Confirmado en Alemania: la acupuntura igual de efectiva contra la migraña que las agresivas drogas alopatas.

Marlene Busko

http://www.medscape.com/viewarticle/587243

January
23, 2009 — Acupuncture is at least as effective as prophylactic drugs for
migraine and may also benefit some patients with frequent tension-type headache,
2 large reviews conclude.

"The data suggest that in about half of
patients, acupuncture decreases the frequency of migraine or frequent
tension-type headache by about 50%, which is quite similar to other effective
treatments for these disorders," lead reviewer Klaus Linde, MD, from the Center
for Complementary Medicine Research at Munich Technical University, in Germany,
told Medscape Psychiatry.

"Compared with drug treatments, acupuncture
has fewer side effects, although some patients are adverse to needle insertion,"
he added.

Perhaps surprisingly, the reviews found similar benefits in
migraine patients from true acupuncture and sham acupuncture, where needles were
placed in incorrect locations or did not penetrate the skin, suggesting needle
placement is not critical for these patients.

"Putting a needle in the
wrong place may still have some physiologic effect on the body," review author
Andrew Vickers, MD, from Memorial Sloan-Kettering Cancer Center, in New York,
told Medscape Psychiatry.

The reviews are published online January 21 in
the Cochrane Database of Systematic Reviews.

Acupuncture Commonly Used

Tension-type headaches are typically bilateral and mild to moderate in
intensity, whereas migraine headaches are characterized by recurrent attacks of
mostly one-sided, severe headache, typically with nausea and/or sensitivity to
light and sound.

According to the authors, back pain and arthritis are
the most common conditions treated by acupuncture, followed by chronic headache
and migraine.

Use of acupuncture varies by country. In the United
States, a 2002 national survey revealed that 4.1% of Americans had used
acupuncture at some time in their lives, and almost 10% of acupuncture users had
been treated for migraine or headache.

In Germany, a similar 2002 survey
revealed 8.7% of adults received acupuncture treatments in the previous year. So
far, social health insurance in that country covers the costs of acupuncture for
chronic low back pain and osteoarthritis of the knee, but not for headache, said
Dr. Linde.

Acupuncture and Migraine

According to the first
review, most patients with migraine can be adequately managed by treating acute
attacks. However, patients with frequent, poorly controlled migraine need
prophylactic intervention.

Drugs such as propranolol, metoprolol,
flunarizine, valproic acid, and topiramate are effective in reducing migraine
frequency in some patients, but the drugs' adverse effects often lead patients
to stop taking them.

A 2001 review of studies of acupuncture for
migraine found promising but insufficient evidence to support it as standard
treatment.

To determine the effectiveness of acupuncture for treating
migraine in studies up to 2008, investigators examined 22 randomized controlled
trials with 4419 participants who had been diagnosed with migraine with or
without aura.

The studies were at least 8 weeks long and compared
acupuncture prophylaxis with routine care (acute treatment), sham acupuncture,
or another intervention.

Six trials, including 2 large trials with 401
and 1715 patients, which compared acupuncture prophylaxis with acute care, found
that after up to 4 months of acupuncture, patients had fewer headaches. Of these
6 trials, 1 showed the beneficial effects of treatment continued at 9-month
follow-up.

In 14 trials that compared true acupuncture vs sham
acupuncture, patients in both groups had fewer migraines, but pooled data
analysis did not show true acupuncture was superior to sham acupuncture for any
outcome.

In 4 trials that compared acupuncture with proven prophylactic
drug treatments, patients reported greater improvements and fewer adverse
effects with acupuncture.

"Collectively, the studies suggest that
migraine patients benefit from acupuncture, although the correct placement of
needles seems to be less relevant than is usually thought by acupuncturists,"
the authors write.

Acupuncture and Tension-Type Headache

In the
second review article, investigators examined the effectiveness of acupuncture
for tension-type headaches.

Tension-type headaches typically occur
infrequently and are adequately treated by over-the-counter medications.
However, in some patients, the headaches are frequent (from 1 to 15 days a
month) or chronic (15 or more days a month).

Analgesic drugs or
nonsteroidal anti-inflammatory drugs can be used to treat pain from tension-type
headache episodes of up to 10 days a month, and guidelines recommend
antidepressants such as amitriptyline for chronic tension-type headaches.

A 2001 review of acupuncture for idiopathic headache was inconclusive.

To investigate the effectiveness of acupuncture for reducing the
frequency of tension-type headache in studies up to 2008, the investigators
examined 11 trials with 2317 participants.

Two large trials investigated
whether adding acupuncture to basic care, which involved treatment of acute
headache with painkillers, was superior to basic care alone. The studies found
significant short-term benefits (up to 3 months) associated with adjunctive
acupuncture therapy. The number of headache days was reduced by at least 50% in
47% of patients who received acupuncture plus basic care. In patients who
received basic care alone, 16% experienced a 50% reduction in the number of
headache days.

Six trials comparing true acupuncture with sham
acupuncture found the number of headache days was reduced by at least 50% in 50%
of patients who received acupuncture but only in 41% of patients who received
sham acupuncture, a small but significant difference.

"The available
evidence suggests that acupuncture could be a valuable option for patients
suffering from frequent tension-type headache," the authors write.

Another Treatment Option

If headaches are not too frequent (up
to 2 migraine attacks per month and up to 8 days of mild tension-type headache
per month), treatment with analgesics should be sufficient. Relaxation or
biofeedback can also be helpful, said Dr. Linde.

However, if headaches
are more frequent and are not well controlled, prophylactic treatment is
indicated. In migraine, this typically consists of drugs such as beta blockers,
calcium antagonists, or other drugs such topiramate or valproate.

"Acupuncture seems similarly or possibly even more effective and has
fewer side effects than medication, but it requires more contact time with a
provider. So acupuncture is 1 option in more severe or frequent headaches," he
said.

Available data suggest that for migraine or for frequent
tension-type headache, 8 to 12 acupuncture sessions that are typically 20 to 30
minutes long should produce an effect that lasts about 6 months and possibly
longer.

"However, as with other therapies, not all patients respond," he
said.

Dr. Linde was involved in 1 of the reviewed trials and has
received conference travel reimbursement and, in 2 cases, speaker fees from
British, German, and Spanish medical acupuncture societies and the Society of
Acupuncture Research. Dr. Vickers received an honorarium for presentations at
the 2007 meeting of the Society for Acupuncture Research. The financial
disclosures of the other authors are listed in the paper. The review was partly
supported by the National Institute of Arthritis and Musculoskeletal and Skin
Diseases, the International Headache Society, and the National Center for
Complementary and Alternative Medicine.

Cochrane Database Syst Rev.
2009;1: CD001218 Abstract, CD007587. Abstract