The International Headache Congress (IHC) 2023 was held in Seoul, Korea, September 14-17, 2023. As the theme of the congress was "RISING SUN OVER HEADACHES," the focus of attention was on novel therapeutic agents, including the calcitonin gene-related peptide receptor (CGRP antibody) and Pituitary adenylate cyclase-activating polypeptide, which represents the next step after CGRP. In the area of acupuncture and moxibustion, there were presentations at the Lunch Seminar and Parallel Scientific Session, where active discussions took place.

[Objective] We report a case in which we unexpectedly encountered a patient with a transient ischemic attack (TIA) caused by severe stenosis of the left middle cerebral artery (MCA) during the course of acupuncture treatment.Patient: A 79-year-old man suffered from bilateral shoulder pain. He was diagnosed with a frozen shoulder at the orthopedic department and was referred to the acupuncture department.[Results] During the course of acupuncture treatment, the subject occasionally exhibited subtle behavioral features, such as difficulty in speech, holding incoherent conversations, and forgetting where he put things. The symptoms were observed repeatedly during treatment, so the acupuncturist referred the patient to the neurosurgical department for a consultation. Magnetic resonance imaging (MRI) of the brain showed an old cerebral infarction in the watershed area in the left paraventricular region, and MR angiography (MRA) revealed left middle cerebral artery stenosis. Single photon emission computed tomography showed decreased blood flow in the left MCA area. The symptoms could be considered TIA with motor and sensory aphasia. The administration of aspirin was started, and the symptoms disappeared.[Discussion and Conclusion] The acupuncturist has more opportunities to obtain information about the patient due to the longer time spent in acupuncture therapy compared to general outpatient treatment. Acupuncture can play an important role in medical partnership. It is also important that the acupuncturist has sufficient medical knowledge.

[Objective] To report reduction in frequency of headaches and use of medication and improvements in quality of daily life via C2 peripheral nerve field stimulation using electroacupuncture (EA-C2-PNfS) in a patient with migraines triggered by weather changes. [Case] A woman in her 60s complaining of headache.[Clinical History] Her headaches began to worsen in X-41 years. The OTC drug became ineffective from around X-15 years, and subject was diagnosed with migraine and overuse of headache medication by a neurosurgeon. Her headache was alleviated by the appropriate medications. She began a new job from August, X-1 year and headaches and over-medication increased in frequency. The acupuncture treatment was started in May, X year. The frequency of headaches was 8 times mo (month).[Subjective Symptoms] Throbbing pain occurred mainly in the frontal and occipital regions, often accompanied by nausea, vomiting, and optic/auditory hyperesthesia. The main trigger was weather changes.[Family History] Father, maternal grandmother and brothers have a history of headaches.[Diagnosis] Migraine.[Evaluation] Headache Diary (frequency of headache and medication), Headache Impact Test (HIT-6) (Quality of daily life).[Treatment] EA-C2-PNfS was performed once a week. Interval of the treatment was adjusted depending on the patient's condition. [Results] Though weather- related transient aggravations were occasionally observed, the frequencies of the headache and use of medication gradually decreased; The frequency of the headache was 8 times/mo at the start of the treatment, 6 times/mo after 12 weeks, 8 times/mo after 24 weeks, 3 times/mo after 36 weeks, once a mo after 48 weeks, 4 times mo after 54 weeks. The frequency of medication was 8 times/mo at the start of the treatment, 2 times/mo after 12 weeks, 6 times/mo after 24 weeks, 3 times mo after 36 weeks, once a mo after 48 weeks, 4 times/mo after 54 weeks. The score of HIT-6 also improved from 68 to 57. The treatment was concluded with patient satisfaction.[Discussion] In this case, migraine triggered by weather changes was remarkably alleviated. Recently an activation of the spinal trigeminal nucleus was implicated in the pathology of weather-associated headaches. EA-C2-PNfS may inhibit the abnormal activity of spinal trigeminal nucleus.

[Introduction] We report a case of patient with migraine that improved after acupuncture and additional treatment for comorbidities of dry eye.[Case presentation] Subject was a 59-year-old female patient who was 156 cm tall and 49 kg in weight (BMI: 20.1). Her blood pressure was 122/69 mmHg, and her pulse was 70 beats per minute. She had suffered from headaches for about ten years and had been previously diagnosed with migraine. Due to the worsening of the headaches, she began acupuncture treatments. Since the onset of the headaches, she was also diagnosed with dry eye.[Treatment] At the initial visit, the subject's Headache Impact Test (HIT-6) score was 65. Manual acupuncture in her back and neck area and C2 peripheral nerve field stimulation with electroacupuncture were performed for migraine. At week four of treatment, the HIT-6 score was 60 and the headaches appeared 14 times a month, which improved to 48 and 7, respectively, at week 12. However, her headaches worsened after treatment interruption. At week 40, the HIT-6 score and headache frequency worsened and increased to 60 and 13, respectively. Acupuncture treatment for migraine was resumed, and treatment for comorbidities of dry eye, that included manual acupuncture around the orbits and self-care, was also performed. Subsequently, her headaches ameliorated significantly. At week 56, the HIT-6 score was 48 and the headaches appeared only five times a month. Migraine relief persisted and the symptoms of dry eye also improved.[Discussion and Conclusion] The additional dry eye treatment had a positive effect in improving the symptoms of migraine. It has been speculated that the pathogenesis of both diseases is related to central sensitization of the optical and trigeminal nervous systems. If so, the improvement of dry eye symptoms may have had an effect on migraine relief as well.