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Acupuncture in the treatment and prevention of migraines
September 24, 2007
Image from Hua’s Jūshikei hakki, 1716
Acupuncture is an increasingly popular treatment in the U.S. for ailments from allergies to gastrointestinal problems. Traditional Chinese medicine has been using acupuncture for over 2000 years, but was first widely recognized in the United States in the 1970s (http://www.medicalacupuncture.org/acu_info/articles/helmsarticle.html). There has recently been a great deal of research conducted on the use of acupuncture for the treatment and prevention of pain, as well as specifically examining its effectiveness for migraines. I intend to look at the literature and see whether acupuncture really is helpful for migraine sufferers.
Traditional Chinese medicine is centered around the idea of qi (also known as “chi”), the life energy of the universe and everything in it. In this system, there are 12 major organs (the gallbladder, liver, heart, spleen, lung, large intestine, small intestine, pericardium, urinary bladder, kidney, stomach, and the San Jiao, or “triple warmer,” which represents the trunk of the body). Each organ has its own meridian with separate points on it – these are the points stimulated in acupuncture. There are five elements (water, wood, fire, earth and metal) and two principles (yin and yang); any imbalance in these five elements or two principles causes a blockage or imbalance in the flow of qi (either within the organ or between a pair of organs), which leads to illness and pain. The goal of acupuncture is to restore balance to the affected area and to unblock and normalize the flow of qi by stimulating particular points on the body.
Acupuncture has been hailed as the cure for all that ails us and denounced as touchy-feely new age nonsense. So which is it? Can getting poked with tiny sharp needles really take away your migraines? For that matter, is getting poked with tiny sharp needles actually safe, or do you run the risk of catching deadly infections?
There are a great number of studies which indicate that acupuncture can be very effective in the treatment of migraines, but many of these cannot be taken too seriously due to methodological issues. Griggs et al. (2006) found that only three of the 13 trials they examined “achieved consistently high scores (for reporting acupuncture and methodological quality).” All three of these studies found no significant benefits from the acupuncture; however, two of these studies had sample sizes of less than 35 participants, a tiny sample which Griggs et al. (2006) points out may have caused false negatives.
The only remaining study that Griggs et al. found qualified is that of Allais et al. (2002), which had a large sample size of 160 participants (all of whom were women with migraines) who were randomly assigned into two groups. The first group received acupuncture therapy (on a weekly basis for two months, followed by a monthly basis for the next four months) and the second was given flunarizine, a common migraine treatment in Europe (10 mg daily for the first two months followed by 10 mg twenty days a month for the next four months.).
Allais et al. (2002) found that within the acupuncture group, the number of migraine attacks, the intensity of the pain during the migraine attacks, as well as the amount of pain medication taken for migraines significantly decreased over the course of the study. In the flunarizine group, the migraine frequency and pain medication also significantly decreased, but subjects did not see a significant decrease in pain intensity during migraine attacks. Allais et al. also found that 12.6 % of the acupuncture patients became headache free by the end of the study, compared with just 9.5% of the flunarizine patients. The major side effects in the acupuncture group were feeling drowsy after receiving treatment (about 10% of participants) and experiencing pain at the site of needle insertion (around 8%). For the flunarizine group, the most common side effects were drowsiness (occurring in 35% of subjects), weight gain (22% of subjects) and depression (7% of the subjects). Allais et al. (2002) found that the number of patients reporting side effects was significantly lower in the acupuncture group than the flunarizine one. This study indicates that acupuncture is very helpful in the treatment and prevention of migraines.
Streng et al. (2006) conducted a similar study comparing acupuncture to metoprolol, another common pharmaceutical treatment for migraines. This study also consisted of two groups, the first receiving acupuncture treatment (a total of eight to fifteen treatments over the course of twelve weeks – the precise treatment was not standardized over the whole group so as to simulate routine conditions) and the second a daily 100 to 200 mg dose of metoprolol. Streng’s results indicate that acupuncture is as effective as metoprolol at decreasing the number and intensity of migraine attacks (with no significant differences in the effect between groups), but notes that these results cannot be weighed too heavily as they missed their recruitment goal by over 300 subjects (obtaining 114 out of the 480 they’d wanted). 17 of the 58 subjects in the metoprolol group dropped out by the end of the study (compared to two from the acupuncture group), which could certainly have a large skewing effect upon the results. Of the metoprolol dropouts, seven refused metoprolol treatment, seven experienced intolerable side effects on the medication and another experienced worsening of symptoms (the reasons for the last two dropouts were unclear); meanwhile, no acupuncture patient dropped out because of adverse effects. Streng et al. (2006) found that patients receiving acupuncture treatment experienced a significantly lower number of side effects than those on metoprolol. Adverse effects were reported by participating physicians as either “strong” or “mild;” in the acupuncture group, no “strong” adverse effects were reported while the physicians reported six patients in the metoprolol group experienced “strong” adverse effects. Physicians reported that 15% of the acupuncture patients experienced “mild” adverse effects, while 55% of patients in the metoprolol group experienced “mild” adverse effects. On the self-report pain questionnaire, a significant number of acupuncture patients reported side effects than the metoprolol patients (12% and 35%, respectively). In summary: acupuncture appears to be as effective as metoprolol in the treatment of migraines, with no significant differences in results for reduction of symptoms. However, the majority of patients on metoprolol experienced adverse effects, and a significant number had intolerable adverse effects, compared to relatively few acupuncture patients experiencing mild adverse effects. This indicates that acupuncture is better tolerated than metoprolol, but these results are questionable since the metoprolol group had such a high dropout rate (approximately 29%).
Several studies comparing sham acupuncture to verum acupuncture documented comparable effects in both groups (Diener et al., 2006, Linde et al., 2006). Diener et al. (2006) used three groups: verum acupuncture, sham acupuncture, and standard therapy (pharmaceuticals). For their sham acupuncture, they used prescribed areas where no acupuncture was known, and needles were applied superficially without any manual stimulation. The problem with this type of sham acupuncture, as described in MacPherson et al. (2002), is that even though the needles aren’t inserted at known acupuncture points, they still may cause a physiological response accounting for the apparent effectiveness of the sham treatment. Linde et al. (2005) also used three groups, but used a treatment-free control rather than standard therapy (they still had the verum and sham acupuncture groups). Linde also use prescribed non-acupuncture points with superficial insertion for the sham acupuncture, so their results are similarly questionable. Linde et al. (2006) found that patients receiving verum acupuncture experienced significantly fewer symptoms and migraine attacks than those receiving no treatment, and a significant number experienced a 50% or greater reduction in the number of migraine attacks (sham acupuncture was not compared to the no-treatment control).
Diener et al. (2006) found that acupuncture patients (both verum and sham) experienced greater decreased pain at 6 and 13 weeks (by the full 26 weeks of the study, the differences between acupuncture and standard treatment were no longer significant) and experienced better physical health, as compared to the standard treatment group. This indicates that acupuncture, sham or verum, is as effective as standard treatments for migraine.
But why? Linde et al. (2007) examined the impact of patient expectations on outcomes. They conducted four separate studies comparing acupuncture with sham acupuncture (the same superficial non-acupuncture needling in their previous study) and a non-treatment group. The four studies were conducted on migraine sufferers (the 2005 study described above), patients experiencing repeated tension-type headaches, patients experiencing chronic low back pain, and patients with osteoarthritis of the knee. All trials found that acupuncture and sham acupuncture had a significant affect as compared to the non-treatment group, but only one (the osteoarthritis study) found a significant difference in outcome between verum and sham acupuncture. In these four trials, they also asked patients about their general attitudes towards acupuncture and about whether they expected a positive outcome (it’s important to note that a positive attitude towards acupuncture didn’t necessarily mean that the patient expected a positive outcome for himself). Linde et al. (2007) found that a significant number of patients with high confidence that the treatment would help them experienced improvement. These results are interesting, and seem to suggest that the beneficial results from acupuncture may be psychosomatic – however, the issue certainly bears more study, as Linde et al. (2007) seems to be the only study of this nature, and they didn’t examine whether people who thought acupuncture wouldn’t work at all experienced any improvement.
have been a great number of reviews (Braverman, 2004, Ernst & White, 2001,
& Lao, 2003) regarding the safety of acupuncture, and the overwhelming
consensus seems to be that if you use a trained and licensed acupuncturist who
utilizes clean needle technique and disposable needles, you’re almost certainly
safe from serious adverse effects. The bottom line seems to be that if you suffer
from migraine headaches and are interested in acupuncture as an alternative to
harsh medications with unpleasant side effects, find a reliable acupuncturist
(who is licensed by the appropriate state and/or federal agencies) and go for
it: It’s safe and a significant number of people have found it effective.
Acuxo.com – A general resource about acupuncture with detailed descriptions and diagrams of the meridians and points in the traditional Chinese acupuncture system.
Answers.com – An easy to understand definition and explanation of acupuncture.
MedicalAcupuncture.org – The homepage for the American Academy of Medical Acupuncture, an organization of physicians who incorporate acupuncture into their medical practices. The learning center has explanations about acupuncture and the theories for why it works, and the site also has a helpful medical acupuncturist referral page which can help you find a reliable, licensed acupuncturist in your area (U.S. only).
NCCAM.NIH.gov – The homepage for the National Center for Complementary and Alternative Medicine, a division of the National Institutes of Health. They have a very helpful fact sheet on acupuncture as well as information on other forms of alternative medicine.
NCCAOM.org – The homepage for the National Certification Commission for Acupuncture and Oriental Medicine, a non-profit organization which licenses trained acupuncturists. Forty states require NCCAOM examination and licensing.
Allais, G., De Lorenzo, C., Quirico, P.E., Airola, G., Tolardo, G., Mana, O., & Benedetto, C. (2002). Acupuncture in the prophylactic treatment of migraine without aura: A comparison with flunarizine. Headache, 42(9), 855-861.
Braverman, S.E. (2004). Medical acupuncture review: Safety, efficacy and treatment practices. Medical Acupuncture, 15(3), 12-16.
Diener, H., Kronfeld, K., Boewing, G., Lungenhausen, M., Maier, C., Molsberger, A., et al. (Apr 2006). Efficacy of acupuncture for the prophylaxis of migraine: A multicentre randomized controlled clinical trial. Lancet Neurology, 5(4), 310-316.
Ernst, E. & White, A.R. (2001). Prospective studies of the safety of acupuncture: A systematic review. American Journal of Medicine, 110(6), 481-485.
Griggs, C., & Jensen, J. (2006). Effectiveness of acupuncture for migraine: Critical literature review. Journal of Advanced Nursing, 54(4), 491-501.
Hua, S. (1716). Jūshikei hakki (Shi si jing fa hui. Japanese & Chinese). (p. 28 recto). Tokyo: Suharaya Heisuke kankō, Kyōhō gan.
Lao, L., Hamilton, G.R., Fu, J., Berman, B.M. (2003). Is acupuncture safe? A systematic review of case reports. Alternative therapies in health and medicine, 9(1), 72-83.
Linde, K., Streng, A., Jürgens, S., Hoppe, A., Brinkhaus, B., Witt, C. et al. (2005). Acupuncture for patients with migraine: A randomized controlled trial. Journal of the American Medical Association, 293(17), 2118-2125.
MacPherson, H., White, A., Cummings, M., Jobs, K.A., Rose, K., Niemtzov, R.C. (2002). Standards for reporting interventions in controlled trials of acupuncture: The STRICTA recommendations. The Journal of Alternative Medicine, 8(1), 85-89.
Streng, A., Linde, K., Hoppe, A., Pfaffenrath, V., Hammes, M., Wagenpfeil, S. (2006). Effectiveness and tolerability of acupuncture compared with metoprolol in migraine prophylaxis. Headache, 46(10), 1492-1502.
 Flunarizine is not available in the United States – this was a European study.
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