Exploring the effectiveness of acupuncture in migraine

Abstract

Overview: Migraine is a moderate or severe unilateral pulsating headache, often accompanied by a variety of symptoms (Ferrari, 1998; Cady & Dowson, 2002; Teri, 2016). It affects 10-12% of the general adult population (Teri, 2016) and is one of the world’s most disabling illnesses (Silberstein, 2004), implying an undesirable impact on the personal, social, physical and mental functioning (Blau, 1987; Cady & Dowson, 2002; Loder & Marcus, 2004) and direct and indirect healthcare costs are tremendous (Cady & Dowson, 2002; Silberstein, 2004; Da Silva, 2015). Pharmacological treatment is often used, however causes side-effects and a substantial percentage of migraineurs are unsatisfied with treatment (Silberstein, 2004). Acupuncture has been used to treat migraine for millennia by the Chinese and may provide an alternate and effective option to migraineurs (Allais et al., 1999; Cabioglu & Cetin, 2008). However, reviews have concluded that the effectiveness of acupuncture for migraine remains unclear and authors called for randomized controlled trials with higher methodological qualities and larger populations (Griggs & Jensen, 2006; Wu, 2009). In addition, a pattern suggested that modern trials tend to have better structures and methodological qualities than older studies (Griggs & Jensen, 2006). Aims and Objectives: The aim of this literature review was therefore to collect and evaluate the most recent trials concerning acupuncture and migraine, and their outcomes. The intention was to provide readers with the most up-to-date findings in this field, while identifying gaps in research. Inclusion and Exclusion Criteria: Only randomized controlled trials about acupuncture and migraine, concerning humans, published in English and from 2010 onwards, were included. Search Outcome: Sixteen randomized controlled trials were found. Assessments of Trials: Evaluation of trials was done individually, involving a critical appraisal with the Jadad Scale, STRICTA Guidelines and CONSORT Checklist. Outcomes and Conclusions: More recent trials had indeed improved methodological qualities when compared to older studies. On a general note, ‘true’ acupuncture produced an analgesic effect and resulted more effective than ‘sham’ acupuncture and Western pharmacotherapy. The duration of acupuncture’s effects, however, appear to be short-lasting. The beneficial effects of applications of further manipulations and stimulations for migraine (such as electro-acupuncture), remains yet to be explored. It is suggested that brain regions involved in pain mechanisms are activated when migraineurs are treated with acupuncture. It seems that most acupuncturists follow similar protocols of needling for migraine, and the most common points used were listed and explained. Implications and Recommendations: Acupuncture for migraine was deemed as a safe practice, providing more or same benefits as pharmacological treatment with less adverse side-effects for patients, hence, it is highly recommended that acupuncture is included within the healthcare system as one of the treatment options for migraineurs. Moreover, acupuncturists could use this review as a reference for evidence-based material and to help them provide the best care for their patients. More studies related to migraine need to be done in order to further assess the implication of acupuncture on pain threshold, costs and duration of therapeutic effects. Moreover, the applications of further stimulations and manipulations with acupuncture versus acupuncture alone for migraine need to be tested. However, high quality, uniform trials are essential in order to be able to draw firm conclusions on these aspects.