Migraine and Acupuncture

According to the Migraine Trust 190,000 people will suffer a migraine attack today in the U.K. Thats a pretty staggering statistic and often it can be very debilitating to the sufferer.

So what is a migraine?

Migraine is a complex condition with a wide variety of symptoms. For many people the main feature is a painful headache. Other symptoms include disturbed vision, sensitivity to light, sound and smells, feeling sick and vomiting. Migraine attacks can be very frightening and may result in you having to lie still for several hours.The symptoms will vary from person to person and individuals may have different symptoms during different attacks. Your attacks may differ in length and frequency. Migraine attacks usually last from 4 to 72 hours and most people are free from symptoms between attacks. Migraine can have an enormous impact on your work, family and social lives.

Are there different types of Migraine?

There are different types of migraine. In 1988 the International Headache Society produced a classification system for migraine and headache which has been adopted by the World Health Organisation. This has been updated since then and is the established basis for defining types of headaches. The International Classification of Headache Disorders system gives different names to the different types of migraine and headache that involve different symptoms. This helps doctors to diagnose and treat them.

The most common types of migraine fall into two categories:

• migraine with aura
• migraine without aura.

The ‘migraine with aura’ label is also used for some of the rarer forms of migraine, which also have another name. These include migraine with brainstem aura, where symptoms such as loss of balance, double vision, or fainting can occur. Familial hemiplegic migraine, where reversible paralysis occurs, is also classed as ‘migraine with aura’. There are other rare forms of migraine, which are classed separately.Not everyone will have a ‘typical’ migraine. The experience of the condition will be unique to you.

Many patients are prescribed medications by a Doctor

They fall into two categories:

1. Acute
Non Steroidal anti-Inflammatories such as Aspirin, Ibuprofen, Diclofenac, Naproxen, Tolfenamic Acid, Flurbiprofen. Other painkillers such as Paracetamol and codeine phosphate.

2. Prophylactic
Sumatriptan, Almotriptan, Eletriptan, Frovatriptan, Naratriptan, Rizatriptan, Zolmitriptan, Ergot Alkaloids, Isometheptene mutate.

However many people want to avoid taking drugs and other treatment are available.

Acupuncture has been demonstrated to be effective. Acupuncture studies in headache have concentrated almost entirely on the prevention of headache rather than acute treatment. A Cochrane systematic review first published in 2001 analysed 16 studies involving 1151 patients and concluded that ‘the existing evidence supports the value of acupuncture for the treatment of idiopathic headaches’, but called for further large-scale studies. Large, randomised controlled clinical trials involving several thousand patients have now been conducted, funded by German health insurance companies. These studies have compared acupuncture with standard treatment (drugs and advice given by physicians) and demonstrate persistent and clinically relevant benefits under real-life conditions and equivalence to specialist drug management. However, no convincing evidence of superiority to ‘sham’ acupuncture has been shown for headache. To skeptics, this suggests that ‘acupuncture doesn’t work’ (i.e. ‘it is no better than placebo’). To supporters of acupuncture, it suggests that while the studies show that it may not matter quite so much how the acupuncture is done, i.e. where the needles are placed or how deeply, acupuncture is much better than no treatment and equivalent to conventional treatment options, with considerably fewer side-effects.

In so-called ‘pragmatic’ studies, the real-world effectiveness of acupuncture has been assessed when given in addition to usual treatment. Patients are randomized to ‘acupuncture’ or ‘no additional treatment (standard GP management) without the use of a placebo. In one such study, patients suffering with chronic headache (80% with migraine) were given 12 sessions of acupuncture over 3 months. This resulted in 34% fewer headache days, 15% less medication, 15% fewer days off work and 25% fewer GP visits after one year. The cost-effectiveness, expressed per ‘quality-adjusted life year’ (QALY), the recommended measure, was £9000 per QALY, well under the threshold of £20-30 000 per QALY) required by the National Institute of Clinical Effectiveness (NICE). These results have been repeated in Europe.

The National Institute for Health and Care Excellence (NICE) include in their headache guideline (2012, updated 2015) that a course of up to 10 sessions of acupuncture may be offered by a healthcare professional if neither topiramate or propranolol are suitable or work well for a particular patient. However, there is no mandate for health professionals to prescribe acupuncture. In practice its availability on the NHS is inconsistent.

Linde K et al. Acupuncture for migraine prophylaxis. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD001218.
Diener HC. et al. Efficacy of acupuncture for the prophylaxis of migraine: a multicentre randomised controlled clinical trial. Lancet Neurol. 2006 Apr;5(4):310-6.
Linde K, Streng A, Jurgens S, Hoppe A, Brinkhaus B, Witt C et al. Acupuncture for patients with migraine: a randomized controlled trial. JAMA 2005;293(17):2118-25.
Vickers A. et al. Acupuncture for chronic headache in primary care: large, pragmatic, randomised trial BMJ 2004;328;744-9.
Wonderling D et al. Cost effectiveness analysis of a randomised trial of acupuncture for chronic headache in primary care. BMJ 2004;328;747.
National Institute for Health and Care Excellence. Headaches in over 12s: diagnosis and management (NICE guidelines [CG 150]). 2012 (updated 2015).