If you think the average migraine is bad, imagine having one that lasts a week. Then imagine being told by your doctors to just take a couple of Excedrins and deal with it. And then, as you grow increasingly desperate for something stronger, imagine being told to avoid prescription migraine medication as long as you can stand it.

Having suffered from those searing migraines since I was 12, I knew I wouldn’t be able to stand it for very long. And so I tried acupuncture. I could never remember how many needles Mr. Cai used or where he put them — except for the one on the top of my head. Every time that needle slid into my scalp, the crushing pressure in my head dissipated in an instant.

In my attempt to discover what was actually going on in my body on those sessions with Mr. Cai, I uncovered a world of both ancient and nascent science. My pain relief wasn’t just happening around the needle site, said Dr. Elizabeth Manejias of the Hospital for Special Surgery in New York City, who explained to Inverse that “there are a lot of different reactions happening in the body.” Manejias is not only a physiatrist and a doctor of sports medicine but also a certified acupuncturist. As such, she’s in a rare bridge between the worlds of Western and complementary medicine. Unlike many physicians who dismiss Eastern practices for lacking scientific integrity, Manejias instead seeks the science in them.

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Centuries of alternative medicine have produced elaborate maps of acupuncture points, but Western scientists are only beginning to understand it.

The arcane-looking maps of the human body that line the walls of acupuncture studios might suggest that the practice is more superstition than science, but Manejias explains that the maps actually have a strong physiological basis, despite their roots in traditional Chinese medicine and its focus on the flow of Qi. There’s a science to finding an acupuncture point, she says, and inserting a needle in the right spot can relax muscle contractions, improve blood circulation, and reduce inflammation to the area. But most importantly, it can relieve pain.

Pain is a sensation caused by signals traveling along the nerves to activate pain centers in the brain. Those signals can be stopped in their tracks by painkilling drugs, massage therapy, or, in my case, well-placed needles. “[Acupuncture] activates local nerve fibers around the ankle joint, for example, but then it also sends signals through the spinal cord to your brain, and it activates centers in your central nervous system,” Manejias explains. The nervous system, in turn, causes the release of the body’s natural endorphins, which provide morphine-like pain relief. Endorphins bind the body’s opioid receptors to block pain signals, creating the sensation of painlessness.

While the points she picks often align with the meridian points in traditional Chinese acupuncture, Manejias takes a different approach. If she was treating someone with a sprained ankle, for example, she would look for tender spots on and around the ankle. These tender spots, or trigger points, are spots that are very irritable, tight bands of skeletal muscle that can be painful when they are stretched, flexed, or pressed. Given a patient’s trigger spots, the nature of their injury and pain, the anatomy of their ankle, and other factors, Manejias can narrow down their different acupuncture points.

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Acupuncturists pick spots based on the traditional Chinese meridian points or by looking for trigger points.

Scientists are only beginning to understand the physiological basis of acupuncture’s effects. In a 2008 review published in the journal Progress in Neurobiology, neurobiologist Zhi-Qi Zhao from Shanghai’s Fudan University broke down exactly how acupuncture coaxes the body into producing endorphins and other pain-relieving neurochemicals. Zhao explains that certain nerve fibers known as afferent fibers get activated as an acupuncturist twists a needle up and down. These signals travel to the parts of the brain that process and inhibit pain. He points out that adding an electrical component to acupuncture — that is, through electrified needles — can increase the amount of pain-relieving neurochemicals that are produced.

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An acupuncturist can add electric stimulation to help increase endorphin levels.

But the myriad of physiological effects that acupuncture elicits is also what makes it so hard to study with modern science. “We just can’t say with any certainty which one is responsible for most of the pain effect,” said Manejias, who explained that acupuncture is unique and specific to each patient. Not everyone has the same treatment points, even if they have the same diagnosis. As such, it’s hard to do a study in which treatments are carefully controlled.

Manejias points out that acupuncture makes it hard to have a control group in the first place. While researchers studying drugs can easily give participants a placebo pill, it’s not quite as simple to give people fake acupuncture. While there is simulated acupuncture or “sham acupuncture,” she explains, “patients know that they’re being needled.” This inability to study the placebo effect is especially confounding because research suggests that it plays an especially big role in acupuncture’s success. In a 2006 review in the journal Rheumatology, a team of UK researchers analyzed 18 studies on acupuncture, comparing the success of sham vs. manual acupuncture treatments, and concluded that “the placebo effect of acupuncture as a treatment for pain can be impressive.”

sham acupuncture needle placebo
Sham acupuncture needles don't penetrate the skin and are used for the placebo group.

While acupuncture has been a part of traditional Chinese medicine for hundreds of years — the first documented treatment was dated around 100 B.C. — Western medicine has only started looking into integrating it into modern treatments. This also means the research on acupuncture is just as young, and researchers are still testing the different theories on how it works.

Since my first appointment with Mr. Cai, I have gone to three other acupuncturists for my headaches. Sometimes I lay on my stomach, and sometimes I am belly up. They’ve put needles in my hands, my eyebrows, and various parts of my scalp. But no matter who I go to, I always get a needle on the top of my head.

Photos via Flickr / psyberartist, Getty Images / Joe Raedle, Flickr / Official U.S. Navy Imagery, Zhang et al, Flickr / yugenro