HEADACHE & MIGRAINE (© JCM Ltd)

ACUPUNCTURE EFFECTIVE FOR ACUTE MIGRAINE
Chinese researchers have found acupuncture to be an effective treatment for acute migraine. In a multicentre randomised controlled trial, they compared verum acupuncture with two different types of sham acupuncture. 175 patients received one session of real or sham treatment and were observed over a period of 24 hours. Visual analog scale (VAS) pain scores in the fourth hour after treatment decreased by a median of 1.0 cm in the verum acupuncture group, 0.5cm in first sham acupuncture group and 0.1cm in the second sham acupuncture group. Similarly, there was a significant difference in the change of VAS scores from baseline in the second hour after treatment, when only patients treated with verum acupuncture showed significant decreases in VAS scores from baseline (a median of 0.7cm). Significant differences were also observed in pain relief, relapse or aggravation within 24 hours after treatment between the real and sham acupuncture groups. Most patients in the acupuncture group experienced complete pain relief (40.7%) and did not experience any recurrence or intensification of pain (79.6%). The authors conclude that verum acupuncture is more effective than sham in the treatment and prevention of acute migraine pain and that these findings support the notion that specific physiological effects distinguish genuine acupoints from non-acupoints. (Acupuncture for treating acute attacks of migraine: a randomized controlled trial. Headache. 2009 Jun;49(6):805-16).

ACUPUNCTURE WORKS FOR HEADACHES
The addition of 12 additional trials (carried out since 2001) to the Cochrane Database Systematic Review of acupuncture for migraine prophylaxis increased the number of trials meeting the inclusion criteria to 22, involving a total of 4419 participants. The authors' new conclusion, based on the additional data, is that there is now consistent evidence that acupuncture provides additional benefit in the treatment of acute migraine attacks to routine care. They go on to state that the results do not support the effect of true acupuncture over sham interventions, although they explain that this is difficult to interpret. However, they further conclude that the current available studies suggest that acupuncture is at least as effective as, or possibly more effective than, prophylactic drug treatment, with fewer adverse effects and that it should be considered as a treatment option for migraine patients. (Acupuncture for migraine prophylaxis. Cochrane Database Syst Rev. 2009 Jan 21;(1):CD001218). In a second review article, investigators examined the effectiveness of acupuncture for tension-type headaches. Six additional trials have been added since the previous version of the review (published in 2001), making a total of 11 trials (2317 participants) meeting the inclusion criteria. Two large trials found significant short-term benefits (up to three months) associated with acupuncture as an adjunct to basic care (treatment of acute headache with painkillers). The number of headache days was reduced by at least 50% in 47% of patients who received acupuncture plus basic care, compared to 16% experiencing a 50% reduction in the number with basic care alone. The authors conclude that the available evidence suggests that acupuncture is a valuable option for patients suffering from frequent tension-type headache. (Acupuncture for tension-type headache. Cochrane Database Syst Rev. 2009 Jan 21;(1):CD007587).

ACUPUNCTURE BETTER THAN MEDICATION FOR CHRONIC HEADACHE
A systematic review has confirmed the benefits of acupuncture in the treatment of chronic headache. The study, carried out by US authors, included 31 studies in its meta-analysis. The majority of trials comparing verum (true) acupuncture with sham acupuncture were found to show a trend in favour of verum acupuncture. The combined response rate in the acupuncture group was significantly higher compared with sham acupuncture both at early and late follow-up. Combined data also showed acupuncture to be superior to medication for headache intensity, headache frequency, physical function and treatment response rate. (Acupuncture for the management of chronic headache: a systematic review. Anesth Analg. 2008 Dec;107(6):2038-47).

ACUPUNCTURE IMPROVES HEADACHE TREATMENT
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 to a control group receiving no acupuncture 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]).

ACUPUNCTURE COST-EFFECTIVE FOR HEADACHE
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).

ACUPUNCTURE IMPROVES AUTONOMIC REGULATION IN MIGRAINE
A positive response to acupuncture by migraine sufferers is associated with beneficial changes in the regulation of the autonomic nervous system. Thirty migraineurs were randomly allocated to two groups receiving either verum acupuncture (VA) or sham acupuncture (SA) treatment. Across the combined VA and SA groups, clinical responders (those with at least 50% reduction of migraine attacks) exhibited a decrease of the low-frequency band of heart-rate variability (an index of cardiac autonomic control) in the course of the treatment, which was not be observed in patients without clinical benefit. Both VA and SA therefore seem to have a beneficial influence on the autonomic nervous system in migraineurs. (Acupuncture in migraine: investigation of autonomic effects. Clin J Pain. 2008 Feb;24(2):106-15).

ACUPUNCTURE FOR MIGRAINE
Italian researchers have conducted a trial on migraine sufferers that attempts to separate the specific effects of a true TCM acupuncture treatment from the effects of both standard sham acupuncture and a mock ‘acupuncture healing ritual’. One hundred and sixty patients were divided into four groups: true acupuncture (TA) plus normal drug therapy (Rizatriptan), ritualised mock acupuncture (RMA) plus Rizatriptan, standard mock acupuncture (SMA) plus Rizatriptan and Rizatriptan only (R). The Migraine Disability Assessment (MIDAS) Questionnaire was administered before treatment and at three (T1) and six months (T2) from beginning treatment, and the MIDAS Index (MI) was calculated. Rizatriptan intake was also checked in all groups of patients. All groups underwent a significant decrease of MI at T(1) and T(2), compared with T(0). TA was the only treatment that provided a significant improvement at both T(1) and T(2) compared with the use of Rizatriptan only (R). The RMA group showed a transient improvement of MI at T(1), suggesting that part of the treatment’s benefits may be due to non-needle effects of the acupuncture procedure. (Traditional Acupuncture in Migraine: A Controlled, Randomized Study. Headache. 2007 Sep 14 [Epub ahead of print]).

ACUPUNCTURE FOR TENSION-TYPE HEADACHE
Tension-type headache (TTH), improves after acupuncture, but the difference between real and sham treatment is not significant, a new German study has found. The randomised, controlled, multicentre, patient-and observer-blinded trial was carried out in 122 outpatient practices on 409 patients with TTH. Patients had either verum acupuncture (according TCM principles) or sham acupuncture (superficial needling at non-acupuncture points) administered by physicians with specialist acupuncture training. Ten 30-minute sessions were given over a six-week period, with additional sessions available for partial response. Response was defined as a greater than 50% reduction in headache days/month at six months and no use of excluded medication or other therapies. Thirty-three percent of verum patients and 27% of sham controls were classed as responders. The difference between real and sham acupuncture was therefore non-significant. Verum was superior to sham for most secondary endpoints, including headache days. (Acupuncture for tension-type headache: a multicentre, sham-controlled, patient- and observer-blinded, randomised trial. J Headache Pain. 2007 Oct;8(5):306-14).


LASER ACUPUNCTURE EFFECTIVE FOR CHILDREN’S HEADACHES
Laser acupuncture can provide significant benefit in the treatment of children with headache. Researchers in Germany carried out a randomised, double-blind, placebo-controlled trial of laser acupuncture in 43 children (mean age 12.3 years) with various types of headache. Patients received a course of four treatments over four weeks with either active or placebo laser. The acupuncture treatment was individualised based on TCM criteria. Follow up continued for another 12 weeks. The mean number of headaches experienced per month decreased significantly by 6.4 days in the treated group (vs a decrease of 1.0 days in the placebo group). Headache severity and monthly hours with headache were also found to decrease significantly at all time points compared to baseline, and were significantly lower than those of the placebo group at all time points. (Laser acupuncture in children with headache: A double-blind, randomized, bicenter, placebo-controlled trial. Pain. 2007 Nov 15 [Epub ahead of print]).

ACUPUNCTURE EQUIVALENT TO DRUGS FOR MIGRAINE
A review of current studies on acupuncture and migraine concludes that a six-week course of acupuncture is not inferior to a six-month prophylactic drug treatment, but that specific TCM-based point selection, point stimulation and needling depth may not be that important. The review suggests that acupuncture should be integrated into existing migraine therapy protocols. Role of acupuncture in the treatment of migraine. Expert Rev Neurother. 2007 Sep;7(9):1121-34).

ACUPUNCTURE & HEADACHE
In a randomised, controlled trial, 74 patients with chronic daily headache were randomly assigned to receive either medical management alone (headache medication) or medical management plus acupuncture (10 treatments over six weeks). The patients receiving acupuncture were reported 3.7 times less suffering due to headaches at six weeks, and further showed improvements in the Headache Impact Test and mental state, and reduced limitation of daily activities and social functioning. The medication only group showed no improvement in any of the measures studied. (Headache 2005;45:1113-1123).

ACUPUNCTURE & MIGRAINE
Acupuncture (up to 15 sessions over 12 weeks) was compared with metoprolol (a standard migraine prophylaxis medication) for effectiveness and tolerability in 113 patients randomised to one of two groups. The number of days with migraine decreased by 2.5 days in the acupuncture group compared to 2.2 in the medication group and those experiencing 50% or greater reduction in attacks was 61% for acupuncture and 49% for medication. Severe adverse effects occurred only in the medication group. (12th Annual Symposium on Complementary Health Care, 19-21 September 2005, Exeter, UK).

ACUPUNCTURE & TENSION HEADACHE
A German trial compared ‘true’ acupuncture, sham acupuncture and no acupuncture in 270 female patients suffering from episodic or chronic tension-type headache. The acupuncture protocol, which was carried out at 28 different clinics, was developed through consultation with various German acupuncture experts and societies and delivered by practitioners with a median of 500 hours training and 10 years practice. Main points were Fengchi GB-20, Jianjing GB-21 and Taichong LIV-3, with secondary points chosen from a list according to pain location and inducing factors such as weather conditions (e.g. cold wind: Hegu L.I.-4, Lieque LU-7, Waiguan SJ-5 and Dazhui DU-14). Twelve treatment sessions were given over eight weeks, deqi was obtained and at least one further needle stimulation was given during retention. In the minimal acupuncture group, patients were needled at a minimum of five non-points at the same frequency as the true acupuncture, but without obtaining deqi or applying manual stimulation. Patients in the control group received no treatment for twelve weeks and were then given acupuncture. The number of headache days decreased in both acupuncture groups (6.5 in the true acupuncture and 6.0 in the minimal acupuncture group) compared to a 1.5 reduction in the controls, but the differences between the two acupuncture groups was not significant. The number of responders (at least 50% reduction in headache days) was 46% in the true acupuncture group and 35% in the minimal acupuncture group, compared to 4% in the waiting list controls. Whilst both acupuncture groups also showed general health improvements (disability scores, SF-36 physical and mental health, depression scores) there was again no significant difference between them. (BMJ, doi:10.1136/bmj.38512.405440.8F).

LASER ACUPUNCTURE & CHRONIC TENSION HEADACHE
Laser acupuncture has a distinct advantage over needle acupuncture in clinical trials since it is considerably easier to apply a placebo intervention. In a study of the use of laser acupuncture in the treatment of chronic tension-type headache, 50 patients were randomly allocated to treatment or placebo groups. Patients in the treatment group received low energy laser acupuncture to Lieque LU-7, Hegu L.I.-4, Yangbai GB-14 and Fengchi GB-20 bilaterally (for 43 seconds at 1.3) for ten treatments three times a week. The placebo group was treated identically except that the laser output was set to zero. At the end of the study the true laser group recorded significantly reduced headache intensity, duration of attacks and median number of days with headache per month than the placebo group. (Acupuncture in Medicine, 2005, vol 23(1) Page 13-18).

ACUPUNCTURE FOR CHRONIC HEADACHE
Another large German study similarly compared the effects of randomly assigned acupuncture, self-elected acupuncture and non-acupuncture controls on chronic migraine and tension headache in a total of 15,056 patients. After three months of treatment (fifteen sessions) the frequency of headache days reduced significantly and quality of life scores improved significantly between the acupuncture and control groups. There was no significant difference in improvement scores between the migraine and tension headache patients. (11th Annual Symposium on Complementary Health Care 2004).

CHINESE MEDICINE FOR CHRONIC HEADACHES
This German study compared the number of days of moderate headache experienced by two groups of chronic headache sufferers, one after 4 weeks of Chinese herbal medicine and acupuncture treatment at a Chinese medicine hospital in Kotzting, Germany, and the other assigned to a non-treatment waiting group. Fifty-two percent of patients in the treatment group experienced a greater than 50% reduction in headache days, compared to 16% in the waiting group. Patients with migraine and tension-type headache improved more than patients with other chronic headaches. (Complementary Therapies in Medicine (2004) 12, 71-78).

ACUPUNCTURE FOR CHRONIC HEADACHE
Acupuncture has demonstrated a clear long-term benefit for patients suffering from chronic headaches. 401 patients were randomly assigned to receive either individualised acupuncture treatment (12 treatments over 3 months), or normal care from their general practitioner (control). At 12 months after the onset of treatment, headache scores in the acupuncture group fell by 34% (compared to 16% in the control group), with 22 fewer days of headache a year. They took 15% less medication, made 25% fewer doctor visits, and took 15% fewer days off work. The acupuncture group also showed statistically significant improvements in quality of life, as measured by the SF-36 health status questionnaire, specifically in physical role functioning, energy and change in overall health. The greatest improvements were found in patients with migraine. In another paper by the same research team, it was found that the cost-effectiveness of giving acupuncture compared favourably with other health service interventions. The authors note that “each week 10% of general practitioners in England either refer patients to acupuncture or practise it themselves, and headache is one of the most commonly treated conditions” and conclude that "Acupuncture in addition to standard care results in persisting, clinically relevant benefits for primary care patients with chronic headache, particularly migraine, compared with controls. Expansion of NHS acupuncture services for headache should be considered." (BMJ, doi:10.1136/bmj.38029.421863, 15 March 2004) .

ACUPUNCTURE & MIGRAINE
Women who opt for acupuncture instead of a drug to prevent migraines report feeling fewer initial symptoms, fewer attacks, and less side effects from the treatment, new study findings report. The study, carried out at the Woman's Headache Centre at the University of Turin, Italy, compared the effect of acupuncture with oral flunarizine in preventing non-aura migraine over a 6-month period. The 160 women enrolled in the study had experienced headaches at least twice a month in the year prior to the study and had had no previous experience of acupuncture. Acupuncture was given once a week for the first 2 months and then once a month for the next 4 months. The same points were used at each treatment and retained for 20 minutes: Taichong LIV-3, Sanyinjiao SP-6, Zusanli ST-36, Zhongwan REN-12, Hegu L.I.-4, Neiguan P-6, Fengchi GB-20, Yangbai GB-14, Taiyang (M-HN-9) and Baihui DU-20. The flunarizine group received the drug daily for the first 2 months and then for 20 days per month for the next 4 months. The frequency of headaches and the use of symptomatic drugs significantly decreased during treatment in both groups, however the number of attacks after 2 and 4 months of treatment was significantly lower in the acupuncture group, as was analgesic consumption after 2 months of treatment. At six months however, no such differences existed between the two treatment groups. Pain intensity was significantly reduced only by acupuncture treatment and side effects were significantly less frequent in the acupuncture group - overall, women taking flunarizine were more likely than those receiving acupuncture to drop out of the study, for reasons that included depression, weight gain and sleepiness.  (Headache  2002, Vol. 42(9) p.855-861).

ACUPUNCTURE IN LONG-TERM MIGRAINE
A study carried out in Austria has demonstrated the long-term benefits of acupuncture in the treatment of migraine. 26 patients were treated by local and distal body points, once weekly, for between 6 and 13 treatments. The majority showed reduced frequency of attacks and use of analgesics. Significantly, a follow-up survey showed maintained improvement over a 3-year period. (Headache, 1995; 35(8): 472-474).