Acupuncture significantly reduced migraine frequency
Compared with sham acupuncture, true acupuncture showed a greater degree of persistent, superior and clinically relevant benefits for migraine prophylaxis, according to research published in JAMA Internal Medicine.
“Among neurological disorders, migraine is a leading cause of disability and significantly contributes to individual and societal burdens owing to pain and environmental sensitivities,” Ling Zhao, PhD, of the Chengdu University of Traditional Chinese Medicine in Sichuan, China, and colleagues wrote. “Approximately 25% to 38% of migraineurs need preventive therapy, and pharmacotherapies ... However, such treatments are often associated with an increased risk of adverse events.”
Acupuncture is commonly used in China and Western countries to manage migraines; however, its long-term effects are uncertain, according to Zhao and colleagues. Therefore, they performed a multicenter, three-arm, parallel clinical trial to determine the long-term efficacy of true acupuncture for migraine prophylaxis in comparison to sham acupuncture and being placed on a waiting list for treatment. A total of 249 participants aged 18 to 65 years (77.1% women) who experienced migraines without aura (based on criteria from the International Headache Society) with a frequency of two to eight times per month were enrolled in the trial and randomly assigned to one of three groups: true acupuncture, sham acupuncture or wait list (control).
Participants in the true and sham acupuncture groups received 20 sessions of electroacupuncture treatment over 4 weeks and were followed for 20 weeks after treatment. Those in the waiting-list group did not receive treatment during the trial period. All participants self-recorded migraine attacks in a diary. The researchers measured the change in frequency of migraine attacks from baseline to week 16, as well as the number of migraine days, average headache severity and medication intake every 4 weeks within 24 weeks.
Across all groups, baseline characteristics were similar, according to Zhao and colleagues. Sixteen weeks after randomization, they found that the mean frequency of migraine attacks decreased most in the true acupuncture group with a reduction of 3.2, compared with 2.1 for the sham acupuncture group and 1.4 for the waiting-list group. The reduction in migraine frequency among those in the true acupuncture group was significant. The sham acupuncture and waiting-list groups were not statistically different (difference of 0.7 attacks; 95% CI, –0.1 to 1.4). In addition, the frequency of migraine attacks, migraine days, and VAS scores were significantly lower in the true acupuncture group than in the other two groups.
“Compared with [sham acupuncture] and [waiting list] control groups, [true acupuncture] manifested persisting superiority and clinically relevant benefits for at least 24 weeks in migraine prophylaxis, including reducing the number of migraine frequency and days with migraine, as well as decreasing pain intensity,” Zhao and colleagues concluded.
In an accompanying editorial, Amy A. Gelfand, MD, of the pediatric headache program at the University of California, San Francisco, wrote that while the study by Zhao and colleagues contains many strengths, it does not “convincingly demonstrate acupuncture’s efficacy for migraine prevention” due to acupuncturists, by necessity, not being blinded and the potential of participants being unblinded.
“Putting all other hesitations aside, if the true acupuncture regimen studied in this trial is truly effective for migraine prevention, the logistical barriers inherent in patients being able to access it clinically are likely to be substantial,” she added.
She questioned how many acupuncture providers have the training and equipment necessary to provide electroacupuncture and pointed out that access to an acupuncturist and the lifestyle flexibility that is required may be limited for many patients.
“In this regard, acupuncture is not entirely without potential adverse effects,” Gelfand concluded. “Development of a self-administered home acupuncture device, if feasible, could get around a number of these issues. In the meantime, how best to counsel patients about the utility of acupuncture for migraine prevention? It is probably safe to try — it is not clear it is effective. The main risks are likely to their pocketbook and their time.”
Related, a review by the NIH found that acupuncture is effective in managing common pain conditions such as back pain and osteoarthritis of the knee. The NIH noted that relaxation techniques can also be used to manage severe headaches and migraine. – by Alaina Tedesco
Disclosures: Zhao and colleagues report receiving grants from the State Key Program for Basic Research of China, the National Natural Science Foundation of China and the Project of Youth Fund of Sichuan Province. Gelfand reports consulting for Eli Lilly and Zosano and receiving travel expenses from Teva and research funds from Allergan and eNeura.