**Author details**

by the intervention [15]. Acupuncture was reported to be more effective and to be associated

A large clinical study of acupuncture for headache was conducted in the European Union. The number of headache days at 3 months after acupuncture significantly decreased from 8.4 to 4.7 days in the acupuncture group, while it decreased from 8.1 to 7.5 days in controls. In the economic study, acupuncture improved the quality of life and was highly cost‐effective [16]. The placebo effect of acupuncture, however, is reported to be nearly 40% [17]. The accurate effect should be verified by a double‐blind controlled trial, but it is difficult to establish control

Acupuncture studies are associated with another problem with regard to the reproducibility of the treatment. In most reports, acupuncture was performed by an experienced acupunctu‐

The accurate effect should be verified by a double‐blind controlled trial, but it is difficult to establish control groups in acupuncture studies. So, some studies have used objective assess‐ ments. Chassot et al. reported a crossover trial regarding the effect of electro‐acupuncture (EA) on chronic tension‐type headache, including an assessment using a biological sample [17]. The visual analog scale score decreased more than 50% following EA in nine patients, but it also decreased in the sham period for five patients. The serum brain‐derived neurotrophic factor

Kinfe et al. recently reported that presurgical acupuncture predict the effect of surgical occipital nerve stimulation (ONS) [18]. Twelve patients with chronic refractory headache syndrome eligible for ONS were treated using EA (100 Hz, 30 min) before ONS. For EA, four needles were inserted subcutaneously at the level of C1, defined as 3 cm below the occipital protuberance, 1.5 cm bilateral from the midline (two needles), and 3.5 cm bilateral from the midline (two needles), to ensure that it reached the occipital afferent distribution area [18]. The results showed that surgically implanted ONS was effective in some patients who had previously been non‐responsive to acupuncture. Acupuncture may be a useful new tool for presurgical

**5. Imaging studies of acupuncture for the treatment of headaches**

Some recent reports have assessed the objective effects as well as the subjective effects of acupuncture in the treatment of headaches. Quirico et al. reported that acupuncture altered the cerebral blood flow [19]. The mean cerebral blood flow was changed by the acupoints.

Functional MRI (fMRI) is a form of objective imaging study. Recently, a study was performed to investigate brain dysfunction in patients with migraine and chronic tension‐type headache [20]. In the study of the pain‐induced activation of fMRI, migraine patients demonstrated specific brain activation in the interictal period in comparison with controls. The regions that were activated included the temporal pole, the parahippocampal gyrus, anterior cingulate cortex, lentiform nuclei, fusiform gyrus, subthalamic nucleus, hippocampus, middle cingulate

with fewer side effects than preventive medications [9].

152 Current Perspectives on Less-known Aspects of Headache

rist; however, many parts depend on the technique of operator.

was inversely correlated with pain intensity and degree of depression.

groups in acupuncture studies.

assessment.

Sumire Chiku1 and Yasushi Shibata2\*

\*Address all correspondence to: yshibata@md.tsukuba.ac.jp

1 Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan

2 Department of Neurosurgery, Mito Medical Center, Headache Clinic, Mito Kyodo General Hospital, University of Tsukuba, Tsukuba, Ibaraki, Japan
