Acupuncture May Be Helpful for Chronic Daily Headache

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Acupuncture May Be Helpful for Chronic Daily Headache

News Author: Laurie Barclay, MD

http://www.medscape.com/viewarticle/515298?src=nldne

Oct. 24, 2005 — Acupuncture may be helpful for chronic daily headache

(CDH), according to the results of a randomized trial published in the

October issue of Headache.

" Approximately 4% of adults experience headaches nearly every day, "

write Remy R. Coeytaux, MD, PhD, from the University of North Carolina

at Chapel Hill, and colleagues. " Nonpharmacologic interventions for

frequent headaches may be appropriate because medical management alone

is often ineffective. "

In 74 patients with CDH, the investigators compared medical management

provided by neurologists to medical management plus 10 acupuncture

treatments. The main endpoints were daily pain severity and

headache-related quality of life (QoL).

Patients who received only medical management did not show improvement

in any of the standardized measures. Although daily pain severity scores

trended downward, they were not different between treatment groups (P =

..60). Compared with medical management only, medical management plus

acupuncture was associated with an improvement of 3.0 points (95%

confidence interval [CI], 1.0 - 4.9) on the Headache Impact Test (HIT)

and an increase of at least 8 points on the role limitations caused by

physical problems, social functioning, and general mental health domains

of the Short Form 36 Health Survey (SF-36). Patients in the acupuncture

group were 3.7 times more likely (95% CI, 1.7 - 8.1) to report less pain

from headaches at six weeks (absolute risk reduction, 46%; number needed

to treat, 2).

" Headache-specialty medical management alone was not associated with

improved clinical outcomes among our study population, " the authors

write. " Supplementing medical management with acupuncture, however,

resulted in improvements in health-related QoL and the perception by

patients that they suffered less from headaches. "

Study limitations include unblinded study design, use of subjective

outcomes introducing potential bias, failure to isolate acupuncture as

the single causal variable, lack of a sham control, bias inherent in the

study design, and inability to evaluate the efficacy of medical care

provided by the three study neurologists.

" Additional research is needed to elucidate the extent to which placebo

effects associated with acupuncture contribute to clinical benefit, to

identify clinical characteristics that predict favorable response to

acupuncture, to explore which acupuncture traditions and protocols are

most effective for treating the various causes and manifestations of

CDH, and to determine whether acupuncture is a cost-effective approach

to the treatment of frequent headaches, " the authors write.

The National Institutes of Health have disclosed that they funded this

study, and the Verne S. Caviness General Clinical Research Center at

University of North Carolina School of Medicine also disclosed that they

supported it. The Wood Clinical Scholars Program have

disclosed that they supported Dr. Coeytaux during the design phase of

the study.

Headache. 2005;45:1113-1123

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