Getting to the Root of Migraine - Article

Former RCHM President Stefan Chmelik speaks about his contributions to a internationally renowned textbook on Migraine.

Multidiciplinary Management of Migraine

I was asked to write and be chapter editor for the Chinese and Traditional East Asian Medicine section of an international textbook on the treatment of migraine. Editors César Fernández-de-las-Peñas and Leon Chaitow, a founding colleague at New Medicine Group, envisaged this as the seminal work on the subject. This book was released as Multidisciplinary management of migraine: pharmacological, manual and other therapies (Jones & Bartlett Learning, Sudbury, MA. 2012).

It is my privilege to have worked with Leon Chaitow (1937-2018) over many years and for New Medicine Group in Harley Street to have been home to his clinical work. Leon was the most prolific author and educator I have known. His website remains a rich resource and will continue to be maintained and updated by his daughter Dr Sasha Chaitow, who now manages his legacy (

Part I of the migraine textbook features an in-depth analysis of the epidemiology, differentiation, comorbidities, related factors and pathophysiology of migraine. The remainder of the book then covers major interventions for migraine, with particular focus on pharmacology, manual therapies (i.e. manipulation, neuromuscular and dry needling approaches). Part IV then features important additional migraine therapies, including psychological interventions, the role of placebo, hypnosis and a chapter entitled Acupuncture and Traditional Chinese Medicine for treating migraine, which included an analysis on acupuncture from Mark Bovey.

The decision by Jones and Bartlett to publish this title was significant for the field of Chinese Medicine.
J&B are regarded as an important scholarly publisher with a focus on mainstream life sciences and healthcare. Publishing a major international textbook dedicated to the subject of migraine shows the far-reaching consequences of this life-altering issue and type scale of its impact; featuring a traditional East Asian medicine chapter, which included Chinese Herbal Medicine, was a powerful choice by the publishers and editors indicating the increased recognition of the role of these therapies amongst a more mainstream healthcare profession and public.

Acupuncture and herbal medicine are already used by hundreds of millions of people globally as frontline therapy.
With the demands and nature of healthcare evolving in response to social change, and now more than ever in a pandemic reality world, mainstream biomedicine also finds itself needing to adapt to compensate for the likelihood of becoming overwhelmed by the unmeetable demands of a population suffering symptoms largely as a consequence of preventable and lifestyle orientated issues. As mainstream healthcare becomes increasingly able to offer mainly only acute and end stage care, the role of complementary and holistic systems becomes more evident, especially as the pastoral nature of care allows for lifestyle and behavioural guidance that is essential in the treatment of many modern ailments.

Part of the inspiration for this book was our shared clinical recognition that certain individuals are more likely to experience migraine syndrome, as well as certain other issues and the book devotes a chapter to Peripheral and Central Sensitization in migraine. Central Sensitization Syndrome involves dysregulation of the Autonomic Nervous System (ANS) (Tajti and Vécsei 2009).

In my experience, it is now largely accepted that migraine and tension headaches fall into the category of autonomic dysfunction. The Autonomic Nervous System (ANS) is dominated in large part by the Cranial Nerve X, or vagus nerve. Each area of medical Consultancy has a significant group of patients suffering from dysregulation syndromes, which are generally hard to treat using mainstream biomedical interventions and which occupy a disproportionate amount of Consultant bandwidth. In Cardiology this might be POTS, for Gastroenterologists, it’s most frequently IBS, for Neurologists, it’s often migraine. Any strategy which is effective, scalable and financially sustainable has the potential to offer massive personal, social and economic benefit to a vast and ever-increasing number of people.

The role of stress in migraines & tension headaches

Stress is one of the most significant causes of migraine headaches. Anxiety and mood disorders have been shown to be the most relevant psychiatric comorbidities associated with migraine (Peres 2017) and it is thought that up to 80% of migraine sufferers listed stress and anxiety as triggers for their attacks.

Stress tension can lead to migraines in a number of clinically relevant ways:

  • Accumulation of muscular tension in the neck and shoulders;
  • Breath holding and/or chronic hyperventilation leading to hypocapnia (reduced respiratory CO2);
  • Dysregulation of stress hormone activity, particularly due to perceived overwhelm or reduced stress resiliency.

All of these tend to restrict blood supply to the head and shoulders, lead to over activity of breathing accessory muscles and allow muscle and connective tissue congestion to result.

Chinese Medicine and the treatment of migraines

Research indicates that Chinese Medicine, in the forms of acupuncture and herbal medicine, is at least equally effective as pharmaceutical medicine in treating migraines (Van Kleef et al, 2009).

In addition to Chinese Medicine approaches to treating migraines, at Thrive we also provide instruction in Mindfulness meditation and Breathing Training which are proven methods of improving our ability to react to stressful situations in a more relaxed manner, and preventing many of the chronic health problems associated with stress.

Stefan Chmelik

Stefan Chmelik
is a past President of the RCHM, a published author and founder of New Medicine Group in Harley Street. As well as being a Chinese Herbal Medicine practitioner, he is also founder and CSO for BioSelf Technology Limited.

Chmelik S, Bovey M. Acupuncture and Traditional Chinese Medicine for treating migraine. In: Fernández-de-las-Peñas C, Chaitow L, Schoenen J (eds) Multidisciplinary management of migraine: pharmacological, manual and other therapies. 2012. Jones & Bartlett Learning, Sudbury, MA.

Peres. Anxiety and depression symptoms and migraine: a symptom-based approach research - https://pubmed.ncbi.nlm.nih.go...

Van Kleef et al, 2009

Tajti and Vécsei 2009

The mechanism of peripheral and central sensitization in migraine. A literature review - https://pubmed.ncbi.nlm.nih.go...