THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE

Volume 20, Number 5, 2014, pp. 371–374

ª Mary Ann Liebert, Inc.
DOI: 10.1089/acm.2013.0120

Efficacy of Yamamoto New Scalp Acupuncture Versus

Traditional Chinese Acupuncture for Migraine Treatment

Mehran Rezvani,1 Ahmad Yaraghi,1 Masood Mohseni,2 and Farshid Fathimoghadam1

Abstract

Background: Traditional Chinese acupuncture (TCA) is an effective alternative treatment in migraine head-
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ache. The aim of this study was to compare the therapeutic effect of Yamamoto new scalp acupuncture
(YNSA), a recently developed microcupuncture system, with TCA for the prophylaxis and treatment of
migraine headache.
Methods: In a randomized clinical trial, 80 patients with migraine headache were assigned to receive YNSA or
TCA. A pain visual analogue scale (VAS) and migraine therapy assessment questionnaire (MTAQ) were
completed before treatment, after 6 and 18 sections of treatment, and 1 month after completion of therapy.
Results: All the recruited patients completed the study. Baseline characteristics were similar between the two
groups. Frequency and severity of migraine attacks, nausea, the need for rescue treatment, and work absence
rate decreased similarly in both groups. Recovery from headache and ability to continue daily activities 2 hours
after medical treatment showed similar improvement in both groups ( p > 0.05).
Conclusion: Classic acupuncture and YNSA are similarly effective in the prophylaxis and treatment of migraine
headache and may be considered as alternatives to pharmacotherapy.

Introduction developed variation of acupuncture that has been proposed

to be effective in the treatment of acute and chronic pain and
neurologic disorders.8 There appear to be no other studies
M igraine is a common disorder with a 1-year preva-
lence of 10%–12% and a lifetime prevalence of 15%–
20%.1 Frequent severe headaches results in diminished
comparing the efficacy of Traditional Chinese acupuncture
(TCA) and YNSA in the treatment of migraine headache.
quality of life and long-lasting headaches can lead to de- This study was conducted to compare the effects of these
pression, as well as high economic cost due to absence from two treatment modalities on the frequency and severity of
work.2 Most patients can be satisfactorily treated with the migraine attacks, response to rescue treatment, daily activ-
treatment of acute attacks, but a relevant minority need ity, and nausea and vomiting.
prophylactic interventions because their headaches are too
frequent or are insufficiently controlled with rescue treat-
Methods
ment. Despite the introduction of a wide variety of pro-
phylactic medications, some patients currently experience Between March 2009 and April 2011, a total of 80 pa-
frequent attacks refractory to medications or are unable or tients with migraine headache aged 18–65 years referred to
unwilling to use drug prophylaxis. Thus, an alternative safe an acupuncture clinic were enrolled. Migraine was diag-
and effective treatment modality is needed. nosed according to diagnostic criteria of the International
Acupuncture is a traditional Chinese intervention that has Headache Society.9 Patients with other severe pain disor-
been widely used in the prevention and treatment of mi- ders; bleeding diathesis; or severe diseases of the heart,
graine headaches. A Cochrane review suggested that acu- lung, liver, kidney, or other organs, as well as pregnant or
puncture is at least as effective as, or possibly more effective lactating women were not enrolled. All patients receiving
than, prophylactic drug treatment, and has fewer adverse medical treatment for headaches were advised to continue
effects.3 However, there is no consensus that classic their treatment, and those not receiving any treatment were
acupuncture is more effective than sham interventions.4–7 advised to take 650 mg acetaminophen for their migraine
Yamamoto new scalp acupuncture (YNSA) is recently attacks. Patients were randomly assigned to receive TCA or

1
Department of Anesthesiology, Isfahan University of Medical Sciences, Isfahan, Iran.
2
Department of Anesthesiology, Iran University of Medical Sciences, Tehran, Iran.

371
 372 REZVANI ET AL.

YNSA. Block randomization was done by a table of random Table 1. Baseline Characteristics of Patients
numbers. The study was approved by the regional ethics
committee, and written informed consent was obtained from Classic
all patients. acupuncture YNSA p-
Variable (n = 40) (n = 40) Value
Baseline evaluation for pain characteristics and presence
of complications was performed using a questionnaire that Age (y) 35.4 – 9.5 35.5 – 10 0.94
included a pain visual analogues scale and migraine therapy Men, n (%) 12 (30) 13 (32.5) 0.81
assessment questionnaire. One resident of anesthesiology Duration of migraine (y) 5.4 – 4 5.8 – 3.6 0.64
who was blinded to the assignments recorded outcome Frequency of weekly 2.2 – 1.6 2 – 1.1 0.47
measures from the baseline period to the 12th week after headache
randomization in predefined intervals.
Values expressed with a plus/minus sign are the mean – standard
deviation.
Intervention protocol YNSA, Yamamoto new scalp acupuncture.
In the TCA group, on the basis of clinical symptoms
and traditional Chinese physical examination and diagno- 15 mm for this parameter. On the basis of a power of 0.8 to
sis, several points from the LI4, ST8, ST36, BL2, GB14, detect a significant difference and an a level of 0.05, 36
TB5, GB8, tai yang, SI3, BL10, BL60, GB20, LIV3, KID1, patients are required for each group. Another 4 patients
DU20, si shen cong, LU7, SP6, LIV2, ST36, and REN6 (10% of calculated sample size) were added to compensate
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acupuncture points were selected. Needling was performed for dropouts. Data are presented as mean – standard devia-
by using steel needles (Huan Qiu, China) with different sizes tion. The analyses were performed with Mann-Whitney U
and diameters for different points. In the YNSA group, on test and independent Student t-test for quantitative variables.
the basis of clinical symptoms and diagnostic points in the All the comparisons were two tailed. Any p values < 0.05
hands, neck, and abdomen, different points, especially A1-7, were considered to represent statistically significant differ-
M1-3, and Y psilon points, were selected for the interven- ences. Statistical analysis was performed with SPSS, version
tion (Fig. 1). Needling was done with 25-mm steel needles 16.0, software (SPSS Inc., Chicago, Illinois).
(Huan Qiu). Needles were inserted to a depth of 10–15 mm
and were manually manipulated by rotation methods to Results
achieve de qi. The interventions in the two groups were Demographic variables, duration of migraine, and the
performed by an experienced physician who had worked frequency of weekly headaches were similar between the
with acupuncture for 15 years. two groups (Table 1). All the recruited patients completed
A total of 18 sessions of acupuncture treatments (30 the study period and were recruited into the analysis.
minutes each) in three courses were performed. Each course The frequency and severity of migraine attacks signifi-
included six sessions of acupuncture treatments given every cantly decreased in YNSA and TCA groups (Figs. 2 and 3).
other day, with 1 week rest between the courses. The pa- However, there were no differences between the trends in
tients fulfilled the questionnaire at the end of the second and two groups. At baseline, the rates of work absence due to
eighth weeks of treatment, as well as 1 month after the last headache were 47.4% in the TCA group and 55.3% in the
session of treatment. YNSA groups. One month after the intervention, the rates
decreased to 11.1% and 18.9%, respectively ( p > 0.05). At
Statistical Analyses
baseline, the need for rescue treatment for headache was
The required sample size was calculated with respect to reported in 12.5% of patients in each group. One month after
severity of headache score. From the literature, a standard the intervention, this index was similarly decreased to 2.5%
deviation of 20 mm was expected, and the analysis was of patients in both groups.
carried out with respect to detecting a difference of at least

FIG. 2. The mean frequency of weekly headaches. YNSA,

FIG. 1. Yamamoto new scalp acupuncture points. Yamamoto new scalp acupuncture.
 YNSA VERSUS TRADITIONAL ACUPUNCTURE IN MIGRAINE 373

YNSA is not like classic acupuncture in that it uses a

different somatotope.11 YNSA is a microsystem, a brief and
direct way to balance the body’s system. However, it has
limited capabilities compared with the macroacupuncture
system, which encompasses clinical, spiritual, and a single
body acupoint’s specific physiologic effects. Yet when ef-
fective, YNSA could be a feasible substitute for TCA, with
immediate therapeutic responses. Earlier studies have re-
ported the clinical utility of YNSA in patients with cere-
brovascular disorders, particularly those with stroke.12,13
The findings of this study may extend the clinical applica-
tion of YNSA to patients with migraine.
Patients with migraine may require more and more drugs
for headache prophylaxis. Over the long term, depressed
mood and complications of medications can lead to poor
compliance with drug prophylaxis in these patients. As can
FIG. 3. Pain score in assessment intervals. be expected, a significant proportion of patients do not
regularly use their medications. In this study, all recruited
patients completed the course of treatment. In comparison,
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Recovery from headache and ability to continue daily another study reported that only 2 of 59 patients randomly
activities 2 hours after medical treatment showed similar assigned to 12 weeks of acupuncture treatment withdrew
improvement in both groups ( p > 0.05). Assessment of se- prematurely from the study.14 It would be reasonable to
verity of nausea did not significantly differ between two assume that in the case of similar efficacy, YNSA may be
groups during the follow-up period (Table 2). even better tolerated than TCA because fewer needling sites
are required.
Discussion
In this study, the therapeutic effects of YNSA and TCA
Findings of this study show that both YNSA and TCA can methods on all outcome measures increased with more
effectively reduce the frequency and severity of migraine treatment sessions. Patients were followed for 1 month, and
attacks and improve the response to rescue treatments. Both further improvement after the interventions was noted. In-
methods similarly reduced the need for rescue treatment and vestigators of most of the earlier trials speculated that the
work absence rate and improved daily activities of patients. effect would have increased even further with a longer fol-
Regarding the efficacy and low complication rate of acu- low-up period.4,6,15 However, scarce data on the long-term
puncture methods,3 this treatment may be appreciated as an effects of acupuncture exist. One study followed the patients
appropriate alternative choice for drug prophylaxis in pa- for 9 months after the cessation of treatment and found that
tients with migraine. The current results support the idea the clinical benefits of acupuncture still exist.16 Contrary to
that the acupuncture method has little effect on the outcome, these findings, a small study in 39 patients with migraine
suggesting that point-specific effects play a small role in the headache reported that 6 months after the intervention, 54%
overall response.10 Finally, YNSA, which requires less of patients had relapsed to their preacupuncture state.17
needling than TCA does, may be regarded as an efficacious Clearly, further studies are required to evaluate the long-term
and feasible modality in experienced hands. effects of acupuncture, of any method, on the frequency and
YNSA was introduced by Toshikatsu Yamamoto in 1973. severity of migraine headache. This will help clinicians plan
It is a microsystem of the scalp that uses anatomic and for acupuncture treatments in proper intervals.
channel points to treat disorders. YNSA differs from all The study did have some limitations. The patients who
other microsystems in that it uses an extra palpatory diag- attended the acupuncture clinic may differ from a cross-
nostic system, YNSA neck diagnosis, to determine which section of the population with migraine headache and may
channel point should be manipulated. Using this additional not truly represent the characteristics of the affected pa-
diagnostic tool makes the intervention more specific, with tients. These patients generally have more positive attitudes
less needling required. toward alternative medicine that may affect their response to

Table 2. Severity of Nausea, Headache Recovery, and Ability to Continue Daily Activities
2 Hours After Medical Treatment
Baseline 2 weeks 8 weeks 12 weeks
Follow-up period Classic YNSA Classic YNSA Classic YNSA Classic YNSA
Response to treatment 26 (65) 25 (62.5) 32 (80) 34 (85) 36 (90) 35 (87.5) 36 (90) 34 (85)
Daily activity 27 (67.5) 27 (67.5) 32 (80) 33 (82.5) 36 (90) 35 (87.5) 36 (90) 33 (82.5)
Severity of nausea, median 2 (1, 2) 2 (1, 2) 2 (1, 2) 2 (1, 2) 2 (2, 2) 2 (2, 2) 2 (2, 2) 2 (2, 2)
(interquartile range)
Unless otherwise noted, values are the number (percentage) of patients.
YNSA, Yamamoto new scalp acupuncture.
 374 REZVANI ET AL.

treatment. This study did not intend to compare the thera- 8. Feely R. Yamamoto New Scalp Acupuncture. 2nd ed.
peutic efficacy of TCA and YNSA with sham acupuncture Stuttgart, Germany: Thieme; 2010.
or drug prophylaxis. Patients were followed for 1 month 9. Headache Classification Subcommittee of the Interna-
after cessation of treatment. Thus, the long-term benefits of tional Headache Society: The international classification
acupuncture of either method are uncertain. of headache disorders. Cephalalgia 2004;24(Suppl 1):
Another limitation of the present study was that the pa- 9–160.
tients were not blinded to the interventions because of the 10. Li Y, Zheng H, Witt CM, et al. Acupuncture for migraine
different needling sites in two groups. However, the asses- prophylaxis: a randomized controlled trial. CMAJ 2012;
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ethical reasons, patients were allowed to continue their 11. Yamamoto T, Yamamoto H. Yamamoto New Scalp Acu-
puncture (YNSA). Tokyo, Japan: Axel Springer Japan
medications. This may raise the question about the simi-
Publishing, Inc.; 1998: 17.
larity in the patients’ baseline condition. Of note, the
12. Hegyi G, Szigeti GP. Rehabilitation of stroke patients using
primary evaluation confirmed that the frequency and Yamamoto New Scalp Acupuncture: a pilot study. J Altern
severity of headache, as well as other outcome measures, Complement Med 2012;18:971–977.
were similar between the two groups. 13. Yamamoto T, Schockert T, Boroojerdi B. Treatment of
juvenile stroke using Yamamoto New Scalp Acupuncture
Disclosure Statement (YNSA)—a case report. Acupunct Med 2007;25:200–
No competing financial interests exist. 202.
14. Streng A, Linde K, Hoppe A, et al. Effectiveness and tol-
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