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From Dukehealth.org
News
Acupuncture Offers Headache Relief Over Medication
About This Article
Article Details
Published: Dec. 1, 2008
Updated: Dec. 1, 2008
By Duke Medicine News and Communications
Acupuncture is more effective than medication in reducing the severity and frequency of chronic headaches,
according to a new analysis conducted by Duke University Medical Center researchers.
The National Institutes of Health recommended acupuncture as a viable treatment for chronic headaches a decade
ago and, while research in this field has increased, there have been conflicting reports about its efficacy.
"We combed through the literature and conducted the most comprehensive review of available data done to date
using only the most rigorously-executed trials," says Tong Joo (T.J.) Gan, MD, a Duke anesthesiologist who lead the
analysis.
Researchers analyzed data from only randomized controlled trials evaluating acupuncture for adults with chronic
headaches and were conducted for more than four weeks.
"Acupuncture is becoming a favorable option for a variety of purposes ranging from enhancing fertility to decreasing
post-operative pain because people experience significantly fewer side effects and it can be less expensive than
other options," Gan says. "This analysis reinforces that acupuncture also is a successful source of relief from chronic
headaches."
While everyone experiences an occasional headache, more than 45 million Americans (one in six) suffer from chronic
headaches, 20 million of whom are women. Medication remains the mainstay of treatment with varying levels of
success.
The Duke team looked at studies that compared traditional acupuncture to either medication or a control group who
received sham acupuncture. Similar to traditional acupuncture, the sham therapy entails inserting needles into the
skin but the acupuncturist avoids meridians or areas of the body that Chinese medicine teaches contains vital energy
associated with achieving balance needed for good health.
Researchers analyzed more than 30 studies to arrive at the findings published in the December issue of Anesthesia
and Analgesia. The studies included nearly 4,000 patients who reported migraines (17 studies), tension headaches
(10 studies) and other forms of chronic headaches with multiple symptoms (four studies).
In 17 studies comparing acupuncture to medication, the researchers found that 62 percent of the acupuncture patients
reported headache relief compared to only 45 percent of people taking medication. These acupuncture patients also
reported better physical well-being compared to the medication group. In 14 studies that compared real acupuncture
to sham therapy, 53 percent of acupuncture patients responded to treatment compared to 45 percent receiving sham
therapy.
"Acupuncture has been practiced for thousands of years but only recently has started to become more accepted as
an alternative or supplement to conventional therapies," Gan explains.
"One of the barriers to treatment with acupuncture is getting people to understand that while needles are used it is not
a painful experience," Gan says. "It is a method for releasing your body's own natural painkillers."
Acupuncture therapy is becoming widely available nationwide and a typical course of treatment for chronic
headaches requires 30-minute sessions. Many people begin experiencing relief following five to six visits.
Gan also has conducted research to determine the effect of acupuncture on post-operative pain, nausea and
vomiting. His research has found that acupuncture can significantly reduce pain and the need for pain medications
following surgery. He also found that acupuncture can be as effective as medication in reducing post-operative
nausea and vomiting.
The research was conducted in collaboration with Yanxia Sun, MD. The meta-analysis was supported by Duke's
Department of Anesthesiology.
BBC NEWS
Acupuncture 'beats headache pain'
Acupuncture is an effective treatment for chronic headaches and should be more widely available on the NHS,
experts say.
Writing in the British Medical Journal, UK researchers said patients who were given acupuncture had fewer days of
headaches than those who were not.
They also saw their GP less and were not as reliant on painkillers.
The government said doctors could decide to fund the therapy locally, if they felt patients would benefit.
Researchers analysed 401 patients from across the UK who reported several days of severe headaches each week.
They were randomly allocated to receive up to 12 acupuncture treatments over three months or to a control group
offering other types of care, typically medication.
“ This should help to lift acupuncture out of what is seen to be alternative to mainstream medicine ” ---Dr Mike
Cummings, British Medical Acupuncture Society
All patients completed a diary of headache and medication use for four weeks at the start of the study and again at
three months and 12 months.
They recorded the severity of their headaches on a six-point scale to produce an overall score.
Patients receiving acupuncture experienced 22 fewer days of headache per year, used 15% less medication, made
25% fewer visits to their GP and were absent from work through sickness 15% less than the control group.
The researchers, from centres around the UK, wrote that introducing acupuncture services could lead to significant
long-term benefits for patients with chronic headaches.
They added: "Expansion of NHS acupuncture services for headache should be considered."
The medical director of the British Medical Acupuncture Society, Dr Mike Cummings described the study as
"innovative".
NHS approval
He said: "It is very positive for us. This should help to lift acupuncture out of what is seen to be alternative to
mainstream medicine. "I think acupuncture should be more widely available on the NHS - but with a huge rider, only in
areas where it has been shown to have definite benefits. "It is not a panacea for everything. "It should be made
available in primary care to treat pain and to prevent costly referrals to hospitals."
Ailments which respond well to acupuncture include headaches, neck, shoulder and back pain and osteoarthritis in
the knee, he says.
Each week, 10% of GPs in the UK either refer patients to acupuncture or practise it themselves, and chronic
headache is one of the most commonly treated conditions. It shows a growing recognition by the health service of the
benefit of complementary medicine.
A Department of Health spokeswoman said: "The government appreciates that many people find different
complementary medicines, such as acupuncture, helpful in alleviating the symptoms of certain illness, especially those
for which orthodox medicine does not seems to have a complete answer.
"As a result, some complementary and alternative medicine can be made available on the NHS if local NHS clinicians
and commissioning organisations such as primary care trusts are convinced that it will be a clinical and cost effective
use of resources."
Story from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr/-/2/hi/health/3506400.stm
Published: 2004/03/15 03:41:10 GMT
© BBC MMIX
Acupuncture of Chronic Headache disorders
in primary care: randomized controlled trial and economic analysis
Health Technol Assess. 2004 Nov;8(48):iii, 1-35.
Vickers AJ, Rees RW, Zollman CE, McCarney R, Smith CM, Ellis N, Fisher P, Van Haselen R, Wonderling D, Grieve R.
Integrative Medicine Service, Biostatistics Service, Memorial Sloan-Kettering Cancer Center, New York, USA.
OBJECTIVES: To determine the effects of a policy of using acupuncture, compared with a policy of avoiding acupuncture, on
headache in primary care patients with chronic headache disorders. The effects of acupuncture on medication use, quality of
life, resource use and days off sick in this population and the cost-effectiveness of acupuncture were also examined. DESIGN:
Randomised, controlled trial. SETTING: General practices in England and Wales. PARTICIPANTS: The study included 401
patients with chronic headache disorder, predominantly migraine. INTERVENTIONS: Patients were randomly allocated to receive
up to 12 acupuncture treatments over 3 months or to a control intervention offering usual care. MAIN OUTCOME MEASURES:
Outcome measures included headache score; assessment of Short Form 36 (SF-36) health status and use of medication at
baseline, 3 months and 12 months; assessment of use of resources every 3 months; and assessment of incremental cost per
quality-adjusted life-year (QALY) gained. RESULTS: Headache score at 12 months, the primary end-point, was lower in the
acupuncture group than in controls. The adjusted difference between means was 4.6. This result was robust to sensitivity
analysis incorporating imputation for missing data. Patients in the acupuncture group experienced the equivalent of 22 fewer
days of headache per year. SF-36 data favoured acupuncture, although differences reached significance only for physical role
functioning, energy and change in health. Compared with controls, patients randomised to acupuncture used 15% less
medication, made 25% fewer visits to GPs and took 15% fewer days off sick. Total costs during the 1-year period of the study
were on average higher for the acupuncture group than for controls because of the acupuncture practitioners' costs. The mean
health gain from acupuncture during the year of the trial was 0.021 QALYs, leading to a base-case estimate of GBP9180 per
QALY gained. This result was robust to sensitivity analysis. Cost per QALY dropped substantially when the analysis
incorporated likely QALY differences for the years after the trial. CONCLUSIONS: The study suggests that acupuncture leads to
persisting, clinically relevant benefits for primary care patients with chronic headache, particularly migraine. It is relatively cost-
effective compared with a number of other interventions provided by the NHS. Further studies could examine the duration of
acupuncture effects beyond 1 year and the relative benefit to patients with migraine with compared to tension-type headache.
Trials are also warranted examining the effectiveness and cost-effectiveness of acupuncture in patients with headache receiving
more aggressive pharmacological management.
PMID: 15527670 [PubMed - indexed for MEDLINE]