• Discuss with migraine patients that acupuncture might do just as well for them as drug therapy.
• Explain that drug therapy, like acupuncture, might also halve the number of days with a migraine headaches.

ESSEN, Germany, March 2 – With acupuncture for migraine, apparently it’s the needles that make the point.

Acupuncture for migraine patients proved as effective as standard drug therapy in reducing the number of attacks — but so did sham acupuncture, according to a German study.

The report, published online March 2 byTheLancet Neurology, presented the findings from the German Acupuncture Trials migraine study, a randomized, controlled trial of 960 patients with two to six serious migraine attacks a month.

In the study, patients were assigned to one of three groups. There were 313 patients in the group getting traditional Chinese verum acupuncture, which includes obligatory points plus additional ones chosen by the physician.

Drug prophylaxis was the treatment for 308 patients, while 339 got sham acupuncture given at non-traditional Chinese needling points, according to Hans-Christoph Diener, M.D., at the University of Essen here and colleagues.

Patients received 10 sessions of acupuncture over six weeks or continuous drug prophylaxis. Drugs included beta-blockers, Sibelium (flunarizine), and valproic acid.

The primary outcomes after 26 weeks showed a mean reduction of 2.3 days (95% CI 1.9-2.7) in the Chinese verum group; 1.5 days (95% CI 1.1 to 2.0) in the sham acupuncture group, and 2.1 days (95% CI 1.5-2.7) in the drug therapy group, the researchers said.

These differences, Dr. Diener said, were statistically significant compared with baseline (P< 0.0001), but not across the treatment groups (P=0.09).

Six months after randomization, the number of patients reporting at least a 50% reduction in the number of migraine days was 47% in the Chinese verum group, 39% in the sham group, and 40% in the standard therapy group (P=0.133).

Patients enrolled in the study had between two and six migraine attacks in four weeks, lasting four to 72 hours without acute medication or at least two hours with medication, the researchers said. In addition, two other migraine characteristics had to be met and at least one of the following: nausea, vomiting, or light or sound phobias.

A strength of the study, Dr. Diener said, is its large, randomized controlled design. He also cited the availability of highly competent physicians performing acupuncture.

Among limitations, he said, were that acupuncture was restricted to needling only, and that the number of treatments was limited to between 10 and 15. Also, a relatively high number of patients dropped out in the drug treatment group prior to receiving therapy, having originally expected to receive acupuncture.

A surprising result was the efficacy of sham acupuncture, the researchers wrote. “Ultimately, one could argue that the efficacy of treatment, especially a treatment with almost no adverse events or contraindications, is more important than the knowledge of the mechanism of action of this particular therapy,” Dr. Diener concluded. “The decision whether acupuncture should be used in migraine prevention remains with the treating physician.”

Primary source: The Lancet Neurology Online March 2, 2006