A couple of the awesome people who I’ve had the pleasure of talking with on the phone this week about their chronic migraines asked me about acupuncture. While I have not found acupuncture to be helpful to me personally, I must say that a surprising number of people I speak with say they’ve achieved good results with this treatment. Zhao et al. recently published this randomized trial called “The Long-Term Effect of Acupuncture for Migraine Prophylaxis: A Randomized Clinical Trial” in JAMA (The Journal of the American Medical Association).
BACKGROUND: This study was 24 weeks long (4 weeks of treatment and 20 weeks of follow-up) and was conducted in China. The study included 249 patients who did not take any medications for migraine prevention. Subjects had 2-8 migraines per month without aura at the start of the study. Patients were randomized to receive true acupuncture (TA), sham acupuncture or SA (this was simulated needling or needling at locations on the body that are not true acupoint locations), or to be placed on a wait list. All participants and staff were blinded to treatment assignment. Four acupoints were chosen per treatment, 2 obligatory locations, and two locations based on patient characteristics. Electric stimulation was used after the needle was inserted.
RESULTS: TA significantly decreased migraine frequency when compared to both the SA group and the waitlist group. Patients in the TA group experienced 1.1 fewer migraines than the SA group, and 1.8 fewer migraines than the WL group. Number of days with migraine, migraine frequency, and pain intensity were also all decreased in the TA group. Improvements were also found in emotional health and quality of life with acupuncture. The positive effects of TA began after 3 weeks of treatment and lasted throughout the 24 week study.
WEAKNESSES/QUESTIONS FOR THE AUTHORS: I do not see that this study specifies how baseline diaries were regulated. All that is discussed is diaries during the four week treatment period. I cannot tell if only patients who kept their own personal migraine diaries were included or if directions were given. People tend to vary widely in how they keep pain diaries. Baseline migraines were the main characteristic that all other measures were compared against; therefore, I would have liked to have known more about it. If data collection methods for baseline migraines were different than the methods used for the follow-up migraines it cold lead to significant bias in this study.
MY TWO CENTS: I find this study encouraging. The fact that it was a rigorous randomized clinical trial (RCT) with valid control groups for comparison makes it even more encouraging. One note of caution would be that only patients who had migraine without aura were included in this study; therefore, the results cannot necessarily be extrapolated to migraine with aura. I am so happy that there is a research group that set out to get important work like this published, especially in such a prestigious journal. I give it a thumbs up.