Acupuncture for Migraine: a Feasible Option?

Patients with migraine without aura experienced a long-term reduction in migraine recurrence after undergoing acupuncture compared with patients undergoing a sham procedure.

“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,” researchers led by Ling Zhao, PhD, of the Acupuncture and Tuina School at Chengdu University, China, and colleagues wrote in JAMA Internal Medicine.

According to the researchers, multiple studies have shown that true acupuncture is more effective than sham acupuncture in reducing migraine intensity, frequency of attacks, and number of migraine days. However, data are lacking on whether acupuncture can prevent future migraine attacks.

To investigate, Zhao and colleagues conducted a 24-week randomized trial that randomly assigned 249 participants with migraine without aura aged 18 to 65 to true acupuncture or a sham procedure. A third group of participants was placed on a waiting list. Participants undergoing true acupuncture received treatment at four points and those undergoing a sham procedure had treatment at four points not thought to be active for acupuncture.

Participants underwent 4 weeks of treatment and 20 weeks of follow-up. The participants were asked to record migraines in a diary. The primary outcome was change in frequency of migraine attacks from baseline to week 16.

Overall, 245 participants were included in the intent-to-treat analysis and the majority were women. After follow-up, the mean change in frequency of migraines was significantly different among the three groups (P<0.001). Participants assigned to true acupuncture had a mean decrease in frequency of attacks of 3.2 compared with 2.1 for the sham procedure and 1.4 for the waiting list. This translated into a significant improvement for true vs. sham acupuncture (P<0.001) and compared with the waiting list (P<0.001).

In an editorial that accompanied the research, Amy A. Gelfand, MD, of the pediatric headache program at the University of California San Francisco, highlighted several limitations of the study, including the fact that the acupuncturists were not blinded and could have unintentionally communicated group assignment to the participants, potentially affecting the results.

“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,” Gelfand wrote.

Among those barriers include access to acupuncture that incorporates electrical stimulation, as used in the study, ability to undergo acupuncture daily, as was done in the study, and the lifestyle flexibility to allow for missing partial days of work or school for a month.

“In this regard, acupuncture is not entirely without potential adverse effects,” Gelfand wrote. “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.”

Reference: Zhao L, et al. The long-term effect of acupuncture for migraine prophylaxis. A randomized clinical trial. JAMA Intern Med. Epub 2017 February 20.