FPIN's Clinical Inquiries

Acupuncture for Migraine Headaches



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Am Fam Physician. 2010 Apr 15;81(8):1036-1037.

Clinical Question

Is acupuncture effective in decreasing the frequency of migraine headaches?

Evidence-Based Answer

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).

Evidence Summary

Headache is the leading cause of lost work time in the United States.1 Migraine headaches occur in 18 percent of women and 5 percent of men.2 More than 2.1 million U.S. adults report use of all-cause acupuncture in the previous 12 months, and 10 percent received acupuncture for migraine headaches.3 In England, 21.4 percent of physicians perform acupuncture or refer patients for acupuncture.4 In Germany, acupuncture is the most commonly used preventive treatment for migraine headaches.5

The standardized definition of a decrease in migraine headache frequency is a decrease of 50 percent, based on criteria from the International Headache Society. This is in persons who have two to eight migraine attacks per month for at least one year.6

A 2009 Cochrane review of acupuncture and prophylaxis for migraine headaches analyzed 22 randomized controlled trials (RCTs) with 4,419 patients.7 Six trials compared traditional acupuncture with no prophylactic treatment or standard therapy; 14 trials compared traditional acupuncture with sham acupuncture; four trials compared traditional acupuncture with proven drug treatment; and two trials compared traditional acupuncture with relaxation techniques. At four months, traditional acupuncture reduced migraine headache frequency compared 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 that there is consistent evidence demonstrating that traditional acupuncture is as effective as traditional migraine headache prophylaxis, but not statistically more effective than sham acupuncture (SMD = –0.18; 95% CI, –0.44 to 0.07). This is noteworthy because a 2001 Cochrane review on acupuncture and migraine headaches concluded that traditional acupuncture may have a role in headache treatment; however, the quality and amount of evidence were not convincing at the time.8

A critical literature review in 2007 evaluated 10 well-designed RCTs with 2,015 patients.9 These trials consistently demonstrated that traditional acupuncture was associated with clinically and statistically significant improvement in clinical outcomes compared with no acupuncture. The authors concluded that acupuncture should be 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 not physiologically inert, which makes it difficult to fully control for placebo effects.10 Traditional acupuncture is not consistently superior to sham acupuncture, but because there may be an analgesic effect with any needling, it can be argued that studies should be designed using traditional acupuncture as the intervention and standard medical therapy as the control.

Recommendations from Others

The American Academy of Medical Acupuncture lists acupuncture as a treatment for migraine headache based on World Health Organization recommendations.11,12 A National Institutes of Health consensus statement determined that acupuncture has considerable value and should be expanded into conventional medicine. The statement encourages further study, but does not specifically address migraine headaches.13 According to the Institute for Clinical Systems Improvement, controlled studies specifically applied to migraine headache and acupuncture have produced mixed findings based on three older references.14

Address correspondence to Heather Pickett, LT COL, USAF, MC, SFS at heather.pickett@nellis.af.mil. Reprints are not available 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 as reflecting 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.

REFERENCES

1. Stewart WF, Ricci JA, Chee E, Morganstein D, Lipton R. Lost productive time and cost due to common pain conditions in 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 to age, 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 Health Interview 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 the prophylaxis 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. Cochrane Database 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 migraine prophylaxis. 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.

12. 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. March 2009. 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 Inquiries Network (FPIN). Members of the network select questions based on their relevance to family medicine. Answers are drawn from an approved set of evidence-based resources and undergo peer review. The strength of recommendations and the level of 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 questions or 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.



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