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Evid Based Nurs 12:47 doi:10.1136/ebn.12.2.47
  • Treatment

Acupuncture reduced frequency and pain intensity of primary migraine or tension-type headaches

S N Willich

Dr S N Willich, Charité University Medical Centre, Berlin, Germany; stefan.willich{at}charite.de

QUESTION

In patients with primary headache, does acupuncture plus routine care improve outcomes more than routine care alone?

METHODS

Design:

randomised controlled trial (Acupuncture in Routine Care study).

Allocation:

concealed.

Blinding:

unblinded.

Follow-up period:

3 and 6 months.

Setting:

primary care setting in Germany.

Patients:

3404 patients ⩾18 years of age (mean age 44 y, 77% women based on 3182 patients) who had primary headache (headaches for >12 mo and ⩾2 headaches/mo). Patients with headache caused by somatic diseases (eg, hypertension, meningioma, or meningoencephalitis) were excluded.

Intervention:

immediate needle acupuncture administered in ⩽15 sessions over 3 months, then no acupuncture for the next 3 months (n = 1711) or no acupuncture for 3 months, then delayed acupuncture for the next 3 months (n = 1693).

Outcomes:

days/month with headache. Other outcomes included percent reduction in headache days at 3 months, and pain intensity {assessed using a numeric rating scale, score range 0–10 [most pain]}.*

Patient follow-up:

84% at 3 months and 82% at 6 months (intention-to-treat analysis).

MAIN RESULTS

48% of patients had migraines, and 46% had tension-type headaches. The main results are in the table.

CONCLUSION

Acupuncture reduced frequency and pain intensity of primary migraine or tension-type headaches.

*Information provided by author.

A modified version of this abstract appears in ACP Journal Club.

ABSTRACTED FROM

Jena S, Witt CM, Brinkhaus B, et al. Acupuncture in patients with headache. Cephalalgia 2008;28:969–79.

Immediate acupuncture v no acupuncture at 3 months and delayed acupuncture at 6 months for primary migraine or tension-type headache

Clinical impact ratings: Complementary care 6/7; Family/general practice 6/7; General/internal medicine 4/7; Neurology 6/7; Pain management 5/7

Footnotes

  • Source of funding: health insurance companies (Techniker Krankenkasse, Betriebskrankenkasse, Handelskrankenkasse, and Innungskrankenkasse).

Commentary

Use of acupuncture in the management of headache is now well established in Western medicine. The study by Jena et al has the advantage of being the largest pragmatic trial of acupuncture, with >15 000 participants, including a non-randomised acupuncture group. Although the sample size was large and randomisation procedures were transparent, there were some study limitations. For example, the diagnosis of “headache type” was not made by specialist practitioners, and no differentiation was made between migraine with or without aura. Furthermore, the data obtained mostly relied on patient memory rather than the more standard use of diaries; although pain intensity was reported, there was no description of a formal pain assessment tool. Instead, the study outcomes focused on the number of headache days. The findings that acupuncture was safe and effective reflect the results of other research in the field.1 The popularity of the treatment among patients is emphasised by the difficulties encountered with recruitment for randomisation, which resulted in a large non-randomised acupuncture group.

Jena at al showed that acupuncture is a safe treatment for migraine and is popular with patients. The same authors have also shown it to be internationally cost-effective2 In 2006, Staud and Price3 suggested that carefully controlled clinical trials were required to provide evidence for use of acupuncture in chronic conditions such as headache. Despite acknowledged limitations, this study has gone some way to developing that evidence.

References

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