Cerebral Hemodynamic Responses to Acupuncture in Migraine Patients: A Systematic Review

Abstract

We review the literature conjoining acupuncture, migraine, and cerebral hemodynamics. To do so, we searched PubMed in March 2013 for studies investigating cerebral hemodynamics with functional magnetic resonance imaging (fMRI), near-infrared spectroscopy (NIRS), transcranial Doppler (TCD) ultrasound, and other tools in migraineurs, acupuncture recipients, and migraineurs receiving acupuncture. Our search identified 1321 distinct articles – acupuncture (n = 463), migraine (n = 866), and both (n = 8). Only three (n = 3) satisfied our inclusion criteria. Based on these three, we found the following: (1) Acupuncture may positively influence not just dynamic, but also static cerebral autoregulation during the interictal phase, depending on the intervals between sessions of acupuncture as dose units. (2) TCD can detect pretreatment differences between responders and non-responders to acupuncture, which may be predictive of clinical response. (3) “Point-through-point” needling (at angles connecting acupoints) may be clinically superior to standard acupuncture, thus needling angles may affect treatment effectiveness. None of the reviewed articles investigated patient responses during migraine attack. Although the 2009 Cochrane review affirmed acupuncture as effective prophylaxis for migraine, few studies investigated the cerebrovascular aspects – only analyzing arterial blood flow, but not microcirculation. Future research is warranted in monitoring brain tissue oxygenation to investigate acupuncture as both a preventive and abortive treatment for migraine, varying the type and dose interval and analyzing variations in clinical response.

The Effects of Acupuncture on Cerebral and Muscular Microcirculation: A Systematic Review of Near-Infrared Spectroscopy Studies

“…Our query on June 9, 2014, produced ( n = 18) results. We excluded ( n = 3) reviews [ 10 , 43 , 44 ]. From a review, an additional three candidates, not covered in the database search, were added for consideration, of which only one was obtained and included [ 27 , 44 – 46 ].…”

“…In summary, the findings above indicate that the cerebral tissue oxygenation response to acupuncture, even in healthy young adults, varies widely, with no clear correlation to any single factor. Further research is required to investigate whether the variation in response carries over to subjects exhibiting dysfunction in cerebral autoregulation, as in stroke or migraine, since acupuncture has been found to have modulating effects [ 10 , 47 ]. We recommend that future investigations consider the following for control: population age and fitness/health level; acupuncture type and intensity of stimulation (number of sessions, frequency, and duration); and NIRS machine model and recorded parameters and the number and positioning of probe(s).…”

“…It is a safe, noninvasive technique but has limited reading depth, while the breadth of the monitored region depends on the number and placement of probes [ 19 – 21 ]. Nonetheless, its portability, ease of use, and high temporal resolution are significant advantages over the more spatially comprehensive BOLD-fMRI (blood oxygenation level-dependent functional magnetic resonance imaging), while its ease of use and focus on microcirculation make it an attractive alternative to transcranial Doppler ultrasound (TCD), which focuses on blood flow, usually in specific arteries [ 10 , 22 – 25 ].…”

A Systematic Review and Meta-analysis of the Therapeutic Effect of Acupuncture on Migraine

“…Given that migraine is characterized by elevated intracranial blood flow velocity and pulsatile headaches, TCD detection of intracranial hemodynamic changes can be used to evaluate the improvement of migraine symptoms (47). We, therefore, employed a meta-analysis to analyze the influence of treatment (acupuncture or medication) on intracranial blood flow changes as measured by TCD (Figure 4).…”

Integrative Health Services in School Health Clinics

“…Neuroimaging studies show that acupuncture can calm areas of the brain that register pain and activate those involved in down regulating the stress response . Doppler ultrasound has shown that acupuncture increases blood flow in treated areas (Lo, Lin, Wei, & Sun, 2013). Finally, thermal imaging shows that acupuncture can decrease inflammation (Santos et al, 2013;Stux, Berman, & Pomeranz, 2000).…”