Erjona’s migraines used to arrive on Tuesday afternoons, between three and five o’clock, with a regularity that had made her stop scheduling client meetings for that window. She had tracked them for nearly a year before she came to see me — a small notebook with dates, weather, sleep hours, what she had eaten, what she had drunk, where she had been in her cycle. The notebook was the kind of document a person keeps when they have stopped expecting doctors to solve their problem and have decided to solve it themselves.
She was thirty-four. She worked in marketing for a logistics company with an office near Bllok. The migraines had started in 2024, six months after she moved back from Milan to take care of her mother through a long illness. They had outlasted her mother’s recovery by two years.
The neurologist she had seen — a kind, competent specialist at a private practice in Tirana — had given her sumatriptan for the acute episodes and propranolol as a preventive. The sumatriptan worked. The propranolol made her tired without reducing the frequency. She had tried magnesium, riboflavin, coenzyme Q10, the elimination of nightshades, the elimination of dairy, the elimination of red wine. The migraines kept arriving on Tuesday afternoons.
When she sat down in my office and showed me the notebook, I asked her one question.
“What happens on Monday evenings?”
She paused. She had not asked herself that question.
The pattern under the pattern
Migraines have a reputation for being unpredictable, but a careful look at the data — one’s own data, kept in a notebook — almost always reveals a pattern. The body does not produce a fifteen-hour vascular and neurological event at random. Something precedes it, sometimes by hours, sometimes by a full day. The trick is to find the upstream signal.
In Erjona’s case, the answer turned out to be small but consistent. Monday evenings, after work, she met three friends at a café in Bllok for what they called the catch-up. Two glasses of wine, often three, conversation that ran late. The wine she had eliminated once and then re-introduced after the migraines kept coming anyway. She had concluded the wine was not the trigger. She was wrong, but in a more interesting way than she had assumed.
The wine was not triggering the migraine. The wine was triggering a small, predictable disruption of her sleep architecture, which combined with elevated cortisol on Tuesday morning meetings, which combined with the late lunch she usually skipped on Tuesdays because of those meetings, which combined with — the actual immediate trigger — a small drop in blood sugar around three in the afternoon.
It was a stack of four small factors, none of them sufficient on its own. The pattern was visible only if you looked at all four together.
What acupuncture seems to do for migraine
I have read, over the years, that acupuncture is one of the better-tested traditional treatments for migraine, and that some European countries now suggest it for migraine sufferers when the usual medicines have not worked. The mechanism is still being worked out, as far as I understand it, but the broad picture goes something like this — and here I am simplifying what doctors much more qualified than me have written.
Migraine is, very roughly, a kind of over-reactive event in the brain. Something — stress, a hormonal shift, a missed meal, a glass of wine the night before — pushes the system over a threshold, and the migraine arrives. The brain of a migraine sufferer sits closer to that threshold than the average brain.
Acupuncture, done well and consistently, seems to raise the threshold by a small but useful amount. The needles work, as I understand it, partly on the nerves of the face and head, partly by quietening down inflammation, and partly through the nervous system as a whole — bringing the over-alert “fight or flight” mode back to a calmer baseline.
It is not a cure. It does not eliminate migraines for most patients. What it reliably does, in clients who respond, is reduce the frequency by between thirty and sixty percent and reduce the severity of the episodes that still occur. For someone having eight migraines a month, this means three or four migraines a month. The change is significant. It is also rarely dramatic enough to convince a sceptic in a single session.
What we did
I told Erjona the truth: her notebook had already done eighty percent of the work. The single most useful intervention she could make, before any needle touched her, was to address the Monday evening pattern. Not eliminate the friends. Not eliminate the wine. Reduce the wine to one glass, eat a real lunch on Tuesday before any meeting, carry a small protein snack for the three-o’clock window. She agreed to try this for six weeks.
In parallel, we began acupuncture. Twice a week for the first three weeks, then once a week. Points: Taiyang (the extra point at the temples), Fengchi (the gallbladder-20 point at the base of the skull), Hegu (large-intestine-4, in the hand), Taichong (liver-3, between the toes), and a rotating selection of secondary points based on what her pulse and tongue showed at each visit. A familiar pattern for migraine prevention, the kind of protocol many TCM practitioners have used for many years. Nothing experimental.
The first two weeks: no change. She had two migraines, both on Tuesday.
The third week: one migraine, on Wednesday rather than Tuesday. We discussed whether this was meaningful or coincidence. I told her honestly that I did not know yet.
The fourth week: no migraine.
The fifth week: no migraine.
The sixth week: no migraine.
She came in on the Tuesday of the seventh week, smiling for the first time since I had met her.
“I think I have not had a Tuesday afternoon in three years.”
What I told her, and what I tell anyone with a similar story
Erjona’s migraines have not vanished. She had one in the eighth week, mild, lifted with rest and a single dose of sumatriptan. She has had three more in the eleven months since. Three migraines in eleven months, compared with the previous frequency of two to three per month, is a meaningful change. It is not perfection. It is enough that she has her Tuesdays back.
The lesson I take from her case — and I have seen variations of it many times — is that acupuncture rarely fixes migraine on its own. It works best as part of an honest investigation into what the body is reacting to. The needles raise the threshold. The lifestyle changes lower the load. Together, the gap between threshold and load opens up enough that the migraines do not arrive. There is a short earlier piece on a different migraine-relief acupuncture story, if you want a second example.
If you are reading this and considering acupuncture for your own migraines, the suggestion I would make is this: keep a notebook for at least three months before your first session. Write down everything that seems irrelevant. Hours of sleep, what you drank the day before, where you were in your cycle if you have one, the weather, whether you ate breakfast. The patterns will surface. The acupuncturist’s job is then to help you address what the patterns are showing.
The needles are useful. They are not the whole story.
A small footnote about the diaspora
I notice in my practice that the migraine clients who improve the most are often those who have moved between countries — diaspora returnees, expatriates, people whose nervous systems have adapted twice or three times to new climates, new schedules, new languages. The migrating nervous system seems to be more sensitive to small ongoing disruptions. It also seems to respond particularly well to interventions that respect its complexity rather than trying to override it with a single drug.
I do not have data to back this up, only an impression from many client conversations. But it matches something I notice in myself, having moved from Liaoning to Tirana a few years ago: a body that has crossed borders carries a different kind of attention.
The work is to give it the right kind of quiet.
Yang Wang practises acupuncture at Chinese Massage – Tai Chi Tirana. The parlour is in central Tirana, near Bulevardi Gjergj Fishta. Names in client stories have been changed.