Acupuncture treatment of migraine, nausea, and vomiting in pregnancy
Published Mar 5, 2019 · G. Allais, Giulia Chiarle, Silvia Sinigaglia
Neurological Sciences
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Abstract
One fourth of women of child-bearing age, particularly those 30 to 39 years of age, suffer from migraine headache. Migraine is diagnosed according to clinical criteria: throbbing, often unilateral pain lasting 4 to 72 h, exacerbated by physical exertion, and associated with nausea and/or vomiting, photophobia, and/or phonophobia. The estimated prevalence of hyperemesis gravidarum is 0.3–3%, depending on the clinical criteria and the ethnic group considered. In most cases, it appears to be more common among young women at their first pregnancy, nonsmokers, and non-whites. The prevalence among Asian and Middle East women is nearly 10%. Since precise diagnostic criteria are lacking, estimates of prevalence may include cases of less severe pregnancy sickness. The most widely accepted criteria are as follows: persistent vomiting not attributable to other causes, acute undernutrition as revealed by increased urinary ketones, electrolyte disturbance, acid-base imbalance, and weight loss [1]. Migraine and hyperemesis gravidarum, which share the common symptom of nausea and vomiting, are debilitating illnesses: migraine diminishes productivity and the quality of life, while hyperemesis gravidarum may require hospitalization in severe cases. Treatment for both conditions has been extensively studied, also in complementary integrative medicine. Recent literature reviews have documented the same efficacy of acupuncture as pharmacological therapy in migraine prophylaxis [2]. What remains important is that therapeutic options offered during pregnancy do not affect the progress of pregnancy. Since 1997, the US National Institutes of Health reported on the efficacy of acupuncture for treating nausea. Women with migraine and nausea and vomiting in pregnancy experience a slight improvement in migraine headaches, particularly during the second trimester of pregnancy [3]. Hyperemesis gravidarum and migraine appear to share the same pathogenic mechanisms related to allele variations in the gene for the olfactory neuron receptors that express dopamine. In fact, certain odors can trigger episodes of both conditions. To date, there are no published studies on the treatment of migraine during pregnancy in women with hyperemesis gravidarum. Therefore, the aim of this study was to evaluate the efficacy of a standard acupuncture treatment protocol in reducing the intensity and frequency of attacks of migraine without aura, nausea, and vomiting episodes during the first trimester of pregnancy in women with migraine. The patients involved in the study spontaneously presented to our outpatient acupuncture clinic for the treatment of nausea and vomiting in pregnancy. Women with migraine without aura (diagnosed according to the criteria of the International Classification of Headache Disorders of the international Headache Society, ver. 3 beta) were enrolled if between 8 and 12 weeks of pregnancy and headache had persisted during the first trimester. In all, 12 patients underwent a cycle of 6 acupuncture sessions (4 sessions for 2 weeks, and then 2 sessions, once a week) for a total duration of 4 weeks. Twin pregnancy and chronic hypertension were exclusion criteria. A standard acupuncture protocol was performed using the same 6 acupoints in all patients. Each session lasted 30 min, during which the needles were inserted and stimulated to attain the characteristic sensation, known as De Qi, then no further manipulation was performed. The steel needles were sterile, single use needles measuring 0.25 × 25 mm in diameter. The sessions were conducted by physicians qualified in acupuncture. The * Gianni Allais gb.allais@tiscali.it