Manual acupuncture has proven to be an effective treatment for migraine without aura, says a recent study published in the British Medical Journal (BMJ). The researchers believe acupuncture should now be offered as an acceptable evidence-based treatment option to patients who do not respond to conventional pharmaceutical therapy.
— BMJ (@bmj_company) March 26, 2020
A long-term severe headache should not be mistaken for a headache. It can be migraines with or without aura. Migraines without aura are more common (80%) than any other headache disorders which can last from some hours to even a few days. Migraines without aura can be accompanied by pain on a specific side or area of the head, anxiety, depression, sensitivity to light and sound, nauseating feelings, tiredness and the pain can get worse with physical activity. Migraine is more common in women.
Migraine is commonly treated with over-the-counter and prescription drugs such as sumatriptan, rizaptriptan and frovatriptan. Many patients remain treatment-resistant and opt for botulinum toxin (botox) injections to relieve the pain. Acupuncture can be a viable replacement for all such individuals.
Dr. Heather Angus-Leppan, a consultant neurologist at the Royal Free London NHS Foundation Trust in the UK, says:
We now have good evidence that acupuncture is an effective treatment for episodic migraine.
The researchers conducted randomized clinical trials in seven centers in China from June 2016 to November 2018. They screened out a total of 210 participants from which they randomized 150 because of the inclusion criterion. The criterion included those participants that had two and eight migraine attacks during the period of collecting data by the researchers, called the baseline phase.
The patients were divided into three groups, including manual acupuncture group, sham acupuncture group, and usual care group.
Acupuncture is a Chinese technique of inserting needles through the skin to relieve pain. Manual acupuncture is a technique that includes a rotation of the needle in one or both directions that can range from subtle to forceful lifting of the needles. Sham acupuncture involves needling at non-acupunctural points. Usual care is a term used for the group of participants whose treatment can be controlled by the researchers.
The first and second groups comprised 54 patient whereas the usual care group had 27 patients with an average age of 37 years. Researchers lost contact from 4% of the participants during treatment. All patients received 20 sessions and each session was of 30 minutes. Both the manual and sham acupuncture group received treatment after randomization.
Primary Outcomes: The team noticed that manual acupuncture resulted in a significant reduction in migraine days as well as attacks as compared to sham acupuncture and usual care group. The reductions in migraine days and attacks were beginning to appear in the first four weeks after the baseline period and the reduction continued for the last four weeks of follow-ups.
The researchers also stated that those participants who received manual acupuncture treatment had 2.3 fewer migraine attacks a month whereas usual care and the sham group had 0.4 and 1.6 fewer migraine attacks, respectively.
Secondary Outcomes: The team also used some scales to measure the severity of migraines by giving them prophylactic drugs that are used to prevent a disease from occurring. The scales used by the team included Migraine-Specific Quality-of-Life Questionnaire (MSQ), the Pittsburgh Sleep Quality Index (PSQI), the Migraine Disability Assessment Score (MIDAS), the Beck Anxiety Inventory (BAI) scale and the Beck Depression Inventory-II (BDI-II) scale. They found that patients showed a 50% reduction in the mean number of migraine days and attacks in 20 weeks. This means that acupuncture treatment is better in relieving the pain of migraines than prophylactic drugs.
Professor Wei Wang, Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei , says:
These results support the use of manual acupuncture in patients who are reluctant to use drugs or when they are ineffective – and it should be considered in future guidelines.
The team also measured the patient’s expectancies by using the acupuncture expectancy scale. The findings showed that 8% of the people were withdrawn from the study due to the adverse effects including bleeding, serious pain, palpitation, fainting, and local infection of acupuncture treatment.
Health Units reached out to Prof. Wei Wang and asked how to avoid adverse effects of acupuncture therapy, he explains:
In general, acupuncture is a safe therapy and with low risk of adverse events in clinical practice. The incidence of serious adverse events is very low if a qualified well-trained acupuncturist administers acupuncture according to the standardized procedures.
On most common adverse effects, he says:
The most common adverse events include minor bleeding or subcutaneous hematoma in needling position, local swelling, strong pain during needling, and local muscle pain. Palpitation, fainting, and vegetative symptoms like vertigo and nausea might also be experienced. To avoid these adverse events, acupuncturist should be well-trained, they should administer acupuncture according to the standardized procedures. Notably, the location of acupoint and correct manual manipulation (i.e., intermittently rotation as well as lift and thrust) of the needle is very effective for stopping adverse events. As for acupoints near arteries, internal organs, organs, nerve trunk, and the medulla oblongata, acupuncturists should pay attention to the angle and depth of acupuncture.
If a patient has palpitations and fainting during the process, he advises:
All acupuncture needles should be pulled out immediately. The acupuncturist should let the patient lie down in a well-ventilated room and press corresponding acupuncture point. In severe cases, the necessary drugs should be given. These symptoms are due to nervousness, hunger, fatigue, or the intensity of acupuncture stimulation being too strong. Before receiving acupuncture treatment, patients should calm down, eat something, and choose a recumbent or comfortable position. The doctor should also use moderate stimulation to avoid the occurrence of palpitation and fainting. As for the patient who receives acupuncture treatment for the first time, it is necessary to explain the treatment to patient clearly before acupuncture so as to remove any tension.
For pain during acupuncture, he says:
The acupuncturist should stop the manual manipulation of needle and adjust the angle of acupuncture needle to avoid nerves and blood vessels.
And if there is bleeding during acupuncture, he advises:
Remove the needle and press the bleeding site immediately. Then accurate judgment should be made promptly, including the type of injury, the location and degree of the injury, so as to proceed further with treatment.