Will Acupuncture Help Migraine?

Patient Expert & Health Professional
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Have you considered acupuncture to treat Migraine? So far, the evidence has been inconclusive, and more research is needed to determine its effectiveness. A study, "The Long-Term Effect of Acupuncture for Migraine Prophylaxis: A Randomized Clinical Trial," which was published in the April 2017 issue of JAMA Internal Medicine, adds to our knowledge of acupuncture as a possible treatment for Migraine.

Study objectives

Researchers in China investigated the long-term effects of acupuncture on migraine prevention. They randomly divided participants into either an active treatment group, a sham treatment group, or a waiting-list control group.

Participants

  • 245 patients, ages 18-65
  • Migraine without aura with initial migraine onset before age 50
  • Two to eight attacks per month with symptoms for at least one year
  • Not taking preventive medication

All subjects were asked to complete a diary by recording each migraine attack for the duration of the study. For each attack, patients were asked to note:

  • Time of onset
  • Duration
  • Severity
  • Use of medication

Interventions

1. Active treatment

  • 30-minute treatments
  • Five treatment days with a two-day break in between for four weeks
  • No preventive medications
  • Acute treatment with 300 milligrams of ibuprofen only
  • Four acupoints used (two required, two more chosen from eight options)
  • Each point was treated to achieve Deqi sensation (soreness, numbness, distention, or radiating), which indicates effective needling
  • HANS acupoint electric nerve stimulation (a TENS-like device) used after needle insertion

2. Sham treatment

  • 30-minute treatments
  • Five treatment days with a two-day break in between for four weeks
  • No preventive medications
  • Acute treatment with 300 milligrams of ibuprofen only
  • Four non-points used
  • No attempt made to achieve Deqi sensation
  • HANS acupoint electric nerve stimulation used after needle insertion

3. Waitlist

  • No treatment for the duration of the study
  • Offered 20 acupuncture sessions at no charge once the study had concluded

Results

In the active treatment group, the attack frequency had decreased by 3.2 attacks at 16 weeks after the randomization. There was no significant change in frequency for either the sham treatment or waiting-list groups.

Adverse events

Seven subjects experienced mild-to-moderate adverse events. None required special intervention. All subjects recovered and none dropped out of the study. Adverse events included:

  • Tingling sensation
  • Swelling of the left ankle after needle removed
  • Subcutaneous hemorrhage in needle insertion area

Conclusions

Active acupuncture using this method reduced migraine frequency, severity, and number of migraine days for at least 24 weeks.

Limitations

  1. The treatment was non-standard acupuncture.

  2. Wait-listed participants could not be blinded (prevented from knowing they were not being treated).

  3. There was no comparison of acupuncture against standard migraine prevention treatments.

Commentary from Amy Gelfand, M.D.

A commentary article, “Acupuncture for Migraine Prevention: Still Reaching for Convincing Evidence,” also appeared in the same issue of JAMA Internal Medicine. Migraine specialist Amy Gelfand, M.D., shared her insights about the study in a phone interview. She listed several positives, as well as some concerns, about the practical application of the study results.

Positives:

  1. The study used a sham procedure.

  2. The treatment size was adequate.

  3. There was a lack of serious adverse events.

  1. There were clear differences between the active treatment and sham procedures within the first month.

  2. Benefits from the treatment persisted over the full 20 weeks.

Concerns:

  1. The Deqi sensation may have increased the placebo effect in the active treatment group.

  2. There was no report of whether subjects could accurately guess whether or not they received the active or sham treatment.

  3. The acupuncturists were not blinded, so subtle changes in practitioners’ behavior may have influenced outcomes.

Potential barriers

Patients who want to try acupuncture as a migraine treatment may find it challenging to obtain care that reflects the study results. They may have difficulty for two reasons:

  • Not all acupuncturists are trained to use electrical stimulation acupuncture.
  • Not all patients will be able to take time off work every day for four weeks straight.
  • The cost of daily treatments for four weeks may be too high, especially for those whose health insurance plan will not cover the treatments.

The bottom line for patients

In a recent phone interview, Dr. Gelfand shared these thoughts for patients considering acupuncture as a migraine treatment:

  • It’s probably safe for most patients.
  • Its effectiveness as a migraine preventive is still unclear.
  • Consider the cost of treatment that is usually not covered by insurance.
  • Consider the time investment required for treatment.
  • Consider the risk of choosing acupuncture in lieu of other proven therapies.

See more Helpful Articles:

Migraine Treatment – You Want to Go All Natural?

Sources:

  1. Zhao L., Chen J, Li Y, et al. The Long-term Effect of Acupuncture for Migraine Prophylaxis: A Randomized Clinical Trial. JAMA Internal Medicine. February 20, 2017. doi: 10.1001/jamainternmed.2016.9378.

  2. Gelfand A. Acupuncture for Migraine Prevention: Still Reaching for Convincing Evidence. JAMA Internal Medicine. February 20, 2017. Doi: 10.1001/jamaintermed.2016.9404.

  1. Phone interview with Amy Gelfand, M.D., on March 23, 2017.