New review supports acupuncture for migraine prevention.

Earlier in the  year I was looking at the evidence base for the use of acupuncture for migraine prevention.  At that time the Cochrane review of acupuncture for migraine prophylaxis, rather disappointingly, concluded that, ”  evidence in support of acupuncture for migraine prophylaxis was considered promising but insufficient”.  I was pleased to find today that this review has been updated with the inclusion of 12 new studies.

Acupuncture for migraine review objectives.

To investigate whether acupuncture is a) more effective than no prophylactic treatment/routine care only; b) more effective than ‘sham’ (placebo) acupuncture; and c) as effective as other interventions in reducing headache frequency in patients with migraine.

Acupuncture for migraine review results.

Twenty-two trials with 4419 participants ) were included in the review. Six trials (including two large trials with 401 and 1715 patients) compared acupuncture to no prophylactic treatment or routine care only. After 3 to 4 months patients receiving acupuncture had higher response rates and fewer headaches. The only study with long-term follow up saw no evidence that effects dissipated up to 9 months after cessation of treatment.

Fourteen trials compared a ‘true’ acupuncture intervention with a variety of sham (pretend) interventions. Pooled analyses did not show a statistically significant superiority for true acupuncture for any outcome in any of the time windows, but the results of single trials varied considerably. I would comment that this is not unusual and that so-called sham acupuncture has again and again been shown to have an effect.

Four trials compared acupuncture to proven prophylactic drug treatment. Overall in these trials acupuncture was associated with slightly better outcomes and fewer adverse effects than prophylactic drug treatment. Two small low-quality trials comparing acupuncture with relaxation (alone or in combination with massage) could not be interpreted reliably.

Author’s conclusions.

The review’s author’s concluded that: ” In the previous version of this review, evidence in support of acupuncture for migraine prophylaxis was considered promising but insufficient. Now, with 12 additional trials, there is consistent evidence that acupuncture provides additional benefit to treatment of acute migraine attacks only or to routine care. There is no evidence for an effect of ‘true’ acupuncture over sham interventions, though this is difficult to interpret, as exact point location could be of limited importance. Available studies suggest that acupuncture is at least as effective as, or possibly more effective than, prophylactic drug treatment, and has fewer adverse effects. Acupuncture should be considered a treatment option for patients willing to undergo this treatment.”

The results of this review are a major step forward in getting acupuncture accepted as a major treatment for the prevention of migraine.