Cochrane for Clinicians
Putting Evidence into Practice
Acupuncture for Migraine Prevention
Am Fam Physician. 2017 Jul 1;96(1):23-24.
Author disclosure: No relevant financial affiliations.
Does whole-body acupuncture reduce episodic migraine frequency?
There is moderate-quality evidence that whole-body acupuncture is effective for migraine prevention. Compared with usual care, acupuncture is more effective at reducing headache frequency by at least 50% (number needed to treat [NNT] = 4). Acupuncture reduces headache frequency when compared with sham acupuncture (NNT = 10 at follow-up). Initial benefit of acupuncture over prophylactic medication was maintained at three-month follow-up but not at six months. Assuming an initial frequency of six migraine days per month, this would be reduced to five days with usual care, four days with sham acupuncture or prophylactic medication, and 3.5 days with acupuncture.1 (Strength of Recommendation: A, based on consistent, good-quality patient-oriented evidence.)
Migraine headaches commonly cause disability. Surveys show that 14.1% of Americans and 18.9% of women had a migraine or severe headache in the past three months.2 The authors of this review sought to compare the effect of acupuncture vs. usual care, sham acupuncture, and prophylactic medication.
This Cochrane review included 22 randomized trials and 4,985 patients.1 Trials were limited to patients with 15 or fewer headache days per month, and treatment was limited to whole-body acupuncture. Follow-up evaluation ranged from eight weeks to one year after treatment.
Compared with usual care, acupuncture improved headache frequency (standardized mean difference [SMD] = −0.56; 95% confidence interval [CI], −0.65 to −0.48). An SMD of 0.2 is considered a mild effect; 0.5, a moderate effect; and 0.8, a strong effect. Among patients treated with acupuncture, 41% experienced at least a 50% reduction in headache frequency vs. 17% of those receiving usual care (relative risk [RR] = 2.40; 95% CI, 2.08 to 2.76; NNT = 4 [95% CI, 3 to 6]). Patients in one trial retained the reduction in headache frequency after 12 months compared with those who received usual care (SMD = −0.36; 95% CI, −0.59 to −0.12; NNT = 7 [95% CI, 4 to 25]).
The authors posit that sham acupuncture has a strong placebo effect due to the interactive nature of sham treatment. Despite this, acupuncture consistently reduced headache frequency compared with sham acupuncture (SMD = −0.18; 95% CI, −0.28 to −0.08). At follow-up, 53% of patients treated with acupuncture experienced a decrease in headache frequency of at least one-half vs. 42% with sham acupuncture (RR = 1.25; 95% CI, 1.13 to 1.39; NNT = 10 [95% CI, 6 to 18]).
Five trials compared acupuncture with prophylactic medication, including metoprolol, valproic acid (Depakene), and flunarizine (not available in the United States). Compared with patients receiving medication, those treated with acupuncture were more likely to have their headache frequency decrease by at least one-half at the three-month follow-up (RR = 1.24; 95% CI, 1.08 to 1.44) but not at six months. More patients receiving medication dropped out of the study because of adverse effects than those receiving acupuncture treatment (7% vs. 1%). Adverse effects in patients receiving acupuncture included local pain and bleeding.
Another recent systematic review comparing acupuncture with sham acupuncture showed that acupuncture decreased headache recurrence and received better patient ratings, but it did not change actual headache frequency or severity.3 Guidelines from the Institute for Clinical Systems Improvement recommend the use of acupuncture for episodic migraine prophylaxis.4
The practice recommendations in this activity are available at http://www.cochrane.org/CD001218.
The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the U.S. government.
REFERENCESshow all references
1. Linde K, Allais G, Brinkhaus B, et al. Acupuncture for the prevention of episodic migraine. Cochrane Database Syst Rev. 2016;(6):CD001218....
2. Schiller JS, Lucas JW, Peregoy JA. Summary health statistics for U.S. adults: National Health Interview Survey, 2011. Vital Health Stat 10. 2012;(256):1–218.
3. Yang Y, Que Q, Ye X, Zheng GH. Verum versus sham manual acupuncture for migraine: a systematic review of randomised controlled trials. Acupunct Med. 2016;34(2):76–83.
4. Institute for Clinical Systems Improvement. Headache, diagnosis and treatment of. 11th ed. January 2013. https://www.icsi.org/guidelines__more/catalog_guidelines_and_more/catalog_guidelines/catalog_neurological_guidelines/headache. Accessed May 24, 2017.
These are summaries of reviews from the Cochrane Library.
This series is coordinated by Corey D. Fogleman, MD, Assistant Medical Editor.
A collection of Cochrane for Clinicians published in AFP is available at https://www.aafp.org/afp/cochrane.
Copyright © 2017 by the American Academy of Family Physicians.
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