Nevertheless, it is still important to speak with a doctor before starting to take a daily B-complex vitamin. Trials are being done to establish how useful B vitamins are in helping to alleviate the occupational stress that people experience from their jobs. Not drinking enough water is a well-known migraine and headache trigger, and it only takes minor dehydration to bring on a headache. People can try to drink more water each day to avoid dehydration.
People with severe dehydration may initially need an oral rehydration solution to replace missing electrolytes. Drinking water throughout the day, and maintaining a healthful diet is usually enough to stay sufficiently hydrated.
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Some people find placing a cold or warm compress on their head can be soothing and help to reduce migraine pain. Many people who get migraines report a preference for a cold compress, but warm or cold can work. There are few side effects of using this therapy, though people with circulatory problems, diabetes , or skin issues should avoid extremes of temperature.
People need to collaborate with a doctor or migraine specialist to find a treatment regimen that works, even when trying natural remedies. Keeping a migraine or headache journal can be useful in identifying triggers and effective remedies for migraines. Article last reviewed by Mon 20 August All references are available in the References tab. Acupressure for pain and headaches. Allais, G. Benedetto, C. Acupressure in the control of migraine-associated nausea.
Biofeedback and relaxation training for headaches. Headaches and dehydration. Kisan, R. Sathyaprabha, T. Effect of Yoga on migraine: A comprehensive study using clinical profile and cardiac autonomic functions. Langevin, H. Maghbooli, M. Minton, L. Raising money for migraine research. Sasannejad, P. Stough, C. Reducing occupational stress with a B-vitamin focused intervention: A randomized clinical trial: Study protocol.
Nutrition Journal , 13 , Stress and migraine. Vickers, A. Linde, K. Acupuncture for chronic pain: Individual patient data meta-analysis. MLA Galan, Nicole. MediLexicon, Intl. APA Galan, N. MNT is the registered trade mark of Healthline Media. Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional.
Enter your email address to subscribe to our most top categories Your privacy is important to us. Email an article. There are specific conventions developed to determine whether a 3, 4 or 5 digit code is reimbursable in the old ICD-9 system. The new ICD system consists of characters. The dust has not settled on whether some 3, 4 and 5 digit codes will be acceptable over more lengthy 6 and 7 digit codes.
We start by looking a why certain codes are more commonly reimbursed than others. There are several insurance companies, including Cigna, that accept only a limited number of diagnoses. Currently, Cigna readily reimburses for neck pain, low back pain, nausea due to chemotherapy and nausea due to morning sickness. Anthem Blue Cross-Blue Shield tends to reimburse for a wider variety of diagnosis codes. However, their clinical utilization review guideline published in stipulates:.
That said, most pain codes are reimbursed by Anthem whereas Cigna tends to adhere to strict and narrow guidelines. Neck pain is the first place to start. Most insurance carriers will not balk at the use of cervicalgia as a diagnostic specification.
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The new cervicalgia ICD code is M There is no extra digit ambiguity in this case. Sciatica is another story. The basic ICD sciatica code is M This might be denied because there are five character versions of this code:. This is an example of a new feature in the ICD system. This latter treatment is the same as selected by Chen and Chen 4 for treatment of enuresis. Use two additional needles to complete the treatment.
For persons who have weakness, tingling sensation, or other disorders affecting the arms and hands, needle instead Dingnie Zone 2, with the needle aiming towards the face towards ST If the problem affects one side of the body, needle the opposite side of the scalp, but if it affects both sides, needle both sides of the scalp. For persons with weakness and numbness in the legs, use Dingnie Zone 1, with the needle towards the GV Again, needle either one side or both sides, as appropriate. Use the thrusting technique jinqi in most cases, as this will tonify the deficiency.
The manipulation should be carried out until the patient notices a change in their condition. When treating the arm or leg scalp zones, have the patient attempt movement of the body part while the needle is manipulated. For bladder disorders, have the patient breathe deeply to the lower abdomen, Dan Tian , which should focus attention on the area being treated and help to produce a warming sensation. When treating Eding 1 for the eyes , have the patient gently rub their palms over the eyes.
If an effect is not noted clarifying of vision, change in sensation or strength in affected limbs within about 3 minutes of manipulation time, check that the needling location and needle placement are correct; if correct, it may be necessary to try the lifting method chouqi instead, especially if there is pain.
Once a response is noted, the needle manipulation can be ceased. Patients with leg weakness should attempt to walk for a few minutes.
After about 15 minutes from the previous manipulation , the needles should be manipulated again. At the end of the third manipulation, the patient will be instructed to retain the needles for a period of several hours, up to two days, and then remove the needles themselves or with the aid of someone who can assist them.
The Search for Effective Stroke Paralysis Treatments
The needles used for body acupuncture are removed at the end of the in-clinic treatment session. Holly Gahn, L. She described her basic treatment techniques as follows, indicating that there are a number of other procedures that she may utilize to complete the treatment:. Treatment Course. On the first day, the patient is treated in the morning and in the evening; for the next nine days, the patient is treated once daily. Then, treatment continues at the rate of three times per week until the condition has resolved or the patient has reached what appears to be the maximum level of improvement.
Point Selection. The motor, sensory, balance, vision, and speech areas are utilized as appropriate. For unilateral paralysis, use the contralateral side, but use bilateral treatment of the zones for bilateral paralysis. In cases of generalized brain damage as occurs with anoxic brain damage , Zhu's Eding zone is used predominantly, along with GV and UB-3 bilaterally.
If the patient's scalp becomes sensitive to needling, as might occur with frequent needling of the same zone, it is helpful to alternate from one treatment to the next between the motor and sensory points and the Eding zone. Needling Procedure. Needles are inserted one cun obliquely into the subaproneurotic space. Needles point downwards and are angled off towards the affected limb. It is stimulated by small-amplitude, lift and thrust technique at rapid frequency times per minute if possible. Body needles are also inserted, using standard procedures. Both the scalp and body acupuncture needles are retained for 20—30 minutes and stimulated every 2—3 minutes during this time.
Neuromuscular Re-education. Immediately after the basic needle treatment, the body needles are removed, but the scalp needles are retained. The patient is taken through a series of exercises while the scalp needles are being stimulated simultaneously. If the patient is comatose or otherwise unable to perform these, the practitioner or assistant performs the otherwise passive motions for the patient.
The patient, all the while, is encouraged to try to think about doing the exercises, to visualize it, to visually watch the movements if possible. Verbal encouragement is even given to those who are comatose. As soon in the treatment course as the patient is able to perform the movements, they are encouraged to do so, even if the movement is slight. As they become stronger, the practitioner adds resistance to each exercise weights can be added , thus requiring the patient to apply greater strength and, in some cases, more muscle groups to the task.
The effort put forth by the patient is of utmost importance. For Comatose Patients. The needles should be stimulated strongly manual for 10 minutes. Then add PC-6 and SP-6 with strong stimulation before proceeding to needle the rest of the body and scalp. About needling techniques and duration.
For peripheral facial paralysis, Cui Yunmeng 7 suggests using a. The needle is twirled at a speed of times per minute. Needles are retained for 20—30 minutes, being twirled twice. Needling is done in the facial motor area of the scalp, on the same side as the affected part. For treatment of hemiplegia, Wang, et al.
Acupuncture is given once daily for 40 minutes, with 10 days as one treatment course, and a rest of 3 days between courses. After insertion, the needle is twisted for 5 minutes at a speed tolerable to the patient who is advised to exercise the limbs as best he can. The common one is the rapid needle-twirling method, that is, after being inserted to the lower layer of the galea aponeurotica, the needle is tightly held by the thumb and index fingers, and rapidly twirled for about times per minute.
This manipulation requires a high frequency and continuous movement and lasts 2—3 minutes each time. Within half an hour, the manipulation should be done 2—3 times. Owing to the fact that by this method the needle often twines the muscular fibers and causes pains, it is not well accepted by the patient. Furthermore, the metacarpophalangeal joint of the operator fatigues easily. For this, the finger twirling is replaced by electric twirling, in which the patient is given pulse electric stimulations with dense and loose waves and a current intensity tolerable by the patient.
For the treatment of post-stroke syndrome, Pang Hong 9 reports the following method, based on the teachings of K. For reinforcement, the filiform needle was inserted at an angle of 15—30 degrees to the scalp, slowly and forcefully to beneath the aponeurosis. Pressure was applied to the point for one minute, and the needle was quickly withdrawn after a retention of 10 minutes.
For reduction, the manipulations were similar, except that after 10 minutes of retention the needle was withdrawn slowly, when the skin formed a mount around the retreating needle. For either reinforcement or reduction, the needling took 15 minutes, including the 10 minute period of needle retention.
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Courses of treatment were 10 daily sessions, with efficacy appraised after three courses. The application of reinforcing and reducing manipulations would shorten the therapeutic course, promote the therapeutic efficacy, and decrease the rate of disability. The method of slow-rapid reinforcing-reducing in scalp acupuncture had the advantages of causing less pain and inducing proper occurrence of the needling sensation; therefore, it was well received by the patients.
First, locate the upper point of the motor area, and with the left hand fixed on it, insert the needle obliquely towards the lower point at an angle of 15 degrees with the skin surface. Holding the needle with the right first three fingers, insert the needle quickly until it reaches the loose cellular tissue beneath the scalp. Then turn the needle horizontally with respect to the skin surface, and push it to a depth of about 1. Twist and rotate the needle but never lift and thrust it. Hold the needle between the medial surface of the terminal part of the right index finger and the palmar surface of the terminal part of the right thumb.
With repeated extensions and flexions of the interphalangeal joint of the index finger, one rotates the needle in one direction till it turns two rounds and then in the other direction for another two rounds. One may rotate this way times for one minute, repeat rotating 5—10 minutes later, and retain the needle till 30 minutes after the insertion including the time of rotating. With rotating of the head of the needle, the patient usually reports the feeling of local heat, numbness, and tics.
There may sometimes be radiation of such feelings to contralateral and homolateral limbs. In general, therapeutic effects are achieved with mere appearance of local needling feeling; nevertheless, still better results will be had if the feelings radiate to the limbs. You may produce all the needling feelings with electrical stimulation. To do this, one inserts a 1 cun needle into the upper point of the motor area and pushes it horizontally towards the lower point, and then insert a 1.
The needle was retained for 40 minutes, with small amplitude twistings for another 0. Practice has shown that needling on the motor and sensory areas simultaneously, and on the affected side and the healthy side simultaneously produces better curative effects.
Neuro-Acupuncture and Stroke
In light of the experience of Professor Shi Xuemin, the authors adopted deeper insertion of the needles both on the scalp and on the body. Retention of the needles enhanced vasodilation of the cerebral vessels to increase cerebral circulation more than simple twistings of the needles for the recovery of nervous functions. The authors therefore lengthened the needle retention to 40 minutes. Liu Chunhui and Wang Ying 11 reported on their experience of treating acute apoplexy during a medical visit to Yemen.
The patients were asked to exercise the limb during the needle manipulation. Wu Chengxun 12 reported on using three techniques of needle manipulation. Manual twirling was done with a frequency of — times per minute and the twirling was performed every 3—5 minutes; a needle twirling machine was applied at a frequency of times per minute and applied in the same fashion; an electroacupuncture device was used with a frequency of — waves per minute, with continuous stimulation for 10 minutes.
After the stimulations were applied, needles were retained for several minutes so that the total duration of needling was 25 minutes. The treatment was performed daily for 12 days, and then a rest period of five to seven days was allowed before resuming another course of 12 days treatment. With a total of cases of hemiplegia so treated, it was determined that there was no significant difference in the outcome for the three methods of stimulation. Ji Nan and colleagues 13 used scalp and body acupuncture to treat sequelae of stroke and cerebral injury, claiming improvement in all but 3 of patients, with treatments deemed markedly effective in Needles were inserted, as appropriate to the condition being treated, into zones designated motor area, sensory area, vasomotor area, and speech zones I, II, and III.
For paralysis, they used the method of treating the side opposite the affected limb. Sessions were once daily for 10 days as a course of treatment, applying 2 courses as the standard. Zhang Naizheng 14 described treatment of tremor artuum in 35 individuals using a combination of body points and scalp acupuncture. Using a 26 or 28 gauge, 5 cm long needle, the squeeze-holding method was used for insertion; the angle of insertion was 30 degrees, and the needle was rapidly twirled with a small scope of movement, about times per minute for 2 minutes, and then retained without twirling for 5 minutes; this procedure was repeated three times and then the needle was removed.
Zhang Mingju reported 15 on treatment of cases of hallucinations using scalp acupuncture. The method used was point-through-point needling, with the needles inserted at an angle of about 15 degrees with the scalp and running from GV to GV the Dingzhen 1, which affects the head ; auxiliary treatment locations were needled by similar method, starting at the selected point and then needling through to the next point examples: GB to GB; TB to TB Needles were twirled and agitated for 1—3 minutes.
When the needling sensation is felt is the best time to channel qi to the locality of the disease. Needles were retained for 1—3 hours. Acupuncture was performed daily, and 10 sessions constituted on therapeutic course. After the first course, acupuncture was performed every other day, with 10 sessions constituting the second therapeutic course.
If still necessary, acupuncture was performed twice weekly, with 10 sessions constituting the third therapeutic course. Zhang Hong reported 16 on treatment of 76 cases of senile urinary incontinence. Body and scalp acupuncture was used, with scalp points picked in the leg motor and sensory area 1 cm lateral to GV, corresponds to Eding 4 and reproduction area Epang 2.
Electrical stimulation was adopted, with a frequency of about pulses per minute, with the intensity limited to the patient's tolerance. Needles were retained for 30 minutes. Treatment was given 5 times per week, with 10 treatments constituting one course, with an interval of one week between courses. After 1—2 courses, half the cases were cured, and 20 others markedly improved. Since the scalp is rich in nerves and blood vessels and is more painful than the limb when punctured, the needle insertion should be rapid and kept away from the hair follicles and the tip of the needle should be sharp.
After insertion, the needle body should be rapidly pushed to the lower layer of the galea aponeurotica that is the loose connective tissue to allow the needle to be manipulated freely to cause less pains. In order to strengthen the stimulative sensations, the point-through-point method is used, that is, the needle penetrates several points at the same time. Sometimes the method of two needles punctured to each other is used.
For instance, one needle is punctured from qianding [GV] to baihui [GV] while the other needle from baihui to qianding , both along the midline of the vertex. Chen Zaiwen and Chen Ling 4 described treatment of enuresis in children with scalp acupuncture. It was desirable to insert the needle rapidly through the skin in a vertical direction and then the needle was bent to an angle of 30 degrees to the skin to be pushed forward, preferably under the epicranial aponeurosis. A stronger stimulation often brought about better curative effects.
About the effectiveness of scalp acupuncture in clinical practice. Observation of the graphic [EEG] changes of amplitude, decrease of frequency, decrease of the angle of the main peak, deepening of the valley of the wave indicate that scalp needling dilates blood vessels, improves vascular elasticity, reinforces cardiac contraction, and increases cerebral blood flow. A problem with claimed effectiveness rates for scalp acupuncture is that there is rarely a control group or one that is well-matched to help sort out improvements that might occur spontaneously or due to other therapeutic measures such as ordinary physical therapy that might be undertaken.
However, there may be some benefit to examining the disorders that have been treated by this method and the extent of improvements, whatever the cause, that were noted during the treatment period. In an article on scalp acupuncture for hemiplegia 6 , Wang and his colleagues reported that of cases, 29 were essentially cured, with mobility of limbs recovered. Among 29 cases that were essentially cured, most involved lesions in the external capsule or cerebral lobes, with some single lesions in the internal capsule or brain stem.
However, the 5 ineffective cases had mostly multiple lesions in the basal ganglia, the brain stem, and cerebral ventricles. In an article by Cui Yunmeng 7 , scalp acupuncture for facial paralysis was described. It was reported that 71 out of cases were cured, using 5—40 treatment sessions, given once daily. The shortest course of treatment was 4 sessions and the longest 4 courses [40 sessions] The patients in this series were all difficult cases of pseudobulbar paralysis refractory to western and Chinese drugs. The good therapeutic effects indicated the superiority of this modality.
A study by Wan Zhijie and colleagues on the mechanism of action of scalp acupuncture 17 indicates that cholinesterase is inhibited and, at the same time, muscle force of the extremities is increased. Further, microcirculation is notably enhanced. These changes slowly reverted after treatment to reach pretreatment values after 24 hours, confirming the need for daily scalp acupuncture therapy. Two reports on aphasia inability to speak were presented in the Shanghai Journal of Acupuncture and Moxibustion. In one report, from the Guangdong Provincial Hospital, 72 cases of stroke-caused aphasia were treated and evaluated After applying the needles and getting the qi reaction, the needles were hooked up to an electroacupuncture device and stimulated for 20 minutes once per day.
Those needles were stimulated for about 20 seconds and then retained for 30 minutes once per day.
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