It is an interesting observation. I never heard for it. However it is well known that migraine attack can be triggered by many different, sometimes unbelievable, stimuli. I am very critical about such observations. Is that attention switch or something similar? How many migraine patients have such experience? How long it lasts? Thus to confirm that ear piercing has any effect on migraine it would be necessary made in some form of controlled clinical trial.   Contrary to that what we found in experimental animals is that pain in trigeminal region can produce some of the migraine symptoms. Even in human entrapment of braches of trigeminal nerves can mimic migraine that can be relieved by surgery. Some people are even speaking about “migraine surgery” (see Filipovic at al.  Eur Arch Otorhinolaryngol. 2017 Jan 25)

 Would be interesting to hear some other members of "ResearchGate community"...

Very interesting. Daith piercing usually goes through the region of ear innervated by the auricular branch of the vagus nerve. It is possible that this kind of chronic exogenous stimuli can change the activity of the nerve because it is known that almost 80% of the vagus nerve is afferent. There are also articles regarding auricular acupuncture that can can offer some explanation of the phenomena of the effects of auricular vagus modulation on the whole organism (Auricular Acupuncture and Vagal Regulation    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4811015/). The fact that this is the area where vagus can be modulated in a non-invasive way lately became interesting for medical community but was first described in traditional Chinese medicine long time ago. Physiology of vagus is extremely complex. It is a nerve involved in everything from modification of metabolism induced by neural signals from the gut to regulation of peripheral inflammation through modification of polarization (M1/M2) of macrophages in the spleen through Alpha7Nicotine ACh receptors. To make it even more interesting it is now known that vagus is not just a single nerve in mammals (see extremely interesting Polyvagal theory (myelinated vagus from nucleus ambiguus+non-myelinated vagus from DMNX dual innervation regulatory role) by Stephen Porges eg. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108032/).

Regarding the migraine I believe vagus could explain some of the phenomena of the effects of Daith piercing in migraine patients.

Some articles regarding transcutaneous vagus nerve stimulation as a therapy for migraines:

Treatment of chronic migraine with transcutaneous stimulation of the auricular branch of the vagal nerve (auricular t-VNS): a randomized, monocentric clinical trial

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4496420/:

Transcutaneous Vagus Nerve Stimulation (tVNS) for headache prophylaxis: initial experience

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3620181/

Noninvasive vagus nerve stimulation in the management of cluster headache: clinical evidence and practical experience

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4811015/

For anybody interested in migraine I strongly recommend the work of prof. Lackovic and his team that has made some of the groundbreaking findings that might help us to both understand and treat pain.

Kind regards,

Jan

Hi Jan

Really interesting info! Often, if you dig you find that the ancient chinese, or the anatomists of 150 years ago (for example) already have the many of the answers...

I am at a conference this weekend with Russell Lane and Paul Davies who wrote "Migraine" and have explored a 'Migraine Mechanism"' common to the origins of all primary headaches.

A recent idea to be explored further is the embryological development of the peripheral nervous system and closely related connective tissue from the Neural Crest cells and how this mirrors the close relationship between the free nerve pain fibres and fascial aponeurotic tissues, and indeed the meninges. neurons in the Trigeminal Ganglion are interesting in that single neurons have multiple axons projections peripherally and to the meninges, as well as to the trigemino-cervical tract. I doubt if these complexities are limited to the Trigeminal Ganglion since there is an obvious interlinking between the Trigeminal Nerve and the Vagus nerve in the symptomatology of migraines.

These multiple connections have another interest in that it might well explain the presence of active short chain BoTN-A in multiple locations without the need to explain it with interneuronal spread. There is no mechanism to explain how short chain activated BoTN-A can jump from neuron to neuron when it has lost its infectivity

Interesting, but in the light of the evidence that in migraine treatment by acupuncture is placebo, and the more invasive you get, the more pronounced the placebo effect, it is likely placebo. On the other hand, pressure or cold pressure on the temples more than in the neck relief patients in the attack, but attack abortion should not be confounded with prevention. From a practical point of view, nothing argues against the use, as all our treatments strongly compromise various types of placebo effects.

 Dear Chris, 

Very interesting. Please let us know if you learn anything new regarding this topic on the conference. I bet Russell Lane and Paul Davies will have something to add to this discussion. When I reffered to the findings of prof. Lackovic et al. I thought about the exact same thing - effects and mechanisms of botulium toxin in pain! This is a very interesting field.

Dear Dirk, 

I agree with what you said. I find both acupuncture and research of (underappreciated) placebo extremely interesting. I think it is really hard to design a placebo controlled acupuncture study because of two things. One, sham points acupuncture is not the same as no accupuncture at all. Two, there is a huge importance of placebo in acupuncture as you said it and I don't think it is a bad thing at all. We now know that placebo is much much more than what we previously thought it is. There are several great books on the mechanisms of placebo and tons of great articles. This is still somewhat underexamined and very underappreciated but I believe in the future medicine will use placebo (and try to control it) for much more than just for using it for evaluation of the efficacy of the certain medical interventions (eg. in clinical trials). For placebo I recommend work of prof. Ted Kaptchuk of Harvard and Fabrizio Benedetti, both very important names in the research of placebo mechanisms.

One of the big problems in trying to understand the placebo response is that it means different things to different people. Indeed the original trials on the PREEMPT Protocol for Botox don't show an enormous difference between placebo and Botox on migraines. Absence of evidence (relative in this case) is of course not the same as evidence of absence.

I have a lot of questionmarks over PREEMPT (see one of my articles) and it is interesting that at last Allergan are beginning to revise their injection technique to actually make sure Botox is injected into the belly of the Corrugators, rather than saying it went there. The work has not yet been published but better late than never!!

Heaven forbid we should not embrace the power of placebo. Talking to patients is part of being a good doctor...  

Talking to patients will never stop being a crucial element of clinical practice, but understanding placebo will help us be even better doctors and influence patients even more though talk. This is not a place for this discussion, but this is already accepted in clinics in some hospitals. Eg. After exciting findings that show that placebo works even after patient knows he/she is taking a placebo pill several doctors published successfully lowering dose of psychostimulants in children with ADHD (and lowering the sinde effects), conditioning rituals and cytostatics to lower the side effects in patients in Germany, using placebo to treat chronic pain and lower the consumption of NSAIDs with adverese effect on the gut (and consequently on inflammation and pain),... 

The psychosocial connection of patient and medical practitioner will become even more important the more we understand placebo treatment because they seem to work through some of the shared brain areas. Eg. in patients with severe degeneration of the brain and with frontal lobe lesions the placebo response is absent!

I don't want to go any further because this is a question related specifically to Daith Ear Piercing and Migraines but I would love to discuss it somewhere else.

I recommend  Springer's Handbook of Experimental Pharmacology series: Placebo by Benedetti and several other authors.

Best,

Jan

http://www.springer.com/in/book/9783662445181

 I read your discussion with great interest as it touches the underlying mechanisms of the potential effect that Daith piercing may have on migraines. My background is from biomaterials and I confess immediately that I'm a complete novice in migraine and it's treatment. However, I realised that since the interest in using the piercing as a potential treatment or placebo treatment is high among the patients and apparently some doctors now, there is an opportunity to offer my knowhow for use. Daith piercings have a relatively high complication rate due to the difficult area, type of tissue, piercing models used and lack of standardisation of the actual procedure. No one seems to even know in which exact spot should the piercing be placed to be effective.

Our technology has been developed to alleviate the problems soft tissues have around titanium implants. Basically our material is able to achieve a strong bonding between the cell's and tissues and the implant surface. It is already in use in dental implants and there it's function is to speed up the healing and closure of the gingival tissue wound around the implant, thus reducing the risk of bacteria being able to enter the wound. Other effects observed are that no fibrous encapsulation forms around the implant, inflammatory response is reduced and general healing is improved.

I'm interested in starting a project on the daith piercing, because I read from Dr. Blatchley's internet survey results that exactly these type of complications are common also around the piercings. The goals of the project should be such that the potential treatment would be as safe and effective as the current knowhow already allows. Now, I understand that such project would be foolish to run without the expertise of people like yourselves, because without the understanding of the underlying mechanisms, it would have a high potential going wrong. I wish to therefore ask you all what you think of the potential of Daith piercing as a treatment option. In my mind from an implantology point of view it's a fairly straight forward project. But what are your thoughts on the neurological evidence? what are the main objectives and biggest failure pits?

best regards

Ilkka