Comparison Research Of Acupuncture Protocols On Acute Attack Of Female Migraine Of Shaoyang Meridians

1 OBJECTIVEThe incidences of migraine have been growing steadily with the changing times. The aim of this study is to determine the most efficient therapeutic protocol in treating patients with moderate to severe acute attack of migraine of Shaoyang meridian origin. The aim of which is to alleviate pain and normalize cerebral blood flow in the shortest possible time.2 METHODSThe study was done in the Acupuncture Hospital of China Academy of Chinese Medical Sciences from July 2008 to April 2009. 18 patients who were diagnosed to have moderate to severe migraine of Shaoyang meridian origin were included in the study. They were divided into 2 groups (A and B). Group A inclusion criteria were as follows: Gender: female, Age 20-40 y/o, Moderate migraine; Group B were as follows Gender: female, Age 41-60 y/o, Severe migraine.This research applied four factors and three sub-classes of acupuncture treatment. Data was gathered and an orthogonal test was used to interpret the data. Outcome was assessed using the Visual analogue scale (VAS) every 10, 20, 30 minutes and every hour thereafter to 6 hours, then 12 hours and 24 hours after treatments. And objective measurement of cerebral blood flow using a transcranial Doppler were employed before and 30 minutes after treatment. Data gathered were interpreted using the orthogonal test.2.1 Research Design and Treatment PlanThe best research design to interpret multi variant data is using the orthogonal test. So the L₉(3⁴) orthogonal table was referred to.Four Factors were:A: combination of acupoints B: needle and electro-needle therapyC: auricular acupunctureD: bloodletting therapyThree sub-classes were:A: Combination of acupointsLevel 1: normal group of acupoints (acupoints applied at the side where migraine attacked)Level 2: Level 1+distal group of acupoints (acupoints applied at both sides)Level 3: Level 2+effect-reinforcing group of acupoints (acupoints applied at the side where migraine attacked)POINTS:Local points: sizhukong(SJ23), shuaigu(GB8);temple, fengchi(GB20)Distal points: hegu(LI4), taichong(LV3), zulinqi(GB41), yanglingquan-(GB34), qiuxu(GB40)Effect-reinforcing group: hanyan(GB4), xuanlu(GB5)B: Needle and electro-needle therapyLevel 1: 0 (neither usage of needle nor electro-needle)Level 2: needle therapyLevel 3: electro-needle therapy (applied at local acupoints)C: Auricular acupunctureLevel 1: 0 (without usage of auricular acupuncture)Level 2: auricular needleLevel 3: auricular electro-needleD: Bloodletting therapyLevel 1: bloodletting on superficial collaterals of blood stasis in temple area (or temple) +A shi acupointsLevel 2: bloodletting on superficial collaterals of blood stasis in temple area (or temple) Level 3: 0 (without usage of bloodletting therapy)18 patients were divided into 2 groups. Group A (Gender: female, Age: 20-40 y/o, Moderate severity); Group B (Gender: female, Age: 41-60 y/o, Severe migraine). Random distribution of patients to nine protocols was employed in both groups using single blinded study.A.Needle therapy(1)Horizontal insertion from SJ23 to GB8 or from GB4 to GB5 in depth of 1.5-3 cun. Quick twisting and twirling of needle was done to get Qi.(2)Oblique insertion of needle in both taiyang points, with twisting and twirling until a sensation of soreness and/or distention after was felt.(3)Perpendicular insertion of needle on GB20 was applied. Twisting and twirling manipulation after entry of needle. Perpendicular insertion of needle on fengfu(DU16) in depth of 1.5-2 cun was done and the needle was manipulated to make the sensation of Qi extend to the Vertex of the head, temporo-parietal, Orbital cavity, and frontal area.(4)Perpendicular insertion of needle on LI4, LV3, GB41, GB34, and GB40 with reducing technique applied on each point.All points were manipulated every 15 minutes with 1-minute duration per manipulation. Needles were retained for 30 minutes. B. Electro-needle therapyMethod for entry of needle is the same with needle therapy. After obtaining qi, electric stimulation was applied on the needles through wires attached to the needles. Dense-Dispersed wave was used and the intensity of the stimulation was regulated according to the subjective perception of each patient. All patients were subjected for 30 minutes.C. Auricular acupuncture(1)Auricular needle: Needles were applied on shenmen, sympathetic nerve, subcortex, brainstem, pancreas & gallbladder and a shi point in temporal region with moderate stimulation and without going through the cartilage. Quick twisting and twirling manipulation was employed every 5-10 minutes.(2) Auricular electro-needle:After obtaining qi, electric stimulation was applied on shenmen and a shi point in temporal region. Intensity of stimulation was regulated according to patients maximum tolerable comfort zone. Each lasted for 30 minutes.D. Bloodletting therapyBloodletting therapy was applied on superficial collaterals of blood stasis in the temporal area and a shi acupoints by using a three-edged needle gauge 20, the amount of blood expressed per patient ranged from 0.5 ml to 1.5 ml.2.2 Therapeutic EvaluationVisual Analogue Scale(VAS) was used to grade the degree of pain relief, and Changes in blood flow in cerebral vessels were analyzed using a transcranial Doppler(TCD).2.3 Data Process and Statistical AnalysisEpidata3.1 was used to establish database, and CHISS software was used to analyze the results.3 RESULTSThe results included analytical description of demographic data, general conditions, severity of migraine, influential trend of different factors in different levels of design and different post-treatment times with regards to the degree of pain relief and Cerebral blood flow using transcranial Doppler. Lifestyle improvement, through subjective verbal analysis of patients. Evaluation of Safety of Different protocols applied to each patient.Women with an average age of 37±10.8 (year-old) are most commonly affected. Most of them have a history for 15.8±9 years, duration of the attacks if not treated is 37.5±19.5 hours. Among the 4 therapeutic factors, the auricular and blood letting therapy proved to be most effective to relieve symptoms during the 1st 30 minutes; while the Auricular and Acupoints from 30 minutes to 6 hours; and Needle and electric stimulation after 6 hours to 1 day. However, the data during the 6 hours to 1 day, between the Needle-electric stimulation factor VS the auricular factor have only a small difference between each other.4 CONCLUSIONSThe growing incidence of Acute attacks of Shaoyang migraine HA, debilitating healthy people are growing steadily. With the help of dietary modifications, lifestyle change coupled with immediate treatment with auricular or bloodletting therapy during the acute attack of headache will ensure pain relief during the 1st 30 min after initial treatment. Although, this is the most superior method in the study, nevertheless auricular/acupoints have shown to improve migraine from 30 minutes to 6 hours while Needle/electric stimulation from 7 hours to a day. We cannot totally rank the effectiveness of the treatment models after 24 hours.Visual Analogue pain scale is a subjective way of determining the severity as well as relief of symptoms. It is the best way to accurately determine the effectiveness of the treatment Protocols for pain relief. The results of Transcranial Doppler to determine the changes in Blood flow in the Cerebral vessels is affected by the trajectory of the probe towards the blood vessels which makes it a less accurate prognostic tool in determining effectiveness of treatment. With out dispute, the 4 factors are effective in the different time frames after initial treatment; however, continuous relief of pain after 24 hours can not be assured because the duration of the treatment only encompassed a day.