Post-auricular leech therapy reduced headache & migraine days in chronic migraine
Background: Migraine is an exceedingly common disorder that causes substantial pain, disability and societal burden. Unfortunately, conventional treatments are insufficient, inadequate, or associated with significant risks, such as overuse, abuse or addiction. The Unani system of Medicine has been treating migraine since centuries. Leech therapy (Irsale Alaq) has been employed successfully in severe persistent headache, mania and insomnia since decades.
Aim: The purpose of our study was to evaluate the impact of post auricular leech therapy in migraine and to collect data to warrant further clinical trials.
Methods: We conducted a case series on 7 patients who had failed conventional oral treatments for the migraine. After informed consent, post auricular leech therapy was done. Patients were asked to keep detailed headache calendars, documenting the number of headache days, migraine days, the intensity of headaches/ migraines and analgesic usage. We compared these parameters before and after 2 months of therapy.
Results: We observed a reduction in the number of headache & migraine days and amount of painkillers used without any adverse effects. (P≤ 0.01) Improvement in quality of life was also observed.
Discussion: We reviewed the literature related to the medicinal leeches (Hirudo medicinalis), used for the treatment in these cases. Leech saliva contains certain potent anesthetic, anti-inflammatory and vasodilator substances, suggesting plausible mechanisms of action in these cases.
Conclusion: The preliminary findings indicate the safe and potential therapeutic role of leech therapy. So further trials should be carried out to explore the therapeutic potential of this therapy in chronic migraine.
Keywords: Chronic Migraine, leech therapy, hirudo medicinalis, headache, Unani Medicine, complementary Medicine.
2. Olesen J, Bousser MG, Diener HC, Dodick D, First M, Goadsby PJ, Gobel H, Lainez MJ, Lance JW, Lipton RB, Nappi G, Sakai F, Schoenen J, Silberstein SD, Steiner TJ. New appendix criteria open for a broader concept of chronic migraine. Cephalalgia. 2006; 26:742–746.
3. World Health Organization. Headache disorders. Fact sheet N°277.http://www.who.int/mediacentre/factsheets/fs277/en/. 2004. [Accessed 2014]
4. Ravishankar K. Migraine - The New Understanding. Supplement OF JAPI. 2010; 58:30-33.
5. Katsarava Z, Buse DC, Manack AN, Lipton RB. Defining the Differences Between Episodic Migraine and Chronic Migraine. Curr Pain Headache Rep. 2012; 16:86–92.
6. Tabri M. Moalajat Buqratiya (Urdu translation). New Delhi: CCRUM; 1995, Vol. 1:284-90.
7. Silberstein SD, Young WB. Atlas of migraine and other headaches. 2nd ed. Taylor and Francis. Taylor and Francis group: 14-15.
8. Villalon CM, Centurion D, Valdivia LF, Vries PD, Saxena PR, Migraine: Pathophysiology, Pharmacology, Treatment and future trends. Current vascular pharmacology 2003; 1:71-84.
9. Larus S.G, Migraine, blood pressure and inflammation in relation to cardiovascular diseases and mortality [PhD thesis]; school of health sciences, faculty of medicine, University of Iceland: Nov. 2010.
10. Sina I. In: Al Quanoon Fil Tib. 2nd ed. Pasha Mazhar H., translator. Karachi, Pakistan: Inter Services Press; 1998. P. 408–409.
11. Shiffa M, Siddiqui MA, Sultana A, Zaman F, Fahamiya N, Akhtar MU. Comparative clinical evaluation of leech therapy in the treatment of knee osteoarthritis. Eur J Integr Med 2013; 5(3):261-9. http://dx.doi.org/10.1016/j.eujim. 2012.12.004
12. Michalsen A, Klotz S, Lu¨dtke R, Moebus S, Spahn G, Dobos G. Effectiveness of leech therapy in osteoarthritis of the knee: a randomized, controlled trial. Ann Intern Med 2003; 139(9):724-30. http://dx.doi.org/10.7326/0003-4819-139-9200311040-00006
13. Andereya S, Stanzel S, Maus U, Müller-Rath R, Mumme T, Siebert C, et al. Assessment of leech therapy for knee osteoarthritis. A randomized study. Acta Orthop 2008;79(2):235-43. http://dx.doi.org/10.1080/17453670710015030
14. Michalsen A, Moebus S, Spahn G. Leech therapy for symptomatic treatment of knee osteoarthritis: Results and implications of a pilot study. Altern Ther Health Med 2002; 8(5):84-8.
15. Michalsen A, Deuse U, Esch T, Dobos G, Moebus S. Effect of leeches therapy (Hirudo medicinalis) in painful osteoarthritis of the knee: a pilot study. Ann Rheum Dis 2001; 60(10):986. http://dx.doi.org/10.1136/ard.60.10.986
16. Stange R, Moser C, Hopfenmüller W, Mansmann U, Bühring M, Ühleke B. Randomised controlled trial with medical leeches for osteoarthritis of the knee. Complement Ther Med 2012; 20(1-2):1-7. http://dx.doi.org/10.1016/j.ctim.2011.10.006
17. Bäcker M, Lüdtke R, Afra D, Cesur Ö, Langhorst J, Fink M, et al. Effectiveness of leech therapy in chronic lateral epicondylitis: a randomized controlled trial. Clin J Pain 2011; 27(5):442-7. http://dx.doi.org/10.1097/AJP.0b013e318208c95b
18. Kalender ME, Comez G, Sevinc A, Dirier A, Camci C. Leech therapy for symptomatic relief of cancer pain. Pain Med 2010;11(3):443-5. http://dx.doi.org/10.1111/j.1526-4637.2010.00800.x
19. Bakhshi M, Jalalian B, Valian M, Shariati S, Saeidi T, Ranjbar H. Can Leech Therapy Be Used as an Alternative Treatment for Controlling Migraine Headache? A Pilot Study. Acta facultatis medicae Naissensis. 2015;32(3):189-197
20. Pietrobon D, Moskowitz MA: Pathophysiology of migraine. Annu Rev Physiol. 2013; 75:365–391.
21. Samsam M: Central nervous system acting drugs in treatment of migraine headache. Cent Nerv Syst Agents Med Chem. 2012; 12:158–172.
22. Gödekmerdan A, Arusan S, Bayar B, Sağlam N. Medicinal leeches and hirudotherapy. Turkiye Parazitol Derg. 2011; 35(4):234-9.doi:10.5152/tpd.2011.60.
23. Ali KS, Mustafa GB, Aylin UG, Erkan O. Medicinal leech therapy—an overall perspective. Integr med res. 2017; 6:337–43.
24. Bergmans et al. EHMTI-0394. Predictive parameters for the effect of botulinum toxin infiltrations in chronic migraine. The Journal of Headache and Pain 2014; 15(1):M1.
25. Bright et al. Migraine and tension-type headache treated with stromal vascular fraction: a case series. Journal of Medical Case Reports. 2014; 8:237.
26. The migraine trust. Botox for Migraine. http://www.migrainetrust.org/factsheet-botox-for-migraine-10899 [Accessed December 2014].
27. Anonymous. Headache and migraine. [Accessed 2018]
Available from: https://emedicine.medscape.com/article/1142556-overview#a3
28. Waeber C, Moskowitz MA. Therapeutic implications of central and peripheral neurologic mechanisms in migraine. Neurology. 2003; 8:S9-20. [Medline].
29. Hauge AW, Asghar MS, Schytz HW, Christensen K, Olesen J. Effects of tonabersat on migraine with aura: a randomised, double-blind, placebo-controlled crossover study. Lancet Neurol. 2009; 8(8):718-23. [Medline].
30. Williamson, D. J.; Hargreaves, R. J. Neurogenic inflammation in the context of migraine. Microsc. Res. Tech. 2001; 53:167–178.
31. Pardutz A, Schoenen J. NSAIDs in the Acute Treatment of Migraine: A Review of Clinical and Experimental Data. Pharmaceuticals. 2010; 3:1966-87. Doi:10.3390/ph3061966.
32. Ellrich J, Schepelmann K, Pawlak M, Messlinger K. Acetylsalicylic acid inhibits meningeal nociception in rat. Pain. 1999; 81:7–14.
33. Levy D, Zhang XC, Jakubowski M, Burstein R. Sensitization of meningeal nociceptors: Inhibition by naproxen. Eur. J. Neurosci. 2008; 27:917–22.
34. Anonymous. Propanalol. Orofacial Pain and Headache. [Accessed 2018] Available from
35. Shukla R, Sinha M. Migraine: Prophylactic Treatment. Supplement of JAPI. 2010; 58:26-29. Available from: http://www.japi.org/special_issue_2010/Article_05.pdf
36. Zharkovskiĭ AM, Allikmets LKH. Effect of cholinergic drugs on serotonin metabolism and emotional reactions in rats. Farmakol Toksikol. 1976; 39(3):261-4.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).