Acupuncture for chronic headache in primary care: large, pragmatic, randomised trial

Abstract

Objective To determine the effects of a policy of "use acupuncture" on headache, health status, days off sick, and use of resources in patients with chronic headache compared with a policy of "avoid acupuncture." Design Randomised, controlled trial. Setting General practices in England and Wales. Participants 401 patients with chronic headache, predominantly migraine. Interventions Patients were randomly allocated to receive up to 12 acupuncture treatments over three months or to a control intervention offering usual care. Main outcome measures Headache score, SF-36 health status, and use of medication were assessed at baseline, three, and 12 months. Use of resources was assessed every three months. Results Headache score at 12 months, the primary end point, was lower in the acupuncture group (16.2, SD 13.7, n = 161, 34% reduction from baseline) than in controls (22.3, SD 17.0, n = 140, 16% reduction from baseline). The adjusted difference between means is 4.6 (95% confidence interval 2.2 to 7.0; P = 0.0002). This result is robust to sensitivity analysis incorporating imputation for missing data. Patients in the acupuncture group experienced the equivalent of 22 fewer days of headache per year (8 to 38). SF-36 data favoured acupuncture, although differences reached significance only for physical role functioning, energy, and change in health. Compared with controls, patients randomised to acupuncture used 15% less medication (P = 0.02), made 25% fewer visits to general practitioners (P = 0.10), and took 15% fewer days off sick (P = 0.2). Conclusions Acupuncture leads to persisting, clinically relevant benefits for primary care patients with chronic headache, particularly migraine. Expansion of NHS acupuncture services should be considered.

Acupuncture for Tension-Type Headache: a Multicentre, Sham-Controlled, Patient and Observer-Blinded, Randomised Trial

“…Firstly, sham acupuncture may have a stronger psychological effect than the dummy pill typically used as placebo control in drug trials. Along with other groups [22][23][24], we have observed that both acupuncture forms are invasive treatments. Invasive treatment techniques are almost always perceived by patients as profoundly meaningful, and such a strong "meaning response" [25] could contribute to symptom reduction [26,27].…”

“…Needles were inserted superficially (1-3 mm) and were not stimulated, so as to avoid De Qi in the sham group. The number (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) and type of needles (sterile, singleuse needles, coated, 0.25-0.30 mm thick, 25-40 mm long), and number (10)(11)(12)(13)(14)(15), length (30 min) and frequency (2/week) of treatment sessions were the same in each group. Investigators were instructed to treat patients in each group identically in all ways other than the placement of needles.…”

Combination of acupuncture and spinal manipulative therapy: management of a 32-year-old patient with chronic tension-type headache and migraine

“…3,4 Headache pain relief has been obtained from needling both acupuncture points and sham points. [3][4][5][6][7][8][9] It is interesting to question, however, whether the sham acupuncture points used were actual acupuncture points in acupuncture traditions other than Traditional Chinese Medicine and whether the neurological input that occurred during the sham acupuncture treatment was sufficient to trigger the central and peripheral changes associated with acupuncture analgesia.…”

“…1 These headaches can evolve and become chronic, exacting considerable personal and social economic cost 2 ; they are the most likely headache to lead to analgesic drug overuse. 1,2 Acupuncture has been found to be clinically beneficial for patients with chronic headaches, particularly migraines [3][4][5][6] and tension-type headaches (TTHs). 7,8 Acupuncture has also been suggested to be an effective first-line complementary alternative medicine modality to treat migraines.…”

Acupuntura: prática baseada em evidências

“…Vickers et al 6 , usando escala de escore para cefaléia e questionário de qualidade de vida SF 36, realizaram um estudo prospectivo, randomizado e controlado com 401 pacientes com queixa de cefaléia crônica (maioria enxaqueca), na rede de atenção primária na Inglaterra e no País de Gales. Ele testou a acupuntura (12 sessões em 3 meses) além de medicação contra os cuidados rotineiros (incluindo a medicação consagrada para a cefaléia).…”