Volume 1, Number 1 | Spring 2006

Japanese Acupuncture - Current Research
Efficacy of Acupuncture Treatment for Headache
Satoru Yamaguchi
Department of Oriental Medicine,
Saitama Medical School1.

Introduction

Headache is a symptom frequently encountered indaily practice, but many questions regarding themechanisms of its onset, diagnostics, and therapy still
remain unanswered. The classificiation,1) firstpublished by the International Headache Society in
1988, has been adopted by many clinicians andresearchers. However, in 2003, based on recent
progress in headache research this classification has
been revised by the above mentioned academic society
and published as the International Classification ofHeadache Disorders 2nd Edition (Table 1)2).
IHS
ICHD-II
code

WHO ICD-10NA
code

Part oneDiagnosis
The primary headache

1

[G43]

Migraine

2[G44.2]Tension-type headache (TTH)

3[G44.0]Cluster headache and other trigeminal
autonomic cephalalgias

4[G44.80]

Other primary headaches

Part two

The secondary headache

5.

[G44.88]

Headache attributed to head and/or necktrauma6.

[G44.81]

Headache attributed to cranial or cervicalvascular disorder

7.

[G44.82]

Headache attributedintracranial disorder

8.

[G44.4 or G44.83]

Headache attributed to a substance (2) or
its withdrawal

9.

tonon-vascular

Headache attributed to infection

10.

[G44.882]

Headache attributed
homoeostasis

11.

[G44.84]

Headache or facial pain attributed todisorder of cranium, neck, eyes, ears, nose,sinuses, teeth, mouth or other facial or
cranial structures

12

[R51]

Headache attributed to psychiatric disorderPartthreetodisorderof

Cranial neuralgias, central and primary
facial pain and other headaches

13[G44.847, G44.848 Cranial neuralgias and central causes ofor G44.85]
facial pain

14[R51]Other headache, cranial neuralgia, centralor primary facial pain

Table 1: International Classification of Headache Disorders 2nd Edition(ICHD-II)

2

When complaining about headache in Japan, themost frequent form is tension headache, as describedin the classification. This can be treated withacupuncture as a characteristic form of oriental
therapy, with considerable success. Conversely, thesame therapeutic modality is more useful for
prevention than treatment of actual migraine orcluster headache (functional) attacks. In this study, we
introduce the mechanisms of the onset of tension
headache as a form of transient headache and describe
the effects of acupuncture therapy and its modes ofaction. We also describe acupuncture treatment for
migraine and cluster headache.

2.

Tension headachea. Acupuncture therapy
The author used plethysmography, EMGs andthermography for an investigation of the mechanism ofonset and the modes of action of the acupuncture
therapy. The results of the study showed that for themechanism of onset of headache, excessive tension of
the posterior muscle, groups of the head, the posteriorneck muscles as well as the suprascapular andinterscapular muscle groups are more important thanthe muscles of the head3). Acupuncture therapy is
performed in order to facilitate the relaxation of theexcessive tension of these muscle groups andnormalize the hemodynamics in these muscles.
In the posterior neck region points in the trapezius
and semispinalis capitis muscles, Tenchu (BL10),
Fuchi (GB20), Kankotsu (GB12) by the mastoid
process (insertion of the splenius capitis muscle) thesuprascapular region Kensei (GB21) within the upperfibers of the trapezius muscle; Koko (BL43) wherevarious muscle cross each other in the interscapularregion; or points in the lateral region of the neck in thesplenius muscle or the levator scapulae muscle; or also
in the region of the angulus superior scapulae(insertion of the levator scapulae muscle) are selected
as treatment sites.
Actual acupuncture stimulation is adjusted to thepatient's physical strength, general condition andseverityof
thesymptoms.
Basically,
electro-acupuncture (1 Hz, 10-20 min) is performed in
the regions of the various hypertonic muscles.

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 1, Number 1 | Spring 2006

Inrefractory

cases,

facet

jointneedlingissometimes performed in the C2-3 intervertebral space(medial branches of the dorsal rami of the spinalnerves).
b. Modes of action of acupuncture therapy3-5)
The study also included application of the above
mentioned

non-invasive

EMG

examination

thatprovided for repeated examinations and open loop
video pupillography. This allowed for quantitative
measurement of autonomic nerve function to examine
themodesofactionofacupuncture.

These

examinations provided the following results.
(1) Acupuncture therapy causes relaxation of theexcessive tension of the muscles groups in theposterior

neck,suprascapularandinterscapularregions. It also facilitated normalization of thehemodynamics

and

therebycontributedto

analleviation of the headache (Figure 1).

(3) Acupuncture treatment of the muscle groups in theposterior neck, suprascapular and interscapularregions in patients with tension headache, did not only
elicit local reflexes (axon reflexes), but the evidence
also indicated the possibility of an influence on highercenters.
(4) The reaction of patients with tension headache toacupuncture treatment (autonomic nervous system)
differed from that obtained in healthy persons,suggesting that the acupuncture therapy apparently
contributes to an improvement in the homeostasis of
the body. (Figure 2a, b)
Mean±SE.

A1（mm2)
44

Control (n=30eyes)＊ p<0.05,＊＊＊＊
p<0.01 vs Before

Control (n=30eyes)

Patients (n=60eyes)

Patients (n=60eyes)

42
40
38

＊
＊

＊
＊＊
＊＊ ＊

36
34
32
30
28
26
Before010min20min

0Before

10min

20min

Acupuncture(15min)
Acupuncture(15min) Acupuncture(15min)Acupuncture(15min)Figure 2: Variations in pupillary reactions in patients with tension
headache before and after acupuncture treatmenta)Pupillary area prior to light stimulation (A1)

a: The pupillary area after light stimulation in patients with tension
headache decreased immediately, 10 and then 20 minutes after theacupuncture treatment. In healthy persons no significant variations
between the conditions before and after the acupuncture treatment
were observed.

Figure 1: Thermograms of patients with tension headache before andafter acupuncture treatment(mm22/sec22)
650Upper row: Type 1 covers the posterior area of the neck to thesuprascapular region, Type 2 covers the posterior area of the neck tothe suprascapular region and refers to areas of elevated temperature;

Mean±SE.

AC/％A1Control (n=30eyes)* * p<0.01
vs vsBefore
Beforep<0.01

Patients (n=60eyes)

600

＊＊
＊＊ ＊＊
＊＊

550

＊＊
＊＊

thermograms of patients with tension headache can be grossly divided
into two patterns.

500

Lower row: Improvement of symptoms due to acupuncture treatment450

is associated with a decrease in skin temperature in the areas ofincreased temperature, thus approaching the temperature of thesurrounding areas.

400350
Before(2) The modes of action of acupuncture partially differ
from that of central acting muscle relaxants.

010min20min

Acupuncture(15min)b)

Before010min20min

Acupuncture(15min)

Maximal pupillary contraction velocity (AC)The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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Volume 1, Number 1 | Spring 2006

b: Maximal pupillary contraction velocity following acupuncture
treatment of patients with tension headache led to an immediate
increase, 10 and then 20 minutes after the acupuncture treatment. InUnknown

healthy persons no significant variations between the conditions before

Worseand after the acupuncture treatment were observed.

c. Effects of acupuncture treatment
Patients with tension headache were referred fromdepartments of neurology etc. to our department for aninvestigation of the therapeutic effects of acupuncture.
The study included 86 patients, 22 men and 64 womenwith an average age of 53.6±14.9 years. A visual
analogue scale (VAS) and pain score (PS) were used as
evaluation tools for the therapeutic effects on thepatients' subjective symptoms. The improvement ofsymptoms was calculated in conjunction with theobjective findings: improvement of more than 80%
more than 60% as effective, more than 40% as slightly
effective, less than 40% ineffective and an increase insymptoms as aggravation.
The results showed that in the patient group,
29.1% of the patients also had diseases of the cervicalvertebra and related conditions, while 72.1%
complained of neck and/or shoulder stiffness. In 17(19.8%) of these patients acupuncture treatment wasmarkedly effective, in 39 (45.3%) effective, and in 14(16.3%) slightly effective; so that the overall efficacy
was 81.4% (Figure 3). Acupuncture treatment and theimprovement in shoulder stiffness showed an
extremely high positive correlation (r=0.912; Figure 4)
that resulted in some patients requiring a reduction ofmuscle relaxants or anti-inflammatory drugs.

ShoulderStiffiness

Unchanged
MinimalImprovement
Moderate
Improvement
MarkedImprovement

Y = .614 + .827 * X; R^2 = .832
MarkedImprovement

MinimalImprovement

Moderate
Improvement

Worse

Unchanged

Unknown

HeadacheFigure 4: Therapeutic results for tension headache and shoulder
stiffness

3.

Migraine and cluster headache

Acupuncture treatment for migraine is performed
primarily for preventive purposes mainly during
remission rather than during actual attacks. During
an attack, a combination therapy with triptan
medications is desirable. Since the mechanism of theonset of cluster headaches differs from that ofmigraine, this condition is treated in the classificationof the International Headache Society as anindependent item; but the acupuncture treatment is,
except for the attacks, approximately the same as thatfor migraine.
a. Acupuncture treatment
For the region in which headache occurs mostfrequently, namely in the vicinity of the acupoints
Ganen, Kenryo, Kenri (GB 4-6) and Zui (St8); as well
as for migraine, the vascular mechanism of onset oftrigeminal neuralgia is considered to be likely.
Therefore, points in the course of that nerve, like theheadache
86

MarkedImprovement

shoulderstiffiness62
dizziness

11

selected. Moreover, for the purpose of regulating

MinimalImprovement

autonomic nerve functions of the circulatory system,

Unchanged

Jingei (needling of the carotid sinus) has been added toWorsethe list of needled regions. Application of distantUnknown

upper limb
pain 110%

20%

40%

60%

80%

supraorbital incisure or the point Gekan (St7), areModerate
Improvement100%

needling described in the classics (use of the brighteryang stomach channel of the leg, greater yang bladderand lesser yang gall bladder channels), choosing points
on the legs like Taikei (KI3), Shoyo (LI1), Ichu (BL40),

Figure 3: Results of acupuncture treatment of tension headache andassociated symptoms

4

Konron (BL60), Yoryosen (GB34), Kyukyo (GB40),
Rinkyu (GB41), and similar points are also very

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 1, Number 1 | Spring 2006

important. The courses of these channels on the legs

temperatures in the posterior region of the neck, as

closely resemble that of the sciatic nerve, so thatwell as the supra and interscapular regions. The

stimulation of distant regions presumably acts via theacupuncture

nervous system. Taking stimulation of the temples astemperature, observing an approximation to thethe local site of the pain into account during

surrounding skin temperature (Figure 1) and thus

consideration of the mechanisms of onset, suggests

suggests a partially different mode of action from thatthat a light stimulation (manual thrusting and liftingof central acting muscle relaxants.

treatment

ledtoadecreasein(Jakutaku) manipulation of the needles, rotation and

For the assessment of the influence of acupuncture

electric stimulation of the needles at 30 to 100 Hz)

treatment on the autonomic nerve function in patients

inhibits

withtriggeringofattacksandaggravation.

tensionAlleviation of complicating complaints or fatigue andpupillography

improvement

non-invasive,

ofthegeneralcondition

isalsoheadache,wasanopenemployed,

repetitive

which

andloopvideo

permitted
quantitative

measurements of the autonomic nerve function. The

important.

results showed that prior to light stimulation the4.

Discussion

pupillary area was decreased in size and the primary

Recent epidemiologic studies6) of patients withindicators of the parasympathetic nervous function,

headache in Japan indicate that 8.4% of the patientsmaximal pupillary contraction velocity, and maximal

suffer from migraine and 22.3% from tension headache,pupillary contraction acceleration were increased

indicating a significantly higher incidence for the(Figure 2a, b). Yet, no significant changes werelatter condition. This high incidence of tension

observed for the indicator of sympathetic nerve

headache makes it a good indication for acupuncture

function maximal pupillary dilatation. In healthy

treatment and the condition may be expected topeople, significant changes were not observed forcorrespond well to this treatment modality.

sympathetic and parasympathetic nerve function.

The author used plethysmography, EMGs andRegarding pupillary innervation, pupillary dilatation

thermography for an investigation of the mechanism ofis controlled by sympathetic nerves with their centersonset and the modes of action of the acupuncture

located in the spinal cord (C8-TH1). Pupillary

therapy and reported that the muscle groups of thecontraction on the other hand, is controlled byposterior neck region, as well as suprascapular andparasympathetic nerves having their center in theinterscapular muscles, play an important role in theEdinger-Westphal

development of headache. These results closely

central grey matter. Deduction from these acupuncture

resemble the findings observed during daily clinicaltreatment induced changes in pupillary reaction inpractice and indurations or tenderness in the posteriorpatients with tension headache, suggests an increase

neck and suprascapular muscles. These are frequently

in parasympathetic nervous function. These results

encountered. In the International Classification ofindicate that acupuncture treatment does not only act

Headache Disorders 2nd Edition as revised in 2004,

on the muscle groups in the posterior region of thetender spots are considered of pivotal importance. The

neck, supra and interscapular regions (via axon

effect of acupuncture treatment for these patientsreflexes), but probably also has an influence on higher

showed that wave amplitude and the electric discharge

centers. This influence on higher centers suggests a

from the muscles approached those of healthy persons,close relationship to the mechanism of action ofindicating that the acupuncture treatment led to aacupuncture analgesia.
The results of the investigation by the authors of
the influence of acupuncture treatment on cerebral
blood flow in patients with cerebrovascular disorders
reportedly revealed that the acupuncture therapy led

relaxation of the excessive muscle tension andimprovement

inhemodynamics.

Thermographic

examinations in the same patients revealed a skintemperature

distribution

showinghighernucleus

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

andthesurrounding5

Volume 1, Number 1 | Spring 2006

in a group of patients with markedly decreased
cerebral blood flow, to an improvement of the cerebral
circulation7). Among these results, the above describedacupuncture induced variations in pupillary reaction
in patients with tension headache. Healthy persons, onthe other hand, indicate that acupuncture treatment
elicits different reactions depending on the presence orabsence of symptoms and their severity. This clearlyshows that the treatment contributes to an
improvement in homoeostatic regulation.

5.

Future prospects

Content of the new International Classification ofDisorders 2nd Edition published in
September 2003 by the International Headache Society,also contained cephalagia2). Tension headache isclassified into the following 4 types: occasional
recurrent, frequently recurrent, chronic, plus a suspectform. For further subdivisions relevant diagnostic
criteria have been established. Adopting these criteria
for further investigations into the effects ofacupuncture based on EBM principles is required.
Regarding the mechanisms of onset progress inbiochemical investigations of the influences on higher
centers, will help to illuminate the pathophysiology
and clarify the modes of action of the acupuncture
treatment.

Headache6Reference
1) Headache Classification Committee of the International
Headache Society. Cephalalgia 8 (Suppl 7): 1-96，1988.
2) Headache Classification Subcommittee of the International
Headache Society. The International Classification ofHeadache Disorders, 2nd ed. Cephalalgia 24 (Suppl 1):1-160, 2004.
3)

Yamaguchi

S,MatsuoH,Omata

H,etal.:Thermography in Patients Receiving Oriental MedicalCare: Biomedical Thermology 8 (1): 185-187, 1988
4) Yamaguchi S: Influence of Acupuncture Treatment onPupillary Responses. Journal of the Japanese
Association of Physical Medicine, Balneology andClimatology 58 (4): 232-240, 1995
5) Yamaguchi S, Omata H, Arai C, et al.: Oriental

Medical Therapy for Tension Headache, (6th Report),
Japanese Journal of Headache 26 (1) 45-47, 1997
6) Igarashi H: Journal of The Japanese Society ofInternal Medicine 90 (4): 567-573, 20017) Maruki Y, Shimazu K, Okubo T, et al.: Effect ofacupuncture on cerebral blood flow in patients withCVD (abstr). Journal of Cerebral Blood Flow andMetabolism 9 (suppl.1): 695 1989, Raven Press, NewYork

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