Acupuncture for migraine prophylaxis

 

Abstract

Background

Acupuncture is often used for migraine prophylaxis but its effectiveness is still controversial. This review (along with a companion review on 'Acupuncture for tension-type headache') represents an updated version of a Cochrane review originally published in Issue 1, 2001, of The Cochrane Library.

Objectives

To investigate whether acupuncture is a) more effective than no prophylactic treatment/routine care only; b) more effective than 'sham' (placebo) acupuncture; and c) as effective as other interventions in reducing headache frequency in patients with migraine.

Search methods

The Cochrane Pain, Palliative & Supportive Care Trials Register, CENTRAL, MEDLINE, EMBASE and the Cochrane Complementary Medicine Field Trials Register were searched to January 2008.

Selection criteria

We included randomized trials with a post-randomization observation period of at least 8 weeks that compared the clinical effects of an acupuncture intervention with a control (no prophylactic treatment or routine care only), a sham acupuncture intervention or another intervention in patients with migraine.

Data collection and analysis

Two reviewers checked eligibility; extracted information on patients, interventions, methods and results; and assessed risk of bias and quality of the acupuncture intervention. Outcomes extracted included response (outcome of primary interest), migraine attacks, migraine days, headache days and analgesic use. Pooled effect size estimates were calculated using a random-effects model.

Main results

Twenty-two trials with 4419 participants (mean 201, median 42, range 27 to 1715) met the inclusion criteria. Six trials (including two large trials with 401 and 1715 patients) compared acupuncture to no prophylactic treatment or routine care only. After 3 to 4 months patients receiving acupuncture had higher response rates and fewer headaches. The only study with long-term follow up saw no evidence that effects dissipated up to 9 months after cessation of treatment. Fourteen trials compared a 'true' acupuncture intervention with a variety of sham interventions. Pooled analyses did not show a statistically significant superiority for true acupuncture for any outcome in any of the time windows, but the results of single trials varied considerably. Four trials compared acupuncture to proven prophylactic drug treatment. Overall in these trials acupuncture was associated with slightly better outcomes and fewer adverse effects than prophylactic drug treatment. Two small low-quality trials comparing acupuncture with relaxation (alone or in combination with massage) could not be interpreted reliably.

Authors' conclusions

In the previous version of this review, evidence in support of acupuncture for migraine prophylaxis was considered promising but insufficient. Now, with 12 additional trials, there is consistent evidence that acupuncture provides additional benefit to treatment of acute migraine attacks only or to routine care. There is no evidence for an effect of 'true' acupuncture over sham interventions, though this is difficult to interpret, as exact point location could be of limited importance. Available studies suggest that acupuncture is at least as effective as, or possibly more effective than, prophylactic drug treatment, and has fewer adverse effects. Acupuncture should be considered a treatment option for patients willing to undergo this treatment.

 

Plain language summary

Acupuncture for migraine prophylaxis

Migraine patients suffer from recurrent attacks of mostly one-sided, severe headache. Acupuncture is a therapy in which thin needles are inserted into the skin at defined points; it originates from China. Acupuncture is used in many countries for migraine prophylaxis – that is, to reduce the frequency and intensity of migraine attacks.

We reviewed 22 trials which investigated whether acupuncture is effective in the prophylaxis of migraine. Six trials investigating whether adding acupuncture to basic care (which usually involves only treating acute headaches) found that those patients who received acupuncture had fewer headaches. Fourteen trials compared true acupuncture with inadequate or fake acupuncture interventions in which needles were either inserted at incorrect points or did not penetrate the skin. In these trials both groups had fewer headaches than before treatment, but there was no difference between the effects of the two treatments. In the four trials in which acupuncture was compared to a proven prophylactic drug treatment, patients receiving acupuncture tended to report more improvement and fewer side effects. Collectively, the studies suggest that migraine patients benefit from acupuncture, although the correct placement of needles seems to be less relevant than is usually thought by acupuncturists.

 

摘要

背景

針灸用來治療自發性頭痛

針灸廣泛被用來治療頭痛，但它的效果是有爭議的。

目標

來確定針灸是否: a)比不治療有效；b)比“偽”(安慰劑) 針灸有效；c)像其它介入方式治療自發性(原發性)頭痛一樣有效。

搜尋策略

搜尋 The Cochrane Pain, Palliative & Supportive Care Trials Register, CENTRAL, MEDLINE, EMBASE and the Cochrane Complementary Medicine Field Trials Register 至2008年1月.

選擇標準

納入隨機或半隨機臨床試驗來比較針灸與其他方式治療自發性(原發性)頭痛的治療。

資料收集與分析

關於患者、介入方式、方法，和結果的訊息由至少二個不同評論者擷取使用一種預先測試的標準格式。結果在頭痛頻率和強度作了總結。計算回應者反應比率(回應者反應在治療組/回應者反應率在控制組) 作為針對針灸治療對照組的初步結果指標。因為實驗的差異性和報告量不足，定量統合分析是不可能的。

主要結論

26項實驗包括一共計有1151 名患者(中數， 37; 範圍，10–150) 達到納入標準。16項實驗在有偏頭痛病者中進行，6項在有緊張型頭痛患者之中，和四項中在有各種各樣類型頭痛之病人中。多數實驗有方法學而且/或有缺點報告。在16項實驗中的八個與比較實際和模仿(安慰劑) 針灸中在偏頭痛和緊張類型頭疼患者，報告是實際的針灸顯著效果較好; 在四項實驗有一個趨向傾向於實際的針刺; 而在二項實驗在這介入方式之間中沒有區別。(二項試驗是無法解釋的 。) 10 項實驗比較針灸與其它治療方式產生了矛盾的結果。

作者結論

總之，現有的證據支持針灸治療原發性頭疼治療的價值。但是，證據的質和量不夠充足來讓人有說服力。迫切需要有良好的計劃，大規模的研究在現實生活下評估針灸的好處和成本效益。

翻譯人

本摘要由三軍總醫院詹舜名翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

偏頭痛患者經常苦於反覆性單邊的嚴重頭痛發作。針灸是一種治療，其針被插入到穴位上的皮膚，它起源於中國。許多國家用針灸來預防偏頭痛  也就是，減少偏頭痛發作頻率和強度。我們回顧 22項試驗關於調查用針灸來預防偏頭痛是否有效的。6項試驗調查針灸是否加入基本醫療照顧（通常只用來治療急性頭痛）發現，那些接受了針灸治療病人有較少頭疼的問題。14項試驗比較真正針灸與針灸不足或“偽”針灸的介入方式，是否插入不正確穴位或不穿透皮膚。在這些試驗中的2組已經比以前少頭痛治療，但在2個組治療的效果無差異。在4個試驗中，針灸經過證明與預防性藥物治療相比，病人接受針灸症狀更加趨於改善，副作用較少。總結來說，這些研究表示偏頭痛患者接受針灸是有好處的，雖然針灸師通常認為，正確放置針的位置似乎不那麼重要了。