Acupuncture or Topiramate for Chronic Migraine - A Study
Migraine prevention is difficult at best, but it becomes even more difficult and complex for those with chronic Migraine. Some recent news articles have reported on a study that compared acupuncture and topiramate (Topamax) for chronic Migraine prophylaxis (prevention).
Aim of the study:
"...to investigate the efficacy and tolerability of acupuncture compared with topiramate treatment in chronic migraine (CM) prophylaxis."
Sixty-six CM patients were randomly separated into two study treatment arms:
- The acupuncture group in which acupuncture was administered in 24 sessions, 30 minutes each, over 12 weeks.
- The topiramate group in which topiramate was started at 25 mg per day and increased by 25 mg per day weekly over four weeks to 100 mg per day, followed by an eight-week maintenance period. Beginning with week two, the topiramate was administered in equally divided doses, twice daily.
- Patients were permitted to take acute medications when they had a Migraine or headache, with the only limitation being that they used the same medications throughout the trial.
Extra study info:
- Twenty-four of the patients in the acupuncture group and 25 in the topiramate group met the criteria for medication overuse headache at the beginning of the study.
Of the original 66 patients involved in the study:
- One in the acupuncture group dropped out of the study because of not being able to take time off work.
- Three patients in the topiramate group didn't finish the study because of side effects.
Number of headache/Migraine days per month:
- acupuncture reduced the number of days by 10.7 days per month
- topiramate reduced the number of days by 7.9 days per month
Number of days acute medications taken per month:
- acupuncture reduced the number of days by 9.6 days per month
- topiramate reduced the number of days by 5.4 days per month
- Acupuncture also demonstrated significantly greater improvement in MIDAS (Migraine Disability Assessment), HADS (Hospital Anxiety and Depression Scales), and overall health-related quality of live scores than topiramate.
"Acupuncture should be considered as a treatment option for CM patients willing to undergo this prophylactic treatment, even for those patients with medication overuse. Future clinical trials should focus on the long-term effects of acupuncture on CM."
Summary and comments:
This is an interesting study that presents a beginning premise for follow-up. There are a few elements I'd like to see addressed in future studies:
- Larger study
- Studies conducted in different cultural environments. This study was conducted in Taiwan, where subjects may have been more favorably predisposed toward acupuncture than in other cultural environments.
- A placebo arm. It's not unusual to see 30% placebo rates in studies. With no placebo arm here, I'm left to wonder what the placebo rate might have been.
Despite some weaknesses, this study is a good start. In addition to studies comparing complementary therapies such as acupuncture to pharmaceutical treatments, I'd like to see some studies that combine acupuncture with pharmaceutical treatments. Why not pull out all the stops when people are suffering?
- Sixty-six CM patients were randomly separated into two study treatment arms:
Yang, C-P; Chang, M-H; Liu, P-E; Li, T-C; Hsieh, C-L; Hwang, K-L; Chang, H-H. "Acupuncture versus topiramate in chronic migraine prophylaxis: A randomized clinical trial." Cephalalgia 31(15) 1510–1521.
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