Role of acupuncture in the treatment of migraine

Abstract

I n general, the harder a medical problem is to treat, the more treatment strategies exist. This observation is certainly true for migraine. Patients and physicians are constantly looking for alternatives to drug therapy, which is effective in the short term but may have severe unwanted effects in the long term.Nonpharmacologic treatments begin with common-sense advice, such as educating patients about headache and its management, identifying and managing triggers (e.g., keeping a headache diary) and modifying lifestyle. Some evidence exists for the benefit of behavioural treatment (e.g., relaxation, biofeedback, and cognitive-behavioural therapy).1 Riboflavin and coenzyme Q10 significantly decreased the frequency of migraine attacks, and the prophylactic efficacy of magnesium, particularly for children and migraines related to menstruation, has been substantiated.2 Alpha lipoic acid has not been shown to reduce the frequency of migraine, and there is no clear evidence to support or refute homeopathy.2 In general, most studies for these types of treatments are small and of low methodologic quality. This is no longer the case for acupuncture. A German randomized controlled trial (n = 302) showed that acupuncture is more effective than no acupuncture. Another German randomized controlled trial (n = 794) showed that 11 acupuncture treatments given within a six-week period was at least as effective as a β-blocker taken daily over a six-month period.3,4 As a consequence of these and 20 other high-quality trials involving 4419 participants, the 2009 Cochrane review by Linde and colleagues 5 found that there is consistent evidence that acupuncture is beneficial in the treatment of acute migraine attacks and that the available studies suggest that acupuncture is at least as effective as prophylactic drug treatment and has fewer adverse effects. Therefore, acupuncture should be considered an option for patients willing to undergo this treatment. 5Additional randomized control studies published since the 2009 review are in keeping with this conclusion. Yang and colleagues found that 24 acupuncture treatments, compared with topirmarate, were more effective and safe (11 times more patients experienced adverse effects in the topirmarate group than in the acupuncture group). Wang and coauthors reported that acupuncture was more effective than flunarizine in decreasing the duration of migraine attacks. 6,7 Acupuncture has also been shown to be more effective than standard therapy for the treatment of tension headache, osteoarthritis, shoulder pain and lower back pain, with fewer unwanted adverse effects. 8-12These clinically important results are accompanied by another finding that is common in acupuncture studies: there is no evidence of an additional effect of "true" acupuncture over "sham" acupuncture. 5 The current trial by Li and colleagues 13 did not find a significant difference between traditional Chinese and sham acupuncture in the number of days with a migraine during the study period, but a significant difference wa...

Acupuncture for migraine prophylaxis: a randomized controlled trial

“…Melzack's gate control theory and diffuse noxious inhibitory control might explain the stronger effect on pain inhibitory mechanisms caused by more intense local pain stimulus induced by electrostimulation. [30][31][32][33] This might explain why we found no significant differences between the acupuncture and sham acupuncture groups directly following the treatment period (weeks 5-8) but we did find differences later (weeks [13][14][15][16]. Based on results from previous trials involving patients with migraines, 8,11,12,34 we speculate that the effect would have increased even further with a longer follow-up period.…”

Acupuncture: Specific and Non-Specific Effects

“…the endorphin hypothesis, Melzack's gate control theory, and the principle of counter-irritation, or diffuse noxious inhibitory control (DNIC), which some authors consider as a possible candidate for explaining central pain modulation through acupuncture [25][26][27]. Yet these standard neurophysiological models fail to explain the long-term effects of acupuncture over periods of more than 4 months [28]. According to these models, the activation of pain-inhibiting mechanisms by stimulation of nerve fibers should not persist for more than a few hours, and the initial worsening of symptoms that is often observed in acupuncture treatment should not occur at all.…”

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

“…59,60 More recent studies that support acupuncture for migraine prevention and relief suggest that the pain relief is indeed achieved by the needling process and subsequent neurological changes, but that the results are not as dependent on point specificity or the arrival of "deqi." 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.…”