Acupuncture versus placebo versus sumatriptan for early treatment of migraine attacks: a randomized controlled trial

Abstract

Objectives. To investigate whether acupuncture is superior to placebo and equivalent to sumatriptan for the early treatment of an acute migraine attack. Design. Randomized, partly double-blind (sumatriptan versus placebo) trial. Setting. Two hospitals in Germany (one specialized in traditional Chinese medicine and one in the treatment of headache). Subjects. A total of 179 migraineurs experiencing the first symptoms of a developing migraine attack. Interventions. Traditional Chinese acupuncture, sumatriptan (6 mg subcutaneously) or placebo injection. Main outcome measure. Number of patients in whom a full migraine attack (defined as severe migraine headache) within 48 h was prevented. In patients who developed a migraine attack in spite of early treatment, acupuncture and sumatriptan were applied a second time, whilst patients initially randomized to placebo received sumatriptan. Results. A full migraine attack was prevented in 21 of 60 (35%) patients receiving acupuncture, 21 of 58 (36%) patients receiving sumatriptan and 11 of 61 (18%) patients receiving placebo (relative risk of having a full attack 0.79 (95% CI, 0.64-0.99) for acupuncture versus placebo, and 0.78 (95% CI, 0.62-0.98) for sumatriptan versus placebo). Response to the second intervention in patients who developed a full attack was better with sumatriptan (17/31 patients who received sumatriptan twice and 37/46 patients who had had placebo first) than with acupuncture (4/31). The number of patients reporting side-effects was 14 in the acupuncture group, 23 in the sumatriptan group and 10 in the placebo group. Conclusions. In this trial acupuncture and sumatriptan were more effective than a placebo injection in the early treatment of an acute migraine attack. When an attack could not be prevented, sumatriptan was more effective than acupuncture at relieving headache.

Acupuncture of chronic headache disorders in primary care: randomised controlled trial and economic analysis

“…Effects found in this study that have been previously reported include: differences between acupuncture and control for migraine 7,12,45 that increased between posttreatment and 1-year follow-up, 11 unconvincing effects for tension-type headache, [46][47][48][49] improvements in severity and frequency, 24 and increased benefit in patients with greater headache severity.…”

“…Nonetheless, good evidence from randomised trials shows that acupuncture is superior to placebo in the treatment of migraine. 7,12 Furthermore, this study was modelled on Vincent's earlier double-blind, placebocontrolled trial in migraine, 11 which makes direct comparison possible. Raw data were obtained from the author and results compared directly between trials.…”

“…A full migraine attack was prevented in an approximately similar proportion of patients in the acupuncture and sumatriptan groups, with statistically significant differences between acupuncture and placebo. 12 This evidence is complemented by clinical trials showing differences between acupuncture and placebo for shoulder and neck pain, [13][14][15][16] pain after dental surgery 17 and postoperative vomiting. 18 Finally, although a lack of placebo control may introduce bias, careful identification of the potential biases, attempts to reduce the identified bias (see Chapter 2, Introductory remarks) and appropriate statistical analysis can help to determine an unbiased estimate of the difference between acupuncture and control in this trial.…”

A controlled trial of placebo versus real acupuncture

“…Another problem with sham acupuncture is that sham acupuncture modalities can be distinguished from true acupuncture by experienced patients. 28 Thus it is essential that there is little difference in protocol between the control intervention and true treatment.…”

Acupuncture in the management of myofascial pain and headache

“…A local twitch response (LTR) to snapping palpation, pressure, or needle activation of a trigger point is a characteristic finding in this syndrome [44]. The muscle bands affected are palpably taught, with a focal-sensitive area referred to as a trigger point.…”