An Exploratory Prospective Trial of Rescue Acupuncture for the Treatment of Acute Migraine

Male and female (DoD beneficiaries). Age 18 years or older, who meet eligibility criteria
will be offered an opportunity to participate via Primary Care Manager (PCM) referrals and
posted advertisements will be utilized for recruiting subjects to the study. Some patients
may be patients of the Principal Investigator or Associate Investigator, however, they will
have the study staff recruit their patients to prevent any misconception of coercion or
undue influence. When a potential subject is identified by the treating PCM, the patient
will either be provide a contact number to the Research Staff, the Research Staff will be
given the potential subjects contact information by the PCM, or the PCM will come and get
the Research Staff to speak with the patient directly. Researchers will administer
acupuncture treatments for up to 6 different migraine episodes per subject over the course
of 3 months. This type of Acupuncture for this indication is routinely done as part of
standard-of-care in our Family Medicine and acupuncture clinics both in conjunction with
rescue medications and as a stand-alone therapy.

Screening Visit:

- Obtain signed Informed Consent document and HIPAA Authorization. (research only)

- Review past medical history in Armed Forces Health Longitudinal Technology Application
(AHLTA) to verify the inclusion/exclusion criteria including previous encounter, vital
signs review, medication list, co-morbidities, demographics, problems list, and note
any prior acupuncture received. (research only)

- Record: Date of birth, age, gender, race, ethnicity, last 4 of social security number,
name of standard of care rescue medications (over-the-counter and prescription),
current email address (to be used for scheduling only), height (in inches), weight (in
pounds), history of traumatic brain injury, concussion, or any mild to severe head
trauma, medication use, history of acupuncture. (research only)

- Researchers will ask what the subjects expectations are regarding acupuncture's
effectiveness for migraine. (research only)

- Researchers will instruct subjects not to take their over-the-counter and prescription
headache medications until after their visit with the research staff. (Standard care)

- Researchers will instruct subjects to bring their over-the-counter and prescription
headache medications with them to each visit if their symptoms do not resolve from the
acupuncture treatment. (research only)

- Patient will be instructed to contact the Research Coordinator, as soon as possible,
after onset of migraine symptoms (including prodromal symptoms) to schedule an emergent
visit with the research staff. (research only)

- Patient will be given a contact card with the names and phone numbers of the research
staff to contact when they have a migraine episode.

Migraine Episode:

- Self-reported headache pain severity (0=no headache, 1=mild, 2=moderate, 3=severe)
(Standard care)

- Record type and amount of rescue medications (over-the-counter and prescription) use in
the past 7 days. (research only)

- Acupuncture treatments will be subject dependent, and points could include the N point
(on scalp); various auricular points to include Shen Men, Point Zero, thalamus and
Omega-2; body points to include Liver 2, Liver 3, Gall Bladder 20, bladder 10; and
surface release over tense areas in the neck or shoulders. (Standard care)

- Researchers will document the points used. (Standard care)

*If after 20-30 minutes these patients have not had resolution of their headache, they
may take their standard of care rescue medication. (research only)

- The subject will sit for 20-30 minutes post-acupuncture(research only), and then the
needles will be removed and the subject will be asked:

o Self-reported headache pain severity (0=no headache, 1=mild, 2=moderate, 3=severe)
(research only)

- Subject is allowed to leave and will be informed of the following telephone follow ups:

- 2 Hours post acupuncture:

o Self-reported headache pain severity (0=no headache, 1=mild, 2=moderate, 3=severe)
(research only)

- 4 Hours post acupuncture:

o Self-reported headache pain severity (0=no headache, 1=mild, 2=moderate, 3=severe)
(research only)

- 24 Hours post acupuncture:

- Self-reported headache pain severity (0=no headache, 1=mild, 2=moderate, 3=severe)

- Would you use acupuncture for future pain management? (Yes or no)

- Would you prefer acupuncture or your rescue meds (both over-the-counter and
prescription) for future episodes?

- Record type and amount of rescue medications (over-the-counter and prescription)
used since acupuncture. (research only)

Inclusion:

- Patients must be able to get care at Nellis Air Force Base (a military installation)
in order to participate in this study.

- Male and female DoD beneficiaries, age 18 years or older, who have been previously
prescribed rescue medication to treat their acute migraine episodes.

Exclusion:

- Pregnant

- Absence of ear

- Active cellulitis of ear

- Ear anatomy precluding identification of acupuncture landmarks

- Use of Hearing Aids that preclude the insertion of needles

- Use of anticoagulants

- Unable to drive during rapid onset of migraine or inability to find someone to drive
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