HEADACHE

Headache is one of the most common physical complaints. Almost everyone has a headache at some point in their life, and it appears as a symptom accompanying many diseases discussed in any medical book. Although it is usually seen as a minor ailment, it can be a sign of serious diseases. Therefore, every patient with headache needs careful observation and detailed examination.

Treatment of headaches with acupuncture should be addressed by considering the type of headache and the cause of its occurrence. There are two types of headaches commonly encountered in acupuncture practices. These are vascular and tension-type headaches.

TYPES OF OCCURATION OF HEADACHES

To date, the mechanisms of cranial structures that exacerbate headache have been investigated by different experts and clinical analyses. Wolff showed that nearly all structures of the skull and face are pain sensitive. The periosteum of the skull bones is already sensitive to pain. Not all intracranial structures within the cranium are pain sensitive. The venous sinuses and cortical vessels flowing towards them, the hard membrane of the anterior and posterior pit, the cerebral arteries at the base of the circle of Willis, and the paroxymal portions of the major arteries ascending from them, and the fifth, ninth, and tenth cranial nerves that carry pain fibers from these intracranial structures are pain sensitive structures. The pia-arachnoid and most of the remaining parts of the dura mater, the ependymal membrane of the ventricles, the choroid plexus, and the brain itself are insensitive to normal pain stimuli.

When pain arises from structures above the cerebellum tent, it usually affects the frontal, temporal, and parietal regions of the head and is transmitted via the fifth cranial nerve. Pain arising from the stimulation of the structures below the cerebellum tent usually manifests itself in the occipital, lower occipital and upper cervical regions and is transmitted via the ninth and tenth cranial nerves, as in the upper three cervical nerves.

The main factors of headache are as follows:

1. Dilation and relaxation of the intracranial and extracranial blood vessels referred to above.

2. Inflammation of the pain-sensitive structures of the head.

3. Meningeal irritation.

4. Direct pressure on the sensitive nerves in the head.

5. Changes in intracranial pressure

6. Pain radiating from harmful stimulus elsewhere in the head.

7. Psychogenic causes|- The pain is caused by the constant contraction of the muscles in the head and neck, and in some cases possible enlargement of the cephalic vessels.

ACUPUNCTURE TREATMENT

Although modern drugs do not relieve headaches, acupuncture is still seen as a last resort. However, acupuncture is a method that can be safely applied in all cases of the disease, especially in chronic headaches with recurrent attacks. It can also treat drug addiction caused by illness.

Selection of acupuncture points [1]

Whole head occipital region

Baihui (YD-20)
Fengchi (SK-20)
Fengchi (SK-20)
Houding (YD-19)
Taiyang (Extra-2)
Hegu (NW-4)
Hegu (KB-4)
Kunlun (Me-60)
Lieque (L-7)
Fengfu (YD-16)
Kunlun (HR-60)

Frontal region

Weizhong (HR-40)
Yintang (Extra-1)

Temporal zone

Zanzhu (Me-2)
Taiyang (Extra-2)
Hegu (NW-4)
Fengchi (SK-20)
Taichong (Ka-3
Hegu (KB-4)
Yangbai (SK-14)
Yanglingquan (SK-34)
Neiting (Mi-44)

Parietal region

Baihui (YD-20)
Fengchi (SK-20)
Hegu (KB-20)
Taichong (Ka-3)
Taixi (K-3)

Acupuncture points are determined according to the location of the head and always 2-4 points are needled bilaterally.

[1] Note: Standard Acupuncture Terminology determined by WHO is used for each acupuncture point in this book.

Acupuncture Manipulation

The needle is inserted with a quick insertion to achieve a strong "deqi" sensation. When this feeling is felt at the highest level, depending on the degree of pain, the needle is moved for 1-2 minutes in the form of rotation, pricking or pricking-rotation. Usually, the needles stay for 20-40 minutes and are stimulated for 1-2 minutes at 10-minute intervals.

The most effective course of acupuncture treatment for chronic headache is 1-3 cycles, once a day or every other day. A cure consists of 10 sessions. If the patient does not respond positively to the treatment, the treatment can be interrupted for 3-5 days and different acupuncture points are selected for the next sessions, or electro-acupuncture may be better than any other treatment. Ear points, forehead, occipital and mandible are pinned bilaterally using permanent needles, which are replaced after three days each time.

Most patients respond to the first 10 sessions.

TENSION TYPE HEADACHE

Previously used terms were stress headache, muscle tightness headache, psychogenic headache, normal headache, idiopathic headache, and essential headache.

The majority of headaches are caused by tension, anxiety and depression. These are the most common, and it is likely that most of the population has experienced tension-type headaches at some point. The diagnosis of tension-type headache should be made when the physical examination does not reveal sufficient findings and if the patient's complaints include headache. These headaches can be continuous and usually occur towards the end of the day and the patient complains of pain that seems to last for weeks or months. It is rarely severe and disrupts sleep, but pain relievers are usually ineffective. The exact mechanism of tension-type headache is unknown. One of the causes of tension-type headache is the involuntary continuous contraction of the skeletal muscles of the head and neck, which is of mental or physical origin. Such tension-type headaches are usually of a suppressive and squeezing character, of moderate to mild severity, bilateral and the pain does not increase with physical activity, and is usually manifested as a wrap around the head or a pressure sensation in the vertex. Tension headaches are often described by patients with terms such as "clamp-like", "crushing", "unbearable", and "feeling like a fingernail is being moved towards the skull or a machine pressing on the top of the head". If the pain occurs in the neck, it may radiate to the shoulders.

Case History

WH is a female patient who has been suffering from headaches for two years. The patient said he suffered from ongoing headaches. "It feels like a weight is right above my head, and I usually feel like there is a tight bandage around it, and sometimes I feel a stiffness in my neck. It goes on all day, but it doesn't interrupt my sleep. I took painkillers, my pain did not go away." he stated.

The patient's examination results were normal.

This is a typical tension-type headache. Direct interrogation revealed that the patient's illness began after an argument with a neighbor.

Treatment and Acupuncture Cure

Acupuncture treatment was initiated as designed above. Bilateral acupuncture points, Fengchi (SK-20) and Hegu (KB-4) and single point Baihui (YD-20) were selected. The acupuncture points mentioned above were simultaneously needled. The needles remained in place for 30 minutes. A total of twenty sessions were applied. After the fourth session, there was no pain left. No pain was reported during the ongoing sessions.

Follow-up

During the following 10 months, the patient did not experience any pain.

Case History

GK is a 22-year-old male patient with a 3-year history of pain. He had a bicycle accident that resulted in a brief loss of consciousness. After regaining consciousness, he began to suffer from headaches without nausea and vomiting, and since then he has had constant but mild pains, sometimes with a feeling of pressure at the top of the head, due to poor memory and difficulty concentrating. He received modern medicine and traditional Chinese herbal treatment. But it ended in failure. The patient's examination results were normal. EEG, CT scan and CSF results were also unremarkable.

It is common for headaches to occur following minor head injuries. In short, the vast majority of headaches that occur after a minor head injury are usually associated with contraction of the muscles of the head and neck. It also resembles a tension-type headache caused by concerns over minor injuries rather than a direct trauma.

Treatment and Acupuncture Cure

The patient was treated as described below.

Ear Acupuncture: Forehead, occipital and mandible points were stimulated with permanent press needles.

Body points: Baihui (YD-20), Fengchi (SK-20), Hegu (IB-4).

A 12-session treatment was applied for six weeks. The pain decreased during the initial treatment. There was no pain at the end of the treatment.

Follow-up

There was no return of headaches for the following 8 months.

VASCULAR HEADACHES

Many clinical headaches of vascular origin cannot be classified as only intracranial or extracranial; headaches, especially those associated with fever, infection and migraine.

Migraine Headache

Migraine headaches are mainly extracranial. It is one of the most common neurological disorders. It is a familial disease. Family history is addressed in at least 60% of patients. Migraine is more common in intelligent people and people with professional occupations. Environmental factors may contribute to the onset of attacks and, in rare cases, migraine is initiated by pressing lesions such as aneurysms or angioma.

This group of headaches consists of 7 major categories defined and classified by the Classification Committee of the International Headache Society : (Cephalagia, 1988, Vol 8, Supplement 7, 19-28)

1. Migraine Without Aura

It is an idiopathic disease that occurs in attacks lasting 4-72 hours and recurs. Typical characteristics of headache are unilateral location, mild or severe intensity, increase as a result of routine physical activity, and association with nausea, photo- and phonophobia.

2. Migraine with Aura

Previously used terms are classic migraine, ophthalmic-, hemiparetic-, hemiplegic-, aphasic migraine, and complicated migraine. It is a recurrent idiopathic disease that presents with attacks of neurologic symptoms that can be clearly localized to the cerebral cortex or brainstem. It usually occurs over 5-20 minutes and lasts less than 60 minutes. Headache, nausea, and/or photophobia are symptoms that usually come directly or come after an interval of less than an hour. Headache usually lasts 4-72 hours, but may disappear completely.

3. Ophthalmoplegic Migraine

It is characterized as recurrent attacks of headache due to paralysis of one or more ocular nerves in the absence of intracranial lesions.

4. Retinal Migraine

It is characterized as unilateral transient blindness or recurrent episodes of blindness lasting less than an hour and is associated with headache. Ocular or vascular disorders should be ruled out.

5. Childhood Periodic Syndrome

The term used earlier is equivalent to migraine.

6. Migraine Complications

7. Migraine disorder that does not meet the above criteria

Headaches that are thought to be a form of migraine but do not fully meet the operational diagnostic criteria for any of the migraine types.

Migraine without aura and migrainous disorders that do not meet the above criteria are mostly encountered in acupuncture practice.

Case History

KZ is a 28-year-old female patient with periodic headaches for five years. Headache usually occurred in the temporal region. While it was initially one-sided, it later became bilateral and even generalized. The pain only hit the head during this process, and then it was replaced by a constant pain and lasted for hours during the day. Perhaps attacks occurred several times a month. Nausea and vomiting were infrequent. There were no symptoms before the headache. The pain did not respond to aspirin at a dose of 0.3 to 0.6 gm, and recurred every two hours. Small amounts of barbiturates, caffeine, or amphetamines also did not provide benefits. Pain was moderate to severe. When pain worsened, 60 mg of codeine phosphate was required and ergotamine tartrate did not relieve pain. The patient's mother also had a similar condition.

The examination result showed that the patient was mentally active. His mental state was normal and no abnormal neurological findings were found.

This is a case of migraine vascular headache.

Treatment and Acupuncture Cure

The patient was treated as described below.

Ear Acupuncture: Forehead, occipital and mandible points were stimulated with permanent press needles.

Body points: Taiyang (Extra-2), Fengchi (SK-20), Hegu (KB-4).

Both Auricular Acupuncture and body acupuncture were applied simultaneously twice a week. Ten sessions were applied, no attack occurred after the third session.

Follow-up

The patient did not experience any attacks in the following 10 months.

HEADACHE CAUSED BY MENINGIAL IRRITATION

Meningeal irritation is the cause of many severe headaches. The typical persistent, pounding or burning headache. It is often associated with other manifestations of meningeal irritation, such as nuchal rigidity and Kernig's sign, which is characterized by inflammatory involvement of nerve roots originating from the cervical cord that produces reflex muscle spasm . The pain increases with moving the head and decreases when lying on the bed motionless. Pain is caused by various types of meningitis or the introduction of non-infectious foreign irritants into the subarachnoid space, such as extravasated blood (subarachnoid hemorrhage), air (pneumoencephalography), radiopaque fluid (myelography).

Therapeutic Approach

Treatment of headache caused by meningeal irritation is symptom-oriented. Acupuncture therapy can be applied as a complement to relieve the patient from pain. Two-sided Taiyang (Extra-2), Fengchi (SK-20), Hegu (KB-4) and one-point Baihui (YD-20) are selected. The needle is manually or electrically stimulated to obtain very strong stimulation. When maximum sensation is achieved, the needles are manually stimulated and maneuvered for 1-2 seconds. The needles remain in this position for approximately one hour and are stimulated at 5-10 minute intervals if the pain is severe. Patients are treated once a day. A course of treatment consists of nine sessions.

If the patient does not respond well to the treatment, the acupuncture treatment is discontinued.

HEADACHE CAUSED BY INTRACRANIAL COATING LESIONS

Headache caused by intracranial neoplasm and abscess is usually caused by compression or deformation of the dura (one of the membranes of the IK), intracranial blood vessels, and changes in intracranial pressure and sometimes direct pressure on sensitive nerves. This is often described as a throbbing or burning pain and often comes in bouts. It occurs most often at night and early in the morning. With the gradual growth of the tumor, the headache tends to become longer and more persistent. Headache usually manifests itself with exertion, enthusiasm, sneezing, coughing, bending over, vomiting and bending over the stool (during ablution), and perhaps worst of all, when the patient wakes up in the morning. Pain can be affected by the position of the body. For example, it can happen when the patient lies down or lies on one side. This pain may be relieved when a normal sitting arrangement is taken.

It is often associated with other signs of increased intracranial pressure, such as papilledema and vomiting, but not all of these symptoms and signs need to be present to diagnose an intracranial tumor.

Therapeutic Approach

The treatment of headache caused by intracranial covering lesions is based on the cause. If the lesion is inoperable, acupuncture therapy can be used to reduce pain.

The technique applied is the needling of Baihui (YD-20), Taiyang (Extra-2) and Hegu (KB-4) acupuncture points. Usually the needles stay for an hour. The treatment is applied once a day for 10 sessions in total. No electrical stimulation is used in the treatment of headache caused by the tumor. Simultaneously, the ear points, forehead, occipital and mandible can be pricked using permanent press needles. Four to nine sessions make up a cure.

If the patient does not respond well to treatment, acupuncture is discontinued.

HEADACHE TO SEND

Referred pain is pain felt far from the place of origin. This term is defined as pain and discomfort occurring along the top of the head from the orbital socket to the suboccipital region. But the place where the pain is felt does not have to be the same as the stimulated area. It may also be felt in another part of the body (S-directed pain). In many cases, painful conditions affecting the extracranial suture can cause referral headaches. The localization of referred pain is related to regions supplied by the same segments of the nervous system; eg. A patient with heart disease may feel the pain in the left inner part of the upper extremity because the nerve flow to both the heart and the inner left part of the upper extremity is the same.

The source of the pain may be the face, teeth, and neck and may radiate to the area described above. As a result, in the examination of a patient with headache, primarily painful conditions arising from the disorders of the following organs should be considered.

Eye: glaucoma, uncorrected visual defects or patent strabismus, iritis, optic neuritis.

Nose: nasal congestion, nasal sinusitis.

Upper pharynx: carcinoma of the nasopharynx.

Mouth: dental caries.

Ear: middle ear lesions.

Temporal artery: temporal arteritis.

Neck: cervical spondylosis.

Headache radiating from the eyes, nose, sinuses, or teeth may be associated with fifth cranial nerve divisions. Headache radiating from the ear is either related to the forehead region or most likely related to multisensory innervation by branches of the fifth, seventh, ninth, and tenth cranial nerves at the back of the head, as well as the upper cervical nerves.

Therapeutic Approach

Treatment of referral headache is directed to the cause.

CLINICAL RESEARCH ON ACUPUNCTURE TREATMENT OF HEADACHE

Clinical Therapeutic Results of Acupuncture

Two hundred and twenty-four tension-type and vascular headaches were treated with acupuncture. Each patient was examined by neurologists. The diagnosis of vascular and tension-type headaches was made on the basis of clinical criteria. Patients with organic disorders were excluded as a result of laboratory and radiology studies applied to each patient. The patients' symptoms could not be cured by modern medicine.

All cases consisted of three groups, group A (64 cases), B (53 cases), and C (107 cases). Group A patients received body acupuncture, group B patients received electro-acupuncture, and Group C patients received auricular acupuncture. Positive outcome rates in Groups A, B, and C were 76.5, 84.9, and 81.2 percent, respectively.

NEURALGIA

Neuralgia is not a psychological but a physical chronic nervous disease.

The term "neuralgia" refers to paroxysmal pain that occurs along a nerve. Unfortunately, the term is often used by patients to refer to a state of nervous disorder, and sometimes by physicians to describe any ambiguous, focal condition. In fact, it is not a psychological but a physical chronic nervous disease. Before a diagnosis of neuralgia can be made, nerve disorders with properly pathological lesions, referential pain from an internal organ, and neurotic disorders must be ruled out. There are also histopathological changes in this disorder. Physical, neurological, routine laboratory, radiological, CT scan, EEG and CSF examinations are perfectly normal examinations for patients with neuralgia.

Trigeminal neuralgia, occipital neuralgia, herpes zoster and postherpetic neuralgia are the most common cases in acupuncture practice.

TRIGEMINAL NEURALGIA

Trigeminal neuralgia is characterized by attacks of paroxysmal pain involving one or more of the trigeminal nerve. The cause of the disease is unknown. Also, little is known about its pathology and mechanism. Since it mostly involves the middle and inferior divisions, the teeth are usually seen as the cause of the pain, and the extraction of one or more teeth can also be the cause of this pain. In true trigeminal neuralgia, no neurological deficit is observed in the examinations performed through normal tests. Men and women are equally affected. While it is usually seen in middle-aged adults, it is not very common in advanced age.

It is the most severe craniofacial pain. It appears suddenly. The pain is of a scratching nature, a simple pain may last for a few seconds, but usually a series of such pains follow each other at close intervals. In most cases the pain is in the second and third divisions. Second division pain radiates throughout the upper jaw and third division pain radiates throughout the lower jaw. The first division is rarely affected and the pain radiates across the forehead. Pain may also begin with facial movements and touching parts of the face.

And it can also occur during eating, shaving, laughing, and even talking and washing the face.

Trigeminal neuralgia can be bilateral, but both sides never occur at the same time. The attack may last only a few days or a few weeks, if left untreated it tends to continue for months or years. However, regression in discomfort is not very common.

ACUPUNCTURE TREATMENT

Selection of Acupuncture Points

The main acupuncture points are applied according to the location of the branches where the pain occurs. 3 to 5 points are pinned each time.

First division of the fifth cranial nerve Second division of the fifth cranial nerve

Touwei (S-8)
Sibai (S-2)
Zanzhu (HR-2)
Chengqi (S-1)
Sizhukong (TE-23)
Xiaguan (S-7)
Taiyang (Extra-2)
Yingxiang (KB-20)
Yangbai (SK-14)
Quanliao (IB-18)

Third division of the fifth cranial nerve

Xiaguan (S-7)
Jiache (S-6)
Dicang (S-4)
Chengjiang (CV-24)

Additional points: 2-3 points are chosen to get a good response.

To blow the "wind":

Fengchi (SK-20)
Yifeng (TE-17)

For tonification:

Sanyinjiao (Da-6)
Zusanli (S-36)
Baihui (YD-2)
Taichong (Ka-3)
Hegu (KB-4)

For symptom relief, the above-mentioned points should be used together, but sometimes a combination of points may be needed because trigeminal neuralgia is a very painful condition. The patient often experiences mental stress as well. Therefore, using the Heart Shu point or other ports will increase the effect, especially in long-term cases.

Acupuncture Manipulation

The technique consists of needling the acupuncture points until the "deqi" phenomenon as mentioned above is reached. The needles are then manipulated by hand for 1-2 hours by inserting and lifting and turning-twisting them counterclockwise. The needles are then attached to the electrical stimulator. Intermittent current is applied with a frequency of 3 seconds for 30 minutes.

The patient is treated once a day until 10 sessions are completed.

If progress is made, sessions are resumed. If a set of acupuncture points does not produce any results after 10 needlings, the points are changed.

Case history

ZS is a 43-year-old female patient who has been suffering from severe, frustrating, and seizure-like pain in the lower right half of her face for about two years. The pain started in the lower jaw and then spread to the upper jaw. The pain started suddenly and lasted only a few seconds and then disappeared completely, but a series of similar pains followed one after another. The number of attacks varied from day to day. There were times when the pain woke him from sleep, and activities such as talking, eating, brushing his teeth, and washing his face increased his pain. The patient's teeth were shown as the cause of the pain and 4 of them were extracted. The patient did not respond to carbamazepine. He said the pain was "the worst pain in the world".

The studies did not yield any significant results. During a sudden attack, he suddenly held his face and became worried for 1-2 minutes. There were bouts of pain due to contact in the right corner of the mouth.

This is a typical case of trigeminal neuralgia involving the second and third divisions.

Treatment and Acupuncture Cure

The patient was treated as shown below.

Xiaguan (S-7), Sibai (S-2), Jiache (S-6), Dicang (S-4), Fengchi (SK-20), Sanyinjiao (Da-36), Zusanli (S-36) points are used .

Ten sessions were applied. After 8 sessions, there was no attack.

Follow-up

The patient was normal during the one-year follow-up treatments.

Occipital Neuralgia

Pain radiating from the back of the head to the vertex is very common, and the term occipital neuralgia is often used by many physicians. Occipital neuralgia is not well defined and the existence of primary idiopathic occipital neuralgia is uncertain. Pain in the occipital region can often be a manifestation of some underlying factors such as neck spine disorders, myositis, osteoarthritis or foramen magnum and spinal cord tumors, and even serious intracranial diseases. In terms of the treatment of the disorder, it is very important to eliminate the underlying causes before the diagnosis of occipital neuralgia is made.

The pain is usually bilateral and continuous, but it may become paroxysmal by penetrating the head, behind the ear, and vertex. It is severe. Sneezing and coughing or laughing can increase the pain. For this reason, the patient usually keeps his neck straight. There may be hyperesthesia throughout the occipital region. A tenderness along the occipital nerves below the occipital mound is common.

ACUPUNCTURE TREATMENT

Selection of Acupuncture Points

Key Points

Fengchi (SK-20)
Tianzhu (HR-10)
Huatuojiaji (Extra points C2, C3, C4 spinal
placed 0.5 inches from the protrusions)

Additional point

Tongtian (HR-7)
Chengguang (HR-6)
Four to six acupuncture points were pricked at a time.

Acupuncture Manipulation

When the Fengchi point is pinned, the needle should be placed perpendicularly, then the tip of the needle should be opposite the zygomatic bone, indicating that the direction of needling is diagonal. 1-1.5 cm needling depth is sufficient. If the Tongtian and Chengguang points are pricked, the direction of the needle tip should be towards the painful area. If the Huatuojiaji points are pricked, the needle body should be parallel to the spine, below the subcutaneous tissue and in the caudal direction.

The needle is manipulated until it reaches the "deqi" phenomenon, and then after the needles are inserted into the electric stimulator and adjusted to the reciprocating current with a frequency of 2 seconds for 30 minutes, the needle is lifted and inserted and rotated counterclockwise for 1-2 minutes at a frequency range of 120 per minute.

One session per day is applied to the patient. One cure treatment consists of 10 sessions.

If a set of acupuncture points does not produce any results after four needlings, the points are replaced.

Usually, one or two cycles of treatment achieves the desired effect.

Case History

CG is a 56-year-old male patient who has had a headache along the back of his head for six months. The pain was severe, dull and radiating to the vertex, increasing paroxysmally with head movement. The patient kept his head upright. Analgesics did not have a positive effect on the patient.

Physical, neurological, routine laboratory, CSF and radiological examinations of the patient were normal, except for the painful points at the exit of the occipital nerves.

This is a case of "occipital" neuralgia.

Treatment and Acupuncture Cure

The patient was treated as described below.

A number of acupuncture points were selected: bilateral Fengchi, right Huatuojiaji C2 and left Huatuojiaji C3, and bilateral Tongtian. The patient received treatment once a day. The intensity of the pain decreased gradually after the fourth session and there was mild pain at the end of the first course. The pain subsided after the fourth session of the second cycle.

Follow-up

The patient did not experience any pain for the following nine months.

HERPES ZOSTER AND POSTHERPETIC NEURALGIA

Herpes zoster is a disease caused by a virus involving the posterior spinal root and its nerve node and posterior horn of the spinal cord. Mild to severe pain may begin before the rash or the pain may continue after the rash has disappeared. If the pain persists for more than a month after the vesicles appear, a diagnosis of postherpetic neuralgia should be sought.

Postherpetic pain is a unilateral, severe pain of a burning, stabbing-like character and is probably the result of scar tissue formation in the involved areas. Relief of pain is indicative of a different therapeutic problem. It is usually seen in middle-aged and elderly people. It is seen at the same rate in men and women. Herpes zoster may be symptomatic and may occur due to malignant diseases such as tuberculosis and trauma.

ACUPUNCTURE TREATMENT

Selection of Acupuncture Points

Main points:

The "containment" method is used, that is, the rash or pain is surrounded by needles. In addition, a needle is inserted every 2.5 cm along the center of the rash area towards the center of the lesion. The posterior shu points along the bladder canals are selected according to the relevant nerve, adhering to the backbone.

Additional points:

For tonification:

Zusanli (Mi-36)
Sanyinjiao (Da-6)
Baihui (YD-20)
Taichong (Ka-3)

Acupuncture Manipulation

The needle is manipulated by rotating it counterclockwise until the feeling of "deqi" is felt, then the needles are attached to the electrical stimulator and current is applied in a continuous fashion at a frequency of 30 minutes and 2 seconds at bearable intensity.

Treatment consists of 10-session cures once or twice a day.

If the patient progresses, treatment continues. If a set of acupuncture points does not produce any results after 10 needlings, another set of points is selected.

Case History:

KP is a 60-year-old female patient suffering from left chest and back pain for 4 days. The patient, who was in good health before, suddenly started to have a pain in his left chest, and as a result, heart disease was suspected. ECG was normal. Within a few hours, it was followed by a ridge. The pain was tedious, burning and unbearable. He disturbed his sleep. Two days later, herpetic eruption was found on the back. The patient received conventional treatment, but no results were obtained.

This is a typical case of herpes zoster.

Treatment and Acupuncture Cure

The patient was treated with the "containment" method. Ten sterile needles were placed around the herpetic lesions. The needle tips were directed to the center of the skin lesions. After the pricking sensation was captured, the electrical stimulator was attached to the needles. The output intensity did not cause any pain to the patient. Each point was stimulated for 30 minutes. At the same time, Zusanli and Sanyinjiao points were pricked, the patient was treated once a day for the first week, then every other day. After three sessions, the patient felt better and the pain was noticeably reduced. The pain disappeared after 8 sessions. The patient received a total of 15 sessions.

Follow-up

During the following year, the patient did not experience any pain.

GLOSOPHARYNGEAL NEVRALGIA

Glosopharyngeal neuralgia is uncommon. But it is useful to recognize, because when it occurs, it can be confused with trigeminal neuralgia. It has many similarities with trigeminal neuralgia, but its location is different. It can occur in any region with the sensory supply of the ninth and tenth cranial nerves. It can occur in the throat and posterior quadrant of the tongue, sometimes spreading to the ear, lower jaw and neck. The pain may be confined to either the pharynx or just the ear, and the trigger zones may be located at the base of the tongue, tonsillar pit, and/or external canal of the ear.

The pain is as severe as trigeminal neuralgia, lasting only a few seconds in the form of sudden seizures, and many attacks can occur during the day. There are regressions, but the recurrent episodes of pain get longer as time goes on. Although the patient fears that pain will occur, he is comfortable during attacks. Sudden seizures are exacerbated by swallowing, sometimes speaking, yawning or sticking the finger in the ear, and even abruptly turning the head towards the problem area. Sudden seizure with swallowing makes it impossible to eat. Therefore, such patients become severely dehydrated because they cannot take any liquid or solid food.

It may also occur during vessel compression caused by a cerebellopontile angulus tumor or aneurysm. But the role of other cranial nerves and systems is undeniable. It can also be found in tumors of the neck foramen, skull base, nasopharynx and tonsils, pharyngitis and arachnoiditis. Many cases apparently follow acute throat infections. In many cases, the exact cause cannot be determined.

ACUPUNCTURE TREATMENT

Selection of Acupuncture Points

Auricular therapy is applied.

Key Points (two teams)

1. Pharynx

Triple Energizer (stimulation of glossopharyngeal, vagus and facial nerve points)

2. Trachea

Tonsil
Language

Additional Points (two teams):

1. brain stem

Sympathetic nerve
Shenmen

2. Brain

Occipital

Acupuncture Manipulation

Ear points are stimulated twice a week with permanent press needles and two sets of points (both main and additional points) should be applied alternatively. Pieces of dry peas with a diameter of 1-2 mm are attached to the ear points with an adhesive plaster. Dried pea pieces are preferred to permanent press needles because they are less painful when applied and when the patient presses during attacks.

A course of treatment consists of 8-10 sessions. If progress is seen, treatment is continued.

Case History:

MH is a 50-year-old male patient with paroxysmal pain in the back of his throat for two months. The pain was of increasing and suddenly occurring character. Ingestion of solid and liquid foods and even with the pain increased, but it was very short-lived. The pain was not only limited to the throat, but also spread to the right ear. The patient did not respond to analgesics.

Examination was within normal limits.

This patient exhibited paroxysmal pains similar to those in the case of trigeminal neuralgia, except for the location of the pains. This was a case of glossopharyngeal neuralgia.

Treatment and Acupuncture Cure

The patient was treated as described below.

Two sets of auricular acupuncture points were selected and applied alternatively: (1) Pharynx. Triple energizer, brain stem, sympathetic nerve, shenmen; (2) Trachea, tonsil, tongue, brain. Ear points were stimulated with dried pea pieces and press applied twice daily. The patient was treated twice a week, with a one-day break between the two sessions. At the end of the third session, the frequency and severity of pain attacks tended to decrease. There was no attack after 8 sessions.

Follow-up

The patient did not experience pain for the following 6 months.

FACIAL NEURALGIA

Synonyms of facial neuralgia are nervus intermedius neuralgia, facial nerve neuralgia, tympani nerve facial paralysis. It is rarer than glossopharyngeal neuralgia and it is difficult to distinguish cases of facial palsy from glossopharyngeal neuralgia.

ANATOMY

The anatomical basis of this type of neuralgia lies in the eighth cranial nerve, from which the nerve intermedius takes its sensory origin. This nerve probably carries pain fibers originating from neurons in the geniculate ganglion that insert into the spinal region of the trigeminal nerve. This trigeminal nerve is also where the pain fibers of the glossopharyngeal and vagus nerves terminate, at least as low as the dorsal horn of the third cervical segment.

The peripheral distribution is variable and includes the tympanic membrane, walls of the auditory canal, external meatus, concha, tragus, antitragus, and anthelix. It also includes the soft palate, throat and nasopharynx and transmits proprioceptive muscle tendon sensations from the facial muscles. Because it shares its area in the ear with the vagus and glossopharyngeal nerves and innervation of the soft palate, the throat and nasopharynx are the first sites of pain in glossopharyngeal neuralgia, making it difficult to distinguish facial neuralgia from glossopharyngeal neuralgia.

CLINICAL FEATURES

It may be similar to trigemeinal neuralgia except for the difference in the location of the pain. The pain is usually limited to the deeper parts of the ear and external auditory canal, but sometimes just in front of and behind the ear. Here, there may be spread to the mastoid region, soft vein, throat, neck and chin. There is also a painful sensation caused by deep pressure on the face, nose, cheekbone area and behind the eye.

ACUPUNCTURE TREATMENT

Hunt expanded the concept of "facial neuralgia" in order to more easily express the wide variety of facial and headaches and classified them as primary, secondary and reflex. Secondary and reflex neuralgias are neuralgias caused by environmental irritants such as dental caries and deep nasopharyngeal ulcers. Here, acupuncture treatment of primary facial palsy and postherpetic neuralgia will be discussed.

Selection of Acupuncture Points

The pain may radiate behind the anatomical boundaries of the seventh cranial nerve, i.e., the neck, posterior head, apex and front of the head. The spread of pain to these areas can be controlled by anastomoses between the facial nerve and the greater auricular nerve, the cervical cutaneous nerve, and the lesser occipital nerve and all branches of the cervical nerve network. The central termination of pain fibers in the spinal region of the trigeminal nerve constitutes an important mechanism that causes pain to spread to other regions rather than the neck. All these should be taken into account when choosing acupuncture points.

Ear Acupuncture

Main points (2 teams)

1. Triple Energizer (stimulation of glossopharyngeal, vagus and facial nerve points.)

Pharynx
Forehead
Sympathetic

2.temporal nerve

External ear
Brain

Additional Points (2 teams)

1. Mouth

Face
Shenmen
Neck

2.Lower jaw

After head
Brainstem
Electroacupuncture

Points are selected as shown below:

main points

Tinggong (IB-19)
Taichong (KC-3)
Jiaosun (UE-20)
Wangu (SK-12)