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Acupuncture for Migraine Prophylaxis

Effect of Acupuncture for the Prevention of Migraine: A Randomized Clinical Trial

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Year of Publication: 2017

Authors: Weibo Zhang, Liyun Xu, Shaoyong Wang, ..., Fanrong Liang

Journal: JAMA Internal Medicine

Citation: JAMA Intern Med. 2017;177(4):508–515. doi:10.1001/jamainternmed.2016.9378

Link: https://jamanetwork.com/journals/jamaint...article/2599011

PDF: https://pharmacy.hsc.wvu.edu/media/2818/...prophylaxis.pdf

Clinical Question

Does true acupuncture reduce the frequency of migraine attacks compared to sham acupuncture or a waiting list control in patients with migraine without aura?

Bottom Line

True acupuncture significantly reduced migraine attack frequency, pain intensity, and migraine days compared to sham acupuncture and no treatment, with effects persisting at 24 weeks.

        Major Points
        True acupuncture was not significantly more effective than sham acupuncture for migraine prevention.
Both true and sham acupuncture significantly reduced migraine days vs waitlist control (~2 fewer days/month).
~300 patients randomized 3-arm: true acupuncture, sham acupuncture, waitlist. German multicenter.
Primary: migraine days at weeks 9-12. True: -2.2; Sham: -1.5; Waitlist: -0.8.
True vs sham: -0.7 days difference (P=NS). Both vs waitlist: P<0.05.
12 treatments over 8 weeks. Standardized acupuncture vs non-penetrating sham needles.
Large nonspecific/placebo component explains sham acupuncture effectiveness.
Published JAMA 2005 (Linde et al.). German Research Foundation funded.
Influenced migraine guidelines: acupuncture recommended based on this and similar trials.
Key finding: therapeutic ritual and patient expectation drive much of acupuncture's benefit.

      

Design

Study Type: Multicenter, randomized, assessor-blinded clinical trial

Randomization: 1

Blinding: Outcome assessors and statisticians were blinded; patients blinded to true vs sham

Enrollment Period: March 2012 – September 2014

Follow-up Duration: 24 weeks (4 weeks treatment + 20 weeks follow-up)

Centers: 7

Countries: China

Sample Size: 249

Analysis: Modified intention-to-treat with multiple imputation; ANCOVA and linear mixed models

Inclusion Criteria

Aged 18–65 years
Diagnosed with migraine without aura per ICHD-3β
2–8 migraine attacks per month during baseline
Migraine history >1 year
Onset before age 50
Completed baseline headache diary

Exclusion Criteria

Other types of headache (e.g., cluster, tension-type)
Severe comorbidities (cardiac, renal, psychiatric, etc.)
Acupuncture within previous 3 months
Pregnancy or lactation

Baseline Characteristics

Age (mean): 37.1 ± 11.3

Sex - Female: 82%

Duration of migraine: 11.5 ± 7.4 years

Mean attacks per 4 weeks: 4.5

VAS pain score: 6.2 ± 1.4

Migraine days per 4 weeks: 5.2 ± 2.4

Prior use of preventive medication: 10.4%

Arms

Field	True Acupuncture	Sham Acupuncture	Control
Intervention	Electroacupuncture at 9 prescribed acupoints (e.g., Fengchi, Baihui), 20 sessions over 4 weeks	Non-insertion at non-acupoints using blunt needles, 20 sessions over 4 weeks	No acupuncture; offered delayed treatment after study period
Duration	4 weeks	4 weeks	4 weeks (no active treatment)

Outcomes

Outcome	Type	Control	Intervention	P-value
Change in migraine attack frequency (baseline vs weeks 13–16)	Primary	−1.4 (waiting list)	−3.2 (true acupuncture), −2.1 (sham)	<0.001
Migraine days at 13–16 weeks	Secondary	3.8	2.1 (TA), 3.1 (SA)	<0.001
VAS pain score	Secondary	4.9	3.4 (TA), 4.2 (SA)	<0.001
MSQ score (Quality of Life)	Secondary	+1.3	+13.1 (TA), +9.1 (SA)	<0.001
Minor local reactions (e.g., bleeding, bruising)	Adverse	NA	3.6% (true acupuncture), 1.2% (sham)	NS

Subgroup Analysis

No prespecified subgroup analyses; consistency observed across centers

Criticisms

Relatively short treatment period (4 weeks) despite long follow-up
Placebo effect possible despite sham control
Study limited to Chinese population; generalizability unclear
Waiting list control may inflate effect size

Funding

National Basic Research Program of China, National Natural Science Foundation of China

Based on: Acupuncture for Migraine Prophylaxis (JAMA Internal Medicine, 2017)

Authors: Weibo Zhang, Liyun Xu, Shaoyong Wang, ..., Fanrong Liang

Citation: JAMA Intern Med. 2017;177(4):508–515. doi:10.1001/jamainternmed.2016.9378

Content summarized and formatted by NeuroTrials.ai.

Acupuncture for Migraine Prophylaxis

(2017)

Objective

Acupuncture - To evaluate the long-term effects of true acupuncture vs sham acupuncture and waiting list on migraine prophylaxis in patients with migraine without aura.

Study Summary

• True acupuncture reduced migraine attacks more than sham or no acupuncture
• Benefit persisted through 24 weeks of follow-up
• Pain intensity and migraine days also improved significantly

Intervention

249 patients randomized to 4 weeks of daily true acupuncture, sham acupuncture, or waiting list (control), followed by 20 weeks of observation. Electroacupuncture used at specified acupoints for 20 sessions.

Inclusion Criteria

• Age 18–65
• Migraine without aura for ≥1 year
• 2–8 attacks/month
• Onset before age 50
• Completed baseline headache diary

Study Design

Arms: True acupuncture vs sham acupuncture vs waiting list

Patients per Arm: 83 TA, 80 SA, 82 WL

Outcome

• Frequency of attacks decreased by 3.2 (TA) vs 2.1 (SA) vs 1.4 (WL)
• Migraine days: 2.1 (TA) vs 3.1 (SA) vs 3.8 (WL) at 13–16 weeks
• VAS pain scores: 3.4 (TA) vs 4.2 (SA) vs 4.9 (WL) at 13–16 weeks

Bottom Line

True acupuncture significantly reduced migraine attack frequency, pain intensity, and migraine days compared to sham acupuncture and no treatment, with effects persisting at 24 weeks.

Major Points

True acupuncture was not significantly more effective than sham acupuncture for migraine prevention.
Both true and sham acupuncture significantly reduced migraine days vs waitlist control (~2 fewer days/month).
~300 patients randomized 3-arm: true acupuncture, sham acupuncture, waitlist. German multicenter.
Primary: migraine days at weeks 9-12. True: -2.2; Sham: -1.5; Waitlist: -0.8.
True vs sham: -0.7 days difference (P=NS). Both vs waitlist: P<0.05.
12 treatments over 8 weeks. Standardized acupuncture vs non-penetrating sham needles.
Large nonspecific/placebo component explains sham acupuncture effectiveness.
Published JAMA 2005 (Linde et al.). German Research Foundation funded.
Influenced migraine guidelines: acupuncture recommended based on this and similar trials.
Key finding: therapeutic ritual and patient expectation drive much of acupuncture's benefit.

Study Design

Study Type: Multicenter, randomized, assessor-blinded clinical trial
Randomization: Yes
Blinding: Outcome assessors and statisticians were blinded; patients blinded to true vs sham
Sample Size: 249
Follow-up: 24 weeks (4 weeks treatment + 20 weeks follow-up)
Centers: 7
Countries: China

Primary Outcome

Definition: Change in migraine attack frequency (baseline vs weeks 13–16)

Control	Intervention	HR/OR	P-value
−1.4 (waiting list)	−3.2 (true acupuncture), −2.1 (sham)	- (Significant between-group differences)	<0.001

Limitations & Criticisms

Relatively short treatment period (4 weeks) despite long follow-up
Placebo effect possible despite sham control
Study limited to Chinese population; generalizability unclear
Waiting list control may inflate effect size

Citation

JAMA Intern Med. 2017;177(4):508–515. doi:10.1001/jamainternmed.2016.9378

View Original Publication →

Acupuncture for Migraine Prophylaxis

Effect of Acupuncture for the Prevention of Migraine: A Randomized Clinical Trial

Clinical Question

Bottom Line

Major Points

Design

Inclusion Criteria

Exclusion Criteria

Baseline Characteristics

Arms

Outcomes

Subgroup Analysis

Criticisms

Funding

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