Acupuncture is effective for the prevention of migraine without aura

Reference

Xu S, Yu L, Luo X, et al. Manual acupuncture versus sham acupuncture and usual care for prophylaxis of episodic migraine without aura: multicentre, randomised clinical trial. BMJ 2020;368:m697.

Synopsis

This study enrolled 150 patients (82% women, average age 36 years) given a diagnosis by a neurologist in 1 of 7 hospitals in China of episodic migraine without aura. None of the patients had been treated with acupuncture previously. The patients were randomized, using concealed allocation, to receive true acupuncture, sham acupuncture, or usual care alone for 8 weeks, with follow-up for an additional 12 weeks. The acupuncture regimens were intense: 30-minute sessions every other day for 10 sessions followed by a nine-day break, then another 10 of the every-other-day sessions. Sham acupuncture was administered to the back at nonacupuncture points with nonpenetrating needles that elicited a pricking sensation. Usual care consisted of self-management education with diclofenac available for severe pain. Using intention-to-treat analysis, in weeks 13 to 16 (4 weeks after discontinuing treatment), the number of days with migraine decreased by an average 3.5 days with acupuncture as compared with an average 2.4 fewer migraine days for sham acupuncture and 1.0 fewer migraine days for usual care alone (P <.001), starting from a baseline of approximately 6 migraine days per month. Rates were similar in weeks 17 through 20. The number of migraine attacks, which averaged approximately 4 per month at baseline, decreased in weeks 13 to 16 similarly in true and sham acupuncture groups (-2.1 and -2.7) as compared with usual care alone (-0.7) and acupuncture was superior to sham acupuncture and usual care alone in weeks 17 to 20 (-2.3 vs -1.6 and -0.4; P <.001). The average acupuncture expectancy scale score was 10 out of a possible 20, which is lower than average for patients in China who receive acupuncture , which argues against the results being due to placebo effect.