Systematic Review

Acupuncture vs Standard Pharmacological Therapy for Migraine Prevention

Niushen Zhang, MD; Tim Houle, PhD; Nada Hindiyeh, MD; Sheena K. Aurora, MD

Disclosures

Headache. 2020;60(2):309-317. 

In This Article

Abstract and Introduction

Abstract

Background: Standard pharmacological treatment of migraine has many shortcomings. Acupuncture is becoming a more widely used therapy for the prevention and treatment of migraine, but its effectiveness is still in question when compared to the pharmacological treatments even though very few of these have Class A and B evidence for migraine prevention. This is a systematic review of data from existing randomized trials that compare the effectiveness of acupuncture treatment with conventional migraine preventative medications.

Methods: Custom-designed strategy was used for searching Pubmed (includes MEDLINE), Scopus (includes EMBASE). The inclusion criteria were English language and randomized trials. No date restriction was utilized. We included randomized trials and randomized controlled trials in adult patients that compared the clinical effects of acupuncture with a standard migraine preventive medication in patients with a diagnosis of chronic or episodic migraine with or without aura. We excluded letters and studies on acupuncture for headaches other than migraine. Two reviewers checked eligibility; extracted information on patients, interventions, methods, and results; and assessed the quality of the acupuncture intervention based on the American Academy of Neurology Classification of evidence matrix for therapeutic trials. The present review was not registered.

Results: 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.

Conclusions: 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. However, the heterogeneity of the existing studies limits the effective comparison and analysis.

Introduction

Acupuncture is becoming a more widely accepted form of integrative medicine for the prevention and treatment of migraine in the West. Its mechanism of action does not have a definite explanation, but some studies suggest that acupuncture may have anti-inflammatory action via release of neuropeptides from nerve endings, including calcitonin gene-related peptide (CGRP).[1,2] Other theories suggest that acupuncture may exert analgesic effects by the hypothalamic-pituitary-adrenal axis and the endogenous opioid system which are important mediators of the stress response to pain.[3]

In acupuncture research, true acupuncture is often compared with sham acupuncture. There are many different types of sham acupuncture intervention; these include lack of skin penetration by the needle, shallow penetration of the needle, insertion at points that are not traditional acupuncture points, or not achieving "deqi" which is an expected needling response (subjective sensation of local warmth, paresthesia tenderness) that is considered an integral element of the healing process. The 2016 Cochrane review by Linde is one of the most recent and comprehensive investigations that concluded that acupuncture is more effective than no prophylactic treatment, more effective than sham acupuncture, and as effective as pharmaceutical intervention in reducing the frequency of headaches in patients with episodic migraine.[4] The authors found that acupuncture is at least as effective as, or possibly more effective than, prophylactic drug treatment, and has fewer adverse effects. Since 2016, several new studies appear to support the effectiveness of acupuncture in migraine prevention. This article is a focused, systematic review of high quality, randomized controlled trials that study the effectiveness of acupuncture for the treatment of episodic, or chronic migraine compared to the effectiveness of standard pharmacological therapies for the treatment of migraine. In addition, we examined and summarized point selection, treatment period, total number of treatment sessions, and the frequency of treatments.

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