Chronic headache - migraine, chiefly - is often quite resistant to effective medication. Acupuncture is frequently used, but until now the supportive evidence has been open to criticism. However, a new study from the UK brings more convincing results on this form of therapy . . .

Acupuncture for Chronic Headache?

Summarized by Robert W. Griffith, MD
September 17, 2004

Introduction

Migraine and tension-type headache are distressing and persisting conditions that often respond poorly to traditional medications. This leads patients and their doctors to try alternative treatments, including acupuncture. The medical community has been in some doubt as to whether acupuncture is definitely effective in chronic headache. A study conducted in UK has thrown more light on this, and is reported in the British Medical Journal.

What was done

Family doctors (general practitioners) in UK searched their patient files for suitable subjects and sent them letters inviting them to participate in the study. Final suitability was assessed in a telephone interview. The volunteers had to have a diagnosis of migraine or tension-type headache occurring at least twice a month.

A baseline 'headache diary' was completed for 4 weeks. The severity of their headaches was scored using a 6-point scale, 4 times a day. Those with a score of 8.75 or more were eligible for the study, and were randomly assigned to receive their usual care plus acupuncture, or usual care alone.

Those allocated to get acupuncture could have up to 12 treatments over 3 months from an advanced member of the UK Acupuncture Association of Chartered Physiotherapists. The acupuncture points used were determined individually for each patient by the acupuncturist.

Four-week daily headache diaries, medication use, and general health questionnaires were completed at baseline, 3 months, and 12 months.

What was found

There were 401 patients in the study; their average age was 46, 84% were women, and 94% of them had migraine which had lasted, on average, over 20 years. Their average headache score was 25. Of the 205 patients allocated to receive acupuncture, 161 completed the full 12-month trial, with an average of 9 treatments. In the 'usual care only' group, 140 of the allocated 196 patients finished the study.

The average headache score at 12 months was lowered in the acupuncture group by 34% to 16.2. In the usual care group, headache scores fell by 16% to 22.3. This is a highly significant difference, in the statistical sense (i.e. it could not have occurred by chance alone).

Acupuncture patients had the equivalent of 22 fewer days of headache per year, compared with the usual care group. They used 15% less medication, made 25% fewer doctor visits, and took 15% fewer sick days off work.

What this means

This study shows that acupuncture, when done by a well-trained, experienced acupuncturist, leads to persistent relevant benefits for patients with chronic headache, particularly migraine. The duration of the effect is quite impressive - for some of the patients up to a year.

The problem with testing for the effectiveness of acupuncture therapy has always been the ability to 'blind' the patient (i.e. hide from the patient which type of treatment is given) by using a dummy procedure on the 'placebo' patients. One can't really give 'dummy' pin-pricks. Nevertheless, the results are sufficiently convincing that acupuncture should be considered an important option for treating chronic headache. One should just make sure that the acupuncturist is appropriately trained and certified.

Source

• Acupuncture for chronic headache in primary care: large, pragmatic, randomized trial. AJ. Vickers, RW. Rees, CE. Zollman,  et al., BMJ, 2004, vol. 328, pp. 744--749

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