Acupuncture vs. Medication for Migraine Relief: Key Studies

Introduction and Research Purpose

Migraines can be so severe that they become debilitating. They interrupt the daily activities of sufferers and, in some cases, can cause the individual to become violently ill. What is the most beneficial method for treating migraines? Is acupuncture an appropriate method for bringing relief to a woman suffering from terrible migraine attacks? Or is traditional medication the better approach? What are the side effects of acupuncture compared to those of traditional medications?

This paper examines those issues and presents a summary of the findings. The topic was chosen because the number of people who suffer from migraines is significant, and the apparent lack of appropriate strategies to reduce migraine pain is deeply problematic for those individuals who are suffering. Hence, the need for thorough research to determine how healthier outcomes could be achieved for those living with migraines.

The methods used in this paper include searching databases for scholarly, peer-reviewed articles reporting empirical studies relevant to this topic. The databases searched include EBSCOHost and GALE Cengage Learning Power Search. The search was limited to journal articles containing empirical investigations and results; each article selected employed a different set of variables and tested acupuncture combined with prescription medications or acupuncture alone.

The five articles located that pertain precisely to the research question are as follows:

Study One: "Reporting of Clinical Details in Randomized Controlled Trials of Acupuncture for the Treatment of Migraine/Headaches and Nausea/Vomiting" (Elorriaga Claraco et al., 2003), published in the Journal of Alternative and Complementary Medicine. This empirical study investigated 30 randomized controlled trials to determine the degree of reporting of clinical details in those trials.

Study Two: "Traditional Acupuncture in Migraine: A Controlled, Randomized Study" (Facco et al., 2008), published in Headache: The Journal of Head & Face Pain. This research reports a study of 127 patients suffering from migraines "without aura" — aura refers to unusual symptoms that appear prior to the actual migraine in some sufferers. Patients were divided into four groups, some tested with "true acupuncture" (TA) and the drug Rizatriptan, and others with various combinations of TA and Rizatriptan.

Methods and Study Selection

Study Three: "Acupuncture for Treating Acute Attacks of Migraine: A Randomized Controlled Trial" (Li et al., 2009), published in Headache: The Journal of Head & Face Pain. The authors used 175 patients divided into three groups. One group received "verum acupuncture" (14 to 20 needles inserted approximately 1.5 inches deep) and two groups received "sham acupuncture" (needles inserted randomly and not as deeply as with verum acupuncture).

Study Four: "Long-Term, Open-Label Safety Study of Oral Almotriptan 12.5 mg for the Acute Treatment of Migraine in Adolescents" (Berenson et al., 2010), published in Headache: The Journal of Head & Face Pain. The study focused on adolescents aged 12 to 17 and was conducted over a 12-month period using the medication almotriptan.

Study Five: "The Effectiveness of Acupuncture for Chronic Daily Headache: An Outcomes Study" (Plank & Goodard, 2009), published in Military Medicine. This article notes that up to 34.9% of female soldiers and 17.4% of male soldiers are known to suffer from frequent migraines. The study used 26 subjects who had been suffering from chronic daily migraines, and the research encompassed a twelve-week period before acupuncture treatment and a twelve-week period following it.

Target Population: A study of 30 previously conducted trials using acupuncture, involving patients in a number of different contexts.

Study Design: The authors investigated how thoroughly 30 trials reported clinical details on acupuncture efficacy, using a checklist of 50 clinical details they hoped to find in the studies examined.

Outcome Measured: The study found that, on average, 38.7% of important clinical details for each of the 30 trials were either fully or partially reported.

Statistical Outcome: The lowest number of important clinical details found across the 30 trials was 26.4%. Only 16.7% of trial studies provided reliable information, and just 13.3% demonstrated clinical significance.

Side Effects: Side effects from the 30 clinical trials were not reported in this paper.

Study Limitations: The study did not attempt to assess the actual clinical quality or appropriateness of the measures examined, but simply noted either the presence or absence of reporting on those issues.

Summary of Study Findings

Target Population: 160 patients who had suffered from migraines without aura; all were "homogeneous as regards sex and age."

Study Design: A randomized, controlled study conducted over six months with sessions twice a week. Group 1 received true acupuncture plus Rizatriptan; Group 2 received ritualized mock acupuncture and Rizatriptan; Group 3 received standard mock acupuncture plus Rizatriptan; and Group 4 received only the drug.

Outcome Measured: All groups experienced a decrease in migraine pain at both three months and six months, but the group receiving true acupuncture combined with Rizatriptan showed a "significant improvement" at both time points.

Statistical Outcome: The reduction in pain averaged 36% across three and six months. Only the true acupuncture group experienced long-lasting effects. The group that received only the drug saw improvement (p > .0001).

Side Effects: Some participants dropped out due to complications unrelated to migraine headaches.

Study Limitations: No concluding questionnaire was administered, which "may be a limit of the study."

Target Population: 175 individuals with migraines recruited into three groups to receive either verum acupuncture or sham acupuncture.

Study Design: One group received verum acupuncture and two other groups received sham acupuncture. Each patient received one treatment and was observed over a 24-hour period. The outcome measure was the difference in Visual Analog Scale (VAS) pain scores before treatment and at 0.5, 1, 2, and 4 hours following treatment.

Outcome Measured: Significant decreases in VAS scores were observed for both sham and verum acupuncture at the fourth hour after treatment. A decrease was also recorded at the second hour after treatment.

Statistical Outcome: At the fourth hour, VAS scores decreased by a median of 1.0 cm in the verum group and 0.1 cm in sham groups 1 and 2. All three groups experienced pain reduction at the second hour; at that time point, only the verum group showed a VAS reduction of 0.7 cm. All three groups experienced pain relief, but verum acupuncture proved more effective than sham.

Side Effects: No noticeable side effects were reported in this study.

Study Limitations: There was a lack of comparable baseline values from four weeks before randomization and a difference in the duration of disease among subjects, which introduced somewhat skewed outcomes between the control groups.

Target Population: Adolescents between the ages of 12 and 17; 447 adolescents participated.

Study Design: Participants were asked to record their migraines, the frequency of taking almotriptan, and the results from the medication over a 12-month period.

Outcome Measured: The use of almotriptan was "well tolerated" by the adolescents over the 12-month study period.

Statistical Outcome: 40.5% of treated migraines were pain-free at two hours; 65% of treated migraines were pain-free at 24 hours.

Side Effects: 282 participants suffered one or more adverse effects (AEs); eight had "serious" AEs, but none of the AEs were attributed to almotriptan.

Study Limitations: The study involved adolescents only; it would be informative to examine how almotriptan performs in older populations.

Target Population: Military personnel who had been suffering from chronic daily headaches.

Study Design: Each of the 26 subjects received eight sterile, disposable steel acupuncture needles in a 30-minute session, twice a week for four weeks.

Outcome Measured: The effects of pain reduction remained below baseline 12 weeks after the last acupuncture treatment.

Statistical Outcome: The number of days migraines impacted soldiers prior to treatment was 61; after treatment, that number fell to 37.

Side Effects: Patients reported pain, bruising, and bleeding (19 occurrences); anxiety and fatigue (10 occurrences); nausea (7 occurrences); and insomnia (1 occurrence).

Study Limitations: Only 26 individuals were used in this research, and a soldier may not be considered a representative sample of the broader working population.

Conclusion and Recommendations

This research needs to be more widely published and disseminated through the media and in healthcare venues, because there is still a great deal of reticence in the general public about having needles inserted into the body to reduce headaches — or to mitigate any bodily pain. The reluctance to use acupuncture may be due simply to ignorance of the subject, or to a bias against medical techniques associated with traditional Chinese medicine.