Migraine is a chronic neurological disorder characterized by recurrent moderate and severe headache aggravated by stressors. The pain is usually pulsating and unilateral and is often accompanied by nausea, vomiting, phonophobia or photophobia. Migraine, occurring generally in younger people of working age, imposes significant economic, healthcare and social costs. Although many migraine patients benefit in some aspects the medication they also continue to experience discomfort, interference with activities of daily life, and other adverse effects from pharmacological treatments.  Here are the summaries of some recent reports of effect of acupuncture on migraine.  

  1. True acupuncture is super to sham acupuncture in improving migraine 

A large-size randomized acupuncture clinical study was conducted to investigate the long-term effects of true acupuncture compared with sham acupuncture in patients with migraine.  

It was a 24-week randomized clinical trial (Zhao et al., 2017; 4 weeks of treatment followed by 20 weeks of follow-up). A total of 249 participants 18 to 65 years old with migraine without aura were randomly assigned to true acupuncture, sham acupuncture, or a waiting-list control group. Participants in the true acupuncture and sham acupuncture groups received treatment 5 days per week for 4 weeks for a total of 20 sessions. Four acupoints were used per treatment for 30 mins. All patients received acupuncture on 2 obligatory points, including GB20 and GB8. The 2 other points were chosen according to the syndrome differentiation of meridians in the headache region. The potential acupoints included SJ5, GB34, BL60, SI3, LI4, ST44, LR3, and GB40. The use of additional acupoints other than the prescribed ones was not allowed.  

The primary outcome was the change in the frequency of migraine attacks from baseline to week 16. Secondary outcome measures included the migraine days, average headache severity, and medication intake every 4 weeks within 24 weeks. Results showed that true acupuncture exhibited persistent, superior, and clinically relevant benefits for migraine prophylaxis, reducing the migraine frequency, number of days with migraine, and pain intensity to a greater degree than sham acupuncture or waiting list groups. Improvements in the emotional domain of quality of life were also found in true acupuncture group compared with controls. The study showed that true acupuncture may be associated with long-term reduction in migraine recurrence compared with sham acupuncture or assigned to a waiting list among patients with migraine without aura.  

  1. 2. Acupuncture-induced migraine relieving is related to acupoint specificity

Acupuncture has been widely used to treat migraine in China. Acupuncture treatment is very effective in alleviating pain with minimal side effects and cost saving. Acupuncture-induced migraine relieving is now popular in Western countries. Many clinical studies focused on migraine have reported with mixed results. One of the key issues is acupuncture point specificity. Some clinical studies reported a definitive specific effect of alleviating migraine, while other studies showed non-specific effects of acupuncture on relieving migraine. 

 
One of approaches to define acupoint specificity is brain imaging such as positron emission tomography combined with computed tomography (PET/CT) which exhibits specific neuronal activity following acupuncture stimulation. In a recent study (Yang et al., 2012), patients with migraine were enrolled to investigate acupoint specificity using PET/CT. Patients were divided into treatment group and control group. Patients in treatment group received stimulation at specific acupoints of Shaoyang meridians, which is traditionally used to treat migraine. In control group acupoints on Yangming meridians, which are less used for migraine treatment according to the theory of traditional Chinese medicine, were stimulated. At the end of treatment patients in treatment group showed greater pain reduction than patients in control group. PET/CT showed a higher brain metabolism in the middle temporal cortex and orbital frontal cortex and cerebellum in treatment group compared with control group. These findings are in favour of the functional specificity of migraine-treatment-related-acupoints.  

  1. 3.Long-term active acupuncture therapy modified brain pain circuitry for migraine

Migraine attack is sometimes unbearable to the patients and the impact on their families is huge. Loss of productivity due to migraine is enormous to the society. Although the exact cause of migraine is still unknown it is regarded as a central nervous system disorder. Acupuncture is effective in relieving migraine but how it works is not well understood.    

Recently, a randomized controlled clinical trial (Zhao et al., 2014) was conducted, using functional magnetic resonance imaging technique, to compare the difference in brain activation pattern elicited by active acupoints and inactive acupoints in 80 patients with migraine. Pain was measured by using Visual Analogue Scale prior to and following acupuncture treatment. It was found that acupuncture stimulation at active acupoints SJ5, GB20, GB34 and GB40 for 30 minutes once a day for 4 weeks produced a more extensive cerebral response, in particular in pain-related areas and cognitive components of pain processing. The changes in brain response are closely associated with reduction in pain rating scale. In contrast, stimulation at inactive acupoint SJ22, PC7, GB37 and SP3 induced much less brain responses in those pain-related areas and correlated to less reduction in pain rating. Authors suggest that therapeutic effect of long-term acupuncture at active acupoint may be related to its enhancing the formation of psychophysical pain homeostasis in brain of patients with migraine.  

  1. 4. Acupuncture improved psychological profiles of migraine patients while reducing migraine attack

Psychological problems are prominent among migraine patients with severe headache, especially among those with chronic daily headache. A very high percentage of patients with chronic daily headache are depressed. Some patients also suffer from paranoia, hypomania and many others. Conventional approach such as painkillers only temporarily relief headache and do not have effect on the psychological profiles of migraine patients.  

Dr. Vijayalakshmi and colleagues (Vijayalakshmi et al., 2014) investigated effect of acupuncture on psychological profiles of migraine patients. Sixty patients with migraine were randomly divided into acupuncture group and drug treatment group. Patients in the former group received 10 sessions of electroacupuncture treatment within 30 days. Patients in late group were given oral flunarizine 20 mg daily along with paracetamol 500 mg when it is necessary for 30 days. Assessment was carried out before and after completion of treatment, including quality of life questionnaires and migraine disability questionnaires.  

It was found that both acupuncture and drug treatments markedly relieved headache compared with prior treatment scores. Acupuncture significantly improved psychological profiles such as depression, anxiety and hypomania. However pain relief drugs did not affect psychological profiles of migraine patients. Authors conclude that acupuncture is a better treatment option than the conventional therapy. It not only relieves pain also improved psychological profiles in patients with migraine.  

  1. 5. Acupuncture treatment alleviates frequent migraine headache

A randomized, patient/assessor blinded, controlled clinical trial found that acupuncture treatment significantly reduced migraine days, severity of migraine and improved the quality of life of patients with frequent migraine headache attack. The trial was recently reported in the journal of Evidence-Based Complementary and Alternative Medicine.  

Frequent migraine refers the migraine headache attack occurs more than 5 days a month. If the attack occurs more than 15 days a month it is defined as chronic migraine. Migraine is the19th prevalent health condition according a report published by the International Migraine Society. 50% of chronic migraineurs and 27% of episodic migraineurs prefer non-pharmacological therapies including acupuncture due to the side effects of pharmacological treatment.  

Wang et al.,(2015) conducted a randomized, patient/assessor blinded, controlled clinical trial to determine the short and long-term effects and safety of acupuncture, compared with sham acupuncture on frequent migraine patients. Fifty patients with chronic migraine were divided into real acupuncture group (n=26) and sham acupuncture group (n=24). Acupoints selected include mandatory acupoints and supplementary acupoints based on individual diagnosis of Chinese medicine syndrome of migraine. A total of 16 real acupuncture treatment sessions were delivered within 20-week treatment period. The primary outcome measures include a 0-10 Visual Analogue Scale and a Six-Point Likert Scale for measuring intensity of migraine. The secondary outcome measures include severity and quality of migraine, the relief medication usage for migraine and quality of life.  

At the end of treatment it was found that patients within real acupuncture group reported a significant reduced migraine days, less severe migraine and increased pain pressure thresholds compared with sham acupuncture treatment. The improvement of migraine was maintained at the end of 3 month follow-up compared with sham acupuncture group, but not at the end of one-year follow-up. No severe adverse effect was observed. The trial blinding was successful. The results suggested that acupuncture is an effective and safe treatment for short-term relief of frequent migraine in adults. 

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Grateful acknowledgements are due to Drs ArvidsdotterHoriuchiLeManber and Oliveira and colleagues (This paper was based on their articles cited in above Reference section), as well as to Dr. Bai-Yun Zeng for his work in preparing this briefing paper.