20. October 2016 · Comments Off · Categories: Acupuncture, Headache, Pain

A Cochrane systematic review suggests that a course of acupuncture consisting of at least six treatments can be a valuable option for people with frequent tension-type headache. The international team of authors included 12 trials with 2349 adults in their updated review. They highlighted the finding in two large trials that acupuncture added to usual care (pain-killers) resulted in 48 out of 100 participants’ headache frequency reducing by more than half, compared to just 17 out of 100 participants who received usual care only. When compared with sham acupuncture (six trials), headache frequency halved in 52 of 100 participants receiving true acupuncture, compared with 43 of 100 participants receiving sham. One large, high quality trial (with about 400 participants), showed that the effect of true acupuncture was still present six months post-treatment.
Acupuncture for the prevention of tension-type headache. Cochrane Database Syst Rev. 2016 Apr 19;4:CD007587.

The results of a prospective interventional study carried out by American researchers suggests that acupuncture has persistent beneficial effects on both the frequency and intensity of migraines. Fifty-nine individuals with a diagnosis of migraine received acupuncture using a standardised set of points twice a week for four weeks, followed by treatment once a week for an additional four weeks. When pre- and post-intervention measurements were compared, migraine frequency and pain intensity were found to have decreased significantly after acupuncture. Migraine frequency and pain intensity had not returned to pre-intervention baseline levels at follow-up, 12 weeks after the last acupuncture session. The impact of migraine on patients’ quality of life also showed statistically significant improvement. (Standardized set-point acupuncture for migraines. Altern Ther Health Med. 2013 Nov-Dec;19(6):32-7).

NICE (the UK’s National Institute for Health and Clinical Excellence) has published new clinical guidelines on the treatment of headache. They conclude that acupuncture is effective for the prevention of tension-type headaches and migraine, and should be prescribed by doctors. NICE also estimates that overuse of painkillers is one of the most common causes of headache, affecting about one in 50 people. Taking aspirin, paracetamol or non-steroidal anti-inflammatory drugs such as ibuprofen for more than 15 days a month can initiate a vicious cycle where headaches get worse, so sufferers take more painkillers, which make the headaches even worse. (Headaches: diagnosis and management of headaches in young people and adults. NICE Clinical guidelines, CG150: Sept 2012, http: / /publications.nice.org.uk/ headaches-cg150 / guidance).

Acupuncture compares favourably with the drug topiramate for reducing migraine frequency, according to Taiwanese investigators. Sixty-six chronic migraine patients were randomly divided into two treatment groups. The acupuncture group received 24 acupuncture sessions over 12 weeks, while the topiramate group received a four-week titrated dose of topiramate (25-100 mg / day) followed by an eight-week maintenance period at a dose of 100 mg / day. A significantly larger decrease in the mean monthly number of moderate to severe headache days (20.2 days to 9.8 days) was observed in a pilot randomized controlled Altern Complement Med. 2011 10):923-30).

A Chinese multi-centre trial has found that acupuncture is as good as the drug flunarizine at reducing pain and improving quality of life for migraineurs, and more effective than the drug at decreasing the number days on which patients experience migraine attacks. One hundred and forty migraine patients were randomly assigned to two groups: an acupuncture group, treated with verum acupuncture plus a placebo drug, and a control group treated with sham acupuncture plus flunarizine. Both groups received acupuncture three times per week and drugs each night. Patients in the acupuncture group had better responder rates (defined as a reduction in migraine days by at least 50%) and fewer migraine days compared with the control group. No significant differences were found between acupuncture and flunarizine in reduction of pain intensity and improvement of quality of life. (Efficacy of acupuncture for migraine prophylaxis: A single-blinded, double-dummy, randomized controlled trial. Pain. 2011 Aug;152(8):1864-71).

A pilot cohort study carried out on US soldiers has found a standardised acupuncture treatment to be beneficial for chronic headache. Twenty-six subjects suffering from chronic daily headache (mostly migraine) were treated using a standardised set of acupuncture points (manual stimulation at Hegu L.I.-4 and Waiguan SJ-5, with 1-3 Hz electrostimulation at Taichong LIV-3 and Zulinqi GB-41) over twelve weeks (two 30-minute sessions a week for four weeks, followed by once a week for four weeks). The results showed a reduction in the frequency and intensity of headaches at the end of the treatment period, which persisted during a 12 week follow-up. Medication use, depression and quality of life scores also improved. Pain scores continued to decline for eight weeks following the end of the acupuncture intervention, and although beginning to rise again at 12 weeks never reached baseline levels. The authors contrast this with medication trials, where headaches return after cessation of treatment, and hypothesise that monthly maintenance acupuncture treatments might prevent this rise. (The effectiveness of acupuncture for chronic daily headache: an outcomes study. Mil Med. 2009 Dec;174(12):1276-81).

A large German study has compared the effectiveness of acupuncture in addition to routine care in patients with primary headache, to routine care alone. In a randomised controlled trial plus non-randomised cohort study, patients with headache were allocated to receive up to 15 acupuncture sessions over three months or no acupuncture (control group) during the first three months. Patients who did not consent to randomisation received acupuncture treatment immediately. All subjects were allowed to continue usual medical care. Of 15,056 headache patients (mean age 44, 77% female), 1613 were randomised to acupuncture and 1569 to control, while 11,874 were included in the non-randomised acupuncture group. At three months, the number of days with headache decreased from 8.4 to 4.7 in the acupuncture group and from 8.1 to 7.5 in the control group. Intensity of pain and quality of life improvements were also more pronounced in the acupuncture vs. control groups. Treatment success was maintained at six months and the outcome changes in non-randomised patients were similar to those in randomised patients. The authors conclude that acupuncture plus routine care in patients with headache is associated with marked clinical improvements compared with routine care alone. (Acupuncture in patients with headache. Cephalalgia. 2008 Jul 2. [Epub ahead of print]).

A German study has assessed the costs and cost-effectiveness of additional acupuncture treatment in patients with headache. The randomised controlled trial of 3182 patients measured quality of life, cost differences between treatment groups, and the incremental cost-effectiveness ratio (ICER) of acupuncture treatment. The ICER was calculated as 11657 euros per QALY (quality-adjusted life year) gained. According to international cost-effectiveness threshold values, this makes acupuncture a cost-effective treatment in patients with primary headache. (Cost-effectiveness of acupuncture treatment in patients with headache. Cephalalgia. 2008 Apr;28(4):334-45).