Acupuncture: Is There a Point in Patients with Migraines?
Abstract & Commentary
By Dara G. Jamieson, MD, Associate Professor, Clinical Neurology, Weill Medical College, Cornell University. Dr. Jamieson is a consultant for Boehringer Ingelheim and Merck, and is on the speaker's bureau for Boehringer Ingelheim, Merck, Ortho-McNeil, and Pfizer.
Synopsis: Acupuncture is no better than placebo in the prevention of migraine headaches.
Source: Alecrim-Andrade J, et al. Acupuncture in Migraine Prophylaxis: A Randomized Sham-Controlled Trial. Cephalalgia. 2006;26:520-529.
Patients with intractable migraine often turn to alternative medicine for what they hope is safe and effective therapy. However, the efficacy of alternative therapies is often difficult to gauge, given the lack of scientifically rigorous evaluation and the recognized benefit of placebo intervention in headache treatment. Acupuncture has been touted as being of potential benefit to migraine patients; proof of its efficacy is lacking.
This study compared sham acupuncture to real acupuncture in 28 migraine patients who kept a diary to document headache symptoms at baseline and then during and after treatment. Patients were randomly assigned to an acupuncture treatment group for a total of 16 sessions over 12 weeks. The patients and researchers were blinded, and only the acupuncturist knew the type of treatment received. Sham acupuncture was performed with shallow needle insertion, without manipulation, into points that had no influence on headaches. Real acupuncture treatment was performed with insertion and manipulation into points related to the patient's pain topography and principles of traditional Chinese medicine. Patients were followed for 24 weeks after the last treatment.
No statistically significant difference was found between the 2 treatment groups in any pain measure, including migraine attack frequency and total migraine days. However, within group comparisons, it was found that all migraine pain parameters improved in both treatment groups. There was significantly reduced nausea during the follow-up period with real acupuncture, but no differences in vomiting or use of rescue medication was noted. Increased sleepiness, local nodules, and local pain after the sessions were noted with real acupuncture. When asked at the end of the study, patients were unable to tell what type of treatment they received, indicating that the blinding was successful.
Commentary
Real acupuncture was no better than sham acupuncture in preventing attacks in migraine sufferers. However, both treatments offered benefit, emphasizing the strong placebo effect which factors into migraine management. In many randomized, placebo-controlled studies of migraine treatment, there is a 40%-50% rate of improvement in the placebo group. Migraine patients who believe in the benefit of acupuncture may obtain headache relief, but scientific validity for the treatment being any better than placebo is lacking.
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