￼￼￼￼￼￼￼￼￼￼￼￼￼This is an article on research undertaken on Acupuncture for Migraines. This is a shortened version, the full articles can be found via the link at the bottom.
￼Acupuncture for Migraines has been much used as a treatment and also episodic tension headache both in China and the West. This paper assesses the quantity and quality of the evidence for the use acupuncture in treating this condition. Our conclusion is that there is some evidence that acupuncture has a significant therapeutic effect on symptoms such as pain and frequency in migraine attacks.
Introduction for Acupuncture for Migraines
Migraine is described as the most frequently encountered condition treated in the NHS, which does not lead to disability or death, and costs £20 million per annum. It effects about 20% of the UK population of which 60% to 70% are women. It also has dramatic effects on the functioning of the economy, for example in the UK an estimated 60% of sufferers lose time from work (Tukmachi 1994).
Migraine is defined as “a complex constellation of symptoms effecting the nervous system, gastrointestinal tract and vascular systems” (Lewith 1996).
The highly debilitating nature of recurrent migraine attacks and the limited effectiveness of medications, all of which can give rise to unpleasant side effects (Shaikh 1986), bring many patients to acupuncture for treatment. A recent article reported that it is the 6th most common condition presenting to acupuncturists (Wadlow 1996). In a study of student doctors in Norway, 63% said they would refer patients with acupuncture for migraines (Norheim 1993). Thus both public and professionals are becoming aware of the benefits of this form of treatment.
Outcome Trials with Acupuncture for Migraines
In the 6 trials falling into this group, results are mostly given in terms of a ‘global assessment’ of improvement derived either from the patients or practitioner. All these trials were outcome studies which followed a group of patients treated by acupuncture. Outcomes were arrived at either through posing a simple question on perceived change to patients (Tukmachi 1994, Junnila 1986) or from the practitioner’s assessment (Laitinen 1975). In some cases the mechanism for assessing outcome was not clear, and only the studies by Baischer(1995) and Boivie & Brattburg (1987) utilised more detailed outcome measures.
The results ranged from 81% responding positively to treatment ( Shaikh 1986) to 84% (Tukmachi 1984) and as high as 92% (Laitinen 1975). Baischer (1995) reported 69% of patients improving ‘more than 33%’, with 58% maintaining this improvement at a 3 year follow up.
A long term study of 115 patients from Finland found 77% responded to treatment, with a 81% reported reduction in pain levels maintained over 2 years and a 55% reduction in frequency and duration of episodes at 10 months post treatment (Junnila 1986). In this study 75% of patients reduced their drug intake by at least half.
While outcome studies are useful indicators of effectiveness, randomised controlled trials are generally considered more rigorous (Richardson & Vincent 1986). An evaluation of efficacy takes place where a randomised controlled trial is designed to assess the specific effect of acupuncture intervention while excluding the other non-specific effects of treatment generally.
Migraineurs are a highly heterogeneous group in acupuncture terms and the use of simple formulaic acupuncture is unlikely to be an appropriate protocol for treatment (Birch 1998, Blackwell 1991). From the perspective of traditional acupuncture for migraines, treatments should be able to be individualised in at least two dimensions: the choice of points to match the patient, and changes in point prescriptions over time. Other aspects of treatment given as standard, such as lifestyle advice or moxibustion, also need to be included.
The use of a control group that receives a placebo treatment in the form of sham acupuncture should be expected to offer more reliable measure of the benefits of the acupuncture itself. However it appears that the use of sham acupuncture is unsatisfactory as it “seems to have either an intermediate effect between that of placebo and ‘real ‘acupuncture points or effects similar to those of real acupuncture points” (NIH 1997). As a result, the controlled trials that use sham acupuncture as a control will systematically underestimate the therapeutic gain (Vincent & Lewith 1995).
Conclusion for article on Acupuncture for Migraines
All the uncontrolled trials demonstrated that acupuncture for migraines is highly effective, often helping over 80% of patients. This is considerably more effective than a likely placebo response which has been estimated to be from around 30% to as high as 50% (Tavola et al 1992). In all the controlled studies, treatment was shown to be more effective in at least one measure( i.e. pain intensity or frequency of attacks), with statistical significance reached in two studies (Vincent 1989, Tavola et al 1992). In the comparative study (Hesse et al 1994), acupuncture for migraines performed as well as the standard therapy with the added benefit of a lower incidence of side effects. Overall the evidence supports the hypothesis that acupuncture is effective in the treatment of migraine.