If your patients happen to suffer from chronic headaches, they should know that they are not alone. Chronic headache affects approximately one-third of the global population. Furthermore, an estimated 10 million people in the United States visit general practitioners for chronic headache every year. Now, a group of researchers, writing in the December 2008 issue of Anesthesia & Analgesia, has combined data in a unique way to show the strength of evidence for acupuncture to help with this painful problem.
Yanxia Sun, MD, and Tong J. Gan, MB, FRCA, from Duke University in North Carolina, combined data from 31 different studies looking at the effectiveness of acupuncture for treating chronic headache. Combining studies provided them a total of almost 4,000 patients. The obvious advantage to analyzing a large group of studies is that the strength of evidence can be dramatically increased. In order to obtain the pool of studies for analysis, the researchers searched various medical databases for published papers regarding the use of acupuncture to treat chronic headache. Terms such as acupuncture, acupressure, acupoint, electro-acupuncture, headache, tension headache and migraine were used for search purposes. The various trials used a variety of methods including: true versus sham acupuncture (16 trials), acupuncture versus medication treatment (eight trials) and acupuncture versus nonpharmacological treatment (six trials).
True Versus Sham Acupuncture
In combining data from 14 of the 16 studies that compared true and sham acupuncture, the researchers found a significantly higher response rate among patients who received true acupuncture as compared with those who received the sham treatment. Five-hundred and ten of 961 acupuncture patients (53 percent) were classified as responders, compared to 373 of 829 patients (45 percent) receiving sham acupuncture treatment.
Acupuncture Versus Medication
In this collection of studies, the researchers found that patients receiving acupuncture reported significant improvement in headache intensity at early follow-up. Data from seven studies showed that 62 percent of patients receiving acupuncture had a significantly higher response rate to treatment, compared with 45 percent of patients receiving medication at early follow up.
One study found similar effects between acupuncture and physiotherapy for tension-type headache. In looking at two studies that compared acupuncture to "wait-listing," the researchers found that acupuncture treatment was better than wait-listing at both early and late follow-up in terms of both headache frequency and intensity.
The most common side effects that were associated with acupuncture treatments were minor bleeding and bruising at the needle insertion sites. Patients in five studies reported that the needle insertion triggered a migraine attack or headache. Despite this, the researchers felt that the total number of side effects was significantly lower in the acupuncture group compared with medication treatment in three trials.
In looking at the combined data from all 31 of these studies, researchers determined that acupuncture was superior to the other therapies with regard to headache intensity, headache frequency, physical function and response rate. From these findings, they concluded:
"Acupuncture is an effective treatment for chronic headache. Specifically, acupuncture is superior to sham with a significantly higher response rate in patients with migraine and tension-type headache, and it significantly reduced headache intensity at the late follow-up period. When compared with pharmacological and waiting list options, acupuncture was also more effective for reducing headache intensity and frequency."