Eight Less Headache Days a Month? An Inside Look into Our Concussion Research | E5

Our latest episode provides an inside look into a pilot study Sophia Bouwens and Ayla Wolf were both personally involved in on acupuncture's effect on post-traumatic headaches, revealing significant improvements for participants. We discuss the necessity of research-driven therapies, the importance of patient-provider communication, and future opportunities for tailored headache treatments. 

• Introduction to Life After Impact podcast 
• Overview of the pilot study investigating acupuncture for post-traumatic headaches
• Examination of study results and satisfaction levels 
• Discussion of treatment frequency and patient experiences 
• Call for expanded research and individualized treatment approaches 
• Conclusion linking acupuncture research to real-world applications

Research paper:

Herrmann, A. A., Chrenka, E. A., Bouwens, S. G., Tansey, E., K., Wolf, A. A., Chung, K. W., . . . Hanson, L. R. (2024). Acupuncture Treatment for Chronic Post-Traumatic Headache in Individuals with Mild Traumatic Brain Injury: A Pilot Study. J of Neurotrauma. doi:10.1089/neu.2024.0212

Link to research paper: https://www.liebertpub.com/doi/10.1089/neu.2024.0212

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Chapters

• 0:00 Acupuncture for Post-Traumatic Headaches Study
• 10:16 Post-Traumatic Headaches Treatment Success
• 20:39 Traumatic Neck Injuries Discussion

Transcript

Ayla Wolf: 0:00

With very little fanfare, I mean, when we submitted the manuscript, they came back to us with positive reviews and really good feedback, and they're like, this is a great study. And can you just make, like, one small change to this table here? I mean, they didn't have a whole lot of changes they even wanted us to make after they accepted it,

Sophia Bouwens: 0:20

and that's a testament to the whole team. Welcome to the life after impact podcast where we do a deep dive into all things concussion and brain injury related. We talk about all the different symptoms that can follow brain injury, different testing methods, different types of specialists out there, and different therapies available. I'm Sophia Bowens, and I'm here with Dr Ayla Wolf, and we will be your guides to living your best life after impact.

Ayla Wolf: 0:54

In this episode of Life after impact, we are going to talk about our pilot study, which was a research project looking at the use of acupuncture for people suffering from post traumatic headaches. So Sophia, why don't you start out by just giving us a little bit of information on the study, and this was, you know, something that was really your baby, because you had found the funding for it, and you reached out to the right people that started to make this all happen, give people kind of some background.

Sophia Bouwens: 1:23

I was super excited to dive into this with you and have a just even bring this to the table. It was not me that found the funding. It was Dr. Amanda Herman, the lead on the study. The study is titled Acupuncture Treatment for Chronic Post-Traumatic Headache in Individuals with Mild

Traumatic Brain Injury: 1:40

A Pilot Study. It was published in the Journal of Neurotrauma online in October, 2024 what's really interesting about this study? It was a two year pilot study to really just ask a question with this complex condition, post traumatic headache. The question was, really, could we make the change in this diagnosis, in this condition? And then from there, we want to ask more questions, how and why and where and which ways can we do it the best? And

Ayla Wolf: 2:13

I think too, just to give people a really kind of big bird's eye view when it comes to medicine and research, you know, we as acupuncturists can collect all kinds of just data and clinical experience, but in order for what we do to really make it into mainstream medicine or to be widely accepted for, say, a specific condition like post traumatic headaches, you really need the research. You really need to do the research to say, hey, this isn't just my opinion about what's happening in my office, but this is, you know, an actual research study that has an institutional review board and all of these checks and balances to make sure that, you know, we're doing this in a way where we're being objective about our findings. And so the reason why I'm excited about it is because we had good outcomes, which we'll talk about in a minute, but it really opens the door to then say, okay, we did the pilot study. We had good outcomes. So now let's hopefully go out and get more funding to do larger scale studies with hopefully longer durations of treatment, more people, better objective markers that we're gathering throughout and so it's exciting that this initial study was, you know, really, very quickly picked up by the Journal of Neurotrauma.

Sophia Bouwens: 3:33

Which is a big deal.

Ayla Wolf: 3:34

It's a big deal. Each of these journals that publish scientific research, they have an impact score, and the Journal of Neurotrauma at the time of recording here is 3.9 out of five, and that's a really high score. And so what that says is that this journal doesn't just take anybody's research, you know, they really highly vet the research for good quality, good methods. You know, they don't just take anything. And so the fact that with very little fanfare, I mean, when we submitted the manuscript, they came back to us with positive reviews and really good feedback, and they're like, this is a great study, and can you just make, like, one small change to this table here? I mean, they didn't have a whole lot of changes they even wanted us to make after they accepted it.

Sophia Bouwens: 4:20

And that's a testament to the whole team right. Dr. Hermann, who wrote the manuscripts, the people at the institute that did the stats, reviewing and putting it all together, the design that we came up with, the treatment that we came up with, how it impacted patients, and what changes we saw in this really stubborn, difficult to treat condition that only 13% of people are satisfied with their outcomes. With we made an impact there, and the Journal of Neurotrauma was excited about how we did it and what they want more.

Ayla Wolf: 4:51

And so referencing, you know, you just referenced the study we had talked about in a previous episode where 87% of people said they were dissatisfied. With their current treatments for post traumatic headache. So with that kind of statistics, you know, that really did allow us to say, Okay, if 87% of people are dissatisfied, then let's try this, you know, then let's research these other therapies, like acupuncture, because the you know, standard of care is medication, right? And so if medication is not cutting it, if medications not helping these people, what other therapies are out there that could potentially give them relief? And so you know, to be able to have a non pharmaceutical intervention that in terms of our outcomes, you know, people were going into the study with approximately, or on average, 23 headache days per month. And then after the acupuncture, which one group got five treatments only, right? So once a week for five weeks, and then the other group acupuncture, twice a week for five weeks. So we were only looking at an intervention of either five treatments or 10 treatments. And part of the difference in those two arms was to say, you know, does the frequency matter? And what we ended up finding out was that, on average, in both groups, they experienced eight less headache days per month. And if this was a pharmaceutical study, and they found a reduction from, you know, 23 headache days per month down to 15, that would be a blockbuster drug. You know, in just that short of in a five week window, that kind of change. And so that's super exciting, because that, I think, opens the door for us to be able to do more research.

Sophia Bouwens: 6:33

Ask more questions, right? So I wonder too, thinking about dose, because this was a dosing question. But do you think five treatments, clinically, in your experience, is enough treatments for people to have their postmodern headaches resolved?

Ayla Wolf: 6:46

So the research says that when you get a concussion, on average, people get better within 14 to 30 days. But really, the research is saying about 70 to 85% of people recover in this normal window of recovery. And so my patient population is not the population of people who recover in 14 to 30 days. The people that I see are the people who fall in the other category where they didn't recover in a normal, expected window of time. And by the time they see me, their concussion is maybe six months to two years to five years old, and they are suffering with daily headaches, right? And they've been very stubborn, and they've tried this medication and that medication, and this therapy and that therapy, and they're still symptomatic. And so in the cases that I see, it's very rare that those people have miraculous results within five treatments. And usually, you know, we're having to do not just acupuncture, but a lot of other therapies combined. So it's also very hard to say, well, this therapy got them this much better, and that therapy got them that much. It's very hard to tease out out of all the therapies, right? Which one did what? And for me, the reason why I like to have a very large tool bag is because I'm not attached to any one tool either. You know, even as an acupuncturist, it's like, if somebody doesn't want needles, doesn't want acupuncture, I'm like, great, that's fine. I got a whole tool bag here. We can use all kinds of other fun things here. But to answer your question, you know, in the study, we saw a great improvement in people who only had five treatments. However, when we followed up with them three months later, what we saw was that their headaches had gotten worse again after the treatments were stopped or discontinued, because the study ended. And so I think what that study showed is that the acupuncture was helping, but because it was stopped after only five weeks, it wasn't we didn't create enough neuroplasticity to create lasting changes with only five weeks of care.

Sophia Bouwens: 9:53

I agree. I think of it like exercise again. If you go to the gym once a week for five weeks, you're going to be doing better. If you go to the gym once a week or twice a week for five weeks, you're going to be doing better as well. But it's not until that three month or four month period that you might find a bigger difference between the once a week versus twice a week or three times a week treatments. And some studies have shown similar effects with things like migraine you had, the case study you mentioned last episode about the patient that was getting treatment. Do you want to touch on that really quickly?

Ayla Wolf: 10:28

I mean, that was such a great case to highlight the importance of frequency and duration. And so that person was having headaches for 35 years, I think, and every single day she was having a migraine and had been diagnosed with medication overuse headaches going off of all the medications didn't make the headache go away. And so she started doing acupuncture twice a week for six months, and what they found was that after four weeks or eight treatments, she had had no change in her headache. She was still having them every single day, but then by week 12, she was only down to like eight headache days a month, and then by the six months she was having maybe one day a month where she was having a headache. And so again, most people, if they start a therapy, and they do it twice a week for four weeks, and they don't see a change, I think a lot of people are quitting at that point. And I think that that that kind of graph in that paper was just so eye opening to say this was somebody who was having headaches every single day, and six months later, she was having them once a month. That's a big deal after basically 48 acupuncture treatments. But after, you know, 12 weeks, she had significant relief.

Sophia Bouwens: 11:39

And there's so many components that go into studying things. With this study in particular, we did the high dose of two times a week, or low dose one time a week. And because of our funding and our question window, we didn't have time to ask, how does this do after 12 months? We had to first say, like, do we make a change before we put someone through yes, we do. And now, as any pilot study does, it begs more questions and has you do further investigations. So I'm excited to see where we go with it next.

Ayla Wolf: 12:18

Yeah, I've really found that in the process of doing research, it's a process of learning how to do the research better every single time, absolutely. And I know we've talked about wanting to do more research, but also being able to actually have a better differential in terms of you've got, let's say, 100 people with post traumatic headaches. Well, if some of those people are having cervicogenic headaches coming from the neck trauma, what would their treatment look like different from the person who's having true migraines, different from the person who's having migraine like headaches versus the person who's having a tension headache. And so to be able to actually have more individualized approaches based on what's driving the headache, and also a better diagnostic process of saying is there an ocular motor dysfunction that's driving this person's headache versus the other person? And so is there something else that is, you know, keeping them in that state that we need to be paying attention to as well, for example.

Sophia Bouwens: 13:16

I remember calling you with this question and trying to figure out the design for this study. I remember how excited I was, but how challenged it was, she was like, Okay, we have one shot to make one treatment type that everyone's gonna get the same treatment for this really complex condition, post traumatic headache, that can come from many different ways. We have to just figure out one protocol to give everyone. What do we do?

Ayla Wolf: 13:43

Yeah, and that's where I came up with what I felt like was a total shotgun approach, saying, Okay, we're gonna do some points that I know help to increase blood flow to the anterior circulation of the brain, and we're gonna do some points that have a really powerful effect on the brain's ability to inhibit pain in that periaqueductal gray of the mesencephalon. And then we're gonna do a few other points to help shift people out of a sympathetic state into a parasympathetic state. And then we're gonna do a few points around the eyes and with the trigeminal nerve to try to help modulate this trigeminal cervical complex. And so we did really kind of come up with the shotgun approach.

Sophia Bouwens: 14:21

A little bit of everything, sprinkle some of this, sprinkle some of that, and it made a change. It worked, which is remarkable, a testament to acupuncture well.

Ayla Wolf: 14:30

And this is where I just love that the health partners, neuroscience center is so open to doing research on non pharmaceutical options for things like concussion recovery and post traumatic headaches. And I've just loved that Dr Hermann and her whole team are so open to these kinds of therapies and studying them. And then also, I know that there's some research on transcranial magnetic stimulation happening, as we speak, for people with post traumatic headaches through the neuroscience center as well. And so I just love that they're so open minded and willing to do that kind of research and to allocate, you know, all of those research, you know, funding and personnel, and you know, the statistics teams, and you know, managing all of that, the fact that they're allocating all of those, you know, people and resources to studying these therapies, is so exciting.

Sophia Bouwens: 15:22

I think it is exciting, and it starts to shift the dynamic in medicine, right? Because I think as a whole, Western medicine is starting to understand like medications and surgeries can't be our only options. We have to figure out other things too. The providers I work with the neuroscience center, I'm so grateful for because from the physicians that refer patients in who really are willing to find solutions for their patients, to the other therapists they get to work alongside. To find real solutions for each individual is really key, and research is hard. You know, this was a two year pilot study that took six years to complete. We did have a pandemic made a. A little bit of difference there, but we stuck with it, and we have lots more questions to ask moving forward, which is great.

Ayla Wolf: 16:13

And I think that, you know, the military and the VA hospitals have also, you know, really taken up that mantle too, to say, what can we do that's non pharmaceutical because thanks to the opiate crisis, we know that we can't just be throwing addictive pain medication at people, because that creates way more problems. And so I do think that ever since the opiate crisis and the aftermath of that, that people are much more open to trying other therapies and recommending other therapies. But it helps doctors and physicians when they actually have a research, you know, research to say, hey, I have evidence to say that this is worthwhile.

Sophia Bouwens: 16:49

So listeners who are struggling with post traumatic headache, or chronic post traumatic headache, which is more than just immediately after the injury, but three or six months more, could go find that study if they have an acupuncturist that isn't familiar with post traumatic headache, or the neurology of it, or working with it, they could bring that study as a starting point, a launch point, to say this made a difference in this group. Can we start here, or listen to this podcast in our previous episodes, which dive into headache and post traumatic headache more specifically as well, maybe fill out our questionnaire that's on our website.

Ayla Wolf: 17:25

Yeah, that's also a great starting point, because we've talked about this a little bit in previous episodes, that importance of when you're describing your headache to your healthcare providers, it's really important to be able to do that in clear terms. And there are some people that you know, they've not taken any healthcare courses, and so they're experiencing symptoms, but they don't necessarily have the vocabulary to describe them. And once you give people the vocabulary, then they can communicate better. And so that's the whole point of this free headache communication tool that's on the life after impact.com website is like, here is the tool that you can use if you feel like you don't have the right vocabulary to really dive into describing the different types of head pain, whether that is, you know, migraine like or whether it's this neuropathic pain that we did the whole podcast on. And these things are important. These differentiations are important for getting the right kind of therapies.

Sophia Bouwens: 18:21

And they're small uses of language that can make all the difference in your quick interactions with your physicians or providers who are trying to make sure the diagnosis is correct so the treatment is correct and effective.

Ayla Wolf: 18:32

I mean, I had a patient who would often, when she came in, she would describe swelling in her neck, and I kept kind of being like, Okay, I don't this isn't making any sense. I'm palpating your neck. I'm looking at your neck. I'm not seeing any signs of swelling here. And so when I finally said to her, I was like, when I hear the word swelling, you know, I'm typically thinking that there is actual swelling, there's congestion of fluid. I can see this, I can feel this, there might be temperature changes. And I'm like, I'm just not seeing any of this. And what we basically came to find out is that she was using the word swelling to just describe muscle tightness. Oh, and so it was a complete miscommunication, because she was using the word swelling to describe muscle tension. So different, it's very different. And I have people all the time that say they have vertigo, when they don't actually have vertigo, they've just got dizziness. Or I have people that will say they're they have vertigo or dizziness, when really what they have is disequilibrium. And so as people, especially when it comes to brain injuries, you know it's not fair to the people that have the injury that they have to then go out and feel like they have to get a neuroscience degree just to understand their process, right?

Sophia Bouwens: 19:42

And even having one before my injury...

Ayla Wolf: 19:46

Having a legit neuroscience degree!

Sophia Bouwens: 19:48

Having one helps, but it doesn't always get you there!

Ayla Wolf: 19:50

Yeah, and so again, another reason why we're doing the podcast and why I wrote the book is to try to really give people the vocabulary they need to understand what's going on without trying to piecemeal it together from Dr Google.

Sophia Bouwens: 20:03

I'm hopeful that research like what we did helps the world and patients and providers understand some of the options. And I'm excited to see where we go with it in the future, because it was a pilot study, and we do expect to make a bigger study with a better question, or maybe different treatments that get at these different types of post medic headaches.

Ayla Wolf: 20:24

Absolutely, I'm excited for that. We'll put a link to the abstract in the show notes so people can take a look at that. And once again, if this podcast is been helpful to you, feel free to subscribe by clicking the link in our show notes, and you can subscribe at whatever membership level you feel comfortable with. But we appreciate your support. We would love if you would share this podcast. If you have other people that you know are suffering from concussions or post concussion syndrome, and please reach out to us. Let us know if you have questions, topics you want us to cover, at lifeafterimpact@gmail.com

Sophia Bouwens: 21:00

We'd love to hear from you!

Ayla Wolf: 21:02

our next episode is going to be on traumatic neck injuries, and I think that one's going to be a part one, part two.

Sophia Bouwens: 21:09

Yes, that's going to dive into a lot of the confusion that can come between the neck and the head, and how we can dive into that. So stay tuned.

Ayla Wolf: 21:23

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