Randomised study shows acupuncture is effective for migraine prophylaxis

Acupuncture, sham acupuncture and standard prophylactic drug therapy are equally effective for migraine prophylaxis, according to authors of a recent multicentre randomised trial.The trial involved patients who experienced two to six migraines per month and were randomised to receive either Chinese (verum) acupuncture (n = 313), sham acupuncture (needles applied superficially to areas of the skin where there are no known verum acupuncture points; n = 339), or standard prophylactic drugs (beta-blockers, calcium-channel blockers, or antiepileptic drugs; n = 308). Patients randomised to acupuncture received ten sessions over six weeks and patients randomised to standard drug therapy received continuous prophylaxis. A total of 960 patients were randomly assigned to a treatment group, but 125 patients (106 patients from the standard therapy group) withdrew their consent to study participation immediately after randomisation, which the authors explain was primarily due to disappointment at not being randomised to an acupuncture group.In the intention-to-treat population, there was a mean reduction of 2.3 headache days in the verum acupuncture group, 1.5 days in the sham acupuncture group, and 2.1 days in the standard therapy group. The differences in headache days were statistically significant compared to baseline, but there was no significant difference across the treatment groups. The proportion of responders (defined as patients with reduction of migraine days by at least 50%) 26 weeks after randomisation was 47% in the verum group, 39% in the sham acupuncture group, and 40% in the standard therapy group (p = 0.133). The authors note, "The most important result is that all three treatments were effective and that improvement in the number of migraine days was closely similar in all treatment groups." They add that the surprisingly high efficacy of sham acupuncture has been shown in other studies and may point to a powerful placebo effect of acupuncture, but suggest, "Ultimately, one could argue that the efficacy of a treatment, especially a treatment with almost no adverse events or contraindications, is more important than the knowledge of the mechanism of action of this particular therapy."...