Introduction

“[Susan] has been suffering much from the headache and
six leeches a day for ten days together relieved her so lit-
tle that we thought it right to change our measures – and
being convinced on examination that much of the evil lay
in her gum, I persuaded her to attack the disorder there.
She has accordingly had three teeth drawn, and is decid-
edly better, but her nerves are a good deal deranged. She
can only speak in a whisper – and fainted away twice this
morning …”

Jane Austen, Sanditon (1817)

As this quotation shows, the difficulty in establishing the
efficacy of treatments for persistent headaches is not a
new one, and experimentation with new modalities,
though often encouraged, may not be without side

effects. There are data supporting the efficacy of
acupuncture for the treatment of headache [1] and recent-
ly a randomised controlled trial found it both efficacious
[2] and cost-effective [3] for the treatment of chronic
headache in primary care. Questions of efficacy aside,
data showing how often acupuncture is used for the treat-
ment of headache have not been identified. Acupuncture
treatment in the United Kingdom is available on an ad
hoc basis, sometimes from primary care practitioners,
sometimes from private practitioners. There is no stan-
dardised, university-based, structure for training in
acupuncture in the UK.

The aim of this study was to ascertain how often
acupuncture had been used by patients with headache
prior to referral to general neurology outpatient clinics. A
subsidiary aim was to ascertain how many headache
patients would be prepared to try acupuncture treatment,
and how many would be put off by the use of needles.

J Headache Pain (2005) 6:97–99
DOI 10.1007/s10194-005-0160-7

Acupuncture use for the treatment of
headache prior to neurological referral

B R I E F  R E P O R T

A.J. Larner (�)
Walton Centre for Neurology
and Neurosurgery,
Lower Lane, Fazakerley,
Liverpool L9 7LJ, UK
e-mail: a.larner@thewaltoncentre.nhs.uk
Fax: +44-151-529-5513

A.J. Larner

Abstract Acupuncture is a popular
complementary treatment for
various pain syndromes. Some
studies claim efficacy in the
treatment of primary headache
syndromes. However, data on the
frequency of acupuncture use by
patients with headache prior to
neurological referral have not
been identified. In this study, 12%
of patients with headache
attending general neurology
outpatient clinics had already

received acupuncture; of the
remainder, 73% said they would
be willing to try it.

Key words Acupuncture •
Headache • Treatment

Received: 19 November 2004
Accepted in revised form: 16 February 2005
Published online: 8 April 2005



98

Materials and methods

Consecutive new outpatient referrals to general adult neurology
clinics served by one consultant neurologist at three hospitals in
north-west England over a six-month period were assessed. Those
in whom the principal reason for referral or the principal com-
plaint was headache were asked (if they had not already volun-
teered this information) whether they had ever had acupuncture
treatment, and if so the indications for its use, how many treatment
sessions were given, and its subjective efficacy. Those who had
not received acupuncture were asked whether or not they would
be prepared to try it as a treatment for their headaches; if not will-
ing, reasons were sought. Diagnosis of headache syndromes was
based upon internationally agreed criteria [4].

Results

Over the 6-month period (mid April to mid October 2004),
481 new referrals were seen in 53 consecutive clinics. The
principal complaint was headache in 115 (24%; 95% con-
fidence interval [CI]: 20%–28%). Demographic and diag-
nostic data are shown in Table 1. Referral source was gen-
eral practitioner in 105 cases and another hospital practi-
tioner in 10. All patients gave verbal consent to answer
questions about acupuncture treatment.

Twenty patients with headache (17%; 95% CI: 10%–24%)
had been treated with acupuncture at some time. In 14 patients
this was for headache (12% of the total headache cohort, 95%
CI: 6%–18%; see Table 1 for demographic and diagnostic
data), in six for other reasons (other pain syndromes: 4; obses-
sive-compulsive disorder: 1; smoking cessation: 1). Only
three headache patients (21%) volunteered information about
their previous acupuncture treatment.

The reported number of acupuncture treatment ses-
sions for the headache patients ranged from 1 to 10
(mean=6; mode=6; median=6). Eleven reported that
acupuncture was not helpful (one after initial benefit);
three reported benefit (two with chronic migraine, one
with migraine with aura).

Of the 95 patients who had never received acupunc-
ture, 69 (73%; 95% CI: 64%–82%) said they would be
prepared to try it if it were a recognised treatment for
headache. Of the 26 expressing no interest or no opinion,
11 (12%; 95% CI: 5%–19%) made comments suggesting
an aversion to needles (hated needles, were squeamish, or
had a “needle phobia”).

Discussion

The frequency of headache in this general neurology out-
patient clinic population (24%), patient age and gender,
and preponderance of chronic headache were similar to
results in cohorts of headache patients from other general
neurological outpatient clinics [5, 6].

The survey methodology was simple. Results were
dependent upon patient recall, and hence liable to recall
bias, but nonetheless provided some information about the
frequency of acupuncture use for the treatment of
headache prior to neurological referral. Acupuncture had
already been used by 12%, although only one-fifth of
these volunteered the fact. The apparently low efficacy of
acupuncture in this cohort (3/14) is not surprising: pre-
sumably referral would not have happened had acupunc-
ture resolved headache. No patient with fewer than 6
treatments reported benefit. No patient had 12 treatments,

Table 1 Demographic and diagnostic data

Headache patients Used acupuncture for headache

n 115 14
Age range, years 16–78 16–78
Mean age±SEM, years 39.9±14.1 49.7±14.7
Sex ratio M:F (male %) 43:72 (37%) 4:10 (40%)
Specific diagnosis

CTTH 58 2
FTTH 7 1
MO 11 –
MA 11 2
CM/TM 21 8
MOH 5 1
CH/TAC 2 –

CTTH, chronic tension-type headache; FTTH, frequent tension-type headache; MO, migraine without aura; MA, migraine with aura;
CM/TM, chronic migraine/transformed migraine; MOH, medication overuse headache; CH/TAC, cluster headache/trigeminal autonomic
cephalalgia



99

the limit in the randomised trial in primary care that sug-
gested efficacy [2]. Other studies of acupuncture have
shown lack of efficacy [7].

Of those not previously treated with acupuncture, the
majority (nearly three-quarters) expressed interest in try-
ing it, whereas 12% were not interested because of aver-
sion to needles. No data about the prevalence of “needle
phobia” in the general population have been identified.
The problem is occasionally encountered in diabetic
patients requiring insulin [8], but this is infrequent and
often quickly overcome (MW Mansfield, personal com-
munication). These data suggest that if acupuncture

became generally available for the treatment of headache,
demand would probably be high, as anticipated for any
new treatment, irrespective of the potential problems with
needles. Although randomised trials suggest efficacy [2],
the results of pragmatic (phase IV) studies might be less
encouraging.

Hence, just over 10% of patients with headache attend-
ing general neurology outpatient clinics had already
received acupuncture for their headache, and of the
remainder nearly 75% expressed interest in trying it. It
would be interesting to see if similar data emerged from
specialist headache and/or migraine clinics.

References

1. Melchart D, Linde K, Fischer P et al
(2001) Acupuncture for idiopathic
headache. Cochrane Database Syst Rev
1:CD001218

2. Vickers AJ, Rees RW, Zollman CF et
al (2004) Acupuncture for chronic
headache in primary care: large, prag-
matic, randomised trial. BMJ
328:744–747

3. Wonderling D, Vickers AJ, Grieve R,
McCarney R (2004) Cost effectiveness
analysis of a randomised trial of
acupuncture for chronic headache in
primary care. BMJ 328:747–749

4. International Headache Society
Classification Subcommittee (2004)
The international classification of
headache disorders, 2nd edn.
Cephalalgia 24[Suppl 1]:1–160

5. Carson AJ, Ringbauer B, MacKenzie
L, Warlow C, Sharpe M (2000)
Neurological disease, emotional disor-
der, and disability: they are related. A
study of 300 consecutive new referrals
to a neurology outpatient department. J
Neurol Neurosurg Psychiatry
68:202–206

6. Larner AJ (2003) NHS Direct for
headache. J Neurol Neurosurg
Psychiatry 74:1698

7. Karst M, Reinhard M, Thurn P, Wiese
B, Rollnik J, Fink M (2001) Needle
acupuncture in tension-type headache:
a randomised placebo-controlled study.
Cephalalgia 21:637–642

8. Zambanini A, Feher MD (1997) Needle
phobia in type 1 diabetes mellitus.
Diabet Med 14:321–323


	Introduction
	Materials and methods
	Results
	Discussion
	References