What is acupuncture?

Acupuncture is a treatment that involves inserting fine needles at certain points in the body to help produce natural substances, such as endorphins, to relieve pain.

National guidance recommends that acupuncture should only be used as a treatment option for chronic tension-type headaches (TTH) and migraines based on the clinical evidence available.

A tension-type headache is the most common type of headache and the one we think of as a normal, everyday headache. It may feel like a constant ache that affects both sides of the head and you might also feel your neck muscles tighten and a feeling of pressure behind the eyes.

Migraines are generally more serious and involve moderate or severe headaches felt as a throbbing pain on one side of the head. Many people also have additional symptoms such as nausea, vomiting and increased sensitivity to light or sound.

There are different types of migraines but only one qualifies for acupuncture. Migraine with aura (what we know as a classic migraine) is caused by sensory disturbances such as flashes of light, blind spots and other vision changes or tingling in your hand or face.

It is recommended that acupuncture should not be used to treat back pain or spinal (radicular) related pain.

How acupuncture works

An initial acupuncture session usually lasts 20-40 minutes and involves an assessment of the patient's general health, medical history and a physical examination before acupuncture practitioners insert the needles.

During the session the patient will be asked to sit or lie down and remove some of their clothes so practitioners can insert needles into specific points of the body, called acupuncture points.

Patient eligibility criteria:

Patients with chronic tension-type headaches are only eligible for acupuncture when they suffer headaches on 15 or more days per month on average for more than three months, AND:

  • The headache lasts hours to days, or is constant
  • The patient suffers headaches that occur on two sides of the head, the headache feels tight or pressing in quality, is mild or moderately intense and is not made worse by physical activity such as walking
  • The patient does not suffer moderate or severe nausea or vomiting and does not suffer sensitivity to light or sensitivity to loud noises
  • Is not linked to a pre-existing condition.

If the patient fulfils the above criteria, then they may be offered a course of up to 10 sessions of acupuncture lasting up to eight weeks.

Patients who suffer with migraines will be eligible for acupuncture if they match the following national guidelines:

  • The patient’s headaches are fully reversible and develop gradually, either alone or in succession over at least five minutes and last for five to 60 minutes.
  • The patient has already attempted and been unsuccessful with other acute treatments including:
  • Combination therapy, such as an oral Triptan and an NSAID, or an oral Triptan and
  • paracetamol
  • Monotherapy (single drug treatment), such as an oral Triptan, or NSAID, or aspirin, or paracetamol
  • Anti-emetic drug therapy (anti sickness drugs), such as metoclopramide, Domperidone or Prochlorperazine. Even in the absence of nausea and vomiting
  • No use ergots or opioids
  • Medication-overuse induced headaches are ruled out
  • All drug therapies and alternative drug therapy options have been exhausted.

Additionally, the patient must also present with one of the following:

  • Visual symptoms that may be positive (for example flickering lights, spots or lines) and/or negative symptoms (such as partial loss of vision)
  • Sensory symptoms that may be present (for example pins and needles) and negative symptoms (for example numbness)
  • Speech disturbance.

If the patient fulfils the above criteria, then they may be offered a course of up to 10 sessions of acupuncture lasting up to eight weeks.

Advice and further guidance:

  • For more information, search for ‘acupuncture’ at 
  • Choosing Wisely UK is part of a global initiative aimed at improving conversations between patients and their doctors and nurses.

Treatment policy for patients covered by NHS Birmingham and Solihull CCG

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