S4 E5: Migraine and Acupuncture, part two

Migraine and Acupuncture, part two

Series 4, episode 5

Heads Up is the award-winning podcast series on all things headache, brought to you by the National Migraine Centre.  Produced by leading headache doctors, it’s the trusted source of information and support for all those affected by migraine and headache.

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Transcript:

[00:00:00] Did you know that acupuncture has been included by NICE UK as a treatment to be considered for migraine? Our host, Dr Katy Munro, has written a book called Managing Your Migraine with information about this and other treatment options. It’s out on August 26th or pre-order it on Amazon now.

 

[00:00:25] Welcome to the Heads Up podcast brought to you by the National Migraine Centre, the only UK charity treating migraine and headache.

 

Dr. Katy Munro [00:00:36] So I am about to have a chat with Dr. Mike Cummings, who is the medical director of the British Medical Acupuncture Society. So thank you very much for joining me today, Mike. And would you like to just introduce yourself a bit more, detail on how you got into acupuncture and your background?

 

Dr. Mike Cummings [00:00:56] Yes, Well, thank you for inviting me. It’s a pleasure to be here. And I am well, I’m an unorthodox medic in that I did well in medicine, you know, it was portfolio career, and I started this acupuncture thinking I’m going to convert this acupuncture practice into sports medicine and musculoskeletal medicine. I’ll do other things. My early audits, I did some early audits, looking at the military practice, looking at my practice, just keeping data, just looking to see what worked because there wasn’t much information out there. Some patients had these very- they’re not headache patients, but they had headaches, pain in the head referred from muscle, which I saw and I thought, ‘Oh, look, they’ve just disappeared. The headache disappears with one needle in a muscle.’

 

Dr. Katy Munro [00:01:43] Context of people having the acupuncture is very important.

 

Dr. Mike Cummings [00:01:49] I think it is for a couple of reasons in this case. So patients with chronic headaches are, we know, more sensitive than others and they’re certainly more sensitive in the upper part, you know, shoulder, head, neck. They’re definitely more sensitive in this area. And they may be more sensitive- some may be more sensitive all over. And I think, if you create a strong pain stimulus in this area and I know this not from headache patients, just from teaching patients for the last 25 years- not teaching patients. I have taught patients to do needling but I meant teaching doctors, mostly, to do acupuncture and just practically doing the needling. I know that a certain proportion of people will get headaches when you needle certain points in the head and neck. So putting those two things together, thinking, okay, these patients are more sensitive. If I needle certain areas of muscle, there’s the potential to create a headache. Then I need to be careful how I do that. I need to warn the patient. I need to be quite careful and try to get the right level of treatment and that varies greatly. So the context is important in the sense that it’s easy to put patients off both from context. It’s also, with acupuncture specifically, in terms of the treatment, there’s a huge variation in what is optimum treatment for an individual. Huge variation. And that variation is probably mainly mediated by the central nervous system, by their central nervous system, how it’s inherently set up and how it has evolved. And those two things are different. I think your innate- whatever your genome has given you and your environment and how it has changed. So, you know, the very fact that you’ve lived with headaches for so many years will change that environment.

 

Dr. Katy Munro [00:03:50] Yeah, we’ve talked about that a little bit more in earlier episodes about the fact that although it’s a genetic condition, especially migraine, a genetic condition, of course, that just gives people the vulnerability to have headaches, but whether they have headaches is so much a function of what happens to them and what’s going on, not only in their external environment, but also their internal body environments. And then also how they perceive the impact of those headaches affects how they feel about life going forward, doesn’t it? And it is much more complex than just saying, ‘Oh, this will switch that off and then you won’t get them anymore’.

 

Dr. Mike Cummings [00:04:28] Yes, absolutely. You know, acupuncture is just one tool. One tool that I found immensely useful when I was back with the muscles, you know, not only did it turn out to be a treatment that was just as good as my injections, but I started to use it as an extension of my finger so that I could investigate the anatomy of the individual. Coming back to headaches, though, whilst some patients with headaches, I could find one spotting, one bit of muscle and BANG and the headache disappeared. And I thought, this is marvellous, I just need to find the point. And so I spent some years just looking too hard, especially at migraine patients, because I didn’t know as much as I do now about that whole process. And in fact we hadn’t been certain in those days about the genetic- well, we knew there was hereditary- but we weren’t absolutely sure of a genetic fingerprint, so to speak. And now we’re more sure that there’s a clear genetic pattern to predisposition. Of course, these acupuncture needles, you can slide in very often in very many patients, you slide in and they don’t feel anything and they are really surprised and they think, ‘Oh, I haven’t felt anything. Have you done it already?’ And nowadays, I start at the other end of the patient and I gradually get them to wiggle their toes a little bit. I get them to stimulate the needles by movement.

 

Dr. Katy Munro [00:05:57] Oh, so you’re not twisting them?

 

Dr. Mike Cummings [00:06:00] In China they are taught to- where traditionally, you know, the doctor- it’s a different set up and the doctors slide the needles in, they’re very slick at sliding these needles in. They are slightly different needles to the ones I would use. They’re a bit rougher. And then they twiddle them until they start to feel tension and they twiddle and what happens is the connective tissue wraps around the needles a little bit. There’s a little bit of tension. It’s actually quite a gentle stimulus. It’s not like a needle poking in you. They place it in quickly and then rotate it. It’s actually quite a gentle start. Relatively. It’s not quite as gentle as using the superfine Japanese needles and doing very subliminal electrical stimulation, it’s even better but that’s very recent, you know, that we’ve been able to do that. Over centuries they’ve had to be slick at putting needles in and then they twiddle them and they very much go on their feeling. But the patient might be making all sorts of noise, but culturally they are more used to it. In the West, patients aren’t used to feeling the sort of typical needling sensations as much so I ideally don’t want to be touching the needle. I don’t want to be associated with the pain. And if the patient suddenly goes, ‘oh!’, waggles their feet around and goes, ‘Oh, woah, I feel that’. They will instantly stop. And they can stop faster than I can. So I get them to wiggle the toes, gently, just until ‘oh, I can feel something now. There’s something vague, some vague feeling travelling’.

 

Dr. Katy Munro [00:07:32] Are you saying that it’s not necessary to have that intense- because I’ve had acupuncture before and somebody twiddling the needles and get that intense explosion of pain and assumed that that was an important thing to have. But you’re saying that that isn’t the way that your acupuncture technique works, not what you’re aiming for?

 

Dr. Mike Cummings [00:07:51] There are techniques that are very, very gentle and that someone like me as a patient probably wouldn’t feel. I’m not very sensitive to needling, so I probably wouldn’t feel them. There are techniques at that end of the spectrum. And there are techniques at the other end of the spectrum that are closer to torture than treatment.

 

Dr. Katy Munro [00:08:18] Right.

 

Dr. Mike Cummings [00:08:20] Now I perform treatments that span that because you have to work that out for the individual patient. There are some patients- now this is not migraine patients. There aren’t many patients who have chronic headaches, or certainly chronic migraine, there aren’t many that would be in that category I don’t think, I can’t recall very many. But in other pain conditions, certainly there are where they have chronic pain, chronic musculoskeletal pain, where they need the most vigorous needling treatments in order to get any effect. So it’s really very vigorous. But you have to, as a practitioner, you have to very slowly build up to work that out just in case. You don’t want to get that wrong because you will hurt people unnecessarily. So if you’ve got a patient who’s very much more the other end of the spectrum, very much more sensitive and rather like migraine and genetics, acupuncture and genetics. So there is a genetic fingerprint for acupuncture as well. Unfortunately, there hasn’t been as much research or funding for research on this as there has been in migraine. So we don’t have as much detail in fact, it’s probably reserved for mice at the moment.

 

Dr. Katy Munro [00:09:31] Okay.

 

Dr. Mike Cummings [00:09:33] We certainly do know that some strains of mice respond better than others. And interestingly, that the ones that respond the best and the ones that respond the least well are actually the most genetically similar. So that should help us in the future in trying to pin down exactly which areas are critical. Although having said that, of course, in these models we’re looking at acute analgesia models and therefore not always clear whether or not that correlates.

 

Dr. Katy Munro [00:10:04] So my patients, I mean, and also people who have been listening to the podcast are sometimes messaging us and saying, you know, ‘should I have acupuncture? Who should I look for? How should I go about it? What kind of protocols, and things like that, are we meant to be advising patients?’ I think there’s a lot of uncertainty out there. And then of course, we do have a number of patients who say, ‘Oh, well, I’ve tried it and it didn’t work’. So any kind of specific guidance for patients, if they’ve decided that they’d like to give acupuncture a try, what would you say would be your advice for how to go about that?

 

Dr. Mike Cummings [00:10:41] That’s a very good point. I mean, it’s taken, I suppose, over a career of having time because I’ve been employed by the BMAS, which is a charity, so I’ve been in a lucky position of having time to investigate, to set up meetings, to really think about what I’m doing. I’ve realised there’s this huge variety in responsiveness even within the headache population, a huge variety of the nature of how you treat them. And I’ve had perhaps not the best experience of having to see patients who’ve already had acupuncture before, you know, plenty of patients who have already had it and for most- let’s just restrict it to migraine patients. Migraine responds extremely well to relatively gentle acupuncture. So the most important thing for a patient to do, probably, when they’re looking for a practitioner is just look up that they belong to some organisation, they’re regulated in some way. So within health care, we have two different forms of regulation, they come under the same overarching body called the PSA, the Professional Standards Authority. And on one side we have statutory regulators where we are as doctors, we are under the GMC, Nurses, the NMC, and the HCPC, which is a big regulator that covers lots of different regulated health professions. So there’s that side and then now also in recent years there’s the voluntary side and now there’s a lot more- actually, there aren’t a lot more acupuncturists on that side, but there are a lot more bodies that it’s not so obvious. So on that side, that’s called voluntary regulation and what the PSA does is accredit registers. So these are organisations that hold their own register and police that register. So they make sure that their members are keeping up to certain standards and they answer complaints against them. So it’s not quite as tough as statutory regulation, but it’s thought to be good enough that as doctors, for example, we can refer to these people and not maintain the whole responsibility ourselves.

 

Dr. Katy Munro [00:13:15] And so somebody to be on one of those registers would have had to have done some sort of accredited training and prove that they’re keeping their skills up to date, but their registration on that register is voluntarily up to them whether they do that. So you could say that you’re an acupuncturist and not bother to be on any registers, but that doesn’t give any safeguarding to the patient who then decides to go along and see that person. Is that right?

 

Dr. Mike Cummings [00:13:42] That’s right. So it’s always good if you can find a body like that, you know, a professional body. Because we don’t have in the UK, we don’t have the formal recognition of acupuncturists as a health care profession. We know it exists, but we don’t have it in law recognised so that the word can be protected. And that’s what statutory regulation does. It tends to protect titles.

 

Dr. Katy Munro [00:14:12] So the British Medical Acupuncture Society is one of those voluntary registers.

 

Dr. Mike Cummings [00:14:17] No, in fact it’s not. No, that’s quite interesting. Yes, so we’ve got various bodies. I suppose I’ll tell you about the three large bodies.

 

Dr. Katy Munro [00:14:24] Okay.

 

Dr. Mike Cummings [00:14:25] So the BMAS, is the body I belong to, so we instead of being a regulator ourselves, whilst we do very light level regulation, we do have a mechanism, a very light regulation, and we actually rely on the statutory regulator. So all of our members are subject to statutory regulation and a few of them subject to voluntary regulation. So we rely on all the structure of the PSA and all of the structure underneath that for our members. There are other bodies who sit solely under one or other side. On the other side of the register would be the British Acupuncture Council. The British Acupuncture Council is a body that is- it was one of the first, I think, bodies that got recognition as a voluntary regulator under the PSA. BAcC members can join the BMAS because they’re under that side of regulation that actually we’ve now come to recognise. And in fact we do have some members because they’re interested in certain, you know, more of the scientific side of looking at all the research and everything, so that’s that. So there’s two sides of that. So that’s the BMAS and the BAcC. So our members are doctors and nurses and physios and a whole variety of other health professions that you may not have even heard of as they expand and including some sports therapists who are under the other side of regulation, and then the other big group and actually the biggest group of acupuncture professionals in the UK is actually a group of physios called the Acupuncture Association of Chartered Physiotherapists so the AACP. So they’re all regulated under the statutory regulation side and they use a form of acupuncture- well the acupuncture of course is very similar across the board. The more difference between these groups is rather more about how they think about what they’re doing, rather than what actually happens in the treatment and maybe the language that’s used. Let me just tell you about one more group. So we’ve got three groups there. Those are the big groups that are covered by regulation and there should be no problem if you go to any one in those groups. There are some other groups around that aren’t subject to such rigorous regulation, but there’s quite a large group of Chinese practitioners- predominately Chinese practitioners. Now, not all of them have been able to access regulation in these groups for various reasons but that doesn’t mean to say that they’re not good practitioners. Quite a lot of them may well have been trained like us, like doctors, in China.

 

Dr. Katy Munro [00:17:34] Yes.

 

Dr. Mike Cummings [00:17:35] But because of language difficulties or various other things, they don’t find it easy to get the same status in the UK. But then I’m afraid it’s up to you to decide. You have to decide for yourself.

 

Dr. Katy Munro [00:17:52] Yes. Or get a recommendation, I suppose, from somebody else who’s been to that person and found them really helpful and professional. That’s really helpful, because I think people often are, sort of saying to us, ‘can you recommend anybody specifically?’ But of course we don’t tend to do that, it’s not really our role. But guiding people towards those bodies I think is really helpful. So the other thing people say is, you know, ‘if I’m going to try acupuncture how long should I try it for? And how often do you have to have it?’ And then the other thing that sometimes happens is they say, ‘well, I had a couple of sessions, but I didn’t really do anything, so I gave up’. So is there a sort of minimum or maximum?

 

Dr. Mike Cummings [00:18:36] Absolutely. So that’s a very good question. And just thinking back to what I was saying about the variety of sensitivities and of course, the variety of- because acupuncture- because whilst I said, look, I’ve come to use quite a variety of strengths of treatment, not maybe the full spectrum, because some of it wouldn’t be acceptable in this country and some of it I can’t bring myself to do because I feel it’s not a treatment. But there is that extreme and I still occasionally over treat people. I try to get it right, but I still sometimes get it wrong. So if you go, the one important thing is if you go to someone and you find it’s an unpleasant experience, if you can, try not to be put off too much, try just to ask a few more questions next time. Go to someone else. Try someone else. Try and look for someone who’s more gentle, who’s got a reputation for treating children or something, or who’s got a good reputation in groups that you think might be sensitive and there are those people out there who have become really good at very gentle treatment, and then you can try again. So don’t be put off just by a single practitioner because we all get it wrong at times, no matter how good we try and become. And as a patient, you can think that as well and you can think, ‘okay, this person doesn’t fit for me, you know, they’re nice enough, but I just don’t quite- I’m not quite comfortable’. You really need to be comfortable for acupuncture. You need to be relaxed and you need to be not anxious. If you’re a needle phobic, you need to be careful. You need to choose your practitioner carefully and acupuncture can get you over needle phobia, surprisingly. I’ve done it on a few occasions, usually by accident, because the patient hasn’t told me ‘by the way, I’m needle phobic’ until afterwards because acupuncture needles are superfine needles. So if your only experience of needling is injection needles, then all of my needles fit down the middle of the finest needle you’ve ever been injected with, and they don’t have any edge to them. There’s no cutting edge. So most of the time, actually tissues just separate around them and then the hole just fills in again so nothing gets cut and there’s virtually no damage. The tissues change. You can feel it afterwards, but it’s really, really minimal.

 

Dr. Katy Munro [00:21:15] It’s almost like a parting – almost like a pressure parting tissues beneath it rather than sticking something that’s breaking something.

 

Dr. Mike Cummings [00:21:24] Yes. The skin, even, just stretches open and then heals again. So very often you don’t even see any bleeding, you know. But anyway, you were asking me about numbers of treatments, so I’m working up to that. If we go back to my muscle pain and where you do one needle in one bit of muscle, it relaxes, that muscle instantly gets better blood flow, the biochemistry normalises, the nerves instantly become less sensitive. Your nociception, your peripheral nerves coming in quieten down. The pain vanishes within seconds or minutes. So we understand that mechanism. But that is a peripheral phenomenon. If we look at acupuncture, treating other things, a lot of what it treats in terms of chronic pain is a central phenomenon, and it’s to do with a gradual change in activities within the central nervous system. And those activities principally work through descending systems in the spinal cord. The descending inhibitory mechanisms. And of course, they work for the head as well as for the rest of the body. So we have these systems and these systems themselves require repeated stimulus to wind themselves up to their maximum. Though most of us have a certain set point where our inhibition of the periphery, we have a set point, and it varies with individuals. Well, we have two features. We have our set point of how we tonically inhibit and we have how quickly we can wind up sensation. So there are two aspects to this. So patients who have any chronic pain condition usually have a deficit in  one or other of those aspects. And often they have a deficit of this tonic inhibition. Now, I think in migraine, it probably varies over time.

 

Dr. Katy Munro [00:23:25] When you say tonic inhibition, so my understanding of chronic pain is that it’s two features, as you saying, so just for our listeners who may not be quite so in tune with the technicalities of it. One is that you have a pain stimulus that goes repeatedly and then your brain kind of assumes that any stimulus is then pain, because that pathway is so well-worn, because it’s been repeated and repeated, that’s one aspect of chronic pain winding up the brain. And the other is that normally if we have an acute pain, when it stops, so for example, if you touch something hot and then you take your hand away, your brain switches off that pain stimulus. And is that what you’re meaning by the tonic inhibition? Is that the switching off mechanism that says, ‘oh, there isn’t a need to have pain anymore?’ Have I oversimplified that?

 

Dr. Mike Cummings [00:24:18] I think yes, the analogy- yes, I love mechanistic analogies and I have this awful, awful need to be accurate about it.

 

Dr. Katy Munro [00:24:31] Oh yes, please.

 

Dr. Mike Cummings [00:24:33] And yet try and keep it simple. So I like to think of it in terms of amplifiers. So the spinal cord has lots of little amplifiers in them at every level. Depending on the type of stimulus, we either need the amplifier or we don’t. So if you’ve got a strong enough injury, you don’t really need the amplifier. The amplifier still turns on, but you don’t need it. You can feel that and it’s painful and you know to get out of the way. So if you burn yourself, for example, that is strong enough to get straight up and you know about it, and usually it gradually subsides because it’s a relatively minor injury. So the local effect changes and modifies and the stimulus coming in isn’t big enough to make it through the system. So your amplifier has a setting that doesn’t let through stuff. Now, when things become chronic, the amplifier has a set point which has been turned up because of the repeated inputs from the outside, or because of some of the reason those amplifiers have been turned up. And then relatively innocuous inputs might stimulate a greater adversity in the brain, you know, they might be perceived as pain when actually peripherally they’re not really pain. You know, it’s a grey area because we have this wonderful ability to vary our levels of sensitivity, both in the peripheries, out in the ends of the nerves as well as in the spinal cord. And I like the amplifier analogy and what acupuncture seems to do, one mechanism is to try to turn those amplifiers down as much as possible. And we all have a set point for our amplifiers. So we get back to the point, how many treatments do you need? So it looks as though you need 6 to 8 treatments to maximise the the effect on descending inhibition.

 

Dr. Katy Munro [00:26:35] Okay.

 

Dr. Mike Cummings [00:26:36] So for a properly chronic pain patient, then I would recommend 6 to 8 treatments to try. To not give up before that but if you really want to give it a good try, then 6 to 8 treatments. If you’re a chronic headache sufferer and particularly if you have chronic daily headache, I actually might go just a fraction more and I’ve adopted 9 as the number now. I think these patients with chronic migraine and chronic daily headache, they don’t really necessarily have the peripheral drive. They’ve got themselves into a situation where the condition, their genetics, their lifestyle, their experiences have got them into a position where they’re stuck in this model of sensitivity and chronic episode, sort of, acute on chronic- whatever- episodes of sensitivity so that you can feel your blood vessels pulsing which nobody ever wants to have to feel.

 

Dr. Katy Munro [00:27:36] Which some of my patients definitely describe hearing their own heart.

 

Dr. Mike Cummings [00:27:40] Yes exactly. And in fact there’s one acupuncture paper that actually predicts response- the response is slightly better in the patients who have throbbing headache to those that don’t.

 

Dr. Katy Munro [00:27:53] That would be really useful to know if there were some measurable things that we could say, ‘Well, if you’ve got this, this and this as part of your migraine picture, then you’ll do well with acupuncture. Whereas if you’ve got that, that and that, then probably try something else’. Because one of the mantras we have constantly is ‘nothing works for everybody’. And, you know, it’s very much about looking at a range of options and trying different things, sometimes together, sometimes one at a time. But going back to your 6 to 8 or possibly 9 sessions, is that concentrated over 6 to 8 weeks or could that be sort of six sessions spread out over a six month period? Because I’m conscious that an awful lot of people are having to pay privately to have acupuncture. It’s limited availability on the NHS. And so it’s a significant factor in their decision as to whether to try it.

 

Dr. Mike Cummings [00:28:42] Absolutely. And it should be. The 6 to 8, I would say, is chronic pain across the board and that wouldn’t be the end of treatment probably, that would be just for you to make the decision ‘has this made any difference at all? Is this impacting at all?’ Because some people can go from somewhere there where they think, ‘oh, yeah it might be working now’ and persist and become pain free and you don’t want to miss that if you’re one of those. It’s incredible.

 

Dr. Katy Munro [00:29:16] So going back to my question about that, was it 6 to 8 sessions one a week or two a week…?

 

Dr. Mike Cummings [00:29:24] Yeah. So that’s ideally- for chronic daily headache I ask patients to do weekly treatment if they can for up to 9. If they are more episodic, then you can space your 6 to 8 out.

 

Dr. Katy Munro [00:29:36] So occassionally it can be as rapid as that, if it’s episodic rather than chronic pain, probably more likely?

 

Dr. Mike Cummings [00:29:43] Yes, I guess. Rather than daily. Yes. I’ve only seen this in episodic migraine, but for your standard, episodic migraine patient who’s working and this is, you know, it’s taking them out of work a few times a month and it’s becoming a problem, then, you know, you’ve got to fit in your treatment around the rest of your life. So you can afford to, you know, not be too worried about it. If you’re getting on with your life and this is just something you’re trying, then maybe do it weekly if you can, for the first four weeks and then you can start spreading it out, a couple of weeks. And of course, if you find you’ve had a first couple of treatments that actually you feel quite good and you haven’t had any headaches and you’d have thought you might have had one by now, then it’s okay to start spreading it out quite early.

 

Dr. Katy Munro [00:30:33] Okay.

 

Dr. Mike Cummings [00:30:35] Go based on your symptoms.

 

Dr. Katy Munro [00:30:37] Can I ask you a specific question related to that? So we have a number of people who’ve asked us about daith piercings, and those little piercings that are in the sort of upper bit of the inside part of your ear, the pinout of your ear, and there is some people who say, ‘Oh, those are amazing and they worked immediately and I’ve never have a headache again’. And there are many patients who I’ve seen who said, ‘Well, I had them and it didn’t make any difference’. But the theory that they say is that that is an acupuncture point. Now, any thoughts about that?

 

Dr. Mike Cummings [00:31:13] Okay. First of all, the daith piercings I, of course, heard about as well, because people were telling me and they’re saying, is this a type of ear acupuncture because we cover ear acupuncture on our training courses. Points. Okay. So points is another aspect. Is this a type of acupuncture? And I think it’s interesting. I think it’s an interesting observation and I think it needs to be tested. I think is quite possible for some people. It is a bit like- it’s got similarities to acupuncture in the sense that the body is pierced. But as you know, if you’ve had your ears pierced. Well, I haven’t, but I’ve done ENT so I’ve seen the downside of having cartilage pierced by needles and earrings and the like. You can get infection. So it’s usually a lot worse than acupuncture. It’s all painful and it stays painful for longer because they get infected. They nearly always get infected. And then it’s just a matter of whether you get over the infection or not. Does it heal up? Do you get left with a nice piercing and a normal looking ear and the hole will be epithelialized by then so skin will have grown over the inside of the hole and at that point when there’s no redness and it doesn’t hurt and the thing just hangs in your ear now, that’s no longer doing any acupuncture.

 

Dr. Katy Munro [00:32:39] Oh, right.

 

Dr. Mike Cummings [00:32:40] But up until the point that it’s healing, there’s going to be a sensation from tissue going in that could be rather similar to having acupuncture. Could be similar. In which case you can believe that it’s possible for some patients that it did have an effect. It did work for them. But of course, we know acupuncture doesn’t work for everyone, so it’s possible that it works for some and it doesn’t work for others. And of course, when we’re looking at that and I was just talking about the risk-benefit effect, if you look at the risk-benefit, you’ve got a bigger risk for doing that type of intervention. So I think I mean, I would say this, wouldn’t I? But I think it might be advisable to try acupuncture first as a technique because it’s far less risky than having to have a piece of cartilage cut out of your ear and a deforming surgery because you’ve gone for an ear piercing in the cartilage. The ones in the lobe aren’t quite as risky. The ones through cartilage are more risky from an ENT perspective. Bear in mind, as an ENT surgeon, we see a very select group, of course, so I’m not sure how often that happens. It happens with acupuncture in the ear as well, but very, very rarely. Extremely rarely. And I’ve never seen a case from acupuncture. I have seen them from ear piercings.

 

Dr. Katy Munro [00:33:59] So that’s really interesting. It’s not something we advise people to do. And we’ve mentioned a couple of times in previous episodes. But yeah, I just wondered about the relevance with acupuncture.

 

Dr. Mike Cummings [00:34:09] And I think we can’t advise at the moment, but I would really suggest that it gets tested. I think it’s worth getting tested.

 

Dr. Katy Munro [00:34:17] It needs a proper study. Yeah, we need somebody to do some research because again, we’re coming back to the individual and trying to tailor-make things.

 

Dr. Mike Cummings [00:34:24] Exactly.

 

Dr. Katy Munro [00:34:27] Thank you very much for coming on the podcast and giving us all the benefit of your information, experience and wisdom about this. I think people are going to be really interested to hear. So thank you very much. Don’t think I’ve got any more questions about acupuncture.

 

Dr. Mike Cummings [00:34:44] It’s a great pleasure. And I would say, I really I think acupuncture is one of the best treatments, it’s certainly worth trying if you can get over your needle phobia and you can find a nice practitioner.

 

Dr. Jessica Briscoe [00:34:58] Hello, I hope you’ve enjoyed listening to this episode of the Heads Up podcast. I’m not sure if you’re aware that we’re a charity, but we do rely on donations in order to keep going with both our podcasts and with our clinics that we run through the National Migraine Centre. If you have enjoyed the podcast, we’d be really grateful if you could visit the link, which is in the blurb in the podcast information which will take you to our donation page. Here it would be great if you could donate whatever you feel that was necessary for us, however big or small, in order to help us keep going as a charity. The other thing that we really rely on in order for our podcast to reach as many people as possible is your ratings and reviews on whichever podcast platform you listen to us on. So if you could leave us a rating and a review, we’d be really grateful. Thank you.

 

[00:35:50] You’ve been listening to the Heads Up podcast. If you want more information or have any comments, email us on info@NationalMigraineCentre.org.uk. Till next time.