February 10, 2025 • 22 mins
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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Disclaimer:
This podcast is separate and unaffiliated from Sophia Bouwen's work and employment at the Health Partners Neuroscience Center.
Medical disclaimer: this video or podcast is for general informational purposes only, and does not constitute the practice of medicine or other professional healthcare services, including the giving of medical advice. No doctor patient relationship is formed. The use of this information and materials included is at the user's own risk. The content of this video or podcast is not intended to be a substitute for medical advice diagnosis or treatment. Consumers of this information should seek the advice of a medical professional for any and all health related issues.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Ayla Wolf (00:00):
With very little fanfare, I mean, when we
(00:00):
submitted the manuscript, theycame back to us with positive
reviews and really goodfeedback, and they're like, this
is a great study. And can youjust make, like, one small
change to this table here? Imean, they didn't have a whole
lot of changes they even wantedus to make after they accepted
it,
Sophia Bouwens (00:20):
and that's a testament to the whole team.
Welcome to the life after impactpodcast where we do a deep dive
into all things concussion andbrain injury related. We talk
about all the different symptomsthat can follow brain injury,
different testing methods,different types of specialists
(00:42):
out there, and differenttherapies available. I'm Sophia
Bowens, and I'm here with DrAyla Wolf, and we will be your
guides to living your best lifeafter impact.
Ayla Wolf (00:54):
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 ofacupuncture for people suffering
from post traumatic headaches.
So Sophia, why don't you startout by just giving us a little
bit of information on the study,and this was, you know,
something that was really yourbaby, because you had found the
(01:15):
funding for it, and you reachedout to the right people that
started to make this all happen,give people kind of some
background.
Sophia Bouwens (01:23):
I was super excited to dive into this with
you and have a just even bringthis to the table. It was not me
that found the funding. It wasDr. Amanda Herman, the lead on
the study. The study is titledAcupuncture Treatment for
Chronic Post-Traumatic Headachein Individuals with Mild
Traumatic Brain Injury (01:40):
A Pilot Study. It was published in the
Journal of Neurotrauma online inOctober, 2024 what's really
interesting about this study? Itwas a two year pilot study to
really just ask a question withthis complex condition, post
traumatic headache. The questionwas, really, could we make the
(02:00):
change in this diagnosis, inthis condition? And then from
there, we want to ask morequestions, how and why and where
and which ways can we do it thebest? And
Ayla Wolf (02:13):
I think too, just to give people a really kind of big
bird's eye view when it comes tomedicine and research, you know,
we as acupuncturists can collectall kinds of just data and
clinical experience, but inorder for what we do to really
make it into mainstream medicineor to be widely accepted for,
(02:35):
say, a specific condition likepost traumatic headaches, you
really need the research. Youreally need to do the research
to say, hey, this isn't just myopinion about what's happening
in my office, but this is, youknow, an actual research study
that has an institutional reviewboard and all of these checks
and balances to make sure that,you know, we're doing this in a
(02:58):
way where we're being objectiveabout our findings. And so the
reason why I'm excited about itis because we had good outcomes,
which we'll talk about in aminute, but it really opens the
door to then say, okay, we didthe pilot study. We had good
outcomes. So now let's hopefullygo out and get more funding to
do larger scale studies withhopefully longer durations of
(03:20):
treatment, more people, betterobjective markers that we're
gathering throughout and so it'sexciting that this initial study
was, you know, really, veryquickly picked up by the Journal
of Neurotrauma.
Sophia Bouwens (03:33):
Which is a big deal.
Ayla Wolf (03:34):
It's a big deal. Each of these journals that publish
scientific research, they havean impact score, and the Journal
of Neurotrauma at the time ofrecording here is 3.9 out of
five, and that's a really highscore. And so what that says is
that this journal doesn't justtake anybody's research, you
know, they really highly vet theresearch for good quality, good
(03:56):
methods. You know, they don'tjust take anything. And so the
fact that with very littlefanfare, I mean, when we
submitted the manuscript, theycame back to us with positive
reviews and really goodfeedback, and they're like, this
is a great study, and can youjust make, like, one small
change to this table here? Imean, they didn't have a whole
(04:16):
lot of changes they even wantedus to make after they accepted
it.
Sophia Bouwens (04:20):
And that's a testament to the whole team
right. Dr. Hermann, who wrotethe manuscripts, the people at
the institute that did thestats, reviewing and putting it
all together, the design that wecame up with, the treatment that
we came up with, how it impactedpatients, and what changes we
saw in this really stubborn,difficult to treat condition
(04:40):
that only 13% of people aresatisfied with their outcomes.
With we made an impact there,and the Journal of Neurotrauma
was excited about how we did itand what they want more.
Ayla Wolf (04:51):
And so referencing, you know, you just referenced
the study we had talked about ina previous episode where 87% of
people said they weredissatisfied. With their current
treatments for post traumaticheadache. So with that kind of
statistics, you know, thatreally did allow us to say,
Okay, if 87% of people aredissatisfied, then let's try
(05:13):
this, you know, then let'sresearch these other therapies,
like acupuncture, because theyou know, standard of care is
medication, right? And so ifmedication is not cutting it, if
medications not helping thesepeople, what other therapies are
out there that could potentiallygive them relief? And so you
know, to be able to have a nonpharmaceutical intervention that
(05:34):
in terms of our outcomes, youknow, people were going into the
study with approximately, or onaverage, 23 headache days per
month. And then after theacupuncture, which one group got
five treatments only, right? Soonce a week for five weeks, and
then the other groupacupuncture, twice a week for
five weeks. So we were onlylooking at an intervention of
(05:56):
either five treatments or 10treatments. And part of the
difference in those two arms wasto say, you know, does the
frequency matter? And what weended up finding out was that,
on average, in both groups, theyexperienced eight less headache
days per month. And if this wasa pharmaceutical study, and they
(06:16):
found a reduction from, youknow, 23 headache days per month
down to 15, that would be ablockbuster drug. You know, in
just that short of in a fiveweek window, that kind of
change. And so that's superexciting, because that, I think,
opens the door for us to be ableto do more research.
Sophia Bouwens (06:33):
Ask more questions, right? So I wonder
too, thinking about dose,because this was a dosing
question. But do you think fivetreatments, clinically, in your
experience, is enough treatmentsfor people to have their
postmodern headaches resolved?
Ayla Wolf (06:46):
So the research says that when you get a concussion,
on average, people get betterwithin 14 to 30 days. But
really, the research is sayingabout 70 to 85% of people
recover in this normal window ofrecovery. And so my patient
population is not the populationof people who recover in 14 to
(07:07):
30 days. The people that I seeare the people who fall in the
other category where they didn'trecover in a normal, expected
window of time. And by the timethey see me, their concussion is
maybe six months to two years tofive years old, and they are
suffering with daily headaches,right? And they've been very
stubborn, and they've tried thismedication and that medication,
(07:28):
and this therapy and thattherapy, and they're still
symptomatic. And so in the casesthat I see, it's very rare that
those people have miraculousresults within five treatments.
And usually, you know, we'rehaving to do not just
acupuncture, but a lot of othertherapies combined. So it's also
very hard to say, well, thistherapy got them this much
(07:49):
better, and that therapy gotthem that much. It's very hard
to tease out out of all thetherapies, right? Which one did
what? And for me, the reason whyI like to have a very large tool
bag is because I'm not attachedto any one tool either. You
know, even as an acupuncturist,it's like, if somebody doesn't
want needles, doesn't wantacupuncture, I'm like, great,
(08:11):
that's fine. I got a whole toolbag here. We can use all kinds
of other fun things here. But toanswer your question, you know,
in the study, we saw a greatimprovement in people who only
had five treatments. However,when we followed up with them
three months later, what we sawwas that their headaches had
gotten worse again after thetreatments were stopped or
(08:32):
discontinued, because the studyended. And so I think what that
study showed is that theacupuncture was helping, but
because it was stopped afteronly five weeks, it wasn't we
didn't create enoughneuroplasticity to create
lasting changes with only fiveweeks of care.
Sophia Bouwens (08:50):
I agree. I think of it like exercise again. If
you go to the gym once a weekfor five weeks, you're going to
be doing better. If you go tothe gym once a week or twice a
week for five weeks, you'regoing to be doing better as
well. But it's not until thatthree month or four month period
that you might find a biggerdifference between the once a
week versus twice a week orthree times a week treatments.
(09:11):
And some studies have shownsimilar effects with things like
migraine you had, the case studyyou mentioned last episode about
the patient that was gettingtreatment. Do you want to touch
on that really quickly?
Ayla Wolf (09:24):
I mean, that was such a great case to highlight the
importance of frequency andduration. And so that person was
having headaches for 35 years, Ithink, and every single day she
was having a migraine and hadbeen diagnosed with medication
overuse headaches going off ofall the medications didn't make
the headache go away. And so shestarted doing acupuncture twice
(09:47):
a week for six months, and whatthey found was that after four
weeks or eight treatments, shehad had no change in her
headache. She was still havingthem every single day, but then
by week 12, she was only down tolike eight headache days a
month, and then by the sixmonths she was having maybe one
day a month where she was havinga headache. And so again, most
(10:08):
people, if they start a therapy,and they do it twice a week for
four weeks, and they don't see achange, I think a lot of people
are quitting at that point. AndI think that that that kind of
graph in that paper was just soeye opening to say this was
somebody who was havingheadaches every single day, and
six months later, she was havingthem once a month. That's a big
deal after basically 48acupuncture treatments. But
(10:31):
after, you know, 12 weeks, shehad significant relief.
Sophia Bouwens (10:36):
And there's so many components that go into
studying things. With this studyin particular, we did the high
dose of two times a week, or lowdose one time a week. And
because of our funding and ourquestion window, we didn't have
time to ask, how does this doafter 12 months? We had to first
say, like, do we make a changebefore we put someone through
(10:57):
yes, we do. And now, as anypilot study does, it begs more
questions and has you do furtherinvestigations. So I'm excited
to see where we go with it next.
Ayla Wolf (11:14):
Yeah, I've really found that in the process of
doing research, it's a processof learning how to do the
research better every singletime, absolutely. And I know
we've talked about wanting to domore research, but also being
able to actually have a betterdifferential in terms of you've
got, let's say, 100 people withpost traumatic headaches. Well,
(11:35):
if some of those people arehaving cervicogenic headaches
coming from the neck trauma,what would their treatment look
like different from the personwho's having true migraines,
different from the person who'shaving migraine like headaches
versus the person who's having atension headache. And so to be
able to actually have moreindividualized approaches based
(11:55):
on what's driving the headache,and also a better diagnostic
process of saying is there anocular motor dysfunction that's
driving this person's headacheversus the other person? And so
is there something else that is,you know, keeping them in that
state that we need to be payingattention to as well, for
example.
Sophia Bouwens (12:12):
I remember calling you with this question
and trying to figure out thedesign for this study. I
remember how excited I was, buthow challenged it was, she was
like, Okay, we have one shot tomake one treatment type that
everyone's gonna get the sametreatment for this really
complex condition, posttraumatic headache, that can
come from many different ways.
We have to just figure out oneprotocol to give everyone. What
(12:35):
do we do?
Ayla Wolf (12:39):
Yeah, and that's where I came up with what I felt
like was a total shotgunapproach, saying, Okay, we're
gonna do some points that I knowhelp to increase blood flow to
the anterior circulation of thebrain, and we're gonna do some
points that have a reallypowerful effect on the brain's
ability to inhibit pain in thatperiaqueductal gray of the
mesencephalon. And then we'regonna do a few other points to
(13:00):
help shift people out of asympathetic state into a
parasympathetic state. And thenwe're gonna do a few points
around the eyes and with thetrigeminal nerve to try to help
modulate this trigeminalcervical complex. And so we did
really kind of come up with theshotgun approach.
Sophia Bouwens (13:17):
A little bit of everything, sprinkle some of
this, sprinkle some of that, andit made a change. It worked,
which is remarkable, a testamentto acupuncture well.
Ayla Wolf (13:26):
And this is where I just love that the health
partners, neuroscience center isso open to doing research on non
pharmaceutical options forthings like concussion recovery
and post traumatic headaches.
And I've just loved that DrHermann and her whole team are
so open to these kinds oftherapies and studying them. And
then also, I know that there'ssome research on transcranial
(13:49):
magnetic stimulation happening,as we speak, for people with
post traumatic headaches throughthe neuroscience center as well.
And so I just love that they'reso open minded and willing to do
that kind of research and toallocate, you know, all of those
research, you know, funding andpersonnel, and you know, the
statistics teams, and you know,managing all of that, the fact
(14:11):
that they're allocating all ofthose, you know, people and
resources to studying thesetherapies, is so exciting.
Sophia Bouwens (14:18):
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 andsurgeries can't be our only
options. We have to figure outother things too. The providers
I work with the neurosciencecenter, I'm so grateful for
because from the physicians thatrefer patients in who really are
(14:39):
willing to find solutions fortheir patients, to the other
therapists they get to workalongside. To find real
solutions for each individual isreally key, and research is
hard. You know, this was a twoyear pilot study that took six
years to complete. We did have apandemic made a. A little bit of
difference there, but we stuckwith it, and we have lots more
(15:02):
questions to ask moving forward,which is great.
Ayla Wolf (15:09):
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'snon pharmaceutical because
thanks to the opiate crisis, weknow that we can't just be
throwing addictive painmedication at people, because
that creates way more problems.
And so I do think that eversince the opiate crisis and the
aftermath of that, that peopleare much more open to trying
(15:31):
other therapies and recommendingother therapies. But it helps
doctors and physicians when theyactually have a research, you
know, research to say, hey, Ihave evidence to say that this
is worthwhile.
Sophia Bouwens (15:45):
So listeners who are struggling with post
traumatic headache, or chronicpost traumatic headache, which
is more than just immediatelyafter the injury, but three or
six months more, could go findthat study if they have an
acupuncturist that isn'tfamiliar with post traumatic
headache, or the neurology ofit, or working with it, they
could bring that study as astarting point, a launch point,
(16:06):
to say this made a difference inthis group. Can we start here,
or listen to this podcast in ourprevious episodes, which dive
into headache and post traumaticheadache more specifically as
well, maybe fill out ourquestionnaire that's on our
website.
Ayla Wolf (16:21):
Yeah, that's also a great starting point, because
we've talked about this a littlebit in previous episodes, that
importance of when you'redescribing your headache to your
healthcare providers, it'sreally important to be able to
do that in clear terms. Andthere are some people that you
know, they've not taken anyhealthcare courses, and so
they're experiencing symptoms,but they don't necessarily have
(16:42):
the vocabulary to describe them.
And once you give people thevocabulary, then they can
communicate better. And sothat's the whole point of this
free headache communication toolthat's on the life after
impact.com website is like, hereis the tool that you can use if
you feel like you don't have theright vocabulary to really dive
into describing the differenttypes of head pain, whether that
(17:04):
is, you know, migraine like orwhether it's this neuropathic
pain that we did the wholepodcast on. And these things are
important. Thesedifferentiations are important
for getting the right kind oftherapies.
Sophia Bouwens (17:17):
And they're small uses of language that can
make all the difference in yourquick interactions with your
physicians or providers who aretrying to make sure the
diagnosis is correct so thetreatment is correct and
effective.
Ayla Wolf (17:28):
I mean, I had a patient who would often, when
she came in, she would describeswelling in her neck, and I kept
kind of being like, Okay, Idon't this isn't making any
sense. I'm palpating your neck.
I'm looking at your neck. I'mnot seeing any signs of swelling
here. And so when I finally saidto her, I was like, when I hear
the word swelling, you know, I'mtypically thinking that there is
actual swelling, there'scongestion of fluid. I can see
(17:51):
this, I can feel this, theremight be temperature changes.
And I'm like, I'm just notseeing any of this. And what we
basically came to find out isthat she was using the word
swelling to just describe muscletightness. Oh, and so it was a
complete miscommunication,because she was using the word
swelling to describe muscletension. So different, it's very
different. And I have people allthe time that say they have
(18:14):
vertigo, when they don'tactually have vertigo, they've
just got dizziness. Or I havepeople that will say they're
they have vertigo or dizziness,when really what they have is
disequilibrium. And so aspeople, especially when it comes
to brain injuries, you know it'snot fair to the people that have
the injury that they have tothen go out and feel like they
have to get a neurosciencedegree just to understand their
(18:36):
process, right?
Sophia Bouwens (18:38):
And even having one before my injury...
Ayla Wolf (18:42):
Having a legit neuroscience degree!
Sophia Bouwens (18:44):
Having one helps, but it doesn't always get
you there!
Ayla Wolf (18:46):
Yeah, and so again, another reason why we're doing
the podcast and why I wrote thebook is to try to really give
people the vocabulary they needto understand what's going on
without trying to piecemeal ittogether from Dr Google.
Sophia Bouwens (18:59):
I'm hopeful that research like what we did helps
the world and patients andproviders understand some of the
options. And I'm excited to seewhere we go with it in the
future, because it was a pilotstudy, and we do expect to make
a bigger study with a betterquestion, or maybe different
treatments that get at thesedifferent types of post medic
(19:19):
headaches.
Ayla Wolf (19:20):
Absolutely, I'm excited for that. We'll put a
link to the abstract in the shownotes so people can take a look
at that. And once again, if thispodcast is been helpful to you,
feel free to subscribe byclicking the link in our show
notes, and you can subscribe atwhatever membership level you
feel comfortable with. But weappreciate your support. We
(19:41):
would love if you would sharethis podcast. If you have other
people that you know aresuffering from concussions or
post concussion syndrome, andplease reach out to us. Let us
know if you have questions,topics you want us to cover, at
lifeafterimpact@gmail.com
Sophia Bouwens (19:56):
We'd love to hear from you!
Ayla Wolf (19:58):
our next episode is going to be on traumatic neck
injuries, and I think that one'sgoing to be a part one, part
two.
Sophia Bouwens (20:05):
Yes, that's going to dive into a lot of the
confusion that can come betweenthe neck and the head, and how
we can dive into that. So staytuned.
Ayla Wolf (20:19):
Medical disclaimer, this video or podcast is for
general informational purposesonly and does not constitute the
practice of medicine or otherprofessional healthcare
services, including the givingof medical advice. No doctor
patient relationship is formed.
The use of this information andmaterials included is at the
user's own risk. The content ofthis video or podcast is not
(20:41):
intended to be a substitute formedical advice diagnosis or
treatment, and consumers of thisinformation should seek the
advice of a medical professionalfor any and all health related
issues. A link to our fullmedical disclaimer is available
in the notes you
With very little fanfare, I mean, when we
(00:00):
submitted the manuscript, theycame back to us with positive
reviews and really goodfeedback, and they're like, this
is a great study. And can youjust make, like, one small
change to this table here? Imean, they didn't have a whole
lot of changes they even wantedus to make after they accepted
it,
Sophia Bouwens (00:20):
and that's a testament to the whole team.
Welcome to the life after impactpodcast where we do a deep dive
into all things concussion andbrain injury related. We talk
about all the different symptomsthat can follow brain injury,
different testing methods,different types of specialists
(00:42):
out there, and differenttherapies available. I'm Sophia
Bowens, and I'm here with DrAyla Wolf, and we will be your
guides to living your best lifeafter impact.
Ayla Wolf (00:54):
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 ofacupuncture for people suffering
from post traumatic headaches.
So Sophia, why don't you startout by just giving us a little
bit of information on the study,and this was, you know,
something that was really yourbaby, because you had found the
(01:15):
funding for it, and you reachedout to the right people that
started to make this all happen,give people kind of some
background.
Sophia Bouwens (01:23):
I was super excited to dive into this with
you and have a just even bringthis to the table. It was not me
that found the funding. It wasDr. Amanda Herman, the lead on
the study. The study is titledAcupuncture Treatment for
Chronic Post-Traumatic Headachein Individuals with Mild
Traumatic Brain Injury (01:40):
A Pilot Study. It was published in the
Journal of Neurotrauma online inOctober, 2024 what's really
interesting about this study? Itwas a two year pilot study to
really just ask a question withthis complex condition, post
traumatic headache. The questionwas, really, could we make the
(02:00):
change in this diagnosis, inthis condition? And then from
there, we want to ask morequestions, how and why and where
and which ways can we do it thebest? And
Ayla Wolf (02:13):
I think too, just to give people a really kind of big
bird's eye view when it comes tomedicine and research, you know,
we as acupuncturists can collectall kinds of just data and
clinical experience, but inorder for what we do to really
make it into mainstream medicineor to be widely accepted for,
(02:35):
say, a specific condition likepost traumatic headaches, you
really need the research. Youreally need to do the research
to say, hey, this isn't just myopinion about what's happening
in my office, but this is, youknow, an actual research study
that has an institutional reviewboard and all of these checks
and balances to make sure that,you know, we're doing this in a
(02:58):
way where we're being objectiveabout our findings. And so the
reason why I'm excited about itis because we had good outcomes,
which we'll talk about in aminute, but it really opens the
door to then say, okay, we didthe pilot study. We had good
outcomes. So now let's hopefullygo out and get more funding to
do larger scale studies withhopefully longer durations of
(03:20):
treatment, more people, betterobjective markers that we're
gathering throughout and so it'sexciting that this initial study
was, you know, really, veryquickly picked up by the Journal
of Neurotrauma.
Sophia Bouwens (03:33):
Which is a big deal.
Ayla Wolf (03:34):
It's a big deal. Each of these journals that publish
scientific research, they havean impact score, and the Journal
of Neurotrauma at the time ofrecording here is 3.9 out of
five, and that's a really highscore. And so what that says is
that this journal doesn't justtake anybody's research, you
know, they really highly vet theresearch for good quality, good
(03:56):
methods. You know, they don'tjust take anything. And so the
fact that with very littlefanfare, I mean, when we
submitted the manuscript, theycame back to us with positive
reviews and really goodfeedback, and they're like, this
is a great study, and can youjust make, like, one small
change to this table here? Imean, they didn't have a whole
(04:16):
lot of changes they even wantedus to make after they accepted
it.
Sophia Bouwens (04:20):
And that's a testament to the whole team
right. Dr. Hermann, who wrotethe manuscripts, the people at
the institute that did thestats, reviewing and putting it
all together, the design that wecame up with, the treatment that
we came up with, how it impactedpatients, and what changes we
saw in this really stubborn,difficult to treat condition
(04:40):
that only 13% of people aresatisfied with their outcomes.
With we made an impact there,and the Journal of Neurotrauma
was excited about how we did itand what they want more.
Ayla Wolf (04:51):
And so referencing, you know, you just referenced
the study we had talked about ina previous episode where 87% of
people said they weredissatisfied. With their current
treatments for post traumaticheadache. So with that kind of
statistics, you know, thatreally did allow us to say,
Okay, if 87% of people aredissatisfied, then let's try
(05:13):
this, you know, then let'sresearch these other therapies,
like acupuncture, because theyou know, standard of care is
medication, right? And so ifmedication is not cutting it, if
medications not helping thesepeople, what other therapies are
out there that could potentiallygive them relief? And so you
know, to be able to have a nonpharmaceutical intervention that
(05:34):
in terms of our outcomes, youknow, people were going into the
study with approximately, or onaverage, 23 headache days per
month. And then after theacupuncture, which one group got
five treatments only, right? Soonce a week for five weeks, and
then the other groupacupuncture, twice a week for
five weeks. So we were onlylooking at an intervention of
(05:56):
either five treatments or 10treatments. And part of the
difference in those two arms wasto say, you know, does the
frequency matter? And what weended up finding out was that,
on average, in both groups, theyexperienced eight less headache
days per month. And if this wasa pharmaceutical study, and they
(06:16):
found a reduction from, youknow, 23 headache days per month
down to 15, that would be ablockbuster drug. You know, in
just that short of in a fiveweek window, that kind of
change. And so that's superexciting, because that, I think,
opens the door for us to be ableto do more research.
Sophia Bouwens (06:33):
Ask more questions, right? So I wonder
too, thinking about dose,because this was a dosing
question. But do you think fivetreatments, clinically, in your
experience, is enough treatmentsfor people to have their
postmodern headaches resolved?
Ayla Wolf (06:46):
So the research says that when you get a concussion,
on average, people get betterwithin 14 to 30 days. But
really, the research is sayingabout 70 to 85% of people
recover in this normal window ofrecovery. And so my patient
population is not the populationof people who recover in 14 to
(07:07):
30 days. The people that I seeare the people who fall in the
other category where they didn'trecover in a normal, expected
window of time. And by the timethey see me, their concussion is
maybe six months to two years tofive years old, and they are
suffering with daily headaches,right? And they've been very
stubborn, and they've tried thismedication and that medication,
(07:28):
and this therapy and thattherapy, and they're still
symptomatic. And so in the casesthat I see, it's very rare that
those people have miraculousresults within five treatments.
And usually, you know, we'rehaving to do not just
acupuncture, but a lot of othertherapies combined. So it's also
very hard to say, well, thistherapy got them this much
(07:49):
better, and that therapy gotthem that much. It's very hard
to tease out out of all thetherapies, right? Which one did
what? And for me, the reason whyI like to have a very large tool
bag is because I'm not attachedto any one tool either. You
know, even as an acupuncturist,it's like, if somebody doesn't
want needles, doesn't wantacupuncture, I'm like, great,
(08:11):
that's fine. I got a whole toolbag here. We can use all kinds
of other fun things here. But toanswer your question, you know,
in the study, we saw a greatimprovement in people who only
had five treatments. However,when we followed up with them
three months later, what we sawwas that their headaches had
gotten worse again after thetreatments were stopped or
(08:32):
discontinued, because the studyended. And so I think what that
study showed is that theacupuncture was helping, but
because it was stopped afteronly five weeks, it wasn't we
didn't create enoughneuroplasticity to create
lasting changes with only fiveweeks of care.
Sophia Bouwens (08:50):
I agree. I think of it like exercise again. If
you go to the gym once a weekfor five weeks, you're going to
be doing better. If you go tothe gym once a week or twice a
week for five weeks, you'regoing to be doing better as
well. But it's not until thatthree month or four month period
that you might find a biggerdifference between the once a
week versus twice a week orthree times a week treatments.
(09:11):
And some studies have shownsimilar effects with things like
migraine you had, the case studyyou mentioned last episode about
the patient that was gettingtreatment. Do you want to touch
on that really quickly?
Ayla Wolf (09:24):
I mean, that was such a great case to highlight the
importance of frequency andduration. And so that person was
having headaches for 35 years, Ithink, and every single day she
was having a migraine and hadbeen diagnosed with medication
overuse headaches going off ofall the medications didn't make
the headache go away. And so shestarted doing acupuncture twice
(09:47):
a week for six months, and whatthey found was that after four
weeks or eight treatments, shehad had no change in her
headache. She was still havingthem every single day, but then
by week 12, she was only down tolike eight headache days a
month, and then by the sixmonths she was having maybe one
day a month where she was havinga headache. And so again, most
(10:08):
people, if they start a therapy,and they do it twice a week for
four weeks, and they don't see achange, I think a lot of people
are quitting at that point. AndI think that that that kind of
graph in that paper was just soeye opening to say this was
somebody who was havingheadaches every single day, and
six months later, she was havingthem once a month. That's a big
deal after basically 48acupuncture treatments. But
(10:31):
after, you know, 12 weeks, shehad significant relief.
Sophia Bouwens (10:36):
And there's so many components that go into
studying things. With this studyin particular, we did the high
dose of two times a week, or lowdose one time a week. And
because of our funding and ourquestion window, we didn't have
time to ask, how does this doafter 12 months? We had to first
say, like, do we make a changebefore we put someone through
(10:57):
yes, we do. And now, as anypilot study does, it begs more
questions and has you do furtherinvestigations. So I'm excited
to see where we go with it next.
Ayla Wolf (11:14):
Yeah, I've really found that in the process of
doing research, it's a processof learning how to do the
research better every singletime, absolutely. And I know
we've talked about wanting to domore research, but also being
able to actually have a betterdifferential in terms of you've
got, let's say, 100 people withpost traumatic headaches. Well,
(11:35):
if some of those people arehaving cervicogenic headaches
coming from the neck trauma,what would their treatment look
like different from the personwho's having true migraines,
different from the person who'shaving migraine like headaches
versus the person who's having atension headache. And so to be
able to actually have moreindividualized approaches based
(11:55):
on what's driving the headache,and also a better diagnostic
process of saying is there anocular motor dysfunction that's
driving this person's headacheversus the other person? And so
is there something else that is,you know, keeping them in that
state that we need to be payingattention to as well, for
example.
Sophia Bouwens (12:12):
I remember calling you with this question
and trying to figure out thedesign for this study. I
remember how excited I was, buthow challenged it was, she was
like, Okay, we have one shot tomake one treatment type that
everyone's gonna get the sametreatment for this really
complex condition, posttraumatic headache, that can
come from many different ways.
We have to just figure out oneprotocol to give everyone. What
(12:35):
do we do?
Ayla Wolf (12:39):
Yeah, and that's where I came up with what I felt
like was a total shotgunapproach, saying, Okay, we're
gonna do some points that I knowhelp to increase blood flow to
the anterior circulation of thebrain, and we're gonna do some
points that have a reallypowerful effect on the brain's
ability to inhibit pain in thatperiaqueductal gray of the
mesencephalon. And then we'regonna do a few other points to
(13:00):
help shift people out of asympathetic state into a
parasympathetic state. And thenwe're gonna do a few points
around the eyes and with thetrigeminal nerve to try to help
modulate this trigeminalcervical complex. And so we did
really kind of come up with theshotgun approach.
Sophia Bouwens (13:17):
A little bit of everything, sprinkle some of
this, sprinkle some of that, andit made a change. It worked,
which is remarkable, a testamentto acupuncture well.
Ayla Wolf (13:26):
And this is where I just love that the health
partners, neuroscience center isso open to doing research on non
pharmaceutical options forthings like concussion recovery
and post traumatic headaches.
And I've just loved that DrHermann and her whole team are
so open to these kinds oftherapies and studying them. And
then also, I know that there'ssome research on transcranial
(13:49):
magnetic stimulation happening,as we speak, for people with
post traumatic headaches throughthe neuroscience center as well.
And so I just love that they'reso open minded and willing to do
that kind of research and toallocate, you know, all of those
research, you know, funding andpersonnel, and you know, the
statistics teams, and you know,managing all of that, the fact
(14:11):
that they're allocating all ofthose, you know, people and
resources to studying thesetherapies, is so exciting.
Sophia Bouwens (14:18):
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 andsurgeries can't be our only
options. We have to figure outother things too. The providers
I work with the neurosciencecenter, I'm so grateful for
because from the physicians thatrefer patients in who really are
(14:39):
willing to find solutions fortheir patients, to the other
therapists they get to workalongside. To find real
solutions for each individual isreally key, and research is
hard. You know, this was a twoyear pilot study that took six
years to complete. We did have apandemic made a. A little bit of
difference there, but we stuckwith it, and we have lots more
(15:02):
questions to ask moving forward,which is great.
Ayla Wolf (15:09):
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'snon pharmaceutical because
thanks to the opiate crisis, weknow that we can't just be
throwing addictive painmedication at people, because
that creates way more problems.
And so I do think that eversince the opiate crisis and the
aftermath of that, that peopleare much more open to trying
(15:31):
other therapies and recommendingother therapies. But it helps
doctors and physicians when theyactually have a research, you
know, research to say, hey, Ihave evidence to say that this
is worthwhile.
Sophia Bouwens (15:45):
So listeners who are struggling with post
traumatic headache, or chronicpost traumatic headache, which
is more than just immediatelyafter the injury, but three or
six months more, could go findthat study if they have an
acupuncturist that isn'tfamiliar with post traumatic
headache, or the neurology ofit, or working with it, they
could bring that study as astarting point, a launch point,
(16:06):
to say this made a difference inthis group. Can we start here,
or listen to this podcast in ourprevious episodes, which dive
into headache and post traumaticheadache more specifically as
well, maybe fill out ourquestionnaire that's on our
website.
Ayla Wolf (16:21):
Yeah, that's also a great starting point, because
we've talked about this a littlebit in previous episodes, that
importance of when you'redescribing your headache to your
healthcare providers, it'sreally important to be able to
do that in clear terms. Andthere are some people that you
know, they've not taken anyhealthcare courses, and so
they're experiencing symptoms,but they don't necessarily have
(16:42):
the vocabulary to describe them.
And once you give people thevocabulary, then they can
communicate better. And sothat's the whole point of this
free headache communication toolthat's on the life after
impact.com website is like, hereis the tool that you can use if
you feel like you don't have theright vocabulary to really dive
into describing the differenttypes of head pain, whether that
(17:04):
is, you know, migraine like orwhether it's this neuropathic
pain that we did the wholepodcast on. And these things are
important. Thesedifferentiations are important
for getting the right kind oftherapies.
Sophia Bouwens (17:17):
And they're small uses of language that can
make all the difference in yourquick interactions with your
physicians or providers who aretrying to make sure the
diagnosis is correct so thetreatment is correct and
effective.
Ayla Wolf (17:28):
I mean, I had a patient who would often, when
she came in, she would describeswelling in her neck, and I kept
kind of being like, Okay, Idon't this isn't making any
sense. I'm palpating your neck.
I'm looking at your neck. I'mnot seeing any signs of swelling
here. And so when I finally saidto her, I was like, when I hear
the word swelling, you know, I'mtypically thinking that there is
actual swelling, there'scongestion of fluid. I can see
(17:51):
this, I can feel this, theremight be temperature changes.
And I'm like, I'm just notseeing any of this. And what we
basically came to find out isthat she was using the word
swelling to just describe muscletightness. Oh, and so it was a
complete miscommunication,because she was using the word
swelling to describe muscletension. So different, it's very
different. And I have people allthe time that say they have
(18:14):
vertigo, when they don'tactually have vertigo, they've
just got dizziness. Or I havepeople that will say they're
they have vertigo or dizziness,when really what they have is
disequilibrium. And so aspeople, especially when it comes
to brain injuries, you know it'snot fair to the people that have
the injury that they have tothen go out and feel like they
have to get a neurosciencedegree just to understand their
(18:36):
process, right?
Sophia Bouwens (18:38):
And even having one before my injury...
Ayla Wolf (18:42):
Having a legit neuroscience degree!
Sophia Bouwens (18:44):
Having one helps, but it doesn't always get
you there!
Ayla Wolf (18:46):
Yeah, and so again, another reason why we're doing
the podcast and why I wrote thebook is to try to really give
people the vocabulary they needto understand what's going on
without trying to piecemeal ittogether from Dr Google.
Sophia Bouwens (18:59):
I'm hopeful that research like what we did helps
the world and patients andproviders understand some of the
options. And I'm excited to seewhere we go with it in the
future, because it was a pilotstudy, and we do expect to make
a bigger study with a betterquestion, or maybe different
treatments that get at thesedifferent types of post medic
(19:19):
headaches.
Ayla Wolf (19:20):
Absolutely, I'm excited for that. We'll put a
link to the abstract in the shownotes so people can take a look
at that. And once again, if thispodcast is been helpful to you,
feel free to subscribe byclicking the link in our show
notes, and you can subscribe atwhatever membership level you
feel comfortable with. But weappreciate your support. We
(19:41):
would love if you would sharethis podcast. If you have other
people that you know aresuffering from concussions or
post concussion syndrome, andplease reach out to us. Let us
know if you have questions,topics you want us to cover, at
lifeafterimpact@gmail.com
Sophia Bouwens (19:56):
We'd love to hear from you!
Ayla Wolf (19:58):
our next episode is going to be on traumatic neck
injuries, and I think that one'sgoing to be a part one, part
two.
Sophia Bouwens (20:05):
Yes, that's going to dive into a lot of the
confusion that can come betweenthe neck and the head, and how
we can dive into that. So staytuned.
Ayla Wolf (20:19):
Medical disclaimer, this video or podcast is for
general informational purposesonly and does not constitute the
practice of medicine or otherprofessional healthcare
services, including the givingof medical advice. No doctor
patient relationship is formed.
The use of this information andmaterials included is at the
user's own risk. The content ofthis video or podcast is not
(20:41):
intended to be a substitute formedical advice diagnosis or
treatment, and consumers of thisinformation should seek the
advice of a medical professionalfor any and all health related
issues. A link to our fullmedical disclaimer is available
in the notes you
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