Acupuncture reduces the frequency of migraine headaches when used as an adjunct to, or in place of, medical management. (Strength of Recommendation: A, based on meta-analyses)

Blackwell, Jean

Pickett, Heather

University of Missouri: MOspace

<< Return to Previous PageApril 15, 2010 Table of ContentsHEATHER PICKETT, LT COL, USAF, MC, SFS, Nellis Air Force Base Family Medicine Residency, Las Vegas,NevadaJEAN C. BLACKWELL, MLS, AHIP, University of North Carolina at Chapel Hill, Chapel Hill, North CarolinaAm Fam Physician. 2010 Apr 15;81(8):1036-1037.Clinical QuestionIs acupuncture effective in decreasing the frequency of migraine headaches?Evidence-Based AnswerAcupuncture reduces the frequency of migraine headaches when used as an adjunct to, or in place of, medicalmanagement. (Strength of Recommendation: A, based on meta-analyses).Evidence SummaryHeadache is the leading cause of lost work time in the United States.1 Migraine headaches occur in 18 percent ofwomen and 5 percent of men.2 More than 2.1 million U.S. adults report use of all-cause acupuncture in theprevious 12 months, and 10 percent received acupuncture for migraine headaches.3 In England, 21.4 percent ofphysicians perform acupuncture or refer patients for acupuncture.4 In Germany, acupuncture is the mostcommonly used preventive treatment for migraine headaches.5The standardized definition of a decrease in migraine headache frequency is a decrease of 50 percent, based oncriteria from the International Headache Society. This is in persons who have two to eight migraine attacks permonth for at least one year.6A 2009 Cochrane review of acupuncture and prophylaxis for migraine headaches analyzed 22 randomizedcontrolled trials (RCTs) with 4,419 patients.7 Six trials compared traditional acupuncture with no prophylactictreatment or standard therapy; 14 trials compared traditional acupuncture with sham acupuncture; four trialscompared traditional acupuncture with proven drug treatment; and two trials compared traditional acupuncturewith relaxation techniques. At four months, traditional acupuncture reduced migraine headache frequencycompared with drug treatment (standard mean difference [SMD] = –0.26; 95% confidence interval [CI], –0.41 to–0.11), and compared with no treatment (SMD = –0.43; 95% CI, –0.60 to –0.27). The authors concluded thatthere is consistent evidence demonstrating that traditional acupuncture is as effective as traditional migraineheadache prophylaxis, but not statistically more effective than sham acupuncture (SMD = –0.18; 95% CI, –0.44 to0.07). This is noteworthy because a 2001 Cochrane review on acupuncture and migraine headaches concludedthat traditional acupuncture may have a role in headache treatment; however, the quality and amount of evidencewere not convincing at the time.8A critical literature review in 2007 evaluated 10 well-designed RCTs with 2,015 patients.9 These trialshttp://www.aafp.org/afp/2010/0415/p1036.html?printable=afp1 of 3 4/21/2010 11:15 AMconsistently demonstrated that traditional acupuncture was associated with clinically and statistically significantimprovement in clinical outcomes compared with no acupuncture. The authors concluded that acupuncture shouldbe incorporated into existing migraine headache therapy protocols.There is considerable controversy in the acupuncture research community regarding the role of sham acupuncture,which incorporates needle placement in nonacupuncture points. Experientially, sham treatment is notphysiologically inert, which makes it difficult to fully control for placebo effects.10 Traditional acupuncture is notconsistently superior to sham acupuncture, but because there may be an analgesic effect with any needling, it canbe argued that studies should be designed using traditional acupuncture as the intervention and standard medicaltherapy as the control.Recommendations from OthersThe American Academy of Medical Acupuncture lists acupuncture as a treatment for migraine headache based onWorld Health Organization recommendations.11,12 A National Institutes of Health consensus statement determinedthat acupuncture has considerable value and should be expanded into conventional medicine. The statementencourages further study, but does not specifically address migraine headaches.13 According to the Institute forClinical Systems Improvement, controlled studies specifically applied to migraine headache and acupuncture haveproduced mixed findings based on three older references.14Address correspondence to Heather Pickett, LT COL, USAF, MC, SFS at heather.pickett@nellis.af.mil. Reprints are notavailable from the authors.Author disclosure: Nothing to disclose.The opinions and assertions contained herein are the private views of the authors and are not to be construed as official, or asreflecting the views of the U.S. Air Force Medical Service or the U.S. Air Force at large.Copyright Family Physicians Inquiries Network. Used with permission.REFERENCES1. Stewart  WF, Ricci  JA, Chee  E, Morganstein  D, Lipton  R.  Lost productive time and cost due to common pain conditionsin the US workforce.  JAMA.  2003;290(18):2443–2454.2. Stewart  WF, Lipton  RB, Celentano  DD, Reed  ML.  Prevalence of migraine headache in the United States. Relation toage, income, race, and other sociodemographic factors.  JAMA.  1992;267(1):64–69.3. Burke  A, Upchurch  DM, Dye  C, Chyu  L.  Acupuncture use in the United States: findings from the National HealthInterview Survey.  J Altern Complement Med.  2006;12(7):639–648.4. Thomas  KJ, Nicholl  JP, Fall  M.  Access to complementary medicine via general practice.  Br J Gen Pract. 2001;51(462):25–30.5. Diener  HC, Kronfeld  K, Boewing  G, et al., for the GERAC Migraine Study Group.  Efficacy of acupuncture for theprophylaxis of migraine: a multicentre randomised controlled clinical trial [published correction appears in Lancet Neurol.2008;7(6):475].  Lancet Neurol.  2006;5(4):310–316.6. ICD-10 guide for headaches.  International Headache Classification Committee.  Cephalalgia.  1997;17(suppl 19):1–82.7. Linde  K, Allais  G, Brinkhaus  B, Manheimer  E, Vickers  A, White  AR.  Acupuncture for migraine prophylaxis.  CochraneDatabase Syst Rev.  2009;(1):CD001218.8. Melchart  D, Linde  K, Fischer  P, et al.  Acupuncture for idiopathic headache.  Cochrane Database Syst Rev. 2001;(1):CD001218.9. Endres  HG, Diener  HC, Molsberger  A.  Role of acupuncture in the treatment of migraine.  Expert Rev Neurother. 2007;7(9):1121–1134.10. Streng  A, Linde  K, Hoppe  A, et al.  Effectiveness and tolerability of acupuncture compared with metoprolol in migraineprophylaxis.  Headache.  2006;46(10):1492–1502.11. American Academy of Medical Acupuncture. Frequently asked questions about acupuncture.http://www.medicalacupuncture.org/acu_info/faqs.html. Accessed February 24, 2010.http://www.aafp.org/afp/2010/0415/p1036.html?printable=afp2 of 3 4/21/2010 11:15 AM12. Bannerman  RH.  Acupuncture: the WHO view  World Health.  197924–29.13. National Institutes of Health. Acupuncture. NIH Consensus Statement. 1997;15(5):1–34. http://consensus.nih.gov/1997/1997Acupuncture107html.htm. Accessed February 9, 2010.14. Institute for Clinical Systems Improvement. Health care guideline: diagnosis and treatment of headache. 9th ed. March2009. http://www.icsi.org/headache/headache__diagnosis_and_treatment_of_2609.html. Accessed March 11,2010.Clinical Inquiries provides answers to questions submitted by practicing family physicians to the Family Physicians InquiriesNetwork (FPIN). Members of the network select questions based on their relevance to family medicine. Answers are drawnfrom an approved set of evidence-based resources and undergo peer review. The strength of recommendations and the levelof evidence for individual studies are rated using criteria developed by the Evidence-Based Medicine Working Group(http://www.cebm.net/levels_of_evidence.asp).The complete database of evidence-based questions and answers is copyrighted by FPIN. If interested in submitting questionsor writing answers for this series, go to http://www.fpin.org or e-mail: questions@fpin.org.A collection of FPIN's Clinical Inquiries published in AFP is available at http://www.aafp.org/afp/fpin.AFP Home | Past Issues | CME Quiz | Contact AFP | Search AFPhttp://www.aafp.org/afp/2010/0415/p1036.html?printable=afp3 of 3 4/21/2010 11:15 AM

Acupuncture for migraine headaches

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