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 Acupuncture Offers Headache Relief Over Medication

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Published: Dec. 1, 2008
Updated: Dec. 1, 2008
By Duke Medicine News and Communications

Acupuncture is more effective than medication in reducing the severity and frequency of chronic headaches, according to a new analysis
conducted by Duke University Medical Center researchers.
The National Institutes of Health recommended acupuncture as a viable treatment for chronic headaches a decade ago and, while research
in this field has increased, there have been conflicting reports about its efficacy.
"We combed through the literature and conducted the most comprehensive review of available data done to date using only the most
rigorously-executed trials," says Tong Joo (T.J.) Gan, MD, a Duke anesthesiologist who lead the analysis.
Researchers analyzed data from only randomized controlled trials evaluating acupuncture for adults with chronic headaches and were
conducted for more than four weeks.
"Acupuncture is becoming a favorable option for a variety of purposes ranging from enhancing fertility to decreasing post-operative pain
because people experience significantly fewer side effects and it can be less expensive than other options," Gan says. "This analysis
reinforces that acupuncture also is a successful source of relief from chronic headaches."
While everyone experiences an occasional headache, more than 45 million Americans (one in six) suffer from chronic headaches, 20
million of whom are women. Medication remains the mainstay of treatment with varying levels of success.
The Duke team looked at studies that compared traditional acupuncture to either medication or a control group who received sham
acupuncture. Similar to traditional acupuncture, the sham therapy entails inserting needles into the skin but the acupuncturist avoids
meridians or areas of the body that Chinese medicine teaches contains vital energy associated with achieving balance needed for good
Researchers analyzed more than 30 studies to arrive at the findings published in the December issue of Anesthesia and Analgesia. The
studies included nearly 4,000 patients who reported migraines (17 studies), tension headaches (10 studies) and other forms of chronic
headaches with multiple symptoms (four studies).
In 17 studies comparing acupuncture to medication, the researchers found that 62 percent of the acupuncture patients reported headache
relief compared to only 45 percent of people taking medication. These acupuncture patients also reported better physical well-being
compared to the medication group. In 14 studies that compared real acupuncture to sham therapy, 53 percent of acupuncture patients
responded to treatment compared to 45 percent receiving sham therapy.
"Acupuncture has been practiced for thousands of years but only recently has started to become more accepted as an alternative or
supplement to conventional therapies," Gan explains.
"One of the barriers to treatment with acupuncture is getting people to understand that while needles are used it is not a painful experience,"
Gan says. "It is a method for releasing your body's own natural painkillers."
Acupuncture therapy is becoming widely available nationwide and a typical course of treatment for chronic headaches requires 30-minute
sessions. Many people begin experiencing relief following five to six visits.
Gan also has conducted research to determine the effect of acupuncture on post-operative pain, nausea and vomiting. His research has
found that acupuncture can significantly reduce pain and the need for pain medications following surgery. He also found that acupuncture
can be as effective as medication in reducing post-operative nausea and vomiting.
The research was conducted in collaboration with Yanxia Sun, MD. The meta-analysis was supported by Duke's Department of

                       Acupuncture 'beats headache pain'

Acupuncture is an effective treatment for chronic headaches and should be more widely available on the NHS, experts say.
Writing in the British Medical Journal, UK researchers said patients who were given acupuncture had fewer days of headaches than those
who were not.
They also saw their GP less and were not as reliant on painkillers.
The government said doctors could decide to fund the therapy locally, if they felt patients would benefit.
Researchers analysed 401 patients from across the UK who reported several days of severe headaches each week.
They were randomly allocated to receive up to 12 acupuncture treatments over three months or to a control group offering other types of
care, typically medication.

This should help to lift acupuncture out of what is seen to be alternative to mainstream medicine ” ---Dr Mike Cummings, British Medical
Acupuncture Society

All patients completed a diary of headache and medication use for four weeks at the start of the study and again at three months and 12
They recorded the severity of their headaches on a six-point scale to produce an overall score.
Patients receiving acupuncture experienced 22 fewer days of headache per year, used 15% less medication, made 25% fewer visits to
their GP and were absent from work through sickness 15% less than the control group.
The researchers, from centres around the UK, wrote that introducing acupuncture services could lead to significant long-term benefits for
patients with chronic headaches.
They added: "Expansion of NHS acupuncture services for headache should be considered."
The medical director of the British Medical Acupuncture Society, Dr Mike Cummings described the study as "innovative".
NHS approval
He said: "It is very positive for us. This should help to lift acupuncture out of what is seen to be alternative to mainstream medicine. "I think
acupuncture should be more widely available on the NHS - but with a huge rider, only in areas where it has been shown to have definite
benefits. "It is not a panacea for everything. "It should be made available in primary care to treat pain and to prevent costly referrals to
Ailments which respond well to acupuncture include headaches, neck, shoulder and back pain and osteoarthritis in the knee, he says.
Each week, 10% of GPs in the UK either refer patients to acupuncture or practise it themselves, and chronic headache is one of the most
commonly treated conditions. It shows a growing recognition by the health service of the benefit of complementary medicine.
A Department of Health spokeswoman said: "The government appreciates that many people find different complementary medicines, such
as acupuncture, helpful in alleviating the symptoms of certain illness, especially those for which orthodox medicine does not seems to have
a complete answer.
"As a result, some complementary and alternative medicine can be made available on the NHS if local NHS clinicians and commissioning
organisations such as primary care trusts are convinced that it will be a clinical and cost effective use of resources."
Story from BBC NEWS:

Published: 2004/03/15 03:41:10 GMT


                                            Acupuncture of Chronic Headache disorders
         in primary care: randomized controlled trial and economic analysis

                                         Health Technol Assess. 2004 Nov;8(48):iii, 1-35.

Vickers AJ, Rees RW, Zollman CE, McCarney R, Smith CM, Ellis N, Fisher P, Van Haselen R, Wonderling D, Grieve R.

Integrative Medicine Service, Biostatistics Service, Memorial Sloan-Kettering Cancer Center, New York, USA.

OBJECTIVES: To determine the effects of a policy of using acupuncture, compared with a policy of avoiding acupuncture, on headache in primary care
patients with chronic headache disorders. The effects of acupuncture on medication use, quality of life, resource use and days off sick in this population
and the cost-effectiveness of acupuncture were also examined. DESIGN: Randomised, controlled trial. SETTING: General practices in England and
Wales. PARTICIPANTS: The study included 401 patients with chronic headache disorder, predominantly migraine. INTERVENTIONS: Patients were
randomly allocated to receive up to 12 acupuncture treatments over 3 months or to a control intervention offering usual care. MAIN OUTCOME
MEASURES: Outcome measures included headache score; assessment of Short Form 36 (SF-36) health status and use of medication at baseline, 3
months and 12 months; assessment of use of resources every 3 months; and assessment of incremental cost per quality-adjusted life-year (QALY)
gained. RESULTS: Headache score at 12 months, the primary end-point, was lower in the acupuncture group than in controls. The adjusted difference
between means was 4.6. This result was robust to sensitivity analysis incorporating imputation for missing data. Patients in the acupuncture group
experienced the equivalent of 22 fewer days of headache per year. SF-36 data favoured acupuncture, although differences reached significance only
for physical role functioning, energy and change in health. Compared with controls, patients randomised to acupuncture used 15% less medication,
made 25% fewer visits to GPs and took 15% fewer days off sick. Total costs during the 1-year period of the study were on average higher for the
acupuncture group than for controls because of the acupuncture practitioners' costs. The mean health gain from acupuncture during the year of the
trial was 0.021 QALYs, leading to a base-case estimate of GBP9180 per QALY gained. This result was robust to sensitivity analysis. Cost per QALY
dropped substantially when the analysis incorporated likely QALY differences for the years after the trial. CONCLUSIONS: The study suggests that
acupuncture leads to persisting, clinically relevant benefits for primary care patients with chronic headache, particularly migraine. It is relatively cost-
effective compared with a number of other interventions provided by the NHS. Further studies could examine the duration of acupuncture effects beyond
1 year and the relative benefit to patients with migraine with compared to tension-type headache. Trials are also warranted examining the effectiveness
and cost-effectiveness of acupuncture in patients with headache receiving more aggressive pharmacological management.
PMID: 15527670 [PubMed - indexed for MEDLINE]