Acupuncture is tied to a persistent reduction in headache frequency, but the placebo effect may still play a role in outcomes, according to results of a study published in JAMA Internal Medicine.
According to the US National Center for Health Statistics, approximately 1 out of 7 Americans is affected by migraine headaches, and migraine treatment is a leading cause of emergency department and outpatient visits.
Pharmacological preventive therapy for migraine can be accompanied by fatigue, sleep interference, gastrointestinal effects, weight gain, and medication overuse headaches. While research is inconsistent, acupuncture is a common treatment for acute treatment and prevention of migraines in China.
Ling Zhao, PhD, from the Acupuncture and Tuina School at Chengdu University of Traditional Chinese Medicine in Sichuan, China, and colleagues sought to assess the long-term prophylactic benefit of acupuncture in patients with migraine without aura.
The investigators conducted a randomized sham-controlled clinical trial over 4 weeks with 20 weeks of follow-up. The 249 participants aged 18 to 65 years were randomly assigned to 20 sessions of true acupuncture (electroacupuncture), sham acupuncture, or to a waitlist group. Prophylactic medications were not permitted in the study protocol but participants could take ibuprofen for acute relief.
Outcome data was obtained from headache diaries to assess change in migraine frequency, severity, and medication use. Participants were also assessed with the Zung self-rating anxiety scale (SAS), the Zung self-rating depression scale (SDS), and the migraine-specific quality-of-life questionnaire (MSQ) at baseline and at week 4.
The change in frequency of migraine attacks was significantly different in the true acupuncture group vs the sham acupuncture group (reduced by 3.2 and 2.1, respectively; difference of 1.1; 95% CI, 0.4-1.9; P =.002). In a similar manner, the change in frequency was significantly different between the true acupuncture group and the waitlist group (difference of 1.8; 95% CI, 1.1-2.5, P <.001).
The true acupuncture group reported sustained improvements in frequency of attacks and migraine days at weeks 4 through 24
(P <.001 for all) and reduced need for acute medication. The true acupuncture group also showed improvements in the MSQ and SAS compared to the waitlist group (P <.05 for all). However, no differences were noted between the true and sham acupuncture groups for SAS, SDS, or MSQ with the exception of the emotional function subscale.
Although the study was limited by a lack of comparison with standard migraine prophylaxis, the investigators noted, “True acupuncture exhibited persistent, superior, and clinically relevant benefits for migraine prophylaxis, reducing the migraine frequency, number of days with migraine, and pain intensity.”
In an accompanying editorial, Amy Gelfand, MD, of the Pediatric Headache Program at the University of California in San Francisco, highlighted the study’s strengths of utilizing a sham control arm and its lack of significant adverse events. However, Dr Gelfand was concerned about potential unblinding in participants and acupuncturists, leading to a placebo response.
When considering counseling patients on the use of acupuncture for migraine prophylaxis, Dr Gelfand advised, “It is probably safe to try — it is not clear it is effective. The main risks are likely to their pocketbook and their time.”
Disclosures: Dr Gelfand reports relationships with Eli Lilly, Zosano, Teva, Allergan, eNeura, MedImmune, and Quest Diagnostics.
- Zhao L, Chen J, Li Y, et al. The long-term effect of acupuncture for migraine prophylaxis: a randomized clinical trial [published online February 20, 2017]. JAMA Intern Med. doi:10.1001/jamainternmed.2016.9378
- Burch RC, Loder S, Loder E, Smitherman TA. The prevalence and burden of migraine and severe headache in the United States: updated statistics from government health surveillance studies. Headache. 2015;55(1):21-34.
- Gelfand AA. Acupuncture for migraine prevention still reaching for convincing evidence [published online February 20, 2017]. JAMA Intern Med. doi:10.1001/jamainternmed.2016.9404