True Acupuncture No More Effective Than Sham Acupuncture for Migraine—But Both More Effective Than No Treatment at All
]]>Migraine headaches]]> are characterized by intense pulsing or throbbing pain on one side of the head. They are often accompanied by nausea, vomiting, and extreme sensitivity to light and sound. Studies suggest that up to 7% of men and 18% of women suffer from these disabling headaches.
Migraine sufferers plagued by frequent episodes often take a two-pronged approach to their condition: preventing attacks and relieving symptoms during attacks. Beta-blockers, calcium channel blockers and tricyclic antidepressants can reduce the frequency of migraine attacks, but they are not always effective or well tolerated.
As a result, many migraine patients turn to alternative therapies such as acupuncture. Acupuncturists insert fine needles into specific points on the body with the aim of preventing or relieving a variety of symptoms, including pain. Though some acupuncture studies over the past decade have shown promising results, acupuncture has not been convincingly established as an effective way to prevent migraine headaches.
In an article published in the May 4, 2005 Journal of the American Medical Association , researchers report that true acupuncture was no more effective than sham acupuncture in reducing the number of moderate to severe migraine headaches. Interestingly, however, both true and sham acupuncture were significantly more effective at preventing migraine headaches, compared to no treatment at all.
About the Study
The researchers recruited 302 patients (88% of whom were women) who suffered from migraine headaches.
The participants were randomly assigned to one of three treatment groups:
- True acupuncture . Twelve 30-minute sessions over a period of eight weeks. Needles were placed at defined acupuncture points.
- Sham acupuncture . Twelve 30-minute sessions over a period of eight weeks. Needles were placed in at least five out of ten predefined non -acupuncture sites.
- Waiting list control group . Twelve weeks of no treatment, followed by true acupuncture as described above.
Practitioners who were trained and experienced in acupuncture administered both the true and sham acupuncture. Although the practitioners knew whether the patients were receiving true or sham acupuncture, the patients did not.
All patients maintained a headache diary from four weeks before the start of treatment, through 12 weeks after the start of treatment, and then at weeks 21-24 after the start of treatment. They noted all migraine attacks and rated the pain intensity of each one.
Finally, patients reported any adverse effects.
Between the four weeks preceding the start of treatment and weeks nine to 12 after the start of treatment, the number of days with a migraine of moderate to severe intensity decreased by an average of 2.2 days in both the true acupuncture and sham acupuncture groups.
On the other hand, patients in the waiting list control group experienced a decrease in moderate to severe migraines of only 0.8 days (from a baseline of 5.4 days) during the same time period. This differed significantly from both the true and sham acupuncture groups.
The researchers also measured the proportion of responders , or patients whose moderate to severe migraines decreased by more than half. They found that 51% of true acupuncture patients and 53% of sham acupuncture patients were responders, compared to only 15% of patients in the waiting list group.
Patients receiving true or sham acupuncture were also significantly less likely than patients in the waiting list group to need medication, experience other symptoms associated with migraines, or have their activities impaired by migraines. There were no significant differences between the true and sham acupuncture groups in these areas.
None of the patients receiving true or sham acupuncture reported any serious adverse effects.
This study is limited by the fact that subjects were primarily recruited through newspaper advertisements, which means they may have had a more positive attitude towards acupuncture than the average migraine sufferer.
How Does This Affect You?
This study found no significant differences between true and sham acupuncture in the reduction of moderate to severe migraine headaches. Interestingly, however, both true and sham acupuncture were significantly more beneficial than no treatment at all.
But if true acupuncture fared no better than sham acupuncture, then why should both—or either—be more effective than no treatment at all? The study authors speculate that although their sham acupuncture was designed not to elicit a response, it may have stimulated an unintentional physiolologic response that helped prevent migraines.
Another possibility is that true and sham acupuncture may have a powerful placebo effect. In medication trials, a person taking a placebo is simply swallowing a pill. But with acupuncture, even the sham acupuncture patient is interacting frequently with a practitioner, and is experiencing the ritual associated with acupuncture. As a result, the benefit of the overall experience, if not the acupuncture itself, may be profound enough to have a clinically important impact.
While true acupuncture was no more effective than sham acupuncture in this study, this form of therapy does appear to have some benefit. And, unlike with medications, the risk of adverse effects is minimal. If you decide to try acupuncture, the National Center for Complementary and Alternative Medicine recommends the following:
- Ask your primary health care provider if he or she can recommend a practitioner.
- Find out about the practitioner’s license and credentials, and where they received their training.
- Ask you insurer whether they will cover the cost of therapy.
Also, when you meet with the acupuncturist, be sure to discuss his or her treatment plan up front. Like many medications, the effectiveness of acupuncture can only be determined after a trial period. A competent acupuncturist will be able to estimate the number of sessions required during this period. It is also essential that you discuss all migraine treatments you are receiving with both your primary care provider and your acupuncturist.
National Center for Complementary and Alternative Medicine
National Institutes of Health
National Headache Foundation
National Institute of Neurological Disorders and Stroke
National Institutes of Health
Linde K, et al. Acupuncture for patients with migraine: a randomized controlled trial. JAMA . 2005; 293:2118-2125.
Last reviewed May 5, 2005 by ]]>Richard Glickman-Simon, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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