No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Single-blind, randomized, pilot study combining shiatsu and amitriptyline in refractory primary headaches
Abstract
Complementary alternative medicine, such as shiatsu, can represent a suitable treatment for primary headaches. However, evidence-based data about the effect of combining shiatsu and pharmacological treatments are still not available. Therefore, we tested the efficacy and safety of combining shiatsu and amitriptyline to treat refractory primary headaches in a single-blind, randomized, pilot study. Subjects with a diagnosis of primary headache and who experienced lack of response to ≥2 different prophylactic drugs were randomized in a 1:1:1 ratio to receive shiatsu plus amitriptyline, shiatsu alone, or amitriptyline alone for 3 months. Primary endpoint was the proportion of patients experiencing ≥50%-reduction in headache days. Secondary endpoints were days with headache per month, visual analogue scale, and number of pain killers taken per month. After randomization, 37 subjects were allocated to shiatsu plus amitriptyline (n = 11), shiatsu alone (n = 13), and amitriptyline alone (n = 13). Randomization ensured well-balanced demographic and clinical characteristics at baseline. Although all the three groups improved in terms of headache frequency, visual analogue scale score, and number of pain killers (p < 0.05), there was no between-group difference in primary endpoint (p = ns). Shiatsu (alone or in combination) was superior to amitriptyline in reducing the number of pain killers taken per month (p < 0.05). Seven (19%) subjects reported adverse events, all attributable to amitriptyline, while no side effects were related with shiatsu treatment. Shiatsu is a safe and potentially useful alternative approach for refractory headache. However, there is no evidence of an additive or synergistic effect of combining shiatsu and amitriptyline. These findings are only preliminary and should be interpreted cautiously due to the small sample size of the population included in our study.
... This questionnaire was standardized and localized by Mahram (1994) according to Iranian culture and its reliability was estimated at 94.52%. The total score of this instrument is obtained in a range of 20-80, which is classified as no anxiety [20], mild anxiety [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39], moderate anxiety [40-59], and severe anxiety [60-80] [14,24]. ...
... According to the findings of a study by Kobayashi et al., massage relieved chronic low back pain in patients [26]. In another study, Dreyer et al. found that a 20 min massage on the second and third days of surgery was significantly effective in reducing pain and anxiety and increasing comfort after colorectal surgery [27] Likewise, the results of a study by Villani et al., showed the positive effect of massage in relieving refractory headaches [28]. In line with the findings of the present study, those of other studies have shown that massage could reduce depression in Alzheimer's patients [29] and anxiety in patients with burns [30] and improve the quality of life of patients with multiple sclerosis [31]. ...
Introduction
Patients with breast cancer are prone to numerous physical and mental complications due to their disease condition and the treatments they receive. Anxiety is one of the common psychological complications observed in such patients. This study aimed to investigate the effect of acupressure massage on anxiety during chemotherapy in patients with breast cancer.
Methods
This single-blind randomized clinical trial study was conducted on 70 cancer patients undergoing chemotherapy. The intervention group (n=35) received acupressure massage in three 5-minute periods with 2-minute breaks between them. However, in the control group (n=35), the same area was only touched for a while in a similar way that was performed in the intervention group. Patients' anxiety was measured before and after the intervention using the Spielberger State-Trait Anxiety Inventory. The collected data from both groups were analyzed in SPSS software (version20).
Results
The difference between patients' anxiety was significant after the intervention in the two groups. Accordingly, the level of anxiety among patients in the experimental group was significantly reduced after the intervention, compared to the control group (P=0.001).
Conclusion
Due to the simplicity and low cost of massage, it is recommended that this method be adopted to reduce patients' anxiety along with other treatments.
... Similarly, whilst the clinical outcomes of clients receiving shiatsu were also not evaluated, the areas of reported clinical interests and expertise closely aligned with the Western European survey of shiatsu practitioners [27], a wide range of Australian CM practitioners [26], and clinical research evaluating the effectiveness of shiatsu, oriental meridian massage and acupressure [32][33][34][35]. Not surprisingly, the most commonly reported areas of clinical expertise or special interest generally aligned with conditions and symptoms reported by practitioners as benefitting from shiatsu. ...
... However, whilst national clinical priorities are important, focusing research on single conditions or symptoms runs the risk of missing simultaneous improvements in multiple clinical outcomes, along with positive health attributes such as wellness, disease prevention, self-efficacy and resilience [28][29][30]. Shiatsu therapy is a complex intervention that utilises a holistic, individualised approach [1,2,[32][33][34][35]. The challenge of coding many of the open-ended responses from practitioners regarding commonly observed positive clinical outcomes into a single disease category or symptom, suggests that many shiatsu therapy outcomes are more holistic. ...
Background
Shiatsu is an under-represented modality within complementary medicine (CM) research. No previous data has been collected on the shiatsu workforce in Australia.
Objectives
This study aimed to characterise shiatsu practitioners in Australia and their clinical practice with the view of informing clinical research.
Methods
In 2016, a 32-question on-line cross-sectional survey was advertised to shiatsu practitioners on the Shiatsu Therapy Association of Australia’s (STAA) mailing list and through other professional associations. Descriptive statistics were used to analyse the data.
Results
Of the 121 respondents 70.3% (n = 85) were female, the median age was 48 years and 74.4% (n = 90) were STAA members. The median number of years in practice was ten. Most were self-employed (93.3%, n = 112/120) working less than 20 h per week (82.1%, n = 92/120) in a variety of settings, most commonly solo practice (76%, n = 91/120) followed by group practices alongside other shiatsu practitioners, allied health or medical doctors (53.3%, n = 64/120). Practitioners reported typically spending over an hour of contact time with a broad range of clients who often had multiple healthcare needs, including those incurring a high burden of disease such as chronic pain and mental health. The top four symptoms/conditions that practitioners reported improved outcomes were pain/musculoskeletal (40.6%, n = 128/315), mental health/wellbeing (26.0%, n = 82/315), fatigue (10.2%, n = 31/315) and gastrointestinal (6.3%, n = 20/315). On average, a positive effect was reportedly observed following four treatments at 1–2 week intervals. Almost two thirds (63.2%, n = 67/106) of practitioners reported regularly referring their clients to other health professionals.
Conclusions
Results from the first national workforce survey of shiatsu practitioners in Australia suggest Shiatsu practitioners are engaging in the shared care of their clients’ health and wellbeing, including referrals or recommendations to other healthcare practitioners. Practitioner characteristics generally align with those reported for the broader field of CM in Australia and shiatsu practitioners in Western Europe. Reported positive outcomes for chronic diseases and common yet difficult-to-treat symptoms signal areas for future clinical research.
... Similarly, whilst the clinical outcomes of clients receiving shiatsu were also not evaluated, the areas of reported clinical interests and expertise closely aligned with the Western European survey of shiatsu practitioners [27], a wide range of Australian CM practitioners [26], and clinical research evaluating the effectiveness of shiatsu, oriental meridian massage and acupressure [32][33][34][35]. Not surprisingly, the most commonly reported areas of clinical expertise or special interest generally aligned with conditions and symptoms reported by practitioners as benefitting from shiatsu. ...
... However, whilst national clinical priorities are important, focusing research on single conditions or symptoms runs the risk of missing simultaneous improvements in multiple clinical outcomes, along with positive health attributes such as wellness, disease prevention, self-efficacy and resilience [28][29][30]. Shiatsu therapy is a complex intervention that utilises a holistic, individualised approach [1,2,[32][33][34][35]. The challenge of coding many of the open-ended responses from practitioners regarding commonly observed positive clinical outcomes into a single disease category or symptom, suggests that many shiatsu therapy outcomes are more holistic. ...
... Though evidence for shiatsu is limited, studies have demonstrated benefits for: stress/anxiety, pain, muscle/joint issues, migraine, ability to cope, mind-body awareness, mobility, energy and mental clarity, and sleep disturbances. (34)(35)(36)38,39,(55)(56)(57)(58)(59) These studies reported no adverse effects aside from mild, transient fatigue or achiness. (34) Shiatsu has been shown to be an intrinsically safe therapy in qualified hands (60) with numerous potential benefits. ...
Background:
Dementia is a progressive neurological condition that affects over 50 million people. It impacts quality of life for those diagnosed, their care partners, and the relationship between the two. Strategies to enhance quality of life and relationships are needed. Shiatsu may improve care partners' well-being. Using touch through shiatsu may offer a meaningful way for care partners to interact with their partners living with dementia.
Purpose:
The purpose of this study was to explore care partners' experience of using both self-shiatsu and shiatsu with their partner, as well as to explore care partners' perceptions of the impact of shiatsu on the quality of their relationship.
Setting:
This study took place at a centre providing programs for persons living with dementia and their care partners.
Participants:
Participants were current and former attendees of the centre's programs.
Research design:
This was a qualitative study with an interpretive/descriptive approach. Care partners were taught self-shiatsu to manage stress and a simplified, short shiatsu routine to use with their partner. Semi-structured interviews were conducted to elicit care partners' experiences and explore their ongoing use of shiatsu at two and six weeks post-workshop.
Findings:
Four care partners completed the study. A wide range of experiences with shiatsu were described, representing four key themes: Enhanced Awareness, Integrating Shiatsu into the Relationship, Barriers and Facilitators, and Potential and Possibility. Two found self-shiatsu beneficial. Using shiatsu with their partner was a favourable experience for only one, who found it a pleasant way to connect and interact. None of the participants felt using shiatsu with their partners affected their relationship quality.
Conclusions:
The findings of this study are inconclusive. Self-shiatsu may be a helpful self-management approach for some care partners, but not for others. Shiatsu for persons living with dementia may not fit into the routines of many care partners. For others, however, it may offer a means to connect.
... Amitriptyline is widely used for a variety of chronic pain, but in clinical use, with the increase of amitriptyline dose, many patients have suffered from many side effects such as dry mouth, nausea, dizziness and urine retention caused by intolerance to systemic administration [7]. Some studies have confirmed that amitriptyline has local anesthetic properties and analgesic effect by applying local subcutaneous, epidermal application, intrathecal and nerve block methods [8]. Other studies have shown that compared with traditional local anesthetics, amitriptyline has a better intensity of analgesic action and a longer duration of action [9]. ...
Objective
to investigate the analgesic effect of amitriptyline on neuropathic pain model rats, diabetic neuropathic pain model rats and fibromyalgia model rats. Methods: the healthy male Sprague wrote - Dawley (SD) rats were taken as the research object, and they were randomly divided into model group (group A), beside the sciatic nerve and injection of 5 mm amitriptyline group (group B), beside the sciatic nerve and injection of 10 mm amitriptyline group (group C), beside the sciatic nerve and injection of 15 mm amitriptyline group (group D), intraperitoneal injection of amitriptyline group (group E). Pain induced by selective injury of sciatic nerve branches in rats, pain induced by chronic compression of sciatic nerve, diabetic neuropathic pain and fibromyalgia were conducted to determine the pain threshold of mechanical stimulation in rats after drug administration. Results: the pain threshold of mechanical stimulation in the local amitriptyline group (group B, C, D) was significantly higher than that in the group A and group E at each time point after drug treatment, and the pain threshold of mechanical stimulation gradually increased with the increase of concentration. There was no statistically significant difference in mechanical stimulation pain threshold between group A and group E at each time point after drug treatment. Conclusion: para-sciatic injection of amitriptyline at different concentrations has analgesic effects on neuropathic pain, diabetic neuropathic pain and fibromyalgia in rat models, and amitriptyline directly ACTS on the local sciatic nerve.
... For ages, e.g. shiatsu has been applied to initiate body healing processes by human touch applying pressure to designated body areas [1][2][3][4][5][6]. ...
AbstractAn experimental analysis has been carried out applying infrared monitoring demonstrating that empty mindedgyoki skin contacting is capable of activating human’s bio intelligence and KI generating energy at injured body partsactivating self-healing processes. This effect rises without that the injured body part has been touched directly andcan only be generated if the touching person is skilled in gassyo gyoki.
(PDF) Experimental Analysis of Human Touch Activated Self-healing Body Energy: Gyoki Body Resonancing. Available from: https://www.researchgate.net/publication/332786282_Experimental_Analysis_of_Human_Touch_Activated_Self-healing_Body_Energy_Gyoki_Body_Resonancing [accessed Feb 26 2020].
... For ages, e.g. shiatsu has been applied to initiate body healing processes by human touch applying pressure to designated body areas [1][2][3][4][5][6]. ...
Abstract:
An experimental analysis has been carried out applying infrared monitoring demonstrating that empty minded
gyoki skin contacting is capable of activating humans bio intelligence and KI generating energy at injured body
parts activating self-healing processes. This effect rises without that the injured body part has been touched directly
and can only be generated if the touching person is skilled in gassyo gyoki.
Key words: Seiki, Shiatsu, bio-intelligence, resonance
... For example, pain scores following a course of Shiatsu had dropped significantly in this study (Table 3). This is in line with other studies that have demonstrated the benefits of Shiatsu in reducing pain levels when treating headaches and fibromyalgia [41,42]. Pain can be a complex symptom to manage, so the finding that Shiatsu has benefitted these patients is very encouraging. ...
Introduction: The study investigated the effectiveness of Shiatsu therapy in relation to the management of health and wellbeing concerns of cancer and palliative care patients in an out-patient clinic.
Method: Patients are referred to the Complementary Therapies Service for symptom management, particularly stress and anxiety, but also other symptoms such as nausea or insomnia. Data was collected following use of the Measure Yourself Concerns and Wellbeing (MYCaW) questionnaire, which was designed for evaluating supportive care interventions.
Results: Mean changes in post-intervention MYCaW scores were highly significant (p < 0.001), demonstrating
considerable improvements in both presenting symptoms and perceptions of wellbeing. Based on a significance level of 0.05, both the Wilcoxon signed-ranks test and the two-tailed t-test indicated that post-treatment ranks and means were statistically significantly lower than pre-treatment ranks and means in the categories.
Conclusion: Anxiety, stress management and pain scores were the most improved. Wellbeing scores also improved, on average, by two points on the Likert scale. Patients stated that ‘being listened to’ and ‘being heard’ were important factors when describing how Shiatsu had helped.
We suggest that a study using larger numbers is necessary in order to provide more robust evidence rather
than emerging trends.
... For this reason, these techniques are considered intrinsically safe and to be effective in a number of stress-related or painful conditions. [2][3][4][5][6][7][8][9] However, the effect of Shiatsu in patients with AD and geriatric depression has not been previously evaluated. ...
Objectives:
Among the complementary and alternative medicine, Shiatsu might represent a feasible option for depression in Alzheimer's disease (AD). We evaluated Shiatsu on mood, cognition, and functional independence in patients undergoing physical activity.
Design:
Single-blind randomized controlled study.
Setting:
Dedicated Community Center for patients with AD.
Interventions:
AD patients with depression were randomly assigned to the "active group" (Shiatsu + physical activity) or the "control group" (physical activity alone). Shiatsu was performed by the same therapist once a week for ten months.
Main outcome measures:
Global cognitive functioning (Mini Mental State Examination - MMSE), depressive symptoms (Geriatric Depression Scale - GDS), and functional status (Activity of Daily Living - ADL, Instrumental ADL - IADL) were assessed before and after the intervention.
Results:
We found a within-group improvement of MMSE, ADL, and GDS in the active group. However, the analysis of differences before and after the interventions showed a statistically significant decrease of GDS score only in the active group.
Conclusions:
The combination of Shiatsu and physical activity improved depression in AD patients compared to physical activity alone. The pathomechanism might involve neuroendocrine-mediated effects of Shiatsu on neural circuits implicated in mood and affect regulation.
... contains supplementary material, which is available to authorized users. Triptans may also act by reducing the transmission of pain signals and inhibiting the release of vasoactive peptides in the trigeminal dorsal horn [10]. ...
We performed this systematic review and meta-analysis to evaluate the tolerability and efficacy of intranasal sumatriptan, a selective serotonin agonist, compared to placebo or other migraine therapeutics for the treatment of acute migraine attacks. We searched PubMed, SCOPUS, Embase, and Cochrane CENTRAL for relevant randomized controlled trials (RCTs). Data were extracted from eligible studies and pooled as risk ratios (RR), using RevMan software. We performed subgroup and meta-regression analyses for different doses and treatment endpoints. Sixteen RCTs (n = 5925 patients) matched our inclusion criteria. The overall effect-estimate showed that intranasal sumatriptan was superior to placebo in terms of pain relief (RR = 1.70, 95% CI [1.31, 2.21], p < 0.0001) and headache relief (RR = 1.58, 95% CI [1.35, 1.84], p < 0.00001) at 2 h. Although sumatriptan was superior to placebo in terms of headache relief at 30 min (RR = 1.31, 95% CI [1.08, 1.59], p = 0.005), no significant difference was found between both groups in terms of the frequency of pain-free participants at 30 min (RR = 1.18, 95% CI [0.49, 2.88], p = 0.71). Subgroup analysis and meta-regression models showed that increasing the dose of sumatriptan reduced the time needed for headache relief; however, this clinical improvement with higher doses was associated with more frequent adverse events in comparison to smaller doses. In conclusion, intranasal sumatriptan is effective for the treatment of acute migraine attacks. However, it was associated with a six-fold increase in the risk of taste disturbance, compared to the placebo. Future RCTs are recommended to provide head-to-head comparison of different administration routes and drug formulations of sumatriptan.
BACKGROUND:
Acupuncture is often used for migraine prophylaxis but its effectiveness is still controversial. This review (along with a companion review on 'Acupuncture for tension-type headache') represents an updated version of a Cochrane review originally published in Issue 1, 2001, of The Cochrane Library.
OBJECTIVES:
To investigate whether acupuncture is a) more effective than no prophylactic treatment/routine care only; b) more effective than 'sham' (placebo) acupuncture; and c) as effective as other interventions in reducing headache frequency in patients with migraine.
METHODS:
Search methods: The Cochrane Pain, Palliative & Supportive Care Trials Register, CENTRAL, MEDLINE, EMBASE and the Cochrane Complementary Medicine Field Trials Register were searched to January 2008.
Selection criteria: We included randomized trials with a post-randomization observation period of at least 8 weeks that compared the clinical effects of an acupuncture intervention with a control (no prophylactic treatment or routine care only), a sham acupuncture intervention or another intervention in patients with migraine.
Data collection and analysis: Two reviewers checked eligibility; extracted information on patients, interventions, methods and results; and assessed risk of bias and quality of the acupuncture intervention. Outcomes extracted included response (outcome of primary interest), migraine attacks, migraine days, headache days and analgesic use. Pooled effect size estimates were calculated using a random-effects model.
MAIN RESULTS:
Twenty-two trials with 4419 participants (mean 201, median 42, range 27 to 1715) met the inclusion criteria. Six trials (including two large trials with 401 and 1715 patients) compared acupuncture to no prophylactic treatment or routine care only. After 3 to 4 months patients receiving acupuncture had higher response rates and fewer headaches. The only study with long-term follow up saw no evidence that effects dissipated up to 9 months after cessation of treatment. Fourteen trials compared a 'true' acupuncture intervention with a variety of sham interventions. Pooled analyses did not show a statistically significant superiority for true acupuncture for any outcome in any of the time windows, but the results of single trials varied considerably. Four trials compared acupuncture to proven prophylactic drug treatment. Overall in these trials acupuncture was associated with slightly better outcomes and fewer adverse effects than prophylactic drug treatment. Two small low-quality trials comparing acupuncture with relaxation (alone or in combination with massage) could not be interpreted reliably.
Authors' conclusions: In the previous version of this review, evidence in support of acupuncture for migraine prophylaxis was considered promising but insufficient. Now, with 12 additional trials, there is consistent evidence that acupuncture provides additional benefit to treatment of acute migraine attacks only or to routine care. There is no evidence for an effect of 'true' acupuncture over sham interventions, though this is difficult to interpret, as exact point location could be of limited importance. Available studies suggest that acupuncture is at least as effective as, or possibly more effective than, prophylactic drug treatment, and has fewer adverse effects. Acupuncture should be considered a treatment option for patients willing to undergo this treatment.
Migraine is a common, multifactorial, disabling, recurrent, hereditary neurovascular headache disorder. It usually strikes sufferers a few times per year in childhood and then progresses to a few times per week in adulthood, particularly in females. Attacks often begin with warning signs (prodromes) and aura (transient focal neurological symptoms) whose origin is thought to involve the hypothalamus, brainstem, and cortex. Once the headache develops, it typically throbs, intensifies with an increase in intracranial pressure, and presents itself in association with nausea, vomiting, and abnormal sensitivity to light, noise, and smell. It can also be accompanied by abnormal skin sensitivity (allodynia) and muscle tenderness. Collectively, the symptoms that accompany migraine from the prodromal stage through the headache phase suggest that multiple neuronal systems function abnormally. As a consequence of the disease itself or its genetic underpinnings, the migraine brain is altered structurally and functionally. These molecular, anatomical, and functional abnormalities provide a neuronal substrate for an extreme sensitivity to fluctuations in homeostasis, a decreased ability to adapt, and the recurrence of headache. Advances in understanding the genetic predisposition to migraine, and the discovery of multiple susceptible gene variants (many of which encode proteins that participate in the regulation of glutamate neurotransmission and proper formation of synaptic plasticity) define the most compelling hypothesis for the generalized neuronal hyperexcitability and the anatomical alterations seen in the migraine brain. Regarding the headache pain itself, attempts to understand its unique qualities point to activation of the trigeminovascular pathway as a prerequisite for explaining why the pain is restricted to the head, often affecting the periorbital area and the eye, and intensifies when intracranial pressure increases.
The debate on the clinical definition of refractory Chronic Migraine (rCM) is still far to be concluded. The importance to create a clinical framing of these rCM patients resides in the complete disability they show, in the high risk of serious adverse events from acute and preventative drugs and in the uncontrolled application of therapeutic techniques not yet validated.
The European Headache Federation Expert Group on rCM presents hereby the updated definition criteria for this harmful subset of headache disorders. This attempt wants to be the first impulse towards the correct identification of these patients, the correct application of innovative therapeutic techniques and lastly aim to be acknowledged as clinical entity in the next definitive version of the International Classification of Headache Disorders 3 (ICHD-3 beta).
Background:
Chronic migraine (CM) is a disabling disorder characterized by ≥15 headache days per month that has been shown to significantly reduce quality of life. Migraine-prevention guidelines recommend preventive medications as the standard of care for patients with frequent migraine. The aim of this study was to assess adherence to 14 commonly prescribed oral migraine-preventive medications (OMPMs) among patients with CM.
Methods:
Retrospective claims analysis of a US claim database (Truven MarketScan® Databases) was queried to identify patients who were at least 18 years old, diagnosed with CM, and initiated an OMPM (antidepressants, beta blockers, or anticonvulsants) between January 1, 2008 and September 30, 2012. Medication possession ratios (MPR) and proportion of days covered (PDC) were calculated for each patient. A cutoff of ≥80% was used to classify adherence. The odds of adherence between OMPMs were compared using logistic regression models.
Results:
Of the 75,870 patients identified with CM, 8688 met the inclusion/exclusion criteria. Adherence ranged between 26% to 29% at six months and 17% to 20% at 12 months depending on the calculation used to classify adherence (PDC and MPR, respectively). Adherence among the 14 OMPMs was similar except for amitriptyline, nortriptyline, gabapentin, and divalproex, which had significantly lower odds of adherence when compared to topiramate.
Conclusion:
Adherence to OMPMs is low among the US CM population at six months and worsens by 12 months.
Migraine is a disabling neurological disorder, aggravated by accompanying symptomatology, such as nausea. One of the most interesting approaches to nausea adopted by traditional Chinese medicine is the stimulation of the acupoint PC6 Neiguan. Actually there are no studies in medical literature as to the efficacy of treating PC6 acupoint for gastrointestinal symptoms in migraine attacks. Our study aimed at verifying if pressure applied to the acupoint PC6 was effective on nausea during migraine. Forty female patients suffering from migraine without aura were enrolled, if nausea was always present as accompanying symptomatology of their migraine. The patients were treated randomly for a total of six migraine attacks: three with the application of a device, the Sea-Band(®) wristband, which applies continual pressure to the PC6 acupoint (phase SB), and three without it (phase C). The intensities of nausea at the onset, at 30, 60, 120 and 240 min were evaluated on a scale from 0 to 10. The values were always significantly lower in phase SB than in phase C. Also the number of patients who reported at least a 50 % reduction in the nausea score was significantly higher in phase SB than in phase C at 30, 60 and 120 min. Moreover, the consistency of the treatment (response in at least two out of three treated attacks) was reached in 28 % patients at 60 min; in 40 % at 120 min and 59 % at 240 min. Our results encourage the application of PC6 acupressure for the treatment of migraine-associated nausea.
According to the revised 2nd Edition of the International Classification of Headache Disorders, primary headaches can be categorized as chronic or episodic; chronic migraine is defined as headaches in the absence of medication overuse, occurring on ≥15 days per month for ≥3 months, of which headaches on ≥8 days must fulfill the criteria for migraine without aura. Prevalence and incidence data for chronic migraine are still uncertain, owing to the heterogeneous definitions used to identify the condition in population-based studies over the past two decades. Chronic migraine is severely disabling and difficult to manage, as affected patients experience substantially more-frequent headaches, comorbid pain and affective disorders, and fewer pain-free intervals, than do those with episodic migraine. Data on the treatment of chronic migraine are scarce because most migraine-prevention trials excluded patients who had headaches for ≥15 days per month. Despite this lack of reliable data, a wealth of expert opinion and a few evidence-based treatment options are available for managing chronic migraine. Trial data are available for topiramate and botulinum toxin type A, and expert opinion suggests that conventional preventive therapy for episodic migraine may also be useful. This Review discusses the evolution of our understanding of chronic migraine, including its epidemiology, pathophysiology, clinical characteristics and treatment options.
Shiatsu, similar to acupressure, uses finger pressure, manipulations and stretches, along Traditional Chinese Medicine meridians. Shiatsu is popular in Europe, but lacks reviews on its evidence-base.
Acupressure and Shiatsu clinical trials were identified using the MeSH term 'acupressure' in: EBM reviews; AMED; BNI; CINAHL; EMBASE; MEDLINE; PsycARTICLES; Science Direct; Blackwell Synergy; Ingenta Select; Wiley Interscience; Index to Theses and ZETOC. References of articles were checked. Inclusion criteria were Shiatsu or acupressure administered manually/bodily, published after January 1990. Two reviewers performed independent study selection and evaluation of study design and reporting, using standardised checklists (CONSORT, TREND, CASP and STRICTA).
Searches identified 1714 publications. Final inclusions were 9 Shiatsu and 71 acupressure studies. A quarter were graded A (highest quality). Shiatsu studies comprised 1 RCT, three controlled non-randomised, one within-subjects, one observational and 3 uncontrolled studies investigating mental and physical health issues. Evidence was of insufficient quantity and quality. Acupressure studies included 2 meta-analyses, 6 systematic reviews and 39 RCTs. Strongest evidence was for pain (particularly dysmenorrhoea, lower back and labour), post-operative nausea and vomiting. Additionally quality evidence found improvements in sleep in institutionalised elderly. Variable/poor quality evidence existed for renal disease symptoms, dementia, stress, anxiety and respiratory conditions. Appraisal tools may be inappropriate for some study designs. Potential biases included focus on UK/USA databases, limited grey literature, and exclusion of qualitative and pre-1989 studies.
Evidence is improving in quantity, quality and reporting, but more research is needed, particularly for Shiatsu, where evidence is poor. Acupressure may be beneficial for pain, nausea and vomiting and sleep.
Migraine is a disorder with variable natural history. In some sufferers, migraine evolves over time into a state of headaches on more days than not. This process of migraine chronification is poorly understood, but risk factors have been clearly identified. Herein, we first discuss the role of heritability and of genetic risk factors on migraine chronification. We follow with a discussion of the role of comorbid conditions and environmental exposures. We suggest that clinicians consider risk factor modification as part of migraine management, aspiring to not just relieve current pain and disability, but to avoid migraine progression. Reducing attack frequency, avoiding medication overuse, appropriately using preventive drugs and behavioral therapies, and encouraging weight loss should be part of migraine therapy to improve current pain and disability and also to avoid future pain and disability by preventing chronification.
The aim was to determine the magnitude of the nocebo (adverse effects following placebo administration) in clinical trials for primary headache disorders. We reviewed randomized, placebo-controlled studies for migraine, tension-type headache (TTH), and cluster headache treatments published between 1998 and 2009. The frequency of nocebo was estimated by the percentage of placebo-treated patients reporting at least one adverse side effect. The dropout frequency was estimated by the percentage of placebo-treated patients who discontinued the treatment due to intolerance. In studies of symptomatic treatment for migraine, the nocebo and dropout frequencies were 18.45% and 0.33%, but rose to 42.78% and 4.75% in preventative treatment studies. In trials for prevention of TTH, nocebo and dropout frequencies were 23.99% and 5.44%. For symptomatic treatment of cluster headache, the nocebo frequency was 18.67%. Nocebo is prevalent in clinical trials for primary headaches, particularly in preventive treatment studies. Dropouts due to nocebo effect may confound the interpretation of many clinical trials.
Because migraine worsens in a sizeable subgroup of sufferers, but not in most, identifying factors that predict the change from episodic into chronic migraine is of extreme interest and should be seen as a priority in headache research.
Potentially remediable risk factors include frequency of migraine attacks, obesity, excessive use of medications containing opioids and barbiturates, caffeine overuse, stressful life events, depression, sleep disorders and cutaneous allodynia.
While we wait for evidence regarding the benefits of risk factor modifications in the prevention of chronic migraine, several interventions are justifiable based on their other established benefits. For example, decreasing headache frequency with behavioral and pharmacological interventions will decrease current disability even if it does not modify clinical course. Monitoring the body mass index and encouraging maintenance of normal body weight is good practice in patients with and without migraine. Avoiding overuse of caffeine is desirable apart from its potential benefit in preventing progression. Sleep problems should be investigated and treated. Psychiatric comorbidities should be identified and addressed. Medications containing opioids and barbiturates should be reserved for a few selected cases of migraine, and their use should be monitored. For these interventions, the possibility of preventing progression may motivate clinicians to offer good care and patients to engage in the treatment plan.
Management of headache disorders, a leading reason for neurologic outpatient visits, is often difficult. In this article, the authors summarize and categorize the common reasons for treatment failure leading to referral to subspecialty headache centers. They have grouped these treatment failures into five broad categories: 1) the diagnosis is incomplete or incorrect; 2) important exacerbating factors have been missed; 3) pharmacotherapy has been inadequate; 4) nonpharmacologic treatment has been inadequate; 5) other factors, including unrealistic expectations and comorbidity, exist. The authors present an orderly approach to treatment failure to assist neurologists in managing difficult patients. Most refractory headache patients have a biologically determined problem and can be helped by accurate diagnosis or effective treatment. Persistence in treating these patients can be very rewarding. The authors provide a checklist intended to facilitate the management of refractory patients.
This study, which is a part of the initiative 'Lifting The Burden: The Global Campaign to Reduce the Burden of Headache Worldwide', assesses and presents all existing evidence of the world prevalence and burden of headache disorders. Population-based studies applying International Headache Society criteria for migraine and tension-type headache, and also studies on headache in general and 'chronic daily headache', have been included. Globally, the percentages of the adult population with an active headache disorder are 46% for headache in general, 11% for migraine, 42% for tension-type headache and 3% for chronic daily headache. Our calculations indicate that the disability attributable to tension-type headache is larger worldwide than that due to migraine. On the World Health Organization's ranking of causes of disability, this would bring headache disorders into the 10 most disabling conditions for the two genders, and into the five most disabling for women.
The burden associated with headache is a major public health problem, the true magnitude of which has not been fully acknowledged until now. Globally, the percentage of the adult population with an active headache disorder is 47% for headache in general, 10% for migraine, 38% for tension-type headache, and 3% for chronic headache that lasts for more than 15 days per month. The large costs of headache to society, which are mostly indirect through loss of work time, have been reported. On the individual level, headaches cause disability, suffering, and loss of quality of life that is on a par with other chronic disorders. Most of the burden of headache is carried by a minority who have substantial and complicating comorbidities. Renewed recognition of the burden of headache and increased scientific interest have led to a better understanding of the risk factors and greater insight into the pathogenic mechanisms, which might lead to improved prevention strategies and the early identification of patients who are at risk.
Introduction:
Chronic migraine is often complicated by medication-overuse headache (MOH), a headache due to excessive intake of acute medications. Chronic migraine and MOH are serious and disabling disorders. Since chronic migraine derives from the progression of originally episodic migraine, the fundamental therapeutic strategy is prevention. This narrative review describes how to try to prevent the development of MOH and how to manage it once it has appeared.
Areas covered:
A PubMed database search (from 1988 to January 2015) and a review of published studies on chronic migraine and MOH were conducted.
Expert opinion:
In spite of progress in migraine treatment, the prevalence of chronic headaches and MOH has not changed in the course of time. Today, a large number of migraine patients have turned to numerous expert physicians and experienced all sorts of prophylactic treatments without decisive benefits. Their condition seems to have crystallized even more as chronic and intractable. This means that to prevent chronification and MOH, we need more effective drugs and better strategies to use them. In particular, we must detect disease biomarkers and predictive factors for drug response that allow for personalized treatment when migraine is still episodic and make analgesic overuse pointless.
Although the efficacy of behavioral interventions for migraine (e.g., relaxation training, stress management, cognitive-behavioral therapy, biofeedback) is well established, other behavioral interventions that have shown efficacy for other conditions are being adapted to treat migraine. This paper reviews the literature to date on acceptance and commitment therapy (ACT), mindfulness-based interventions, and behavioral interventions for common migraine comorbidities. ACT and mindfulness interventions prioritize the outcome of improved functioning above headache reduction and have demonstrated efficacy for chronic pain broadly. These emerging behavioral therapies show considerable promise for improving outcomes of migraine patients, particularly in reducing headache-related disability and affective distress, but efficacy to date is limited by small trials, short follow-up periods, and a need for comparison or integration with established pharmacologic and behavioral migraine treatments.
Migraine is a complex and multifactorial brain disorder affecting approximately 18% of women and 5% of men in the United States, costing billions of dollars annually in direct and indirect healthcare costs and school and work absenteeism and presenteeism. Until this date, there have been no medications that were designed with the specific purpose to decrease the number of migraine attacks, which prompts a search for alternative interventions that could be valuable, such as acupuncture.
Acupuncture origins from ancient China and encompasses procedures that basically involve stimulation of anatomical points of the body.
This manuscript reviews large and well-designed trials of acupuncture for migraine prevention and also the effectiveness of acupuncture when tried against proven migraine preventative medications.
Acupuncture seems to be at least as effective as conventional drug preventative therapy for migraine and is safe, long lasting, and cost-effective. It is a complex intervention that may prompt lifestyle changes that could be valuable in patients' recovery.
© 2015 American Headache Society.
Background
Complementary and Alternative Medicine (CAM) approaches are widely used among individuals suffering from headache. The medical literature has focused on the evidence base for such use and has largely ignored the fact that these approaches are in wide use despite that evidence base.DiscussionThis article focuses on the uses of CAM by patients and suggests strategies for understanding and addressing this use without referring back to the evidence base. The rationale for this discussion pivots on the observation that patients are already using these approaches, and for many there are anecdotal and historical bases for use which patients find persuasive in the absence of scientific evidence.Conclusion
Until such time as the body of scientific literature adequately addresses non-conventional approaches, physicians must acknowledge and understand, as best as possible, CAM approaches which are in common use by patients. This is illustrated with a case study and examples from practice. This article does not review the evidence base for various CAM practices as this has been done well elsewhere.
Acupressure is a complementary treatment that uses fingers and hands to stimulate acupoints and maintains the balance of energy. The objective of this study was to review the application of acupressure in managing different pains and the effectiveness of acupressure on relieving pain in various settings. A systematic review of English articles using the databases of MEDLINE, PubMed, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) was performed using the search terms of "acupressure" and "pain." Studies during which acupressure was applied as an intervention and assessed for its effectiveness on relieving pain were selected. The studies selected were those published from January 1, 1996 to December 31, 2011 that met the inclusion and exclusion criteria. The participants included patients with dysmenorrhea, labor pain, low back pain, chronic headache, and other traumatic pains. The Oxford 2011 Levels of Evidence was used to appraise the literature. Fifteen studies were extracted for reducing dysmenorrhea (menstrual distress), labor pain, low back pain, chronic headache, and other traumatic pain. These papers were further reviewed for their study design, adequacy of randomization and concealment of allocation, blinding of participants, interventions, and outcome measurements. Acupressure has been shown to be effective for relieving a variety of pains in different populations. The review begins to establish a credible evidence base for the use of acupressure in pain relief. The implication for health care providers would be incorporating acupressure into their practice as an alternative therapy to facilitate patients who suffer from pain.
To provide updated evidence-based recommendations for the preventive treatment of migraine headache. The clinical question addressed was: What pharmacologic therapies are proven effective for migraine prevention?
The authors analyzed published studies from June 1999 to May 2009 using a structured review process to classify the evidence relative to the efficacy of various medications available in the United States for migraine prevention.
The author panel reviewed 284 abstracts, which ultimately yielded 29 Class I or Class II articles that are reviewed herein. Divalproex sodium, sodium valproate, topiramate, metoprolol, propranolol, and timolol are effective for migraine prevention and should be offered to patients with migraine to reduce migraine attack frequency and severity (Level A). Frovatriptan is effective for prevention of menstrual migraine (Level A). Lamotrigine is ineffective for migraine prevention (Level A).
Headache disorders are very common, but their monetary costs in Europe are unknown. We performed the first comprehensive estimation of how economic resources are lost to headache in Europe.
From November 2008 to August 2009, a cross-sectional survey was conducted in eight countries representing 55% of the adult EU population. Participation rates varied between 11% and 59%. In total, 8412 questionnaires contributed to this analysis. Using bottom-up methodology, we estimated direct (medications, outpatient health care, hospitalization and investigations) and indirect (work absenteeism and reduced productivity at work) annual per-person costs. Prevalence data, simultaneously collected and, for migraine, also derived from a systematic review, were used to impute national costs.
Mean per-person annual costs were €1222 for migraine (95% CI 1055-1389; indirect costs 93%), €303 for tension-type headache (TTH, 95% CI 230-376; indirect costs 92%), €3561 for medication-overuse headache (MOH, 95% CI 2487-4635; indirect costs 92%), and €253 for other headaches (95% CI 99-407; indirect costs 82%). In the EU, the total annual cost of headache amongst adults aged 18-65 years was calculated, according to our prevalence estimates, at €173 billion, apportioned to migraine (€111 billion; 64%), TTH (€21 billion; 12%), MOH (€37 billion; 21%) and other headaches (€3 billion; 2%). Using the 15% systematic review prevalence of migraine, calculated costs were somewhat lower (migraine €50 billion, all headache €112 billion annually).
Headache disorders are prominent health-related drivers of immense economic losses for the EU. This has immediate implications for healthcare policy. Health care for headache can be both improved and cost saving.
The drop-out rate among patients receiving preventive treatment for migraine is higher than 30%. This situation is not very widely known and the risk factors that lead patients to drop out from treatment have yet to be identified.
To evaluate some of the factors that can predispose patients to drop out of preventive treatment.
We conducted a prospective study of patients suffering from migraine who required preventive treatment for the first time with one of what are considered the top three first-choice drugs, i.e. a beta-blocker (nadolol), a neuromodulator (topiramate) or a calcium antagonist (flunarizine). Two groups were established according to whether patients dropped out of treatment or not. Different demographic and clinical variables were analysed and compared in the two groups.
Of 800 patients with migraine who required preventive treatment for the first time, the drop-out rate was 19.7%. In the drop-out group, the variables 'age', 'number of seizures', 'number of seizures prior to preventive treatment' and 'side effects' showed significant differences with those from the group of patients who did not drop out of preventive treatment.
The drug used as preventive treatment, the side effects, a younger age and a lower number of seizures before starting the preventive treatment favoured higher drop-out rates. Whether the migraine was episodic or chronic, the presence of medication abuse and the drugs used to treat the seizures were not related with dropping out of preventive treatment.
The objective of this review is to assess the clinical evidence for or against acupressure as a treatment for neurological disorders. We searched the literature from 12 databases from their inception to July 2010. We included any type of controlled clinical trial (CCT) in which patients with neurological disorders were treated with acupressure. The methodological quality of all clinical trials was assessed using the Cochrane risk of bias analysis. In total, two randomized clinical trials (RCTs) and four CCTs were included. Four studies (one RCT and three CCTs) compared the effects of acupressure with routine care or no treatment in patients with stroke and showed significant effects of acupressure on improving patient function and symptoms. One RCT, which compared acupressure with sham acupressure and no treatment in patients with headache, also showed that acupressure significantly reduced headache severity and pain. However, all trials were open to methodological limitations and a high risk of bias. In conclusion, current evidence showing that acupressure is an effective treatment for improving function and symptoms in patients with stroke is limited. However, the evidence is insufficient to draw conclusions concerning the effects of acupressure on other neurological disorders. More rigorous studies are warranted.
The terms refractory headache and intractable headache have been used interchangeably to describe persistent headache that is difficult to treat or fails to respond to standard and/or aggressive treatment modalities. A variety of definitions of intractability have been published, but as yet, an accepted/established definition is not available. To advance clinical and basic research in this population of patients, a universal and graded classification scheme of intractability is needed, and must include a definition of failure, to which and how many treatments the patient has failed, the level of headache-related disability, and finally, the intended intervention (clinical or research) and intensity of the intervention. This paper addresses each of these variables with the intent of providing a graded classification scheme that can be used in defining intractability for clinical practice interventions and clinical research initiatives.
The efficacy of acupressure in relieving pain has been documented; however, its effectiveness for chronic headache compared to the muscle relaxant medication has not yet been elucidated. To address this, a randomized, controlled clinical trial was conducted in a medical center in Southern Taiwan in 2003. Twenty-eight patients suffering chronic headache were randomly assigned to the acupressure group (n = 14) or the muscle relaxant medication group (n = 14). Outcome measures regarding self-appraised pain scores (measured on a visual analogue scale; VAS) and ratings of how headaches affected life quality were recorded at baseline, 1 month after treatment, and at a 6-month follow-up. Pain areas were recorded in order to establish trigger points. Results showed that mean scores on the VAS at post-treatment assessment were significantly lower in the acupressure group (32.9+/-26.0) than in the muscle relaxant medication group (55.7+/-28.7) (p = 0.047). The superiority of acupressure over muscle relaxant medication remained at 6-month follow-up assessments (p = 0.002). The quality of life ratings related to headache showed similar differences between the two groups in the post treatment and at six-month assessments. Trigger points BL2, GV20, GB20, TH21, and GB5 were used most commonly for etiological assessment. In conclusion, our study suggests that 1 month of acupressure treatment is more effective in reducing chronic headache than 1 month of muscle relaxant treatment, and that the effect remains 6 months after treatment. Trigger points help demonstrate the treatment technique recommended if a larger-scale study is conducted in the future.
Complementary and alternative medicine (CAM) is increasingly common in the treatment of primary headache disorders despite lack of evidence for efficacy in most modalities. A systematic questionnaire-based survey of CAM therapy was conducted in 432 patients who attended seven tertiary headache out-patient clinics in Germany and Austria. Use of CAM was reported by the majority (81.7%) of patients. Most frequently used CAM treatments were acupuncture (58.3%), massage (46.1%) and relaxation techniques (42.4%). Use was motivated by 'to leave nothing undone' (63.7%) and 'to be active against the disease' (55.6%). Compared with non-users, CAM users were of higher age, showed a longer duration of disease, a higher percentage of chronification, less intensity of headache, were more satisfied with conventional prophylaxis and showed greater willingness to gather information about headaches. There were no differences with respect to gender, headache diagnoses, headache-specific disability, education, income, religious attitudes or satisfaction with conventional attack therapy. A higher number of headache days, longer duration of headache treatment, higher personal costs, and use of CAM for other diseases predicted a higher number of used CAM treatments. This study confirms that CAM is widely used among primary headache patients, mostly in combination with standard care.
Migraine patients suffer from recurrent attacks of mostly one‐sided, severe headache. Acupuncture is a therapy in which thin needles are inserted into the skin at defined points; it originates from China. Acupuncture is used in many countries for migraine prophylaxis – that is, to reduce the frequency and intensity of migraine attacks. We reviewed 22 trials which investigated whether acupuncture is effective in the prophylaxis of migraine. Six trials investigating whether adding acupuncture to basic care (which usually involves only treating acute headaches) found that those patients who received acupuncture had fewer headaches. Fourteen trials compared true acupuncture with inadequate or fake acupuncture interventions in which needles were either inserted at incorrect points or did not penetrate the skin. In these trials both groups had fewer headaches than before treatment, but there was no difference between the effects of the two treatments. In the four trials in which acupuncture was compared to a proven prophylactic drug treatment, patients receiving acupuncture tended to report more improvement and fewer side effects. Collectively, the studies suggest that migraine patients benefit from acupuncture, although the correct placement of needles seems to be less relevant than is usually thought by acupuncturists.
The objective of this study was to explore client perceptions of the short-term and longer-term effects of shiatsu.
The study design was a prospective, 6-month observational, pragmatic study.
There were 85 shiatsu practitioners in three countries involved in the study: Austria, Spain, and the United Kingdom.
There were 948 clients receiving shiatsu from 1 of these practitioners.
Shiatsu as delivered by the practitioner in routine practice.
The outcomes measures were symptom severity, changes in health care use (baseline, 3 and 6 months), shiatsu-specific effects, uptake of advice (3 and 6 months), achieved expectations and occurrence of adverse events (4-6 days after first session, 3 and 6 months).
Six hundred and thirty-three (633) clients provided full follow-up data (a response rate of 67%). A typical shiatsu user was female, in her 40s, in paid employment, and had used shiatsu before. At "first-ever" use, the most typical reason for trying shiatsu was "out of curiosity." At "today's" session, the dominant reason was health maintenance. The most mentioned symptom groups were problems with "muscles, joints, or body structure," "tension/stress," and "low energy/fatigue." Symptom scores improved significantly over the 6 months (all symptom groups, Austria and the United Kingdom; two symptom groups, Spain), with moderate effect sizes (0.66-0.77) for "tension or stress" and "body structure problems" (Austria, the United Kingdom), and small effect sizes (0.32-0.47) for the other symptom groups (Spain, 0.28-0.43 for four groups). Previous users reported significant symptom improvement from "first ever" to baseline with moderate effect sizes. Across countries, substantial proportions (> or = 60%) agreed or agreed strongly with shiatsu-specific benefits. At 6 months, 77%-80% indicated that they had made changes to their lifestyle as a result of having shiatsu, and reductions in the use of conventional medicine (16%-22%) and medication (15%-34%). Ten (10) adverse events were reported by 9 clients (1.4%); none of these clients ceased shiatsu.
Clients receiving shiatsu reported improvements in symptom severity and changes in their health-related behaviour that they attributed to their treatment, suggestive of a role for shiatsu in maintaining and enhancing health.
Acupuncture techniques, primarily self-administered acupressure, were evaluated as symptomatic treatment for the pain of migraine, histamine cephalgia, and tension headaches. A twenty-four month study was conducted with a general neuropsychiatric outpatient practice of more than 500 patients, seen for more than 5000 outpatient visits; more than 200 patients had significant headache symptomatology. Appropriate pharmacologic, dietary and psychotherapeutic treatments were administered for underlying metabolic, neurologic and psychiatric disorders. The results of the study indicated that acupuncture techniques were reasonably effective in relieving the pain of migraine and tension headaches. Auto-acupressure replaced outpatient prescriptions for analgesics, ergotamine preparations, steroids, propanolol or methysgeride. The value of auto-acupressure was enhanced by its easy availability of application and lack of toxic effects.
Using the "Bi-Digital O-Ring Test Imaging Technique", the author has been able to accurately localize meridians and acupuncture points that correspond to specific internal organs and has found that most general patterns of meridians and the number of acupuncture points on each of the meridians of specific internal organs of the 12 main internal organs described in the literature of ancient Chinese medicine, are more or less correct, with the exception of some variations and inaccuracies. Each meridian of specific internal organs was found to be connected to the organ representation area in the cerebral cortex of specific internal organs. The acupuncture point has an area and occupies 3-dimensional space. It has a circular or slightly oval boundary with diameter in the range of 3 mm to 2.7 cm, although 6-12 mm are the most common diameters in human adults, with the exception of the area outside the corners of the nailbeds of the fingers and toes. Using the "Bi-Digital O-Ring Test Molecular Identification Method", the author also found that within the boundary of most acupuncture points and meridian lines (including Heart, Stomach, and Triple Burner) were high concentrations of neurotransmitters and hormones, including Acetylcholine, Methionine-Enkephalin, Beta-Endorphin, ACTH, Secretin, Cholecystokinin, Norepinephrine, Serotonin, and GABA. On all these meridian lines, in addition to the above neurotransmitters and hormones, Dopamine, Dynorphin 1-13, Prostaglandin E1 (PGE1) and VIP were found, but the latter do not usually exist within the boundary of the acupuncture point with the exception of the center midline of the acupuncture point where the meridian line is situated. Serotonin, Norepinephrine, and Cholecystokinin appeared in either one of the above 2 patterns, depending on the individual. Usually, no significant amounts of these neurotransmitters and hormones were found at the surrounding area outside of meridian and acupuncture points. However, the essential amino acid L-Tryptophan (which is a precursor of Serotonin), was usually found outside of the boundary of the acupuncture point and the meridian but not within the boundary of the acupuncture point and the meridian. Wherever Serotonin appeared, L-Tryptophan disappeared significantly and when the Serotonin disappeared, L-Tryptophan reappeared. In addition to the above common neurotransmitters and hormones, the Heart meridian had additional Atrial Natriuretic Peptide in both the meridian and its acupuncture points. Similarly, the Stomach meridian had additional Gastrin in both the meridian and its acupuncture points. Likewise,the Triple Burner meridian had additional Testosterone (in the male) and Estrogen (especially Estriol and Estradiol in the female.
Acupuncture and acupressure points correlate well with sites on the body that have low transcutaneous electrical resistance (TER). Using lightly sedated, adult Sprague-Dawley rats, we identified an acupoint (i.e. site with low TER) located on the hind limb of the rat and compared the effects of acupressure at this site on the nociceptive threshold to an adjacent, non-acupoint site (i.e. site with high TER). Focal pressure (55.42 +/- 2.2 g) was applied to the site for 10 minutes and the tail flick response (TFR) was determined by draping the distal portion of the tail over a heated wire (75 +/- 5 degrees C). Three trials were performed during each of three randomized conditions (i.e. acupoint, placebo and control) and the trials were averaged. All rats tested (5/5) showed a statistically significant increase in TFR following 10 minutes of acupressure at the acupoint compared to placebo or control trials (p = 0.007). Acupressure at the placebo point resulted in a TFR that was not statistically different from the control. Systemic administration of naloxone completely abolished the tail-flick inhibition induced by acupressure at the acupoint. These data suggest that acupressure elicits an antinociceptive effect in rats that is mediated by the endogenous release of opioids.
In this article, we meta-analytically examined the efficacy of biofeedback (BFB) in treating migraine. A computerized literature search of the databases Medline, PsycInfo, Psyndex and the Cochrane library, enhanced by a hand search, identified 86 outcome studies. A total of 55 studies, including randomized controlled trials as well as pre-post trials, met our inclusion criteria and were integrated. A medium effect size (d =0.58, 95% CI=0.52, 0.64) resulted for all BFB interventions and proved stable over an average follow-up phase of 17 months. Also, BFB was more effective than control conditions. Frequency of migraine attacks and perceived self-efficacy demonstrated the strongest improvements. Blood-volume-pulse feedback yielded higher effect sizes than peripheral skin temperature feedback and electromyography feedback. Moderator analyses revealed BFB in combination with home training to be more effective than therapies without home training. The influence of the meta-analytical methods on the effect sizes was systematically explored and the results proved to be robust across different methods of effect size calculation. Furthermore, there was no substantial relation between the validity of the integrated studies and the direct treatment effects. Finally, an intention-to-treat analysis showed that the treatment effects remained stable, even when drop-outs were considered as nonresponders.
Acupressure on the "extra 1" point decreases bispectral index (BIS) values and stress.
We investigated the BIS, melatonin, beta-endorphin, and verbal stress score values before, after 10 min of acupressure application on the extra 1 point, on a sham point, after no acupressure, and 1 h after completion of each intervention in 12 volunteers.
The BIS and verbal stress score values were decreased after acupressure on the extra 1 point (P = 0.0001 and P = 0.008, respectively), but melatonin and beta-endorphin did not change.
Acupressure on the extra 1 point has no effect on melatonin and beta-endorphin levels.
1) To reassess the prevalence of migraine in the United States; 2) to assess patterns of migraine treatment in the population; and 3) to contrast current patterns of preventive treatment use with recommendations for use from an expert headache panel.
A validated self-administered headache questionnaire was mailed to 120,000 US households, representative of the US population. Migraineurs were identified according to the criteria of the second edition of the International Classification of Headache Disorders. Guidelines for preventive medication use were developed by a panel of headache experts. Criteria for consider or offer prevention were based on headache frequency and impairment.
We assessed 162,576 individuals aged 12 years or older. The 1-year period prevalence for migraine was 11.7% (17.1% in women and 5.6% in men). Prevalence peaked in middle life and was lower in adolescents and those older than age 60 years. Of all migraineurs, 31.3% had an attack frequency of three or more per month, and 53.7% reported severe impairment or the need for bed rest. In total, 25.7% met criteria for "offer prevention," and in an additional 13.1%, prevention should be considered. Just 13.0% reported current use of daily preventive migraine medication.
Compared with previous studies, the epidemiologic profile of migraine has remained stable in the United States during the past 15 years. More than one in four migraineurs are candidates for preventive therapy, and a substantial proportion of those who might benefit from prevention do not receive it.
Chronic migraine—classification, characteristics, and treatment
- H Diener
- D Dodick
- P Goadsby
The new book of shiatsu. Fireside Books
- P Lundberg