15 March 2004 - written by BUPA's Health Information Team
British doctors have found that acupuncture can reduce the number of days of migraine a person has a year, as well as reducing the amount of medication they need and days off work. The results of their study are published on the website of the British Medical Journal.
How did the study work?
The study was designed to look at the use of acupuncture as an option for GPs prescribing treatment for migraines and tension-type headaches. GPs randomly offered their patients either standard treatment (medication and GP advice) or standard treatment plus acupuncture. Those who received acupuncture had up to 12 acupuncture sessions over the space of three months.
How many people were studied?
The doctors identified 401 people with chronic headache, most of them had migraines while the others had tension-type headaches. All the people were aged 18-65 years old and had an average of at least two headaches a month.
What were the results?
At the end of 12 months, people who had acupuncture in addition to standard treatment had 34 percent less severe headaches than people who only received standard treatment. Before treatment, the acupuncture group had a mean weekly headache score of 24.6 which fell to 16.2 after 12 months. The group that recieved only standard treatment had a weekly headache score of 26.7 before treatment and a score of 22.3 after 12 months.
During the 12-month study, people who had acupuncture in addition to standard treatment reported 15.6 days of headache during the four weeks before treatment and only 11.4 days of headache in four weeks at the end of the 12-month period. In contrast, those people who received standard treatment only reported 16.2 days of headache in the four weeks before treatment and 13.6 days of headache in four weeks at the end of the 12-month period.
These results mean that the people who recieved acupunture with standard treatment had 1.8 days less of headache every four weeks, when compared with those who did not have acupuncture. This works out as 21.6 days less of headache a year.
Over the 12-month period of the study, people who received acupuncture with standard treatment took a mean number of 12.6 days off from work (standard deviation of 18.9 days). In comparison, the standard treatment only group took 13.8 days off from work (standard deviation of 16.2 days). When these results were analysed statistically, the result is that the acupuncture group took 15 percent less days off work.
How were these results measured?
People filled in a headache diary for four weeks before their treatment started. They then repeated this at three months and one year after starting treatment. They were asked to assess the severity of their headache on a six-point scale four times a day. These scores were added together to give a daily headache score.
In addition, people filled in questionnaires that measured their use of headache treatments and days off sick from work.
What does this mean?
Most doctors agree that acupuncture can play a useful role in reducing pain from headaches but, up until now, the evidence has not been conclusive. This study provides further evidence for the benefits of acupuncture as a treatment for migraine. This is because the study was controlled, the people studied were randomly assigned to either standard treatment or standard treatment plus acupuncture, and the study involved a sizeable number of people.
In addition, the study also shows that acupuncture appears to offer long-lasting benefits. Most of the acupuncture group only received acupuncture for the first three months of treatment, yet their headache severity scores were significantly lower than those for standard-treament only when measured a full nine months after acupuncture treatment had stopped.
What do the study's authors believe this study shows?
The authors of this study believe that the results show that the use acupuncture in addition to standard treatment leads to persisting, clinically useful benefits for people with chronic headache, particularly migraine. They argue that acupuncture should be used more widely to treat headaches.
· BUPA factsheet: Acupuncture
· BUPA factsheet: Headaches
· BUPA factsheet: Migraine
· Vickers AJ, Rees RW, Zollman CE, et al. Acupuncture for chronic headache in primary care: large, pragmatic, randomised trial. British Medical Journal.doi:10.1136/bmj.38029.421863.EB (published 15 March 2004)
April, 2001, Vol. 02, Issue 04
· Acupuncture Superior to Drug Therapy for Migraines
· Study Highlights the "Exceptional Usefulness" of Treatment
· By Editorial Staff
· According to the National Headache Foundation, as many as 28 million Americans suffer from migraine headaches each year.1 Migraines can be caused by a variety of physical and environmental factors, including diet, stress, allergens, menstruation, and changes in the weather. They can last from a few minutes to several days, which in some cases may completely incapacitate the person suffering an attack.
Migraine headaches are also one of the leading causes of time missed from work. It is estimated that migraine sufferers lose more than 157 million workdays each year, leading to a loss of approximately 50 billion dollars per year due to absenteeism and medical expenses caused by headache. An additional four billion dollars a year is spent on pain relievers for migraines and other headaches, but many of these remedies either do not work as needed, or simply mask an underlying condition.
In one of the largest studies of its kind to date, a team of investigators in Italy examined the effectiveness of acupuncture versus a variety of pharmacological therapies in treating migraines. Their results, published in a recent issue of the Journal of Traditional Chinese Medicine,2 revealed that patients given acupuncture experienced fewer migraine episodes, missed fewer days from work, and suffered no side effects compared to patients on conventional drug therapy. They also found acupuncture to be more cost-efficient, estimating a savings of hundreds of millions of dollars in private and social health expenditures if it were used to treat headaches alone instead of drugs.
A total of 120 subjects with a history of migraine headaches (without aura) were divided into two treatment groups of 60 patients each. The first group was treated with acupuncture (a maximum of three courses of 10 treatments twice a week, with a one-week break between each course). Acupuncture needles were applied to five points -- ST8; GB5; GB20; GV14; and LU7 -- with practitioners using the reducing method.
The second group of patients received drug therapy consisting of two or three treatments using a variety of pharmaceutical products (flunarizine; nimodipine; dihydroergotamine; lisuride; sumatriptam; or amitriptiline). A subgroup of pharmaceutical patients received a drug called longastatine, along with electrical stimulation.
All patients received a 30-minute medical examination at the beginning of the study, with 15-minute examinations at intervals of three, six and 12 months. For the month prior to the start of care, and for 12 months following the first course of treatment, patients were also given a set of monthly time-sheets and asked to track several criteria, including the duration and severity of symptoms; general psychological and physical condition; side-effects; and work absences.
To measure the daily impact of migraines, the researchers assigned values to the frequency, duration and severity of migraine symptoms. One unit of value was noted for each hour a patient had a migraine. If the migraine caused moderate pain, another unit was added; if the pain was intense, two units were added. Another unit was added if the migraine lowered the patient's quality of life during that hour; two units were added if the patient became bedridden because of the condition. At the end of each month, the units were totaled and expressed as a negative number, indicating the extent to which a patient's quality of life had been affected by migraine attacks.
Statistical analysis of the groups found that acupuncture improved the symptoms of migraine without aura "more significantly" than any type of pharmacological therapy. Total symptom scores in the acupuncture group dropped more than 7,800 points from the start of study to six months after the first treatment; in comparison, scores in the drug therapy group dropped less than 4,500. Twelve months after the start of the study, total symptoms scores for patients using drug therapy were still nearly twice those compared to subjects treated with acupuncture
These variations were also seen on an individual patient basis Six months after receiving their first treatment, the average migraine value for a patient in the drug therapy group was 65.45, a reduction of nearly 46% from the start of care. For those in the acupuncture group, however, the results were even more dramatic: the average acupuncture patient's migraine values decreased nearly 80%, from 163.72 at the start of the study to just 33.17 six months later. Acupuncture patients also experienced considerably fewer absences from work in the second six months of treatment compared to drug therapy patients.
The study also indicates that, contrary to those who would like to pigeonhole acupuncture into the realm of pain relief (and little else), it can do much more than just treat a painful condition. If research is conducted professionally and treatment is applied properly, acupuncture's reach can extend beyond the walls of a clinic or pain center to have a positive effect on a nation's social and financial well-being as well.
1. NHF Headache Facts. Available from the National Headache Foundation (http://www.headaches.org/).
2. Liguori A, Petti F, Bangrazi A, Camaioni D, Guccione G, Pitari GM, Bianchi A, Nicoletti WE. Comparison of pharmacological treatment versus acupuncture treatment for migraine without aura - analysis of sociomedical parameters. J Tradit Chin Med 2000;20(3):231-40.
Editor's note: If you would like to comment on this article, please contact Acupuncture Today by fax (714-899-4273