Acupuncture for Migraines and Headaches
Acupuncture for migraine prophylaxis Klaus Linde1, Gianni Allais2, Benno Brinkhaus3, Eric Manheimer4, Andrew Vickers5, and Adrian R White6
Migraine is a disorder with recurrent headaches manifesting in attacks lasting 4 to 72 hours. Typical characteristics of the headache are unilateral location, pulsating quality, moderate or severe intensity, aggravation by routine physical activity and association with nausea and/or photophobia and phonophobia (IHS 2004). Epidemiological studies have consistently shown that migraine is a common disorder with a 1-year prevalence of around 10% to 12% and a lifetime prevalence of between 15% and 20% (Oleson 2007). In Europe, the economic cost of migraine is estimated at 27 billion Euro per year (Andlin-Sobocki 2005). Most migraine patients can be adequately treated with treatment of acute headaches alone, but a relevant minority need prophylactic interventions, as their attacks are either too frequent or are insufficiently controlled by acute therapy. Several drugs, such as propranolol, metoprolol, flunarizine, valproic acid and topiramate, have been shown to effectively reduce attack frequency in some patients (Dodick 2007). However, all these drugs are associated with adverse effects. Dropout rates in most clinical trials are high, suggesting that the drugs are not well accepted by patients. There is some evidence that behavioral interventions such as relaxation or biofeedback are beneficial (Holroyd 1990; Nestoriuc 2007), but additional effective, low-risk treatments are clearly desirable.
Twenty-two trials with 4419 participants (mean 201, median 42, range 27 to 1715) met the inclusion criteria. Six trials (including two large trials with 401 and 1715 patients) compared acupuncture to no prophylactic treatment or routine care only. After 3 to 4 months patients receiving acupuncture had higher response rates and fewer headaches. The only study with long-term follow up saw no evidence that effects dissipated up to 9 months after cessation of treatment. Fourteen trials compared a ’true’ acupuncture intervention with a variety of sham interventions. Pooled analyses did not show a statistically significant superiority for true acupuncture for any outcome in any of the time windows, but the results of single trials varied considerably. Four trials compared acupuncture to proven prophylactic drug treatment. Overall in these trials acupuncture was associated with slightly better outcomes and fewer adverse effects than prophylactic drug treatment. Two small low-quality trials comparing acupuncture with relaxation (alone or in combination with massage) could not be interpreted reliably.
Authors’ conclusions—In the previous version of this review, evidence in support of acupuncture for migraine prophylaxis was considered promising but insufficient. Now, with 12 additional trials, there is consistent evidence that acupuncture provides additional benefit to treatment of acute migraine attacks only or to routine care. There is no evidence for an effect of ’true’ acupuncture over sham interventions, though this is difficult to interpret, as exact point location could be of limited importance. Available studies suggest that acupuncture is at least as effective as, or possibly more effective than, prophylactic drug treatment, and has fewer adverse effects. Acupuncture should be considered a treatment option for patients willing to undergo this treatment.
FULL ARTICLE: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3099267/pdf/nihms284323.pdf
Migraine is a disorder with recurrent headaches manifesting in attacks lasting 4 to 72 hours. Typical characteristics of the headache are unilateral location, pulsating quality, moderate or severe intensity, aggravation by routine physical activity and association with nausea and/or photophobia and phonophobia (IHS 2004). Epidemiological studies have consistently shown that migraine is a common disorder with a 1-year prevalence of around 10% to 12% and a lifetime prevalence of between 15% and 20% (Oleson 2007). In Europe, the economic cost of migraine is estimated at 27 billion Euro per year (Andlin-Sobocki 2005). Most migraine patients can be adequately treated with treatment of acute headaches alone, but a relevant minority need prophylactic interventions, as their attacks are either too frequent or are insufficiently controlled by acute therapy. Several drugs, such as propranolol, metoprolol, flunarizine, valproic acid and topiramate, have been shown to effectively reduce attack frequency in some patients (Dodick 2007). However, all these drugs are associated with adverse effects. Dropout rates in most clinical trials are high, suggesting that the drugs are not well accepted by patients. There is some evidence that behavioral interventions such as relaxation or biofeedback are beneficial (Holroyd 1990; Nestoriuc 2007), but additional effective, low-risk treatments are clearly desirable.
Twenty-two trials with 4419 participants (mean 201, median 42, range 27 to 1715) met the inclusion criteria. Six trials (including two large trials with 401 and 1715 patients) compared acupuncture to no prophylactic treatment or routine care only. After 3 to 4 months patients receiving acupuncture had higher response rates and fewer headaches. The only study with long-term follow up saw no evidence that effects dissipated up to 9 months after cessation of treatment. Fourteen trials compared a ’true’ acupuncture intervention with a variety of sham interventions. Pooled analyses did not show a statistically significant superiority for true acupuncture for any outcome in any of the time windows, but the results of single trials varied considerably. Four trials compared acupuncture to proven prophylactic drug treatment. Overall in these trials acupuncture was associated with slightly better outcomes and fewer adverse effects than prophylactic drug treatment. Two small low-quality trials comparing acupuncture with relaxation (alone or in combination with massage) could not be interpreted reliably.
Authors’ conclusions—In the previous version of this review, evidence in support of acupuncture for migraine prophylaxis was considered promising but insufficient. Now, with 12 additional trials, there is consistent evidence that acupuncture provides additional benefit to treatment of acute migraine attacks only or to routine care. There is no evidence for an effect of ’true’ acupuncture over sham interventions, though this is difficult to interpret, as exact point location could be of limited importance. Available studies suggest that acupuncture is at least as effective as, or possibly more effective than, prophylactic drug treatment, and has fewer adverse effects. Acupuncture should be considered a treatment option for patients willing to undergo this treatment.
FULL ARTICLE: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3099267/pdf/nihms284323.pdf