Timothy C. Hain, MD • Page last modified: April 28, 2020
Although acupuncture may be placebo treatment for some conditions, there is credible evidence that acupuncture is helpful for both Migraine and Tension headache. Even if acupuncture were a placebo, we would still be in favor of any placebo that reduces suffering and pain. Chicago Dizziness and Hearing sometimes recommends acupuncture for situations where medications and dietary/life style modifications are not feasible. Pregnant women and persons who have failed all other treatments seem particularly suitable.
In this page, we have attempted to stick to reasonably credible sources. We have attempted to avoid publications written in other languages as well as what appear to us to be "trade journals" for the acupuncture community.
A metanalysis of acupuncture for tension headache was published by the Cochrane Database, an organization that performs metananalyses of treatments. (Linde, Allais et al. 2009). They reported "slightly better results" for some outcomes than control groups, for tension-type headache, and that "acupuncture could be a valuable non-pharmacological tool in patients with frequent episodic or chronic tension-type headaches". With respect to technique, they suggested "Small but statistically significant benefits of acupuncture over sham were found for response as well as for several other outcomes. "
The same organization analyzed acupuncture for migraine headache, and found that "Overall in these trials acupuncture was associated with slightly better outcomes and fewer adverse effects than prophylactic drug treatment."(Linde, Allais et al. 2009). With respect to technique, they suggested "There is no evidence for an effect of 'true' acupuncture over sham interventions, though this is difficult to interpret, as exact point location could be of limited importance. "
Sun and Gan (2008) performed another systemic review, and after reviewing 31 studies, reported that "needling acupuncture is superior to sham acupuncture and medication therapy in improving headache intensity, frequency, and response rate."
Several trials have compared flunarizine to acupuncture. Flunarizine is a little used calcium channel blocker. While we like the idea of trials, we would prefer to see ones comparing more commonly prescribed prevention medications such as anticonvulsants (e.g. topiramate), beta-blockers (such as propranolol), and antidepressants (such as venlafaxine).
According to Shiapparelli et al, there are two diagnostic frameworks in TCM (traditional Chinese medicine) for headaches (Schiapparelli, Allais et al. 2011). These include the meridian diagnosis (pain located), and syndrome diagnoses. Quoting from their abstract, "The four meridians involved in headache are Shaoyang (TE-GB channels, on the temporal sides of the head); Taiyang (SI-BL channels, occiput); Yangming (LI-ST channels, forehead) and Jueyin (PC-LR channels, vertex). The syndromes may be due to excess or deficit. Very generally, the excess syndromes correspond in the majority of cases to migraine and the deficit syndromes to TTH. "
Zheng and others (2010), suggested a "standardized protocol of acupuncture for the management of migraine". The suggested "Bilateral use of the following points is recommended: Fengchi (GB20), Taiyang (EX-HN5), etc. De-qi sensation is requested in acupuncture manipulating procedure, and manual stimulation is suggested. The optimal treatment frequency is twice a week with one week rest between the first 10 and the last 10 sessions. Additionally, the duration of one treatment session ought to be 30 minutes, while it is recommended to use about 20 needles in one session. The total duration of an acupuncture treatment should be at least 10 weeks. "
Zhao and others performed a historical review of acupuncture technique for migraine (Zhao, Ren et al. 2009). They reported that "the Gall Bladder Meridian was the meridian used most frequently, and both local and remote points in the four extremities were used. Acupoints in Yang meridians, especially Fengchi (GB 20), Sizhukong (TE 23) and Shuaigu (GB 8) in Shaoyang meridians were used most frequently. In terms of classification of the special points selected, besides the Crossing Points with meridian qi passing through and crossing in the head, points below the elbow and knee joints, such as Source points, Luo Points, Eight Confluence Points, as well as Five Shu Points were frequently used. "
Laser acupuncture is an alternative to needles. It is reported to be beneficial in a double-blinded placebo-controlled trial of children. (Gottschling, Meyer et al. 2008). It would seem to us that laser acupuncture might have less side effects (i.e. no bleeding), but also less effective.
Acupuncture involves sticking needles into people, and of course there are some risks. According to Zhao et al (Zhao, Zhang et al. 2011), the chance of an adverse event is 3.76% during a course of treatment, with the main ones being Subcutaneous haematoma and haemorrhage in the needling points. The authors did not observe any "serious" adverse events. Older patients had a higher risk.
Cost is another adverse effect. In the US, insurance coverage is variable, with no coverage by Medicare. In Europe, acupuncture is reported to to be cost-effective(Witt, Reinhold et al. 2008).
We think acupuncture should be integrated into headache management (Endres, Diener et al. 2007). We think that conventional methods, including dietary and lifestyle modification, followed by a prophylactic medication should be tried first. Acupuncture seems to us to be an "add on". There are certain groups that might be more suitable - - those in whom medication is less appealing (e.g. pregnant women, children), and persons considering Botox treatment for migraine.