2022 Expert Review of Neurotherapeutics

A 6-week course of acupuncture proves as effective as 6-month drug prophylaxis for migraines, with specific Chinese point selection and stimulation appearing less important.

The study began by revisiting previous research on acupuncture as a treatment for headache, finding shortcomings in many of these studies. It explored the influence of acupuncture on migraine and how it potentially functions. The methodology involved running several large, randomized trials comparing the use of acupuncture to conventional prophylactic drug treatments, spanning a time frame of six weeks to six months, respectively.

In the discussion of the results, it was found that the 6-week acupuncture treatment was just as effective in treating migraines as the 6-month drug treatment. Specific attributes of the acupuncture treatment, such as the selection and stimulation of Chinese points and the depth of the needles, were found to have lower significance than traditionally believed. The paper therefore suggested the integration of acupuncture into existing migraine therapy protocols.

Role of acupuncture in the treatment of migraine Endres HG, Diener HC, Molsberger A

2022 Neurology

True acupuncture over an eight-week period is effective for reducing the frequency of chronic tension-type headache.

In a randomized controlled trial, 218 participants diagnosed with chronic tension-type headache were divided into an intervention group and a control group, with the study conducted from June 2017 to September 2020. The intervention group received 20 true acupuncture sessions over 8 weeks, where each acupuncture point was needled to achieve a sensation, each session lasting 30 minutes. The control group received the same number of superficial acupuncture sessions, serving as a make-believe treatment, where the needling avoided inducing sensations at the acupuncture points.

The results showed a trend towards greater effectiveness of true acupuncture. By week 16, the 'responder rate' (participants reporting at least a 50% reduction in monthly headache days) was higher in the true acupuncture group compared to the superficial acupuncture group, with similar results by week 32. These findings suggest that true acupuncture, involving the creation of a sensation at each acupuncture site, can noticeably reduce chronic tension-type headaches. This was observed without noting significant adverse events, hinting towards the safety of the procedure.

Acupuncture for Patients With Chronic Tension-Type Headache Zheng H, Gao T, Zheng QH, Lu LY, Hou TH, Zhang SS, Zhou SY, Hao XY, Wang L, Zhao L, Liang FR, Li Y

2020 Neurology and Therapy

In many studies, acupuncture has been shown to be a safe, efficacious and readily available alternative therapy which may be beneficial to certain migraine patients.

Migraines are difficult to treat, and current treatment options have many unwanted side effects, such as exacerbating headache pain in those with chronic migraine. Therefore, while the primary treatment for migraines is drug therapy, acupuncture is gaining increasing attention as a viable addition to the treatment management of migraine patients due to its measurable effects on both the duration and frequency of migraine attacks. Many studies suggest that acupuncture is a safe, helpful and available alternative therapy that may be beneficial to certain migraine patients. Nevertheless, further large-scale RCTs are warranted to further consolidate these findings and provide further support for the clinical value of acupuncture.

Acupuncture and Its Role in the Treatment of Migraine Headaches Urits I, Patel M, Putz ME, Monteferrante NR, Nguyen D, An D, Cornett EM, Hasoon J, Kaye AD, Viswanath O.

2019 Headache

There is growing evidence that acupuncture is just as effective and has fewer side effects than many of the standard pharmaceutical agents that are currently used.

Out of the 706 search results, 7 clinical trials, with a total of 1430 participants, met inclusion criteria for trials comparing the effectiveness of acupuncture to standard pharmacologic treatment. Several of the studies showed acupuncture to be more effective than standard pharmacological treatments for migraine prevention; however, methodological heterogeneity precluded aggregation of these data.

Systematic Review: Acupuncture vs Standard Pharmacological Therapy for Migraine Prevention Niushen Zhang, Tim Houle, Nada Hindiyeh, & Sheena K. Aurora

2017 The Journal of Pain

Acupuncture has a clinically relevant effect on chronic pain that persists over time. Referral for acupuncture treatment is a reasonable option for chronic pain patients.

We included randomized trials of acupuncture needling versus either sham acupuncture or no acupuncture control for nonspecific musculoskeletal pain, osteoarthritis, chronic headache, or shoulder pain. Trials were only included if allocation concealment was unambiguously determined to be adequate. Raw data were obtained from study authors and entered into an individual patient data meta-analysis. The main outcome measures were pain and function. An additional 13 trials were identified, with data received for a total of 20,827 patients from 39 trials. Acupuncture was superior to sham as well as no acupuncture control for each pain condition (all P < .001) with differences between groups close to .5 SDs compared with no acupuncture control and close to .2 SDs compared with sham. We also found clear evidence that the effects of acupuncture persist over time with only a small decrease, approximately 15%, in treatment effect at 1 year.

Acupuncture is effective for the treatment of chronic musculoskeletal, headache, and osteoarthritis pain. Treatment effects of acupuncture persist over time and cannot be explained solely in terms of placebo effects. Referral for a course of acupuncture treatment is a reasonable option for a patient with chronic pain.

Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis Vickers, Andrew J. et al.

2017 Pain

Patients with chronic pain can generally be reassured that treatment effects persist after a course of treatment with acupuncture.

The available individual patient data set included 29 trials and 17,922 patients. The chronic pain conditions included musculoskeletal pain (low back, neck, and shoulder), osteoarthritis of the knee, and headache/migraine. We used meta-analytic techniques to determine the trajectory of posttreatment pain scores. Data on longer term follow-up were available for 20 trials, including 6376 patients. In trials comparing acupuncture to no acupuncture control (wait-list, usual care, etc), effect sizes diminished by a nonsignificant 0.011 SD per 3 months after treatment ended. The central estimate suggests that approximately 90% of the benefit of acupuncture relative to controls would be sustained at 12 months. For trials comparing acupuncture to sham, we observed a reduction in effect size of 0.025 SD per 3 months, suggesting approximately a 50% diminution at 12 months.

The effects of a course of acupuncture treatment for patients with chronic pain do not seem to decrease importantly over 12 months. Patients can generally be reassured that treatment effects persist. Studies of the cost-effectiveness of acupuncture should take our findings into account when considering the time horizon of acupuncture effects. Further research should measure longer term outcomes of acupuncture.

The persistence of the effects of acupuncture after a course of treatment: a meta-analysis of patients with chronic pain MacPherson, H; Vertosick, E.A; Foster, N.E; Lewith, G; Linde, K; Sherman, K.J; Witt, C.M; Vickers, A.J

2016 Cochrane Database of Systematic Reviews

The available evidence suggests that a course of acupuncture consisting of at least six treatment sessions can be a valuable option for people with frequent tension-type headache.

Acupuncture added to usual care or treatment of headaches only on onset (usually with pain-killers) in two large trials resulted in 48 in 100 participants having headache frequency at least halved, compared to 17 of 100 participants given usual care only.

Acupuncture was compared with ‘fake’ acupuncture, where needles are inserted at incorrect points or do not penetrate the skin, in six trials. Headache frequency halved in 52 of 100 participants receiving true acupuncture compared with 43 of 100 participants receiving ‘fake’ acupuncture. The results were dominated by one large, good quality trial (with about 400 participants), which showed that the effect of true acupuncture was still present after six months. There were no differences in the number of side effects of real and ‘fake’ acupuncture, or the numbers dropping out because of side effects.

Acupuncture for the prevention of tension‐type headache Klaus Linde,Gianni Allais,Benno Brinkhaus, Yutong Fei,Michael Mehring,Byung‐Cheul Shin,Andrew Vickers,Adrian R White

2015 Neurology

The majority of trials demonstrate a positive effect of acupuncture over control condition in the treatment of neuropathy.

The majority of RCTs reviewed showed clear benefit for acupuncture over control in the treatment of diabetic neuropathy, Bell’s palsy and carpal tunnel syndrome. Acupuncture is probably effective in the treatment of HIV-related neuropathy and there is insufficient evidence for its benefits in idiopathic neuropathy. Meta-analyses of all diabetic neuropathy and bell’s palsy data using a summary estimate random effects model showed combined Odds Ratio (OR) of 4.23, p<0.001 favoring acupuncture over control for pain outcomes. The majority of trials demonstrate a positive effect of acupuncture over control condition in the treatment of neuropathy. Further more rigorously designed studies are needed to better characterize this effect.

Effects of Acupuncture on Neuropathic Pain: A Systematic Review and Meta-analysis Alexandra Dimitrova, Charles Murchison, Barry Oken

2015 Neurology

The majority of trials demonstrate a positive effect of acupuncture over control condition in the treatment of neuropathy.

The majority of RCTs reviewed showed clear benefit for acupuncture over control in the treatment of diabetic neuropathy, Bell’s palsy and carpal tunnel syndrome. Acupuncture is probably effective in the treatment of HIV-related neuropathy and there is insufficient evidence for its benefits in idiopathic neuropathy. Meta-analyses of all diabetic neuropathy and bell’s palsy data using a summary estimate random effects model showed combined Odds Ratio (OR) of 4.23, p<0.001 favoring acupuncture over control for pain outcomes. The majority of trials demonstrate a positive effect of acupuncture over control condition in the treatment of neuropathy. Further more rigorously designed studies are needed to better characterize this effect.

Effects of Acupuncture on Neuropathic Pain: A Systematic Review and Meta-analysis Alexandra Dimitrova, Charles Murchison, Barry Oken

2001 Cochrane Database of Systematic Reviews

The existing evidence supports the value of acupuncture for the treatment of idiopathic headaches.

Due to the clinical heterogeneity and the poor methodological quality of the included studies, straightforward recommendations for clinical practice cannot be made. Overall, some forms of acupuncture seem to be beneficial, but it is unclear which treatment strategies (points, type of stimulation, frequency, etc.) and which providers may be most promising for particular groups of patients.

Though not risk‐free, acupuncture seems to be relatively safe in the hands of qualified providers. Therefore, we conclude that headache patients who want to try acupuncture should not be discouraged. Existing provision of acupuncture to headache patients also seems justified. Whether acupuncture should be more widely recommended and, if so, which particular type of acupuncture should be offered, are questions that cannot be answered at present.

Acupuncture for idiopathic headache Melchart D, Linde K, Berman B, White A, Vickers A, Allais G, Brinkhaus B