Acupuncture may help restore impaired homeostasis of the trigeminovascular pain pathway in migraines. In a collaboration between US and Chinese researchers, 100 migraine without aura (MwoA) patients and 46 matched healthy controls (HCs) were recruited. Patients were randomised to four weeks of verum acupuncture, sham acupuncture or a waiting list. HCs had resting state fMRI scans at baseline, while patients underwent scans before and after treatment. Patients received 20 acupuncture sessions over a period of four weeks, using one of three acupuncture protocols (VA1 – Yanglingquan GB-34, Qiuxu GB-40 and Waiguan SJ-5; VA2 – Xiyangguan GB-33, Diwuhui GB-42 and Sanyangluo SJ-8; VA3 – Zusanli ST-36, Chongyang ST-42 and Pianli L.I.-16). Sham acupuncture consisted of needling at non-acupoints. Compared with HCs, MwoA patients showed increased spontaneous activity at rest in several brain regions involved in pain information processing (posterior insula and putamen/caudate). Reduced spontaneous activity at rest was also seen in MwoA patients in brainstem regions connected with input from the trigeminovascular nociceptive pathway (trigeminocervical complex) and output via the descending pain modulatory system (rostral ventromedial medulla). This decreased activity was observed to have normalised after verum (but not sham) acupuncture treatment.
Acupuncture modulates the abnormal brainstem activity in migraine without aura patients. Neuroimage Clin. 2017 May 22;15:367-375.