For someone experiencing migraine, the impact may be greater still. Pain, nausea, sensitivity to light or sound, and the uncertainty of when another attack might happen can make planning difficult.
People sometimes ask me about acupuncture for headaches and migraine. It is an area where research has been carried out over many years, and where the National Institute for Health and Care Excellence (NICE) includes acupuncture among its recommendations for certain circumstances.
At Nature’s Qi Health in Forres, Moray, I offer traditional acupuncture within an individual, whole-person approach. Understanding your medical history and the nature of your headaches is an important starting point. In this article, I explain the different headache types, what NICE recommends, what the research suggests and what to consider if you are thinking about acupuncture.
Understanding the different types of headache
Headaches have many possible causes. Some are classified as primary headaches, meaning the headache disorder itself is the main condition. Others occur because of an underlying illness, injury or another identifiable cause. Tension-type headache and migraine are among the most common primary headache disorders.
Although they can sometimes overlap, they have different characteristics and may require different approaches to management. A diagnosis from an appropriately qualified healthcare professional helps establish which type you are experiencing.
Tension-type headaches
Tension-type headaches often involve a pressing or tightening sensation. The discomfort may affect both sides of the head and can extend into the face or neck. Pain is usually mild to moderate, and ordinary physical activity does not typically make it worse.
Some people experience tension-type headaches occasionally. Others have them much more frequently. NICE defines chronic tension-type headache as occurring on 15 or more days each month for more than three months. This distinction is important because the NICE acupuncture recommendation specifically concerns prevention of chronic tension-type headaches.
Migraine
Migraine is a neurological disorder involving recurring attacks that can include moderate or severe headache. The pain may be throbbing and can affect one or both sides of the head. Nausea, vomiting, sensitivity to light and sensitivity to sound are common features.
An untreated migraine headache in adults typically lasts between four and 72 hours, although individual experiences vary. Some people experience an aura before or during an attack. An aura may involve temporary visual disturbances, such as flashing lights or zigzag patterns, or changes in sensation or speech.
Migraine can occur with or without aura. New or unusual neurological symptoms require medical assessment, even if you have experienced migraine before.
Headaches caused by medication overuse
Regular use of medicines intended to relieve headaches can sometimes contribute to further headaches. This is known as medication-overuse headache. It can develop in people who already experience migraine or tension-type headaches.
The risk depends on the medication and how frequently it is taken. If you find yourself needing headache medication regularly, discuss this with your GP or pharmacist. It is important to manage medication changes appropriately rather than stopping prescribed treatment without advice.
What does NICE recommend about acupuncture for headaches?
NICE publishes evidence-based guidance to support healthcare decisions in England. Its guidance is also a useful clinical reference for people in Scotland, although NHS Scotland has its own services and arrangements. The relevant guideline is CG150: Headaches in Over 12s: Diagnosis and Management.
It includes two specific recommendations concerning acupuncture.
Acupuncture for chronic tension-type headache
NICE recommends considering a course of up to 10 acupuncture sessions over five to eight weeks for the prevention of chronic tension-type headaches.
The word prevention matters here.
The recommendation concerns reducing the occurrence of future headaches rather than using acupuncture as an emergency treatment during an acute headache. It also applies specifically to chronic tension-type headache, which has a defined frequency and duration.
Someone experiencing occasional headaches may have different treatment needs.
Acupuncture for migraine prevention
NICE also recommends considering acupuncture for migraine prevention in certain circumstances.
Its current guidance says that when propranolol, topiramate and amitriptyline have been ineffective, are poorly tolerated or are unsuitable because of safety concerns, a course of up to 10 acupuncture sessions over five to eight weeks may be considered.
The person’s preferences, other health conditions and risks should inform that decision. These are medicines used in migraine prevention, and the choice between treatment options belongs within appropriate medical care. This recommendation should not be interpreted as suggesting that everyone with migraine needs to try acupuncture, or that acupuncture is superior to recommended medicines.
The NICE headache guideline, CG150, provides the full recommendations and clinical context.
What does the research tell us?
Research into acupuncture for headache prevention includes randomised controlled trials and systematic reviews. Studies have compared acupuncture with usual care, no acupuncture and sham acupuncture, in which a control procedure is used to help investigate the specific effects of needling.
Overall, there is evidence that acupuncture can reduce headache frequency for some people, particularly in the areas reflected in NICE guidance. The size of the benefit varies, and acupuncture does not help everyone.
Evidence for tension-type headaches
A Cochrane systematic review examined acupuncture for the prevention of tension-type headaches. It included 12 randomised trials involving 2,349 participants. The review found that acupuncture may be a useful option for people with frequent episodic or chronic tension-type headaches.
Some trials reported reductions in headache frequency compared with usual care and smaller benefits compared with sham acupuncture. The findings informed the continuing discussion of acupuncture’s role in headache prevention.
Evidence for migraine prevention
A separate Cochrane review examined acupuncture for preventing episodic migraine. It included 22 trials involving 4,985 participants. The researchers found that adding acupuncture to symptomatic treatment reduced headache frequency compared with symptomatic treatment alone, and that acupuncture showed a small benefit over sham acupuncture.
The review also suggested that acupuncture may be at least similarly effective to some preventive medicines in the studies examined, with fewer participants reporting adverse effects. These comparisons require care. Trial designs, medicines, treatment methods and participant groups differ, and results should not be treated as a guarantee for an individual patient.
The research supports considering acupuncture as one possible preventive approach in appropriate circumstances.
What can acupuncture reasonably be expected to do?
In the UK, the Advertising Standards Authority accepts carefully qualified claims about short-term relief of tension-type headaches and migraine headache. The evidence does not support promises of a cure, permanent relief or prevention of every future attack.
It is also important to distinguish the ASA’s advertising guidance from NICE’s clinical recommendations. NICE assesses treatment options for particular patient groups within healthcare pathways. The ASA considers whether claims made in advertising are adequately supported.
Both are relevant when explaining acupuncture accurately. You can read the ASA guidance on acupuncture claims.
How does acupuncture work?
Traditional East Asian medicine and modern biomedical research describe acupuncture through different perspectives. Within traditional medicine, acupuncture points are selected according to the relationships between Qi, meridians, Yin and Yang, and the Five Phases or Elements.
Qi is often translated as vital energy, although its meaning in classical East Asian medicine is broader. The traditional concept of meridians describes pathways through which Qi is understood to move. These are classical medical concepts and have not been established as measurable anatomical pathways by modern science.
Contemporary research has investigated how acupuncture stimulation may influence sensory nerves, pain processing and other physiological responses. Studies suggest that needle stimulation can affect nervous-system activity, but the precise mechanisms underlying clinical outcomes remain under investigation.
The effects seen in trials may involve several interacting factors. I find it important to respect the history of the medicine I practise while remaining attentive to contemporary research.
My approach to headaches at Nature’s Qi Health
When someone comes to me with a history of headaches, I begin by listening. How long have the headaches been occurring? How often do they happen? What has changed over time? Have you received a diagnosis? Are you taking medication? Have you noticed any particular circumstances associated with the headaches?
We also discuss your wider health. Sleep, food, movement, work, emotional wellbeing, medical history and daily routines may all be relevant. These conversations help us understand your circumstances and consider whether acupuncture is appropriate.
Every person has their own experience
Two people may both have migraine, yet their experiences can be quite different. One may have attacks associated with menstruation. Another may notice changes in headache frequency during periods of disrupted sleep. Some people experience aura. Others never do.
These details matter when discussing headache management with your healthcare professional and when considering an acupuncture appointment. Traditional East Asian medicine also places importance on individual patterns. I consider the person as a whole, while recognising that a medical diagnosis and appropriate conventional treatment remain essential.
Choosing an acupuncture approach
I practise traditional Chinese acupuncture and Saam Korean acupuncture. Saam is a Korean system that commonly uses four carefully selected points, often on the hands, arms, feet or lower legs. Its point combinations are based on classical relationships within the Five Phases and meridian system.
Saam’s simplicity, and the care in how it chooses points, have become an important part of my practice. You can explore this further in Saam Korean Acupuncture: The Gentle Four-Needle Approach. There is currently insufficient comparative evidence to establish that Saam is more effective than other acupuncture systems for headache prevention.
The NICE recommendations concern acupuncture generally and do not identify Saam as a superior method.
Working collaboratively
Before treatment, we discuss the approach I am considering and any relevant safety information. You can ask questions and share your preferences. Some people feel a brief tingling, heaviness or dull ache when an acupuncture needle is inserted. Others notice very little.
I encourage you to tell me how you feel. We can adjust or stop the treatment at any point. Your experience helps guide our decisions as we go.
Keeping a headache diary
One of the most useful things you can do before seeking treatment for recurring headaches is to keep a headache diary. NICE recommends considering a diary both to support diagnosis and to monitor the effectiveness of treatment. It suggests recording information for at least eight weeks when the diary is being used to help establish a diagnosis.
A diary may include:
- The date and duration of each headache
- How severe the pain was
- Where the pain was located and what it felt like
- Associated symptoms, such as nausea or sensitivity to light
- Medication taken and the amount used
- Possible triggers or circumstances preceding the headache
- Any relationship with menstruation
- You may begin to recognise patterns that were difficult to see from memory alone.
A diary can also help your GP or headache specialist assess whether treatment is making a meaningful difference.
Looking for patterns without assuming a cause
It can be tempting to attribute every headache to a particular food, activity or stressful event. Sometimes a relationship is clear. At other times, the apparent pattern may be coincidental. Migraine triggers can also interact, and what seems relevant on one occasion may have little effect another time.
A diary provides a more reliable record for discussion with your healthcare professional. I value this attention to observation. It is also consistent with my wider approach to acupuncture: listening to what you experience and reassessing as circumstances change.
Headaches, stress and everyday life
Living with recurring headaches can affect sleep, work, relationships and the activities you enjoy. There may also be times when emotional demands or disrupted routines coincide with an increase in headache frequency. These relationships are complex.
Stress is one possible influence for some people, but migraine is a neurological disorder and should never be dismissed as simply a response to stress. The same applies to persistent or changing headache symptoms that require medical assessment.
At Nature’s Qi Health, I am interested in understanding the different aspects of your experience. We may discuss sleep, activity, food, work and how you are managing the demands of everyday life. My article on acupuncture for stress and emotional wellbeing explores the traditional whole-person approach and the limits of current research.
If persistent discomfort elsewhere in the body is also a concern, you may find Acupuncture for Chronic Pain: What Does the Research Say? helpful.
Headaches during perimenopause and menopause
Some women notice changes in migraine frequency during perimenopause. Fluctuating hormone levels may influence migraine patterns, and changes in sleep can also affect everyday wellbeing. For some women, migraine improves after menopause. For others, it continues.
Menstrual migraine and migraine associated with hormonal transitions require individual assessment and appropriate management. Acupuncture’s role should be considered in relation to the diagnosed headache condition and the evidence for that condition.
It should not be presented as a method of balancing reproductive hormones. You can read more about this stage of life in Acupuncture and Menopause: Women’s Health Through Life’s Changes.
When a headache needs urgent medical attention
Most headaches are not caused by a serious underlying condition, but some symptoms require urgent assessment. Seek emergency medical help for a sudden, extremely severe headache, particularly one reaching maximum intensity within minutes.
Other warning signs include:
- A headache with new weakness, difficulty speaking, confusion or loss of consciousness
- Headache accompanied by fever, neck stiffness or a concerning rash
- New visual loss or severe eye pain
- A significant change in your usual headache pattern
- A new headache following a head injury
- A new headache with scalp tenderness or jaw pain when chewing, particularly in someone over 50
Some situations require immediate emergency assessment; others require prompt medical advice. If you are unsure about the urgency, seek professional guidance. In Scotland, NHS 24 is available on 111 for urgent non-emergency advice, and 999 should be used for emergencies.
Acupuncture should never delay necessary investigation or medical treatment.
What to expect at an acupuncture appointment for headaches
Your first appointment at Nature’s Qi Health begins with a discussion of your health and headache history. I will ask about any diagnosis, medications, investigations and treatments you have already received. If you have kept a headache diary, you are welcome to bring it.
We discuss whether acupuncture is appropriate and what the treatment would involve. Traditional acupuncture uses fine, sterile, single-use needles at selected points. Depending on the approach, these may be placed on the arms, legs, hands, feet or other areas.
The number and location of needles vary according to the treatment. Minor bleeding, bruising, soreness or lightheadedness can occur. Rare serious complications are possible. Please tell me about pregnancy, anticoagulant medication, bleeding disorders, relevant medical conditions and any previous adverse reactions.
A standard appointment lasts approximately one hour and costs £70. You can find more practical information in Your First Acupuncture Appointment in Forres: What to Expect.
