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Acupuncture Treatment No More Effective Than Sham Treatment in Reducing Migraine Headaches

CHICAGO - Migraine patients who received true acupuncture had no decrease in headaches as compared with those who received sham acupuncture treatment, according to a study in the May 4 issue of JAMA.

Migraine is a common and disabling condition that typically includes attacks of severe, pulsating, 1-sided headaches, often accompanied by nausea and sensitivity to sound and light, according to background information in the article. Population-based studies suggest that 6 percent to 7 percent of men and 15 percent to 18 percent of women experience migraine headaches. Many patients require interval treatment as attacks occur often or are insufficiently controlled. Drug treatment with beta-blockers, calcium antagonists, or other agents has been shown to reduce the frequency of migraine attacks; however, the success of treatment is usually modest and tolerability often suboptimal. Acupuncture is widely used for preventing migraine attacks although its effectiveness has not yet been fully established.

Klaus Linde, M.D., of the Centre for Complementary Medicine Research, Technische Universitt Munich, Germany, and colleagues investigated whether acupuncture reduced headache frequency more effectively than sham acupuncture or no acupuncture in patients with migraines. The study consisted of a three-group, randomized, controlled trial (April 2002-January 2003) involving 302 patients (88 percent women), average age 43 years, with migraine headaches, based on International Headache Society criteria. Patients were randomized to either acupuncture, sham acupuncture, or waiting list control. Acupuncture and sham acupuncture were administered by specialized physicians and consisted of 12 sessions per patient over 8 weeks. The sham treatment consisted of needles placed at non-acupuncture points. Patients were treated at 18 outpatient centers in Germany. Patients completed headache diaries from 4 weeks before to 12 weeks after randomization and from week 21 to 24 after randomization.

The researchers found that between baseline and weeks 9 to 12, the average number of days with headache of moderate or severe intensity decreased by 2.2 days from a baseline of 5.2 days in the acupuncture group compared with a decrease to 2.2 days from a baseline of 5.0 days in the sham acupuncture group, and by 0.8 days from a baseline of 5.4 days in the waiting list group. No difference was detected between the acupuncture and the sham acupuncture groups while there was a difference between the acupuncture group compared with the waiting list group (1.4 days). The proportion of responders (reduction in headache days by at least 50 percent) was 51 percent in the acupuncture group, 53 percent in the sham acupuncture group, and 15 percent in the waiting list group.

"In conclusion, in our trial, acupuncture was associated with a reduction of migraine headaches compared with no treatment; however, the effects were similar to those observed with sham acupuncture and may be due to nonspecific physiological effects of needling, to a powerful placebo effect, or to a combination of both," the authors write.

(JAMA. 2005;293:2118-2125. Available post-embargo at JAMA.com)

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