases also pass into the blood stream) to inhibit or block pain signals from any part of the body. One such substance is called β-endorphin, somewhat similar to morphine, which is released from the pituitary gland within the brain into the blood stream, and from the hypothalamus, another part of the brain, into and down the spinal cord. In other words, the needles cause the brain to trigger some of the body’s own built in pain relieving systems.
Hence acupuncture in the hands and feet, where it is usually easy to stimulate the Aδ nerves, can result in a generalised pain relief, not just in the hands and feet, but throughout the body.
Another part of the brain which is reached by the signals travelling along the Aδ nerves is the limbic system, which seems to be crucially involved in emotion. These signals tend to deactivate the limbic system and, as far as pain is concerned, this may reduce the emotional component of that pain, so that we are less bothered by it.
These kinds of effects are not thought to be particularly dependent on where the needles are placed as long as there is a reasonably strong stimulation of the Aδ nerves. (Traditional acupuncturists would demur a bit here: whilst many traditional acupuncture points are considered to trigger numerous general effects throughout the body-mind, these points are considered to be in need of precise location.)
ii) SEGMENTAL EFFECTS
But some effects of acupuncture, whilst not confined to the exact vicinity of the needle, are nevertheless particular to one section of the body. Or rather, to one segment. A segment in this context refers to that part of the body served by nerves which enter and leave the spinal cord at one particular level.
So, for instance, nerves entering and leaving the spinal cord at the level of the fifth lumbar vertebra (L5) in the lower back serve amongst other things, some of the main buttock muscles, as well as the tibialis anterior muscle just outside the shin bone and the muscle which is used to lift up the big toe; and also a band of skin running across the buttock and down the side of the leg and including the top of the foot.
Acupuncture needles inserted into points within this segment may of course trigger the kind of systemic or general effects mentioned above, but they can also have effects particular to the segment in which they lie. One of these is segmental analgesia, whereby pain which has its origin in any part of the segment is relieved by needles placed somewhere within that segment. So if we wanted to treat pain associated with the tibialis anterior muscle we could choose to place needles somewhere in the area innervated by the L5 segment - for example on the top of the foot, or in the lower back adjacent to the L5 vertebra, knowing that the pain relief we are generating will include the tibialis anterior.
One explanation for this segmental pain relief is called gate control theory. In simple terms, once the signal from an Aδ nerve stimulated by an acupuncture needle somewhere –anywhere – in the segment reaches the spinal cord at the L5 level, say, it blocks (or closes the gate to) any pain signals arriving at that level from pain transmitting nerves in the segment, so that these pain signals cannot travel up the spinal cord to the brain, and so we do not feel pain.. So, to reiterate, we can treat pain arising from a specific part of the body by identifying which segment that part lies in, and inserting acupuncture needles at a place within that segment.
Of course we might choose to use acupuncture points at or near the site of the pain, which will obviously lie in the correct segment, but sometimes that may not be possible or appropriate. In the case of a recent injury, for instance, where the tissue around the injury is painful and inflamed, we may think that it is best to avoid acupuncture in and around that painful area, but we can still have a pain killing effect by needling other points in the segment which are at a distance from the painful place.
iii) REFERRED PAIN AND TRIGGER POINTS
Referred pain is pain which is felt at some distance from the part of the body which is damaged or problematic. One type of referred pain which acupuncture is a useful treatment for is pain which is caused by trigger points, which are small knots within muscles that have become tense. The pain caused by a trigger point, either when it is pressed or when the muscle itself is stretched, is usually felt some way away from the trigger point. For instance, a trigger in the trapezius muscle in the shoulder, just to the side of the neck, commonly causes pain which radiates around the side of the head to the temple.
Trigger points can and do appear in many of the muscles in the body; fortunately the location of the pain a particular trigger point causes is fairly predictable, so that if we have reason to believe that a pain may have, at least in part, a muscular origin, we can quickly identify which muscle may be causing the pain and examine that muscle for trigger points, which are easily located by someone trained to use their hands properly. Pressing on the trigger point for a few seconds will often lead the patient to say that that is just the pain they are complaining of.
So in this case we need to treat the trigger point, not the place where the pain is; in the example above, we need to release the muscle in the shoulder, either with acupuncture of massage, so as to make the pain in the side of the head go away. Incidentally, migraine sufferers often identify the temple as the place where the throbbing, pounding pain of a migraine is felt; such people are often found to have an active trigger in the trapezius which, if not entirely responsible for the migraine, is at least part of the problem.
iv) LOCAL TREATMENT
Despite all the above, however, it is still often useful to use acupuncture points in the place where the problem is. One of the localised effects of acupuncture, for instance, is an increase in blood flow around the site of the needle. (This increased perfusion of blood is triggered once again by the Aδ nerves which cause local blood vessels to dilate.) This is often observable as a reddening of the skin around the needle, and can be useful for a number of reasons, such as the fact that it supports the body’s own healing systems, which use the blood to bring the necessary nutrients to the site. Another local effect involves the build-up of endorphins in the vicinity of the needle, peaking at around 24 hours after the treatment, which is perhaps why some of the beneficial effects of acupuncture are often felt a day or two after treatment.
Sometimes people enquiring about acupuncture ask whether you have to believe in it for it to work. What often lies behind this question is the belief that alternative medicine does not have any tangible, physical benefits and any success it may have must be due to the patient believing, or wanting to believe, that they are feeling better; alternative medicine is ‘airy fairy’. If you don’t have faith, perhaps even if you are not gullible enough, nothing will happen. This belief, like most of our beliefs perhaps, is not usually the result of clear thinking and sifting of the evidence; whilst it is true that some people have a more or less blind faith in alternative medicine, or in some branch of it, more common is this, a more or less blind faith that if something is classed as alternative medicine, it must be some kind of airy fairy mumbo-jumbo.
To begin with, the idea that you can lump together all manner of treatments and therapies under the banner of ‘alternative medicine’ and say something meaningful of them as a group, is highly questionable. What they have in common is that they are not generally considered part of mainstream medicine (although that is not entirely true of acupuncture). Whether they have anything else in common is open to question. Knowing something about Alexander technique does not mean you know anything about crystal healing. Knowing something about homeopathy does not tell you anything about acupuncture. Can some kind of vague new-age treatment dreamt up yesterday by someone in need of a quick buck really be classed alongside something like traditional Chinese medicine, an integral part of Chinese culture and civilisation with a history going back 2,000 years or more and providing effective treatments right now in hundreds of hospitals across China? Yet they might both be considered, at least in the west, ‘alternative medicine’.
So the idea that you can bunch all these various treatments together and say they depend on the patient’s faith or gullibility is a non-starter. It may very well be true that some of them do depend heavily on the patient having faith, but I at any rate am not in a position to say. All I can talk about is acupuncture.
As far as acupuncture goes, there are obvious physical measurable results from correctly inserting an acupuncture needle into an appropriate place on the body. To mention only a few, blood flow in the vicinity of the needle increases, certain kinds of nerve endings get stimulated, occasionally a muscle will twitch. It is true that, in the hands of a capable clinician, acupuncture treatment can be, when it needs to be, quite subtle; but it can also be a very vigorous kind of intervention indeed. In the latter case at least, there is nothing airy fairy about it; you don’t have to have faith that something is happening, because you can feel it happening. Of course that you can feel that something tangible is going on doesn’t in itself tell you anything about whether it is an effective treatment (although I think often patients can sense that an intervention is beneficial.) But at least we can be clear that it is, when it needs to be, working on a very physical level, and it is working on that level more or less independently of whether you believe it is going to work or not.
More or less. But in truth it does seem to be that patient expectations play an important part in many medical treatments – alternative, conventional or whatever. If you have a positive expectation that acupuncture will alleviate your symptoms, it is a bit more likely that they will. But it is also the case, for example, that if you have a positive expectation that having an operation(1) will alleviate your symptoms, it is more likely that it will. If you have a positive expectation that the drug diazepam(2) (used to treat anxiety, muscle spasms and seizures) will alleviate your symptoms, it is more likely that it will. And the same for anything from analgesic skin cream(3) to deep brain stimulation(2). (And indeed there is some evidence that if the person treating you has a positive expectation of the treatment, it is also more effective(4).)
This is the placebo effect. Conversely there is also the nocebo effect – if you have an expectation that any given treatment will be ineffective, or perhaps that it will involve some unwelcome side effects, these things become more likely to happen.
It is not that these things, placebo and nocebo, are ‘all in the mind’. If the problem you have is pain, the placebo effect encompasses a measurable increase in endogenous opioids, part of the body’s built in pain relief system(5). Something is happening in your body. Patients with the common cold who perceive their doctor is empathetic show reduced objective markers of inflammation in their blood stream as compared with ones who don’t get the impression their doctor is much bothered.(6) These patients aren’t just imaging they feel better; there are measurable improvement in their bodies.
There is though also the question of how we interpret our experience. A patient who insists that a form of treatment will be ineffective, but who is persuaded to try it anyway, is perhaps likely to undervalue any improvement in their symptoms, or perhaps to ascribe them to some other cause. It’s generally easier to say, if only to oneself, “I told you so” than it is to say “maybe I was mistaken”. Occasionally a patient will come into clinic for their second acupuncture appointment and say something like, “I have to admit my back feels a lot better”. As if in some ways they would rather it wasn’t better! No one likes to eat humble pie.
Another patient, say one who tends to favour alternative medicine, will have something invested in the treatment working, apart from the obvious desire to get better. They are likely to overvalue any improvement in their symptoms, although as we have already seen their positive expectation may make it a bit more likely they will be improving. But even if this improvement is slight, they will tend to make as much of it as they can.
A theme running through this question is that of the relation of mind and body. In the west we are inclined, for historical reasons usually laid at the door of the French philosopher Rene Descartes, to believe that mind and body are separate entities. But it is clear from the above that they are not. Someone with a positive expectation (in their mind, presumably) that their knee pain will improve with treatment may have a greater presence of those enogenous opiods in their body than someone who is more pessimistic. The mind and the body are deeply inter-related; what happens in the mind manifests in the body, what happens in the body triggers effects in the mind. Any slight change in what is going on in the body impacts on the mind; any passing mood or train of thought is associated with subtle changes in the body. And after all, what is mind? Does anyone really know?
So to sum up, the answer to the question is that you don’t have to believe in it for it to work, but on the other hand you are likely to get extra benefit from treatment if you have a positive expectation that it will work. And if you want to try to figure out how much of the benefit you have got from the treatment is ‘in your mind’, and how much of it is ‘in your body’….good luck!
Recently NICE (the National Institute of Health and Care Excellence) issued its first guidelines for GPS on the treatment of Chronic Primary Pain which is pain which seemingly cannot be explained by conventional medical diagnosis. In the past (and maybe, sometimes, in the present) doctors may have been inclined to dismiss patients with this kind of pain, believing perhaps that since the pain could not be explained by conventional medicine, it must not be real. Not good if you are the patient, for whom the pain is all too real.
Of course, conventional medicine is an evolving phenomenon – what cannot be explained today may be explained tomorrow. But again that may not be much comfort to the patient whose pain is today. So it is welcome that the new NICE guidelines recommend, amongst other things, a course of acupuncture for patients with Chronic Primary Pain (rather than painkillers, which it seems are pretty useless for these patients). As an acupuncturist I have a number of strings to my bow, so to speak, in assessing and treating this kind of pain.
For instance, muscles. You might be surprised to hear that a pain which your GP can’t explain, which X-Rays and MRIs can’t see, might sometimes be due to something no more mysterious than a muscle. Muscles that are over-loaded – for example by poor posture, repetitive activities or a past injury – can develop what are called Trigger Points (Or Myofascial Trigger Points to give them their full name.) Trigger Points are irritable knots within overly tight bands within a muscle, and typically cause pain which is usually experienced at a distance from where the Trigger Point is. A Trigger Point in the Gluteus Minimis muscle in the buttock/hip area, for example, typically causes pain down either the side or back of the leg, mimicking sciatic pain.
Trigger Points don’t show up on MRIs and X-Rays, but fortunately there is another very sensitive diagnostic tool which can find them. It is called a hand! Sometimes what people need is not a high tech (and expensive) investigation, but just an old fashioned examination by someone trained to use their hands to examine, in this case, a muscle. When I see patients with painful conditions, I nearly always include in my assessment a hands-on exam looking for Trigger Points which might be causing or reinforcing their pain.
So for example someone might have pain radiating down the back of their leg, and whilst the first thing one might think of is that the sciatic nerve has been irritated or compressed, perhaps by a bulging disc, in this case scans of their spine show no such thing. But if one examines their Gluteus Minimus muscle, one perhaps finds a tight knot in it which, when pressed, causes the patient to flinch or shout, and which may even send a stab of pain down the back of their leg.
In which case, mystery solved, at least in part, although we have still to understand just why they have developed a problem with this muscle. But right away we can start to treat it, as Trigger Points respond well to acupuncture which opens up the tight knot and relaxes the muscle. Massage and cupping therapy may also help with this, and it will be worth having a look of some of the surrounding muscles as well, as it is rare that one gets into trouble in isolation.
But not all Chronic Primary Pain is due to muscles and Trigger Points. Another way to approach it is via Traditional Chinese Medicine (TCM), the system of medicine that underpins traditional acupuncture. TCM provides a different lens through which to view the patient and their pain; we are accustomed to believe that conventional medicine is the only way to understand a person and their health, but as Chronic Primary Pain amongst other things demonstrates, it is not necessarily the be all and end all of health care. One of the characteristics of the TCM approach is that rather than focusing its gaze right down onto the specific symptom – in this case the so far unexplained pain - it takes a more panoramic view of things. (If conventional medicine is a microscope, TCM is a wide-angle lens.) Sometimes pain that cannot be explained by zooming in on it can be understood by zooming out. Look at the patient as a whole and their pain makes perfect sense.
In this kind of situation, unlike with the Trigger Points, acupuncture treatment will probably not be directed at the area of the body where the pain is, but will be more general and systemic, seeking to restore harmony and balance to the person as a whole, so that, amongst other benefits, their pain subsides.
A recent meta-analysis of 19 randomised controlled trials (adding up to 3656 patients) has shown that acupuncture is superior to the drugs propranolol, topiramate, , metoprolol, and funarizine in reducing the frequency of migraines. This is no surprise to me; in my clinical experience the one condition which responds most favourably to acupuncture treatment is migraine, and indeed the improvement can sometimes be dramatic – I have seen patients who have been plagued by frequent debilitating migraines become migraine-free for weeks and months on end after a short course of treatment.
Why migraine so often responds so well to acupuncture I am not entirely sure, but in part I suspect it may be because of acupuncture’s ability to relax muscle tension and in particular to disperse trigger points (small tight knots of tension in muscle tissue which can cause significant pain). I usually find that migraine sufferers are holding a lot of tension in their neck and shoulders, and whether this is the result of their migraines or a partial cause of them, releasing this tension can start to have very positive effects. Muscular tension, indeed, seems to be a neglected cause of lots of health issues, from migraine and headache to irritable bowel syndrome. A hands-on approach using modalities such as acupuncture and massage is often a much better option that drugs, especially when you think of the side effects that often accompany them. Hi-tech modern medicine is wonderful in many ways, but it underestimates the healing power of hands (whether those hands are holding needles or simply massaging tight musculature.)
Acupuncture versus propranolol in migraine prophylaxis: an indirect treatment comparison meta-analysis. J Neurol. 2019 Aug 21
The Chinese medical tradition, going back 2,000 years or more, and of which acupuncture forms a part, is fond of pithy sayings and proverbs. One of these is zhu tong shu xin -“All pain belongs to the Heart”.
This seems decidedly odd to western ears. If you have a pain in your knee, for instance, it is not likely to have anything to do with your heart. But this proverb may start to make some sense if we understand that for the Chinese medical tradition (or at least for a large part of it), the Heart is the seat of something called the ‘Shen’, usually translated as either ‘Mind’ or ‘Spirit’. As in many traditional cultures, the Heart is viewed as the seat of that more or less mysterious entity which makes us who we are, whether we call it mind, spirit, soul or whatever. Of course to our modern way of understanding, the heart is just a glorified pump, and if the mind or spirit is anywhere it is in the brain. But leaving that aside for the moment, we can say that what the proverb is saying is that pain is subjective, it belongs to consciousness or mind; it is an experience in other words.
Modern scientific medicine sees pain indeed as a rather complex experience, reflecting not just damage, to the knee say, but also numerous other things such as our general mood, the state of our social connections, our general health etc. Indeed sometimes there may seem to be nothing wrong with the knee whatsoever, but it still hurts. Pain cannot be measured in the way that blood pressure, cholesterol or body temperature can be measured. No one can tell us how much pain we are really in; only we can know that.
One consequence of this is that in the treatment of pain it is sometimes helpful to treat the Shen. Of course treatment will usually be aimed at the knee, if we have a painful knee, or aimed at least at the tissues responsible for the knee pain – it might come from trigger points in the quadriceps muscles of the thigh perhaps. But sometimes as well it may be helpful to remember that ‘All pain belongs to the Heart’, and seek to calm the Shen, calm the Mind, soothe the person who is suffering the pain. All the more so if the pain is very great, if it is precluding sleep for instance. A human being is not a machine, after all. It’s not just a matter of fixing some faulty mechanics, it is important to remember that we are people, and that our pain belongs in some sense to the Heart as well as to the knee.
Cupping is a form of treatment often used alongside acupuncture as part of Traditional Chinese Medicine, as well as being widespread across traditional cultures in Asia, the Middle East and North Africa. It involves first of all applying a massage oil or other suitable lubricant to the part of the body to be treated and then a special cup in which the pressure has been temporarily lowered, either by briefly introducing a flame inside the cup (the traditional method) or with modern cupping devices using a suction pump. It is a little like reverse massage - rather than someone applying pressure to your body, they are reducing the pressure. The immediate effect is that the tissue on which the cup is placed is drawn up into the cup.
If you've not seen it before, it can look a little alarming, but actually it just feels slightly tight and not at all painful - in fact it is sometimes a useful form of treatment for people who might benefit from acupuncture but whose severe needle phobia puts them off. Once the cups are removed, a circular mark will remain on the skin, perhaps for a few days in some cases, which may be inconvenient if you are a fashion model for instance.
One of the most immediate benefits of cupping is that it stretches the tissue under the cup, which makes it a useful treatment for problems involving overly tense muscles. A recent meta-analysis of research into cupping for neck pain, for example, showed significant reduction in pain and corresponding improvement in function (i.e. the ability to turn your head); unwelcome side effects were infrequent, mild and temporary.* Since a lot of neck pain is at least partly due to muscle tension in the neck and shoulders, that cupping should be helpful is not surprising.
Another effect of cupping is to increase blood flow through the area being cupped and its surroundings - often the area will flush red because of this. Again this helps with tight muscles and facilitates tissue healing, which makes it useful in the treatment of ligaments and tendons, which tend to heal slowly because of their limited blood supply.
* Is Cupping Therapy Effective in Patients with Neck Pain? A Systematic Review and Meta-Analysis MJ Open. 2018 Nov 5;8(11):e021070.
Acupuncture is more effective than anti-inflammatories in the treatment of period pain according to a meta-analysis of 17 randomised controlled trials. (In plain English, that means that some people have taken the trouble to have a look at 17 different respectable clinical trials and pulled all the results together to form a conclusion.) I guess, though, that some women will still prefer to just pop a pill or two to try to deal with their pain at period time, since this is quicker than going to the trouble of having some acupuncture, and maybe cheaper too if they don't have to pay for the drugs. But on the other hand anti-inflammatory medication is not free from side effects; less likely to be a problem perhaps if you only take them once a month. But then suppose you have some other aches and pains as well?
The advantage traditional acupuncture has is that, apart from being such a safe form of treatment, it looks at a woman as a whole being, and not just at her reproductive organs in isolation. In this view, period pain is maybe just the major, or one of the major, manifestations of an underlying disharmony which is not being dealt with at all by just taking a painkiller, convenient as that might be if it works. For example, consider a woman who has painful periods, who also tends to get a bit irritable running up to her period, who sometimes has migraines and who has irritable bowel syndrome. From the point of view of traditional acupuncture, all of these symptoms are part of a package, all of them are branches of the same tree, and what the woman really needs is some treatment which treats the tree as a whole, and not just one branch or another - one medication for the period pain, one for the migraines, one for the bowels etc.
In this example the root of the problem, the disharmony which underlies the various symptoms, is likely to be what is called Liver Qi Stagnation. (This could perhaps be confirmed by asking a few more judicious questions, and perhaps taking the woman's pulse.) Liver Qi Stagnation, of course, is not a term that has any meaning in the context of the form of medicine we are used to, but it has plenty of meaning within the context of the 2,000 years plus of Chinese medicine. In short, it means that things in our system are not flowing freely, transitions are not smooth; as far as the menstrual cycle is concerned, it means that the transitions from one part of the cycle to the next is not happening quite as nature intended, one consequence of which is pain. Live,r Qi Stagnation usually arises as a result of frustration, stress, even repressed anger and might be said to be the characteristic malaise of the modern woman, and the modern man as well, reflecting a way of life which involves a fairly relentless pursuit of ' success' at the expense of some of our deeper needs and nature. (What we are doing to the planet, we are also doing to ourselves.)
From this point of view, acupuncture is a way of restoring the free flow of Qi, releasing built up tension and loosening us up a little, supporting the natural cycles of our being and, in the case of the monthly cycle, promoting a smoother transition from one stage to the next. As well as thus relieving the pain at period time, it can start to open a door to a way of being in which we are more in harmony with our own bodies, with the natural world around us, and are as a result happier, freer and more content.
(Comparative efficacy and safety of NSAIDs-controlled acupuncture in the treatment of patients with primary dysmenorrhoea: a Bayesian network meta-analysis. J Int Med Res. 2018 Nov 30:300060518800609.)
People are complicated, sometimes more so than we would like to think. When it comes to health problems, for example, we often want to look for the one thing that has caused us to be ill; we have a headache, perhaps, because we didn't get enough sleep last night, or we have a headache because we haven't eaten enough; or maybe we have a headache because we are stressed out, or maybe it is the weather which is to blame. But quite often I think it is not that there is one thing behind our being off colour, but an array of factors which taken together add up, perhaps, to a headache or whatever the problem is.
In the case of headaches and migraines, one of these factors is surely to do with our neck and shoulders. When I treat someone who has headaches or migraines, I always have a look at their neck and shoulders. And in fact I have more than a look, I use my hands and examine them. And I almost always find some knots of tension. Often these knots are what are called Trigger Points, small areas of tightness which cause pain. And the thing about Trigger Points is that the pain is usually felt some distance away from the point, as what is called referred pain. So for instance a Trigger Point in the trapezius muscle on top of your shoulder can cause pain on the side of your head, circling round the ear to the temple, a typical kind of pain for some tension headaches and some migraines. So whatever else we do for you in this scenario, we need to gently work on this muscle, releasing the tightness with acupuncture, and maybe with massage or cupping.
As I say, this muscular tension may not be the only factor predisposing you to headaches, and we also need to think about why the tension is there in the first place (hunching our shoulders as a stress response maybe, long hours using a keyboard or driving maybe...) So we need a fairly comprehensive approach, which is why I think acupuncture is such a useful treatment given that it can not only release muscular tension, but it can also promote an overall feeling of relaxation affecting both the body and mind, initiate some of the body's intrinsic pain killing mechanisms, and promote a more harmonious and balanced state of being.
This is backed up by the research; for instance, a recent systematic review of 62 clinical trials, including 4,947 patients in total, found acupuncture to be effective in both the treatment and prevention of migraines, and superior to medication. (The Effect of Acupuncture on the Quality of Life in Patients With Migraine: A Systematic Review and Meta-Analysis. Front Pharmacol 2018 Oct 26:9:1190)
Here is some of the latest news on acupuncture and related things, perhaps with a few of my thoughts thrown in for good measure.