Am Fam Physician. 2010 Jan 1;81(1):29-30.
Is acupuncture effective in preventing migraine headaches?
Acupuncture appears to be effective for prophylaxis of migraine headaches, and may be slightly better than pharmacotherapy. Sham acupuncture is just as effective as real acupuncture. (Strength of Recommendation = A, based on consistent and good-quality patient-oriented evidence).
Migraine headaches are typically unilateral pulsating headaches of moderate to severe intensity that are associated with nausea and phonophobia or photophobia. Most patients with migraine headaches successfully abort acute headaches with medications such as nonsteroidal anti-inflammatory drugs or selective 5-hydroxytryptamine receptor agonists (e.g., sumatriptan [Imitrex]). However, some patients with frequent migraines require prophylactic interventions in addition to acute treatments. Beta blockers, calcium channel blockers, tricyclic antidepressants, and some antiepileptic medications (topiramate [Topamax] and valproic acid [Depakene]) have been shown to be effective preventive medications. Alternative therapies, such as acupuncture, cognitive behavior therapy (CBT), relaxation, and biofeedback have also been suggested for migraine treatment.
In this meta-analysis, the authors examined 22 trials with a total of 4,419 patients to address the effectiveness of acupuncture as a migraine prophylactic intervention. Pooled analysis of six heterogeneous trials indicated that headache frequency, headache days, and headache scores three to four months after randomization were more favorable in patients receiving acupuncture compared with patients receiving routine treatment or no prophylactic treatment. Because the studies were so heterogeneous, reporting effect size may be misleading. Pooled analysis of 14 trials comparing real acupuncture with a variety of sham interventions showed no statistically significant difference between the interventions in migraine response rates (risk ratio = 1.38; 95% confidence interval [CI], 0.96 to 1.97).
Four trials comparing acupuncture with proven prophylactic drug treatment of beta blockers, calcium channel blockers, or valproic acid showed that acupuncture was associated with slightly better outcomes at two months (standard mean difference [SMD] = −0.24; 95% CI, −0.4 to −0.08), four months (SMD = −0.26; 95% CI, −0.41 to −0.11), and six months (SMD = −0.20; 95% CI, −0.35 to −0.05) after randomization, and had fewer adverse effects than prophylactic drug treatment.
The National Headache Foundation recommends the following as first-line therapy for migraine prophylaxis: amitriptyline (10 to 150 mg daily), divalproex (Depakote; 125 to 200 mg daily), timolol (formerly Blocadren; 10 to 30 mg daily), propranolol (Inderal; 20 to 160 mg daily), topiramate (50 to 150 mg daily).1 The National Headache Foundation also endorses acupuncture with CBT, biofeedback, and relaxation as alternative therapies for migraine headaches.2 The American Academy of Neurology has similar recommendations regarding first-line pharmacologic preventive therapy for migraines,3 but states that evidenced-based treatment recommendations are not yet possible for the use of hypnosis, acupuncture, transcutaneous electrical stimulation, cervical manipulation, occlusal adjustment, or hyperbaric oxygen as preventive or acute therapies for migraine.4
JANELLE GUIRGUIS-BLAKE, MD
Author disclosure: Nothing to disclose.
Linde K, Allais G, Brinkhaus B, Manheimer E, Vickers A, White AR. Acupuncture for migraine prophylaxis. Cochrane Database Syst Rev. 2009;(1):CD001218.
1. Kaniecki R, Lucas S. Treatment of primary headache: preventive treatment of migraine. In: Standards of Care for Headache Diagnosis and Treatment. Chicago, Ill.: National Headache Foundation; 2004:40–52.
2. Mauskop A, Graff-Radford S. Special treatment situations: alternative headache treatments. In: Standards of Care for Headache Diagnosis and Treatment. Chicago, Ill.: National Headache Foundation; 2004:115–122.
3. Silberstein SD. Practice parameter: evidence-based guidelines for migraine headache (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology [published correction appears in Neurology. 2000;56(1):142]. Neurology. 2000;55(6):754–762.
4. Campbell JK, Penzien DB, Wall EM, for the U.S. Headache Consortium. Evidence-based guidelines for migraine headache: behavioral and physical treatments. http://www.aan.com/professionals/practice/pdfs/gl0089.pdf. Accessed November 13, 2009.
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