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Head, neck and neurological

  • Acupuncture


    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.
  • Helmet therapy in children

    Helmet therapy in children

    This guidance is produced by The Academy of Medical Royal Colleges (the Academy) as part of the Evidence-based interventions programme. It is based on recommendations from the Expert Advisory Committee and the National Institute for Health and Care Excellence (NICE).

    All guidance has been reviewed by the Birmingham and Solihull & Sandwell and West Birmingham CCGs’ Treatment Policy Clinical Development Groups (TPCDG). This was reviewed to establish if existing CCG policies were already in place which covered the proposed intervention / treatment in question.

    Where there was no current CCG policy for the area in question, the NHSEI policy has been implemented in full into the CCG’s Clinical Treatment Policy portfolio.

    Where there was a current CCG policy for the area in question, then the existing CCG policy has been reviewed by the TPCDG considering the NHSEI EBI policy rationale and evidence base.  A decision has then been taken by TPCDG based on the review as to the most appropriate policy for implementation by taking into account the healthcare needs of our local population.

    The aims of the Evidence Based Interventions programme is to ensure the quality and safety of patient care by, freeing up valuable resources such as time so that more effective interventions can be carried out, reducing harm or the risk of harm to patients, helping clinicians maintain professional practice, creating headroom for innovation, and maximising value and avoiding waste.

  • Chronic fatigue syndrome

    Chronic fatigue syndrome

    What is Chronic Fatigue Syndrome?

    Chronic fatigue syndrome (CFS) is a long-term illness with a wide range of  symptoms. The most common symptom is extreme tiredness.

    CFS is also known as ME, which stands for myalgic encephalomyelitis. There's some debate over the correct term to use for the condition, but this document will refer to it as CFS/ME.

    CFS/ME can affect anyone, including children. It's more common in women, and tends to develop between the patients mid-20s and mid-40s. It can follow from a viral infection, quite often the trigger is unclear. In addition, patients with CFS/ME may have other symptoms, including:

    • Sleep problems
    • Muscle or joint pain
    • Headaches
    • A sore throat or sore glands that aren't swollen
    • Problems thinking, remembering or concentrating
    • Flu-like symptoms
    • Feeling dizzy or sick
    • Fast or irregular heartbeats (heart palpitations)
    • Most people find over-exercising makes their symptoms worse.


    The severity of symptoms can vary from day to day, or even within a day.

    The symptoms of CFS/ME are similar to the symptoms of some other illnesses, so it's important that the patient sees their GP to get a correct diagnosis.

    Most patients with CFS get better over time, although some people don't make a full recovery. It's also likely there will be periods when your symptoms get better or worse.

    Children and young people with CFS/ME are more likely to recover fully.

    Patient eligibility criteria

    Based upon the evidence identified there is some evidence to show Cognitive Behavioural Therapy (CBT) has a positive impact on patients with CFS/ME through reducing symptoms of fatigue.

    There was also moderate quality evidence that Graded Exercise Therapy (GET) was more effective at reducing fatigue compared to ‘passive’ treatment or no treatment and had a positive effect on people’s daily physical functioning, sleep and self-ratings of overall health.

    CBT in the form of a pacing programme or an individualised care package (which combines CBT and GET as required to support the individual patient); will be funded through the commissioned provider in the following circumstances:

    1. The patient has a confirmed diagnosis of mild or moderate CFS/ME


    2. The patient has undergone a holistic assessment with a CFS/ME treatment specialist team and either a group programme, or individualised programme, has been deemed by the specialist clinical team the most appropriate intervention for the patient in their individual circumstances.

    In patient care or therapy in a residential setting are not routinely commissioned for the treatment of CFS/ME due to the lack of clinical evidence to support this intervention.

    This means (for patients who DO NOT meet the above criteria) the CCG will ONLY fund the treatment if an Individual Funding Request (IFR) application proves exceptional clinical need and that is supported by the CCG.

    Advice and further guidance

    • For more information, search for ‘Chronic Fatigue Syndrome (CFS/ME)’ at
    • Choosing Wisely UKis part of a global initiative aimed at improving conversations between patients and their doctors and nurses.

    Or visit the following website:

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