Systematic Review of Episodic Migraine Prophylaxis: Efficacy of Conventional Treatments Used in Comparisons with Acupuncture

Abstract

Objective: A Cochrane Systematic Review published by Linde et al. in 2016 found moderate evidence suggesting that acupuncture is ''at least non-inferior'' to conventional prophylactic drug treatments (flunarizine, metoprolol, and valproic acid) for episodic migraine prophylaxis. The evidence for the efficacy of these conventional treatments must be verified to strengthen and validate the original comparison made in Linde et al.'s 2016 review. The aim of the current authors' systematic review was to verify the efficacy of the conventional treatments used in Linde et al.'s 2016 comparison with acupuncture. Materials and Methods: Search strategies were applied to find studies that could verify the efficacy of conventional treatments for treating episodic migraines. Relevant outcomes and dosages were extracted from the retrieved studies. Each study's quality was assessed, using the Cochrane's collaboration tool for assessing risk of bias and the Cochrane GRADE [Grading of Recommendations Assessment, Development, and Evaluation] scale. Results: There is high-quality evidence suggesting that prophylactic drug treatment, at the treatment dosage ranges used in Linde et al.'s 2016 review, reduced headache frequency at a 3-month follow-up, compared to placebo. Headache frequency at a 6-month follow-up, and responses (at least 50% reduction of headache frequency) at 3-month and 6-month follow-ups could not be assessed. Conclusions: These findings strengthened Linde et al.'s 2016 comparison of conventional treatments and acupuncture for reducing headache frequency at a 3-month follow-up. For episodic migraine prophylaxis, moderate evidence suggests that acupuncture is ''at least non-inferior,'' to now-proven, conventional treatments. This raises significant questions in the debate concerning claims that acupuncture is a placebo-based treatment and the prescriptions of proven conventional treatments that have similar effects as acupuncture.

A Randomized Clinical Trial on Acupuncture Versus Best Medical Therapy in Episodic Migraine Prophylaxis: The Acumigran Study

“…First, our results are in line with previous studies on the effectiveness of acupuncture to standard pharmacologic treatment showing acupuncture to be ''at least non-inferior'' to conventional treatments in episodic migraine [8][9][10]. However, methodological heterogeneity precludes aggregation of these data and impacts comparison among studies [9][10].…”

“…Our ndings are partially similar to those reported in previous studies. A systematic review published by the Cochrane Library in 2016 found moderate evidence favoring acupuncture over conventional treatment for safety and tolerability, given that acupuncture produced a lower number of pooled adverse effects and had a lower likelihood of dropouts [9]. However, previous trials reported a high proportion of participants allocated to drug treatment who withdraw informed consent immediately after randomization (8% [14], 13% [16] and 34% [15]), an high treatment discontinuation (18% [15]) and dropout rates due to adverse effects (9% [12] and 16% [16]).…”

“…In the past decades, acupuncture has been pointed out a valuable non-pharmacological tool in patients with migraine and its use in clinical practice has been increasing in Western countries. A large corpus of evidence has reported encouraging results for acupuncture as a prophylaxis therapy of migraine [8][9][10]. However, trails investigated the e cacy of acupuncture in comparison to pharmacological treatment in episodic migraine showed con icting results, mainly due to differences in population characteristics, study design and outcome measures [10][11][12][13][14][15][16].…”

Is an “Epigenetic Diet” for Migraines Justified? The Case of Folate and DNA Methylation

“…However, a long-term elimination diet can result in undernutrition, a form of malnutrition, which is characterized as the inadequate intake of protein, energy, and micronutrients, and may result in disorders including psychological loads or infection [110]. An easy and quick tool to evaluate the risk of malnutrition resulting from an elimination diet is the Malnutrition Universal Screening Tool (MUST), which can be used to determine nutritional risk [111].…”

Therapeutic Management: When and What

“…Unrelated to placebo effect, a proportion of patients respond to acupuncture treatment in practice. From recently reviews, acupuncture shows at least not inferior efficacy in the prevention of migraine comparing to conventional prophylactic treatment at a 3-month follow-up vs. placebo, although there is lot of discussion about the high proportion of placebo effect in this procedure (no significant difference between verum acupuncture vs. sham acupuncture groups) [173,174]. Only minor gastrointestinal AEs are reported.…”