Auricular Acupuncture: An Adjunctive Alternative Treatment That Can Be Helpful For Migraine Disease and So Much More

How often do you see a patient with a migraine attack who has tried everything to break the current cycle, but nothing is working? Auricular therapy, which is acupuncture of the external ear, may be a helpful option.

In 2012, I had just learned the 5-point Battlefield Acupuncture (BFA) protocol and was asked to “bring my needles” to help a patient experiencing a two-week-long migraine attack that had not responded to any treatments, including intravenous medication in the emergency room. To the surprise of the neurologist, the patient, and even myself, the migraine attack resolved within 20 minutes after I placed five acupuncture points in each ear. Most importantly, the patient experienced no related side effects.

Auricular acupuncture has increasingly been used in pain management settings, including headache clinics and the Veterans Health Administration, as a non-pharmacologic option. While it is not a replacement for evidence-based migraine treatment, it may serve as a helpful adjunct or rescue option for select patients, particularly during prolonged or refractory attacks.

What is Auricular Acupuncture?

Auricular acupuncture is based on the idea that specific points on the ear correspond to different parts of the body. While the precise mechanisms of action are not fully understood, it is theorized that stimulating these points may influence nerves involved in pain and nervous system regulation.^1,2,3,4,5

The outer ear is connected to several important nerves, including branches of the trigeminal nerve (which plays a key role in migraine), the vagus nerve (which helps regulate inflammation and the body’s stress response), and nerves from the upper neck.^1,2,3,4,5  It is thought that stimulating points on the ear send signals to the brain that may help modulate pain processing and reduce migraine symptoms.

Because it is localized, minimally invasive, and generally well tolerated, it can be used for individuals who cannot tolerate medications or have contraindications to certain pharmacologic treatments.

What Is Involved in the Administration of Auricular Therapy?

Auricular therapy may be administered using a standardized protocol or through individualized point selection. Points can be stimulated in several ways, most commonly by placing thin, sterile, single-use needles; semi-permanent needles; or ear seeds used for acupressure.^1,2,4

The sterile needles used in auricular therapy vary in size; however, those used for the ear are approximately the diameter of a human hair. Ear seeds are derived from the Vaccaria plant, and small beads may also be used; both are about the size of a pen tip. The ASP needle is applied using a small applicator (pictured to the right). This involves a minor piercing, and the needle remains in the ear for approximately three days.

Typically, before administering auricular therapy, a general health history is obtained, followed by a focused physical exam as indicated. Examination of the ear for dry patches, lesions, congestion, or redness is important before initiating treatment. Palpation with a point finder or even the tip of a cotton swab can help identify tender or painful areas.

Education on the technique should be provided, and informed consent obtained prior to treatment. Within the Veterans Administration, auricular therapy is considered sufficiently safe that oral consent is standard practice; however, consent requirements may vary by institution or clinic.

Precautions

Auricular therapy with needles should not be performed, or should be performed with caution, in patients who are:

• Weak, exhausted, or anemic, as treatment may be less effective and could worsen fatigue
• Those who have recently eaten a heavy meal or consumed alcohol, as effectiveness may be reduced
• Pregnant patients, for whom pregnancy is considered a relative contraindication (Battlefield Acupuncture (BFA) protocols do not allow needle use, whereas National Acupuncture Detoxification Association (NADA) protocols do allow it; see protocols below)
• Patients who are averse to needles, in which case acupressure may be used instead
• Elderly patients, in whom treatment should be performed with additional care

Side Effects

• Bruising or minor bleeding at the insertion site
• Infection at the site of semi-permanent needle placement (very rare)
• Needle shock or vasovagal reaction (rare); to reduce risk, patients should be seated in a chair with armrests or positioned lying down, particularly during the first administration

Relative Value Units (RVUs)

Billing codes are available for auricular therapy when needles are used. The most commonly used CPT code is 97810, which carries 0.6 RVUs.

Auricular Therapy Protocols

There are two 5-point protocols that are easy to learn, easy to administer in the office, and effective.

The NADA protocol was originally developed to support people with drug and alcohol dependence.^5,6,7,8 It has since expanded to be helpful for chronic pain, mood disorders such as anxiety, and is helpful in reducing stress, improving sleep, and coping with trauma. It has been utilized in natural disasters such as hurricanes and in man-made disasters such as 9/11.^5,6,7,8 In 2024, the Veterans Administration launched a training program for this protocol.

The second protocol, called Battlefield Acupuncture (BFA), was developed by Dr. Richard Neimtzow, a retired Air Force Colonel who was skilled in acupuncture. This was initially developed to help relieve pain on the battlefield. It proved so successful that the Department of Defense and the VA rolled out a training program for health care providers in 2013.⁹ Since then, thousands of clinicians have been trained in the protocol, and thousands of veterans have received this treatment.^9,10,11 The training is open to a variety of clinical staff, depending on the facility, and often includes RNs and LPNs. According to a 2021 Pain Medicine article, the immediate short-term pain relief provided by BFA can help patients start engaging in other self-management strategies, such as yoga or exercise.⁹

Effectiveness of Auricular Therapy

Clinical trials evaluating auricular therapy for migraine remain limited. A literature review identified three studies examining acute or preventive use, each using different techniques (e.g., fixed ear points or semi-permanent needles), and overall suggested that auricular therapy may be a helpful adjunctive treatment for aborting migraine attacks or reducing their frequency and severity.¹² A systematic review and meta-analysis of 10 randomized trials (766 participants) similarly found that auricular acupuncture, when added to standard medications, reduced pain intensity, attack frequency, and duration, with no serious adverse events reported, although systematic safety monitoring was limited.¹³

Evidence from individual studies is mixed but encouraging. A small prospective pilot study using auricular therapy for pediatric migraine in the emergency department reported a rapid and clinically meaningful reduction in pain scores within 15 minutes without adverse events.¹⁴

In a randomized open-label study of adults with episodic migraine, three monthly sessions of auriculotherapy using semi-permanent needles did not significantly reduce migraine days or overall pain intensity compared with controls, but were associated with fewer non-migraine headache days, reduced triptan use, and improved migraine-related disability.¹⁵

Notably, none of these studies used standardized protocols such as Battlefield Acupuncture (BFA) or the National Acupuncture Detoxification Association (NADA) protocol, underscoring the need for larger, well-designed trials using consistent protocols to better define efficacy and safety.

Training Opportunities

Each provider is encouraged to check with their state licensing board to verify eligibility to administer auricular therapy with needles. If needle use is not permitted in your state, acupressure can be administered and may also provide benefit.

Within the Veterans Administration, Battlefield Acupuncture (BFA) and National Acupuncture Detoxification Association (NADA) protocols are taught and available to healthcare professionals. Courses using acupressure are also offered for those not credentialed to use needles.

Learn More

• National Acu-Detox Association
• Battlefield Acupuncture
• People’s Organization of Community Acupuncture (POCA): pocacoop.com
  • Training cost: $300–$400
  • POCA provides a link to current state regulations (as of April 2024): Ear Trainings – POCA
• Auriculotherapy online training programs: Terry Oleson’s course / Health Care Alternatives

There are programs that offer certification for specific protocols; in addition, Terry Oleson’s course offers a certification in a broader use of auricular acupuncture/auriculotherapy. Certification acknowledges specialized training but does not replace the need for licensure in a specific healthcare field.

Final Thoughts

Auricular therapy, including Battlefield Acupuncture and NADA protocols, is generally a safe, effective, and accessible option for patients with acute or chronic pain, migraine, anxiety, and other conditions. Licensed acupuncturist, Lisa Rohleder, founder of POCA, emphasizes, “Anyone who is trained and licensed to give injections or do sutures could learn to use a few simple acupuncture protocols in a matter of weeks and could relieve an enormous amount of suffering.”¹⁶ With proper training, informed consent, and attention to precautions, healthcare providers can integrate auricular therapy into practice to offer rapid relief with minimal side effects, complementing conventional treatments and helping reduce reliance on medications.

References

1. Oleson T. (2003). Auriculotherapy Manual: Chinese and Western Systems of Ear Acupuncture, 3rd edition. New York: Churchill Livingston, 2-19, 56, 172-173.
2. Oleson T. Auriculotherapy Manual: Chinese and Western Systems of Ear Acupuncture, 4th edition. New York: Churchill Livingston, Elsevier, (pp. 2-79), 2014
3. Wirz-Ridolfi A. The History of Ear Acupuncture and Ear Cartography: Why Precise Mapping of Auricular Points Is Important. Med Acupuncture 2019:31(3):145-156. Doi: 10.1089/acu.2019.1349.
4. Helms J. Acupuncture Energetics: A Clinical Approach for Physicians. New York: Thieme Publishers, pp. 3-17, 2007
5. He W, Wang X, Shi H, Shang H, Li L, Jing X, Zhu B. Auricular acupuncture and vagal regulation. Evid Based Complement Alternat Med 2012:2012:786839. Doi: 10.1155/2012/786839.
6. National Acupuncture Detoxification Association. (2011) Acupuncture Detoxification Specialist Training Resource Manual. 4th ed. Wyoming: Laramie.
7. Stuyt E., &Voyles C. (2016). The National Acupuncture Detoxification Association protocol, auricular acupuncture to support patients with substance abuse and behavioral health disorders: current perspectives. Substance Abuse and Rehabilitation. 7, 169-180.
8. Stuyt EB, Voyles CA, Bursac S. NADA Protocol for Behavioral Health. Putting Tools in the Hands of Behavioral Health Providers: The Case for Auricular Detoxification Specialists. Medicines. 2018; 5(1):20. https://doi.org/10.3390/medicines5010020
9. Taylor SL, Giannitrapani KF, Ackland PE, Thomas ER, Federman DG, Holliday JR, Olson J, Kligler B, Zeliadt SB. The Implementation and Effectiveness of Battlefield Auricular Acupuncture for Pain. Pain Med. 2021 Aug 6;22(8):1721-1726. doi: 10.1093/pm/pnaa474. PMID: 33769534
10. Zeliadt SB, et al. (2020) Patient Feedback on the Effectiveness of Auricular Acupuncture on Pain in Routine Clinical Care: The Experience of 11,406 Veterans. Med Care., 58 Suppl 2 9S(2 9 Suppl):S101-S107. doi: 10.1097/MLR.0000000000001368. PMID: 32826779; PMCID: PMC7497594.
11. Dai N, Liu X, Wan H. Practical Applications and Safety of Battlefield Acupuncture for Pain Management: A Systematic Literature Review. J Multidiscip Healthc. 2025 May 17;18:2749-2769. doi: 10.2147/JMDH.S517946. PMID: 40401079; PMCID: PMC12094825.
12. Williams KA. Auricular Therapy for Migraine. Curr Pain Headache Rep. 2024 Aug;28(8):835-841. doi: 10.1007/s11916-024-01261-3. Epub 2024 May 2. PMID: 38696035.
13. Zheng S, Liu L, He X. Clinical Efficacy and Safety of Auricular Acupuncture for Migraine: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Pain Res. 2025 Nov 18;18:6125-6135. doi: 10.2147/JPR.S563246. PMID: 41282367; PMCID: PMC12640141.
14. Graff, Danielle M. MD*; McDonald, Mark J. MD†. Auricular Acupuncture for the Treatment of Pediatric Migraines in the Emergency Department. Pediatric Emergency Care 34(4):p 258-262, April 2018. | DOI: 10.1097/PEC.0000000000000789
15. Michel-Cherqui M, Ma S, d’Ussel M, Ebbo D, Spassova A, Chaix-Couturier C, Szekely B, Fischler M, Lemaire N, Le Guen M. Auriculotherapy in prevention of migraine attacks: an open randomized trial. Front Neurol. 2023 May 22;14:1193752. doi: 10.3389/fneur.2023.1193752. PMID: 37284181; PMCID: PMC10241207.
16. Rohleder L, et al. (2009) Acupuncture is like noodles. Oregon: Working Class Acupuncture,122.