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Acupuncture is treatment modality commonly used in Traditional Chinese Medicine and has been growing in popularity in Western countries.  It has been used for a myriad of different medical conditions, but most commonly used for anesthesia and analgesia.  Fundamental to the practice of acupuncture is the belief system upon which it is founded.  That is, there are meridians which run throughout the body and correspond to different bodily and organ function.  These meridians are fluxes of energy; problems within certain organs will have an impact on the energy level.  Again, fundamental to Traditional Chinese Medicine is the principle of balance.  Thus, the acupuncture needle is placed in the acupuncture spot for a given meridian and can then either draw energy into that meridian or extract energy depending upon the illness.  A more detailed description can be found on our acupuncture pages.

Trials:

The following table was adapted from Table 2 of Manias, et al. "Acupuncture In Headache: A Critical Review."  

CG= Control Group; (n)= number of patients; TG= Treatment Group

Inherent Problems In Trying To Study Acupuncture With Sound Methods:

• Standardization is difficult to achieve, because this therapy is very patient individualized
• Double blinding is also difficult to achieve.  The acupuncturist should intuitively know which treatment is false and which is real since it is a procedure to be performed.  Without blinding results can be confounded by the acupuncturist interaction with the patient.
• Needle insertion seems to provide an analgesic affect governed by endogenous opioids and thus even sham (pseudo) acupuncture may have some beneficial effects.  This also limits the possibility of a crossover time trial.
• Sham (pseudo) acupuncture is where the needles are either inserted just off the classical spots or not inserted to proper depth.  The psychological aspect cannot be removed.
• Acupuncture is used as a prophylaxis and not during an acute setting.

Conclusions:

The above 16 trials have a range of outcomes from strong evidence that acupuncture helps individuals in long term to superiority over pharmacologic treatments to slightly better than pseudo acupuncture to worse than relaxation therapy.  Many of the studies had adequate numbers of patients and long evaluation times which strengthen their results.  Thus, the preponderance of data suggest that there must be at least some positive outcome by treating migraines with acupuncture. 

Other things to consider are risks, cost-effectiveness, and patient motivation.  Risks of acupuncture are low, but do include infection and bleeding as the most common.  The use of sterile disposable needles has greatly reduced infection as a complication.  In addition, severe complications, for example a punctured lung, are very rare.  Cost-effectiveness is a key issue with lack of insurance reimbursement for acupuncture in most cases.  In addition, acupuncture has a strong philosophical and religious foundation that may not be accepted by patients and hamper the successfulness of treatment.

Where, then, is the role of acupuncture in the treatment of migraines?  Precisely where it is right now.  It has not been proven that it is effective enough to be the primary treatment of migraines, especially in an acute setting or those with relatively few migraines.  However, it does seem to have some prophylactic effects and decreases the need for medication.  Thus, a patient refractory to traditional management, increasing migraines despite traditional management, or with the desire and self motivation to try acupuncture, all have the potential to benefit from acupuncture therapy.