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Primary care

Acupuncture for chronic headache in primary care: large,

pragmatic, randomised trial

Andrew J Vickers, Rebecca W Rees, Catherine E Zollman, Rob McCarney, Claire

Smith, Nadia Ellis, Peter Fisher,

Robbert Van Haselen

Abstract

Objective To determine the effects of a policy of “use

acupuncture” on headache, health status, days off sick, and use

of resources in patients with chronic headache compared with a

policy of “avoid acupuncture.”

Design Randomised, controlled trial.

Setting General practices in England and Wales.

Participants 401 patients with chronic headache,

predominantly migraine.

Interventions Patients were randomly allocated to receive up to

12 acupuncture treatments over three months or to a control

intervention offering usual care.

Main outcome measures Headache score, SF-36 health status,

and use of medication were assessed at baseline, three, and 12

months. Use of resources was assessed every three months.

Results Headache score at 12 months, the primary end point,

was lower in the acupuncture group (16.2, SD 13.7, n = 161,

34% reduction from baseline) than in controls (22.3, SD 17.0,

n = 140, 16% reduction from baseline). The adjusted difference

between means is 4.6 (95% confidence interval 2.2 to 7.0;

P = 0.0002). This result is robust to sensitivity analysis

incorporating imputation for missing data. Patients in the

acupuncture group experienced the equivalent of 22 fewer days

of headache per year (8 to 38). SF-36 data favoured

acupuncture, although differences reached significance only for

physical role functioning, energy, and change in health.

Compared with controls, patients randomised to acupuncture

used 15% less medication (P = 0.02), made 25% fewer visits to

general practitioners (P = 0.10), and took 15% fewer days off

sick (P = 0.2).

Conclusions Acupuncture leads to persisting, clinically relevant

benefits for primary care patients with chronic headache,

particularly migraine. Expansion of NHS acupuncture services

should be considered.

Introduction

Migraine and tension-type headache give rise to notable

health,1 2 economic,2 and social costs.2 3 Despite the undoubted

benefits of medication,4 many patients continue to experience

distress and social disruption. This leads patients to try, and

health professionals to recommend, non-pharmacological

approaches to headache care. One of the most popular

approaches seems to be acupuncture. Each week 10% of general

practitioners in England either refer patients to acupuncture or

practise it themselves,5 and chronic headache is one of the most

commonly treated conditions.6

A recent Cochrane review of 26 randomised trials of

acupuncture for headache concluded that, although existing evidence

supports the value of acupuncture, the quality and

amount of evidence are not fully convincing.7 The review identifies

an urgent need for well planned, large scale studies to assess

the effectiveness and cost effectiveness of acupuncture under

“real” conditions. In 1998 the NHS National Coordinating Centre

for Health Technology Assessment commissioned us to conduct

such a trial (trial number ISRCTN96537534). Our aim was

to estimate the effects of acupuncture in practice8: we established

an acupuncture service in primary care; we then sought to determine

the effects of a policy of “use acupuncture” on headache,

health status, days off sick, and use of resources in patients with

chronic headache compared with a policy of “avoid acupuncture.”

This reflects two real decisions: that made by general practitioners

when managing the care of headache patients and that

made by NHS entities when commissioning health services.

Methods

The protocol and recruitment methods have been published

previously.9 10 The study included 12 separate sites consisting of a

single acupuncture practice and two to five local general

practices. Study sites were located in Merseyside, London and

surrounding counties, Wales, and the north and south west of

England.

Accrual of patients

Practices searched their databases to identify potential

participants. General practitioners then sent letters to suitable

patients, providing information about the trial. A researcher at

the study centre conducted recruitment interviews, eligibility

screening, and baseline assessment by telephone. Patients’ conditions

were diagnosed as migraine or tension-type headache, following

criteria of the International Headache Society (IHS).11

Patients aged 18-65 and who reported an average of at least two

headaches per month were eligible. Patients were excluded for

any of the following: onset of headache disorder less than one

year before or at age 50 or older; pregnancy; malignancy; cluster

headache (IHS code 3); suspicion that headache disorder had

specific aetiology (IHS code 5-11); cranial neuralgias (IHS code

12); and acupuncture treatment in the previous 12 months. Eligible

patients completed a baseline headache diary for four weeks.

Patients who provided written informed consent, had a mean

Additional tables A and B and a description of the sensitivity analyses are

on bmj.com

BMJ Online First bmj.com page 1 of 6

Cite this article as: BMJ, doi:10.1136/bmj.38029.421863.EB (published 16

March 2004)

Copyright 2004 BMJ Publishing Group Ltd

weekly baseline headache score of 8.75 or more, and completed

at least 75% of the baseline diary were randomised to a policy of

“use acupuncture” or “avoid acupuncture.” Given a power of 90%

and an of 5%, we estimated that we would require 288

evaluable patients to detect a reduction in headache score of

35% in the acupuncture group, compared with 20% in controls.

We assumed a dropout rate of about 25% and planned to

randomise 400 patients.

Randomisation

We used randomised minimisation (“biased coin”) to allocate

patients. The minimised variables were age, sex, diagnosis

(migraine or tension-type), headache score at baseline, number

of years of headache disorder (chronicity), and number of

patients already allocated to each group, averaged separately by

site. We used a secure, password protected database to

implement randomisation, which was thus fully concealed.

Treatment

Patients randomised to acupuncture received, in addition to

standard care from general practitioners, up to 12 treatments

over three months from an advanced member of the

Acupuncture Association of Chartered Physiotherapists. All acupuncturists

in the study had completed a minimum of 250 hours

of postgraduate training in acupuncture, which included the

theory and practice of traditional Chinese medicine; they had

practised acupuncture for a median of 12 years and treated a

median of 22 patients per week. The acupuncture point

prescriptions used were individualised to each patient and were

at the discretion of the acupuncturist. Patients randomised to

“avoid acupuncture” received usual care from their general practitioner

but were not referred to acupuncture.

Outcome assessment

Patients completed a daily diary of headache and medication use

for four weeks at baseline and then three months and one year

after randomisation. Severity of headache was recorded four

times a day on a six point Likert scale (box) and the total

summed to give a headache score. The SF-36 health status questionnaire

was completed at baseline, three months, and one year.

Every three months after randomisation, patients completed

additional questionnaires that monitored use of headache treatments

and days sick from work or other usual activity.While the

study was under way we added an additional end point: we contacted

patients one year after randomisation and asked them to

give a global estimate of current and baseline headache severity

on a 0-10 scale. This enabled us to obtain data from patients who

were unwilling to complete diaries, for use in sensitivity analysis.

Statistical considerations

The primary outcome measure was headache score at the one

year follow up. Secondary outcome measures included headache

score at three months, days with headache, use of medication

scored with the medication quantification scale (MQS),12 13 the

SF-36, use of resources, and days off usual activities. We revised

the statistical plan to employ adjusted rather than unadjusted

analyses after publication of the initial protocol but before we

conducted any analyses. We analysed our data on Stata 8

software (Stata Corporation, College Station, Texas) using

ANCOVA for continuous end points, 2 for binary data, and

negative binomial regression for count data such as number of

days of sick leave. We entered minimisation variables into

regression models as covariates. We analysed data according to

allocation, regardless of the treatment received. We conducted

sensitivity analyses to examine the possible effect of missing data

(see appendix on bmj.com).

Results

Recruitment took place between November 1999 and January

2001. Figure 1 shows the flow of participants through the trial.

Compliance of patients was good: only three patients in the control

group reported receiving acupuncture outside the study.

Acupuncture patients received a median of nine (interquartile

range 6-11) treatments, with a median of one treatment per

week. The dropout rate was close to that expected and approximately

balanced between groups. Patients who dropped out were

similar to completers in terms of sex, diagnosis, and chronicity,

but they were slightly younger (43 v 46 years, P = 0.01) and had

higher headache score at baseline (29.3 v. 25.6, P = 0.04). Table 1

shows baseline characteristics by group for the 301 patients who

completed the trial: the groups are highly comparable. Thirty

one of the patients who withdrew provided three month data,

and an additional 45 provided a global assessment. Only 6% of

patients (12 in each group) provided no data for headache after

randomisation.

Table 2 shows results for medical outcomes for patients

completing 12 month follow up. In the primary analysis mean

headache scores were significantly lower in the acupuncture

group. Scores fell by 34% in the acupuncture group compared

with 16% in controls (P = 0.0002). This result was highly robust

to sensitivity analysis for missing data (smallest difference

between groups of 3.85, P = 0.002; see appendix on bmj.com).

When we used the prespecified cut-off point of 35% as a

clinically significant reduction in headache score, 22% more

acupuncture patients improved than controls, equivalent to a

number needed to treat of 4.6 (95% confidence interval 9.1 to

3.0). The difference in days with headache of 1.8 days per four

weeks is equivalent to 22 fewer days of headache per year (8 to

38). The effects of acupuncture seem to be long lasting;

although few patients continued to receive acupuncture after

the initial three month treatment period (25, 10, and 6 patients

received treatment after 3, 6, and 9, months, respectively), headache

scores were lower at 12 months than at the follow up after

treatment. Medication scores at follow up were lower in the acupuncture

group, although differences between groups did not

reach significance for all end points. In an unplanned analysis

we summed and scaled all medication taken by patients after

randomisation and compared groups with adjustment for base-

Likert scale of headache severity

0: no headache

1: I notice the headache only when I pay attention to it

2: Mild headache that can be ignored at times

3: Headache is painful, but I can do my job or usual tasks

4: Very severe headache; I find it difficult to concentrate and can

do only undemanding tasks

5: Intense, incapacitating headache

Table 1 Baseline characteristics. Values are numbers (percentages) of

participants unless otherwise indicated

Acupuncture (n=161) Control (n=140)

Mean age in years (SD) 46.4 (10.0) 46.2 (10.8)

Female 133 (83) 120 (86)

Migraine diagnosis 152 (94) 132 (94)

Tension-type headache 9 (6) 8 (6)

Mean chronicity in years (SD) 21.3 (14.5) 21.9 (13.3)

Primary care

page 2 of 6 BMJ Online First bmj.com

line scores. Use of medication use fell by 23% in controls but by

37% in the acupuncture group (adjusted difference between

groups 15%; 95% confidence interval 3%, 27%; P = 0.01). SF-36

data generally favoured acupuncture (table 3), although

differences reached significance only for physical role functioning,

energy, and change in health.

Assessed for eligibility (n=694)

Randomised (n=401)

Not randomised (n=293)

Excluded (n=103)

Insufficient severity (n=72)

Declined participation (n=118)

Allocated to control (n=196)

Received no acupuncture (n=193)

Allocated to acupuncture (n=205)

Received acupuncture (n=186)

Completed 3 month assessment (n=173)

Withdrew at 3 months (n=27):

Lost to follow up (n=2)

Intercurrent illness (n=6)

Withdrew consent (n=11)

Adverse effects (n=1)

Treatment inconvenient (n=4)

Treatment ineffective (n=3)

Completed subsequent assessment (n=5)

Completed 3 month assessment (n=153)

Withdrew at 3 months (n=38):

Lost to follow up (n=2)

Intercurrent illness (n=7)

Withdrew consent (n=29)

Completed subsequent assessment (n=5)

Completed 6 month assessment (n=152)

Withdrew at 6 months (n=4):

Lost to follow up (n=1)

Treatment ineffective (n=1)

Withdrew consent (n=2)

Completed subsequent assessment (n=22)

Completed 6 month assessment (n=129)

Withdrew at 6 months (n=11):

Lost to follow up (n=2)

Intercurrent illness (n=1)

Withdrew consent (n=8)

Completed subsequent assessment (n=18)

Completed 9 month assessment (n=165)

Withdrew at 9 months (n=3):

Lost to follow up (n=2)

Withdrew consent (n=1)

Completed subsequent assessment (n=6)

Completed 9 month assessment (n=132 )

Withdrew at 9 months (n=4):

Died (n=1)

Lost to follow up (n=2)

Withdrew consent (n=1)

Completed subsequent assessment (n=11)

Completed assessment at 12 months (n=161)

Withdrew at 12 months (n=10):

Lost to follow up (n=4)

Intercurrent illness (n=1)

Treatment inconvenient (n=1)

Withdrew consent (n=4)

Completed assessment at 12 months (n=140)

Withdrew at 12 months (n=3):

Lost to follow up (n=1)

Withdrew consent (n=2)

Fig 1 Flow of participants through the trial.

Table 2 Headache and medication outcomes. Higher scores indicate greater

severity of headache and increased use of medication. Differences between

groups are calculated by analysis of covariance. Values are means (SD)

unless otherwise indicated

End point

Baseline After treatment (at three months after randomisation) At 12 months

Acupuncture

(n=161)

Controls

(n=140)

Acupuncture

(n=159)

Controls

(n=136) Difference‡ 95% CI P value

Acupuncture

(n=161)

Controls

(n=140) Difference‡ 95% CI P value

Weekly headache score 24.6 (14.1) 26.7 (16.8) 18.0 (14.8) 23.7 (16.8) 3.9 1

6 to 6.3 0.001 16.2 (13.7) 22.3 (17.0) 4.6 2.2 to 7.0 0.0002

Days of headache in

28 days

15.6 (6.6) 16.2 (6.7) 12.1 (7.2) 14.3 (7.3) 1.8 0.7 to 2.9 0.002 11.4 (7.5)

13.6 (7.5) 1.8 0.6 to 2.9 0.003

Clinically relevant

improvement in

score*

— — 65 (41%) 37 (27%) 14% 3% to 24% 0.014 87 (54%) 45 (32%) 22% 11% to 33% 0

0001

Clinically relevant

improvement in

frequency†

— — 36 (23%) 17 (13%) 10% 2% to 19% 0.024 49 (30%) 21 (15%) 15% 6% to 25% 0

002

Scaled pain medication

(weekly)

16.5 (18.1) 14.3 (17.6) 11.0 (13.6) 11.4 (14.1) 1.6 -0.7 to 3.9 0.16 8.5 (12

2) 8.7 (12.6) 1.2 -0.6 to 3.1 0.19

Scaled prophylactic

medication (weekly)

9.0 (17.8) 13.3 (22.2) 7.9 (17.6) 11.5 (21.3) 0.7 -2.4 to 3.8 0.7 5.0 (14.4)

11.1 (21.3) 3.9 0.5 to 7.4 0.026

Use of any prophylactic

medication in 28 days

40 (25%) 45 (32%) 34 (21%) 39 (29%) 7% -3% to 17% 0.15 22 (14%) 37 (26%) 13%

4% to 22% 0.005

*As defined in study protocol: 35% or greater improvement in headache score

from baseline.

†International Headache Society definition: 50% or greater reduction in days

with headache.14

‡Adjusted difference: positive favours acupuncture.

Primary care

BMJ Online First bmj.com page 3 of 6

We conducted interaction analyses to determine which

patients responded best to acupuncture. Although improvements

in mean headache score over control were much larger

for migraine patients (4.9; 95% confidence interval 2.4, 7.5,

n = 284) than for patients who did not meet the criteria for

migraine (1.1; 95% confidence interval - 2.4 to 4.5, n = 17), the

small numbers of patients with tension-type headache preclude

us from excluding an effect of acupuncture in this population.

The interaction term for baseline score and group was positive

and significant (P = 0.004), indicating larger effects of treatment

on patients with more severe symptoms, even after controlling

for regression to the mean. Predicted improvements in headache

score for each quartile of baseline score in acupuncture patients

are 22%, 26%, 35%, and 38%; figure 2 shows comparable data for

days with headache. Neither age nor chronicity nor sex

influenced the results of acupuncture treatment.

Table 4 shows data on use of resources. Patients in the

acupuncture group made fewer visits to general practitioners and

complementary practitioners than those not receiving acupuncture

and took fewer days off sick. Confirming the excellent safety

profile of acupuncture,15 the only adverse event reported was five

cases of headache after treatment in four subjects.

Discussion

Main findings

Acupuncture in addition to standard care results in persisting,

clinically relevant benefits for primary care patients with chronic

headache, particularly migraine, compared with controls. We

also found improvements in quality of life, decreases in use of

medication and visits to general practitioners, and reductions in

days off sick. Methodological strengths of our study include a

large sample size, concealed randomisation, and careful follow

up. We have maximised the practical value of the trial by

comparing the effects of clinically relevant alternatives on a

diverse group of patients recruited directly from primary care.8

Limitations

Control patients did not receive a sham acupuncture

intervention. One hypothesis might be that the effects seen in the

acupuncture group resulted not from the physiological action of

needle insertion but from the “placebo effect.” Such an argument

is not relevant to an assessment of the clinical effectiveness of

Table 3 Health status as scored on the SF-36: values are means (SD)

End point

Baseline After treatment (three months after randomisation) At 12 months

Acupuncture Controls Acupuncture Controls Difference* 95% CI P value

Acupuncture Controls Difference* 95% CI P value

Physical functioning n=161: 81.9

(21.1)

n=139: 85.3

(18.4)

n=156: 82.6

(20.7)

n=134: 81.7

(21.3)

3.0 -0.2 to 6.2 0.07 n=157: 82.6

(23.3)

n=138: 82.3

(20.2)

2.7 -0.7 to 6.0 0.12

Role functioning

physical

n=161: 60.4

(40.2)

n=139: 59.4

(38.6)

n=154: 63.5

(41.4)

n=134: 56.7

(40.8)

5.0 -3.6 to 13.5 0.3 n=156: 70.0

(39.2)

n=137: 60.3

(41.3)

8.8 0.6 to 17.0 0.036

Role functioning

emotional

n=160: 73.2

(36.6)

n=140: 69.6

(39.4)

n=155: 72.4

(39.7)

n=130: 74.7

(36.3)

-5.1 -13 to 2.9 0.2 n=154: 76.0

(37.0)

n=136: 70.1

(39.2)

4.9 -3.5 to 13.4 0.3

Energy or fatigue n=161: 47.9

(19.9)

n=140: 52.2

(20.2)

n=154: 51.3

(21.6)

n=134: 51.8

(20.8)

1.9 -1.8 to 5.7 0.3 n=158: 55.4

(20.7)

n=139: 54.2

(20.7)

4.2 0.6 to 7.7 0.02

Emotional wellbeing n=161: 66.0

(15.0)

n=140: 67.0

(14.1)

n=156: 66.6

(15.3)

n=134: 67.8

(14.0)

-0.9 -3.8 to 2.0 0.5 n=158: 68.3

(15.4)

n=139: 68.9

(14.7)

0.0 -2.9 to 2.9 1

Social functioning n=161: 71.0

(24.9)

n=140: 73.6

(21.6)

n=156: 73.6

(24.8)

n=134: 75.4

(22.6)

-0.8 -5.6 to 4.1 0.8 n=158: 77.9

(25.2)

n=138: 74.8

(23.2)

4.2 -0.8 to 9.2 0.10

Pain n=160: 59.8

(23.3)

n=140: 66.3

(21.3)

n=156: 64.3

(23.6)

n=134: 64.6

(23.5)

2.4 -2.5 to 7.3 0.3 n=158: 65.0

(24.5)

n=139: 63.7

(22.2)

4.4 -0.2 to 9.0 0.063

General health n=161: 60.2

(21.1)

n=140: 64.0

(21.8)

n=156: 61.1

(21.1)

n=134: 61.8

(22.1)

2.1 -1.0 to 5.3 0.2 n=158: 61.9

(22.5)

n=139: 62.5

(22.9)

3.0 -0.4 to 6.5 0.09

Health change n=161: 52.5

(15.4)

n=140: 53.4

(17.0)

n=154: 58.0

(18.9)

n=133: 50.6

(18.3)

7.7 3.5 to 12.0 0.0004 n=158: 62.8

(20.1)

n=137: 55.5

(18.4)

7.9 3.5 to 12.3 0.0004

Higher scores indicate better quality of life. Differences between groups

are calculated by analysis of covariance.

*Adjusted difference: positive favours acupuncture.

Headache days per four weeks at baseline

Reduction in headache days per four weeks

-6

-2

0

2

4

6

8

10

12

-4

4 6 8 10 12 14 16 18 20 22 24 26 28

Fig 2 Frequency of headache at baseline and after treatment. Red dots are

actual

values for patients in the acupuncture group; blue squares are for controls.

The

straight line represents no change: observations above the line improved.

The

curved lines are regression lines (upper red line for acupuncture, lower

blue line

for controls) that can be used as predictions. Some outliers have been

removed

Table 4 Use of resources. Values are means (SD)

Resource Acupuncture Controls Difference between groups* 95% CI P value

No of visits to:

General practitioner 1.7 (2.5) 2.3 (3.6) 0.77 0.56 to 1.06 0.10

Specialist 0.22 (0.9) 0.14 (0.6) 1.13 0.34 to 3.73 0.8

Complementary therapist 2.0 (7.1) 2.3 (6.8) 0.56 0.18 to 1.72 0.3

No of days off sick 12.6 (18.9) 13.8 (16.2) 0.84 0.64 to 1.09 0.2

Visits to acupuncturists and physiotherapists are excluded.

*Adjusted difference between groups. Results are expressed as an incident

rate ratio—the proportion of events in the acupuncture group compared with

controls. Values less than one indicate

fewer events in the acupuncture group. For example, the value of 0.77 for

visits to general practitioners means that acupuncture patients made 23%

fewer visits.

Primary care

page 4 of 6 BMJ Online First bmj.com

acupuncture because in everyday practice, patients benefit from

placebo effects. None the less, good evidence from randomised

trials shows that acupuncture is superior to placebo in the treatment

of migraine.7 16 Furthermore, this study was modelled on

Vincent’s earlier double blind, placebo controlled trial in

migraine,17 which makes direct comparison possible. If placebo

explained the activity of acupuncture we would expect patients

in our control group, who received no treatment, to experience

smaller improvements than Vincent’s placebo treated controls,

leading to a larger difference between groups. However,

improvements in our controls (7.1% from a baseline headache

score of 26.7) were similar to those in Vincent’s trial (10.5% from

27.2) and differences between groups are non-significantly

smaller in the current trial (4.1 v 8.1). This implies that our findings

perhaps cannot be explained purely in terms of the placebo

effect. That said, we are unable to rule out such an explanation

given our lack of placebo control.

Patients in the trial were not blinded and may therefore have

given biased assessments of their headache scores. Measures to

minimise bias included minimum contact between trial

participants and the study team, extended periods of

anonymised diary completion and coaching patients about bias.

The difference between groups is far larger (odds ratio for

response 2.5) than empirical estimates of bias from failure to

blind (odds ratio 1.2).18 The similarity of our results to those of

the prior blinded study provides further evidence that bias does

not completely explain the apparent effects of acupuncture.

Patients recorded all treatments for headache during the

course of the study. Use of medication and other therapies (such

as chiropractic) was lower in patients assigned to acupuncture,

indicating that the superior results in this group were not due to

confounding by off-study interventions.

Comparison with other studies

A strength of the current trial is that its results are congruent

with much of the prior literature on acupuncture for headache.

Effects found in this study that have been previously reported

include: differences between acupuncture and control for

migraine7 16 19 that increased between follow up after treatment

and one year16; unconvincing effects for tension-type headache20–

23; improvements in severity as well as frequency16 24 and

increased benefit in patients with more severe headaches.16

Conclusion

A policy of using a local acupuncture service in addition to

standard care results in persisting, clinically relevant benefits for

primary care patients with chronic headache, particularly

migraine. Expansion of NHS acupuncture services for headache

should be considered.

The views are those of the authors and not that of the NHS. We thank the

following for their contributions: Claire Allen was consumer representative;

Tim Lancaster provided advice on recruitment methods; Kate Hardy was

the study nurse. Acupuncture was provided by Kyriakos Antonakos, Ann

Beavis, Reg D’Souza, Joan Davies, Nadia Ellis (who is a coauthor of this

paper), Sara Jeevanjee, Maureen Lovesey, Bets Mitchell, Alison Nesbitt,

Steve Reece, Stephanie Ross, and Hetty Salmon-Roozen.

Contributors: AJV conceived, designed and analysed the study and is its

guarantor; RWR, CEZ, CMS, and NE contributed to the original design with

particular contributions to outcome assessment (RWR, CMS); patients and

treatment (CEZ); acupuncture treatment (NE). RM contributed to design of

resource outcome assessment; RM, RvH and PF contributed to

development of data collection methods for sensitivity analysis.

Funding: The trial (ISRCTN96537534) was funded by NHS R & D National

Coordinating Centre for Health Technology Assessment (NCCHTA) grant:

96/40/15.

Competing interests: NE provides acupuncture as part of her private

physiotherapy practice.

Ethical approval: South West Multicentre Research Ethics Committee and

appropriate local ethics committees.

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13 Kee WG, Steedman S, Middaugh SJ. Medication quantification scale (MQS):

update of

detriment weights and medication additions. Am J Pain Management 1998;8:83-8

 

14 Tfelt-Hansen P, Block G, Dahlof C, Diener HC, Ferrari MD, Goadsby PJ, et

al.

Guidelines for controlled trials of drugs in migraine: second edition.

Cephalalgia

2000;20:765-86.

15 White A, Hayhoe S, Hart A, Ernst E.Adverse events following acupuncture:

prospective

survey of 32 000 consultations with doctors and physiotherapists. BMJ 2001

323:485-6.

16 Melchart D, Thormaehlen J, Hager S, Liao J, Linde K,WeidenhammerW.

Acupuncture

versus placebo versus sumatriptan for early treatment of migraine attacks: a

randomized controlled trial. J Intern Med 2003;253:181-8.

17 Vincent CA. A controlled trial of the treatment of migraine by

acupuncture. Clin J Pain

1989;5:305-12.

18 Schulz KF, Chalmers I, Hayes RJ, Altman DG. Empirical evidence of bias.

Dimensions

of methodological quality associated with estimates of treatment effects in

controlled

trials. JAMA 1995;273:408-12.

19 Allais G, De Lorenzo C, Quirico PE, Airola G, Tolardo G, Mana O, et al.

Acupuncture

in the prophylactic treatment of migraine without aura: a comparison with

flunarizine.

Headache 2002;42:855-61.

20 White AR, Eddleston C, Hardie R, Resch KL, Ernst E. A pilot study of

acupuncture for

tension headache, using a novel placebo. Acupuncture Med 1996;14:11-5.

21 Karst M, Rollnik JD, Fink M, Reinhard M, Piepenbrock S. Pressure pain

threshold and

needle acupuncture in chronic tension-type headache—a double-blind

placebocontrolled

study. Pain 2000;88:199-203.

22 Karakurum B, Karaalin O, Coskun O, Dora B, Ucler S, Inan L. The

“dry-needle

technique”: intramuscular stimulation in tension-type headache. Cephalalgia

2001;21:813-7.

23 Karst M, Reinhard M, Thum P, Wiese B, Rollnik J, Fink M. Needle

acupuncture in

tension-type headache: a randomized, placebo-controlled study. Cephalalgia

2001;21:637-42.

What is already known on this topic

Acupuncture is widely used to treat chronic pain

Several small trials indicate that acupuncture may be of

benefit for chronic headache disorders

The methodological quality of these studies has been

questioned

What this study adds

Acupuncture led to persisting, clinically relevant reduction

in headache scores

Patients receiving acupuncture used less medication, made

fewer visits to general practitioners, and took fewer days

away from work or other usual activities

Expansion of NHS acupuncture services for chronic

headache, particularly migraine, should be considered

Primary care

BMJ Online First bmj.com page 5 of 6

24 Lenhard L,Waite P. Acupuncture in the prophylactic treatment of migraine

headaches:

pilot study.N Z Med J 1983;96:663-6.

(Accepted 21 January 2004)

doi 10.1136/bmj.38029.421863.EB

Integrative Medicine Service, Biostatistics Service, Memorial

Sloan-Kettering

Cancer Center, 1275 York Avenue, NY, NY 10021

Andrew J Vickers assistant attending research methodologist

Evidence for Policy and Practice Information and Co-ordinating Centre

(EPPI-Centre), Social Science Research Unit, Institute of Education, London

WC1H 0NS

Rebecca W Rees research officer

Montpelier Health Centre, Bristol BS6 5PT

Catherine E Zollman general practitioner

Department of Psychological Medicine, Imperial College London, London W2 1PD

Rob McCarney research officer

Academic Rheumatology,Weston Education Centre, King’s College, London

SE5 9RJ

Claire M Smith senior trials coordinator

Department of Health and Social Sciences, Coventry University, Coventry CV1

5FB

Nadia Ellis lecturer

Royal London Homeopathic Hospital, London W1W 5PB

Peter Fisher director of research

Robbert Van Haselen deputy director of research

Correspondence to: A J Vickers vickersa

Primary care

page 6 of 6 BMJ Online First bmj.com

 

Centro de Medicina Oriental

Acupunctura,Laserterapia,Shiatsu,

Drenagem Linfatica,El-Terapia.

Dr.H.Peter Nussbaumer

351 269 827272 +351 967 044284

medoriental

Santiago do Cacém / Portugal

-------Mensagem original-------

 

De: Chinese Medicine

Data: 03/17/04 10:01:54

Para: Chinese Medicine

Assunto: Re: Good news for acupuncture in UK

 

Hi Phil.

 

This is indeed good news for acupuncture. I've actually found the

direct link to the article at the BMJ. Unfortunately, something is

blocking its download whilst i'm in China.

 

If anyone could download the pdf and email it to me I'll be

grateful, then I'll post it onto the group. The direct link is

http://bmj.bmjjournals.com/cgi/reprint/bmj.38029.421863.EBv2?

maxtoshow= & HITS=10 & hits=10 & RESULTFORMAT=1 & andorexacttitle=and & andorex

acttitleabs=and & fulltext=acupuncture & andorexactfulltext=and & searchid=

1079516893609_1259 & stored_search= & FIRSTINDEX=0 & sortspec=relevance & res

ourcetype=1,2,3,4

 

Big one eh? Shorter version is

http://tinyurl.com/yt9f4

 

I don't know how many hospital trusts will let acupuncture in the

door, but I'm sure a large part of the business will be conducted by

the weekend wonderer doc's rather than real acupuncturists. This

topic has come up before and it's going to be left in the hands of

the associations that speak for the majority of acupuncturists in

the UK. Let's hope their speaking for acupuncturists and not just

acupuncture itself.

 

ploaded an article by the BMJ on UK regulation.

 

Attilio

 

" " <@e...> wrote:

> Hi All,

>

> See this, from Robert McLinton [PA-L List]

>

> Best regards,

> Phil

>

> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

>

> Acupuncture 'beats headache pain'

>

> Acupuncture is an effective treatment for chronic headaches and

> should be more widely available on the NHS, experts say. Writing

> in the British Medical Journal, UK researchers said patients who

> were given acupuncture had fewer days of headaches than those

> who were not. They also saw their GP less and were not as reliant

> on painkillers.

>

> The government said doctors could decide to fund the therapy

> locally, if they felt patients would benefit.

>

> Researchers analysed 401 patients from across the UK who

> reported several days of severe headaches each week.

>

> They were randomly allocated to receive up to 12 acupuncture

> treatments over three months or to a control group offering other

> types of care, typically medication.

>

> This should help to lift acupuncture out of what is seen to be

> alternative to mainstream medicine Dr Mike Cummings, British

> Medical Acupuncture Society All patients completed a diary of

> headache and medication use for four weeks at the start of the

> study and again at three months and 12 months.

>

> They recorded the severity of their headaches on a six-point scale

> to produce an overall score.

>

> Patients receiving acupuncture experienced 22 fewer days of

> headache per year, used 15% less medication, made 25% fewer

> visits to their GP and were absent from work through sickness 15%

> less than the control group.

>

> The researchers, from centres around the UK, wrote that

> introducing acupuncture services could lead to significant long-

term

> benefits for patients with chronic headaches.

>

> They added: " Expansion of NHS acupuncture services for

> headache should be considered. "

>

> The medical director of the British Medical Acupuncture Society,

> Dr Mike Cummings described the study as " innovative " .

>

> NHS approval

>

> He said: " It is very positive for us. This should help to lift

> acupuncture out of what is seen to be alternative to mainstream

> medicine.

>

> " I think acupuncture should be more widely available on the NHS -

> but with a huge rider, only in areas where it has been shown to

> have definite benefits.

>

> " It is not a panacea for everything. It should be made available

in

> primary care to treat pain and to prevent costly referrals to

> hospitals. "

>

> Ailments which respond well to acupuncture include headaches,

> neck, shoulder and back pain and osteoarthritis in the knee, he

> says.

>

> Each week, 10% of GPs in the UK either refer patients to

> acupuncture or practise it themselves, and chronic headache is

> one of the most commonly treated conditions.

>

> It shows a growing recognition by the health service of the

benefit of

> complementary medicine.

>

> A Department of Health spokeswoman said: " The government

> appreciates that many people find different complementary

> medicines, such as acupuncture, helpful in alleviating the

> symptoms of certain illness, especially those for which orthodox

> medicine does not seems to have a complete answer.

>

> " As a result, some complementary and alternative medicine can be

> made available on the NHS if local NHS clinicians and

> commissioning organisations such as primary care trusts are

> convinced that it will be a clinical and cost effective use of

> resources. "

>

> Story from BBC NEWS:

> http://news.bbc.co.uk/go/pr/fr/-/2/hi/health/3506400.stm

>

> Published: 2004/03/15 03:41:10 GMT

>

> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

>

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