by Michael Devitt

A new report published in the online version of the British Medical Journal has found that acupuncture is a useful, cost-effective treatment for chronic headaches, particularly migraines. The report found that over a 12-month period, headache patients who received regular acupuncture sessions reported fewer headaches, had a higher quality of life, missed fewer days from work, used less medication, and made fewer visits to a general practitioner than patients given standard treatment for headaches.

The research was conducted at a series of single acupuncture practices and general practices in Wales and Great Britain. In the study, the authors recruited 401 patients who suffered from chronic headaches, predominantly migraine headaches. The patients were randomized to receive either acupuncture or "usual care" from a general practitioner. In the acupuncture group, subjects standard care for headaches, and were also treated with acupuncture up to 12 times over a three-month period. Treatment patterns were individualized to each patient, and different points were used based on the discretion of the acupuncturist providing care. In the usual care group, patients received standard headache care from their general practitioner, but were not referred out for acupuncture.

At various times throughout the study, patients used a daily diary to track the frequency and severity of headache pain, and any related medication use. Headache severity was measured four times a day on a six-point scale, with the total summed to give a headache score. In addition, the patients completed the SF 36 Health Status Questionnaire at the start of the study, and at three months and 12 months after treatment. Patients also completed a series of questionnaires every three months that monitored use of different headache treatments, days missed from work due to illness, and other usual activities.

Initially, there was not much difference between patients in either group. By the 12-month interval, however, striking differences were noted in terms of frequency of headache, doctor visits and medication use:

• Patients given acupuncture had an average of 1.8 less days with headaches over the first four weeks of the study compared to the control group. When projected over 52 weeks, the authors estimated that acupuncture would result in an average 22 fewer days of headaches per year.
• The effects of acupuncture appeared to be long-lasting. At the start of treatment, the average weekly headache score among acupuncture patients was 24.6. Three months after the start of the study, the average score had dropped to 18.0; at 12 months, it had dropped by more than 34 percent, to 16.2. In the standard care patients, weekly headaches scores dropped only 16 percent over the course of the year.
• Results from the SF-36 questionnaire showed significant benefits for acupuncture patients in terms of physical role functioning, energy levels and changes in health. Over the course of a year, physical role functioning, energy and health change scores increased an average of 9.6, 7.4 and 10.3 points, respectively, for those in the acupuncture group. These scores also increased in usual care patients, but at much lower levels.
• Acupuncture patients used an average of 15 percent less medication to treat headaches than patients receiving only usual care. They also made 26 percent fewer visits to a general practitioner, and missed fewer days from work due to sickness.

"Acupuncture in addition to standard care results in persisting, clinically relevant benefits for primary care patients with chronic headache, particularly migraine, compared with controls," the researchers commented. "We also found improvements in quality of life, decreases in use of medication and visits to general practitioners, and reductions in days off sick."

In their conclusion, the researchers admitted they could not rule out the occurrence of a placebo effect, as the study did not include a sham acupuncture group. In addition, since the patients knew which treatment group they were assigned to, there remained the possibility that patients could give somewhat biased assessments of their treatments. However, the authors noted that the results of their study were similar to results seen in blinded, placebo-controlled trials, which "provides further evidence that bias does not completely explain the apparent effects of acupuncture."

The authors recommended that their findings should be taken into account by policymakers when assessing the most cost-effective ways of treating patients. They also called for an expansion of acupuncture services for the treatment of chronic headaches in the National Health Service, which provides health care to millions of Britons each year.

In an interview with the BBC, Dr. Mike Cummings, the medical director for the British Medical Acupuncture Society, called the study "innovative" and agreed with the authors' assertions.2

"It is very positive for us," he said of the research. "This should help to lift acupuncture out of what is seen to be alternative to mainstream medicine É It should be made available in primary care to treat pain and to prevent costly referrals to hospitals."

References

1. Vickers AJ, Rees RW, Zollman CE, et al. Acupuncture for chronic headache in primary care: large, pragmatic, randomized trial. British Medical Journal Online First; doi:10.1136/bmj.38029.421863.EB. Published March 15, 2004. Available at www.bmj.com.

2. Acupuncture beats headache pain. BBC News, March 15, 2004.

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Reprinted with permission from Acupuncture Today.