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Interview with Dr. Jeff Baird
Treating Migraines with Medical Acupuncture
August 17, 2000
8:00 p.m. to 9:00 p.m. (EST)
Moderator Good evening, and welcome to HealthAtoZ's chat on acupuncture and headaches. Tonight's chat with Dr. Jeff Baird (ndldoc1), a board member of the American Academy of Acupuncture, will be starting in a few minutes.
Moderator I'd like to welcome Dr Baird to the chat, and thank him for taking time to host this one-hour, interactive question-and-answer session. Would anyone like to ask Dr Baird a question?
docmara4 How do you abort the migraine that just started?
ndldoc1 Occasionally I can treat someone with a combination of acupuncture and manipulation. If the correct triggers are needled it can sometimes abort one before it gets too bad. However, many times we need to use one of the new meds like imitrex or maxalt.
Kate1 Hi Dr Baird...a simple question: Do you find acupuncture effective for headaches?
ndldoc1 You may want to ask my wife. If she works to hard or often after lifting weights she develops triggers in her trapezius that we can treat early and she can avoid the headache entirely. My patients find it immensely helpful and at times when manipulation has not had its intended effects acupuncture has proved markedly effective.
docmara4 What would you do to help eliminate the feeling of confusion and disassociation that sometimes persists even after the pain is gone?
ndldoc1 Confusion in the patient or the doctor?
docmara4 Patients often have confusion, dizziness and disassociation
ndldoc1 docmara4- These points I have not used much but they are very helpful for opening up channels for the flow or chi that is stagnant. They may have some effect if there is strong emotional overlay but you may want to use the 4 gates.
drloew1 What are the best acupuncture points to treat classic migraines?
ndldoc1 Classic migraines from a traditional Chinese orientation may be completely different for a different person. The standard points for headaches are the areas around the neck and shoulders the feet and hands. If you are familiar with the terminology the points would usually be LI 4 St 36 GB 20 21 Bl10.
Barrett2 Do you have any idea what underlying mechanism explains the effect? Just wondering about the underlying mechanism of effect. Any physiology you might suggest. Something that doesn't require a belief system?
ndldoc1 I assume you mean-how does it work. My belief system has a hard time as well. The release of endorphins is well documented.
Kate1 So you diagnose traditionally?
ndldoc1 I have recently started doing more with tongue diagnosis which is incredibly revealing for the underlying pathology and helping determine the points to needle.
Kate1 Do you use pulse?
ndldoc1 At times, but I find the tongue gives me better information.
jyoon1998 How do you treat Shao Yang type headaches?
ndldoc1 Shao yang type headaches for those new to the term are related to the organ of the gall bladder and we see them in the more hard driven type. We use liver and gall bladder points including distal points in the leg gb 39, 40 liver points such as 3,4 and local points around the neck such as gb 21 20.
docmara4 Do you treat migraines un pregnant women with acupuncture?
ndldoc1 In this country they are not treated more for medical legal reason. In all other countries there is little reason not to treat pregnant women until the later stages and that is to prevent inducing early labor. There are some very good studies showing a benefit in treating for turning a breach presentation
drloew1 how often should the treatments be given if the initial one did not work?
ndldoc1 drloew1-If there is absolutely no response-that is they never felt better even for a day or an hour, the diagnosis is probably wrong and you need to look elsewhere and you should be awfully sure that the person does not have a medical condition that needs treating. The last patient that did not respond to acupuncture had a severe case of hypothyroidism. Headaches were her only symptom.
drloew1 What if the migraine is primarily frontal? Should the focus be in the head/neck points?
ndldoc1 drloew1 Points on the back of the neck probably refer to the front of the head based on some embryological effect. Two doctors Travell and Simmons did an amazing amount of work looking at trigger points and their referral patterns.
lacb drloew1 I would say that if the headache is primarily frontal, it is more likely to be a tension headaches than a migraine and would probably focus on other points of tension...such as the back of the neck, as Dr. Baird said. Also consider frontal sinuses as a possible cause, then tai yin/yang ming might be useful... I would also consider local points, such as gb 13,14,15 bl4... would you agree, Dr. Baird, and Dr. Broome,....
ndldoc1 lacb-Frontal points can be very useful for the congestion and pain of sinusitis acute and chronic.
mac15 Absolutely and take any local tender acupuncture point
mac15 Could you comment on windows of the sky points for migraines?
ndldoc1 mac15 Window of the sky points are big for migraines for their obviously locally related effects as well as there energetic effects based on TCM.
drloew1 Any new pearls for treating obesity?
ndldoc1 There is none. Acupuncture works as well as anything for addressing cravings until the person can make some lifestyle changes but is won't replace it. As our master used to say, if acupuncture worked for obesity, there wouldn't be so many fat acupuncturists
drloew1 Please clarify I know of a lot of slim acupuncturists.
ndldoc1 You haven't seen the academy board members lately. Many people do not follow what they preach.
docmara4 Combination of hypnosis and acupuncture may work better for obesity.
ndldoc1 Ear points are still probably the best if you want to try it
lacb: What is sarapin?
ndldoc1: An extract of the pitch plant. It blocks type c pain fibers and works well for muscle triggers. If is made by High Chemical company. Sorry, that should be pitcher plant, the fly eating variety. They are thought to improve the circulation and the free flow of chi and blood.
eschindlr ndldoc1 - You mentioned using prednisone for cluster headaches. Thus the steroid use include trigger point injection with steroids? Or only orals?
ndldoc1 aschindlr I rarely use steroids in tp's usually sarapin and 2% works fine.
lacb ndldoc1 When you said sarapin and 2%- were you referring to lidocaine?
ndldoc1 When you mix the two 50-50 you get 1% which is about correct and safe
lacb ndldoc1 where do you get it?
ndldoc1 Call my nurse at 520-669-9229 and she will tell you where to call her name is Wanda.
eschindlr For all: High Chemical Company 1-800-788-sarapin
drloew1 How about treatment for chronic LBP?
ndldoc1 Yes I usually just do a trial of a medrol pack
drloew1 In treating a patient with cluster migraine, would you recommend a 3x a week treatment?
ndldoc1 At least 3x / week and maybe daily if the person wanted to avoid using drugs.
drloew1 Would also treat a patient with cluster migraine, the same way?
ndldoc1 Clusters are perhaps the toughest of all to treat. I may try acupuncture and manipulation but often the get a much better response using prednisone for me. But yes treat the same way and more often.
lacb mac15 What advice can you give me about treating sciatica?
ndldoc1: Treat sciatica at the bladder points if it is pure posterior leg pain with bladder 40 59 51 26 if there is a lateral component to it you need to treat the pt GB 30 with a long needle 3.5" and distal GB pts 36 39.
lacb ndldoc1 Do you tonify with needles or use moxa, say in a chronic case of sciatica?
ndldoc1 lacb I wish I could use more moxa. It has a great effect cupping also works well as does PENS technique.
lacb ndldoc1 Do you prefer moxa to electricity?
ndldoc1 The preference comes from what you can do in your office and what works better for the patient. I will very often alternate to find out which one the patient prefers and then treat with that.
lacb ndldoc1 Cupping for sciatica? Where- along the bl line?
ndldoc1 lacb Yes. Check for the thick ropey nodules over the SI joint and lower lumber area and cup there.
lacb ndldoc1 What is the pens technique?
ndldoc1 lacb It is a technique developed by Dr Bill Craig. it is fairly simple to see but hard to put here. You can be information about this from the American Academy of medical Acupuncture at 1-800-521-2262. There was a review and published study of the pens technique in the JAMA with in the last one and a half years. Basically it is a shotgun approach to tries to increase the local production of endorphins and enkephalins
eschindlr nldoc1 - In summary and going back to migraines, it looks as if the general treatment theory to which you subscribe is the use of local points to alleviate musculoskeletal pain and points to assist in optimizing local blood flow. Please clarify for me if I've missed something.
ndldoc1 eschindlr yes but often I will use classical points especially the liver and heart points. The effects of treating the local trigger points based on the work of Travell and Simons is well established in the traditional literature. Also the needles do have inherent ability to produce microcurrent which treats the points.
lacb eschindlr I think that's right, but I think you also need to take into account the
background of the patient using the five phases model in determining the underlying cause of the headache..
Moderator That's all the time we have tonight for questions. Thanks Dr Baird for your insightful answers, and thanks to everyone else for their great questions. Remember, you can continue chatting here for as long as you like. Good night, and thanks again!
ndldoc1 thank you all for your interest and questions. My daughters open house calls me. Good night
eschindlr Thanks Dr. Baird. Your time is appreciated.
lacb ndldoc1 Thanks!!!
--- chat continues after Dr. Baird's departure ---
lacb Anyone else here practice acupuncture?
eschindlr lacb - I've not spent much time using five phases in history taking. Often my focus has been on the patients immediate problem. How have you found it useful. (And yes, I use acupuncture.)
lacb eschindlr I haven't had much chance to find out how useful it can be, but Joseph helms touts it in his class. Where did you get your training in acupuncture?
lacb eschindlr I'm in the middle of the course now, and have only been practicing on friends and family, and , myself, of course.
eschindlr I took Joe Helms class in 1996. He is a genius in patient care. You made the suggestion that five phases might be useful. As I am western trained I have had trouble with some of the more exoteric aspects of acupuncture and found the more direct/pragmatic tecnics to my liking. e.g. PENS (percutaneous electrical nerve stimulation)
lacb I understand, I am western trained, as well, but I find the 5 phases model interesting..
lacb I'm still trying to figure out how to incorporate all this into my practice...how did you do it?
eschindlr How to incorporate acupuncture? Easy. First in medicine is do no harm. Looking at a disease process one looks at benefit-risk ratios with all therapies. If I could wave my hands over a patient with them without touching them and they got better that would be the best treatment.
eschindlr Continuing back to incorporating acupuncture. Traditional Chinese medicine had four aspects. Your are learning acupuncture. There was also tui na (massage or manipulation), herbs (or as I see them, medicines) and what the patient does for themselves be it T'ai chi, chi gong, or meditation. I present all this to my patients and use my western training, incorporate acupuncture where appropriate when it would present a less risky treatment for my patient. I will not withhold an antibiotic, for example, from a patient with cellulitis although I may include acupuncture for pain control if the patient was amenable. Acupuncture is an adjunct to what is probably the finest medical system in history. Not a replacement for it. Osteopathy is a tool the DOs have (and I have been trying to learn) that they use in addition to other medical treatment modalities. We can simply add acupuncture in the same manner and use it where it is appropriate.
eschindlr I also like the single point technic (also know as black hole as taught by Allejandro, a Canadian in my class). I had learned through my martial arts training (which included medical training) that the best acupuncturist was one who could use the least needles to help the patient. PENS appears to help a lot. I not necessarily skilled enough to treat a patient with only one point.
lacb eschindlr PENS sounds like it is referring to stick the needles in and hook up electricity, is this right?
eschindlr Yes. PENS is sticking in needles and hooking up electricity but it is not that simple. There are specific patterns, frequencies, and it is important to understand the patients anatomy so that as the patients condition changes, you can adjust your therapy accordingly.
lacb do you have any recommendations in terms of resources to read more on PENS and Allejandro's black hole technique?
eschindlr Resources? Continue your class. That is where I got my original exposure to PENS (also know as the Bill Craig technic) and to the black whole technic.
lacb eschindlr I guess my bigger problem is that I work for a large hospital right now with some screwy administration and initially they said they would pay for Joe Helms' class and that I would be able to practice acupuncture in the office, but after working with them for a year, now they won't pay, and I'm not so sure they will let me practice.
eschindlr The problem with being an employee is that you are an employee. I am too but elected to improve my ability to provide care and have paid for all my acupuncture training myself. It was worth every penny. Not economically but in my abilities and patient (and my) satisfaction.
lacb I think I need to find somewhere else to practice, you wouldn't have any connections in Charlotte, NC, would you?
lacb I would love to continue this conversation.... my husband has been calling me relentlessly for dinner for a half an hour now... if you get a minute- I'd love to hear about some of your experiences getting started... my email address is lcurry@carolina.rr.com- if not - you have been so helpful- thanks a lot- oh, and I can already feel the class paying off!!
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