Acupuncture vs. Pharmacological Prophylaxis of Migraine: A Systematic Review of Randomized Controlled Trials

Abstract

Introduction: Migraine is a chronic paroxymal neurological disorder characterized by attacks of moderate to severe headache and reversible neurological and systemic symptoms. Treatment of migraine includes acute therapies, that aim to reduce the intensity of pain of each attack, and preventive therapies that should decrease the frequency of headache recurrence. The objective of this systematic review was to assess the efficacy and safety of acupuncture for the prophylaxis of episodic or chronic migraine in adult patients compared to pharmacological treatment. Methods: We included randomized-controlled trials published in western languages that compared any treatment involving needle insertion (with or without manual or electrical stimulation) at acupuncture points, pain points or trigger points, with any pharmacological prophylaxis in adult (≥18 years) with chronic or episodic migraine with or without aura according to the criteria of the International Headache Society. Results: Nine randomized trials were included encompassing 1,484 patients. At the end of intervention we found a small reduction in favor of acupuncture for the number of days with migraine per month: (SMD: -0.37; 95% CI -1.64 to -0.11), and for response rate (RR: 1.46; 95% CI 1.16-1.84). We found a moderate effect in the reduction of pain intensity in favor of acupuncture (SMD: -0.36; 95% CI -0.60 to -0.13), and a large reduction in favor of acupuncture in both the dropout rate due to any reason (RR 0.39; 95% CI 0.18 to 0.84) and the dropout rate due to adverse event (RR 0.26; 95% CI 0.09 to 0.74). Quality of evidence was moderate for all these primary outcomes. Results at longest follow-up confirmed these effects. Conclusions: Based on moderate certainty of evidence, we conclude that acupuncture is mildly more effective and much safer than medication for the prophylaxis of migraine.

Keywords: RCTs; acupuncture—therapy; migraine; pharmacological prophylaxis; systematic review.

Figure 1

PRISMA flow diagram.

Figure 2

Risk of bias assessment.

Figure 3

Forest plot of primary outcomes—results at the end of the intervention. (A) Number of days with migraine per months; (B) Response rate to treatment; (C) Pain intensity.

Figure 4

Forest plot of primary outcomes—results at the end of the intervention. (A) Dropout due to any events; (B) Dropout due to adverse events.

Figure 5

Forest plot of secondary outcomes—results at the end of the intervention. (A) Frequency of migraine attack per month; (B) Disability; (C) Use of rescue medication; (D) Number of subjects with at least one adverse event.

Figure 6

Forest plot of secondary outcomes—results at the end of the intervention. (A) Quality of Life: mental health; (B) Quality of Life: physical health.

Figure 7

Forest plot of primary outcomes—results at longest available follow-up. (A) Number of days with migraine per months; (B) response rate to treatment; (C) Pain intensity.

Figure 8

Forest plot of secondary outcomes—results at longest available follow up. (A) Frequency of migraine attack per month; (B) Disability; (C) Use of rescue medication.

Figure 9

Forest plot of secondary outcomes—results at longest available follow up. (A) Quality of Life: mental health; (B) Quality of Life: physical health.