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MIGRAINE TREATMENTS NOW AND IN THE FUTURE

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Vickers AJ, Rees RW, Zollman CE, McCarney R, Smith CM, Ellis N, Fisher P, Van Haselen R. Acupuncture for chronic headache in primary care: Large, pragmatic, randomised trial. BMJ. 2004;328:744-750.

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: Randomized, controlled trial.

Setting: General practices in England and Wales.

Participants: Four hundred and one patients with chronic headache, predominantly migraine.

Interventions: Patients were randomly allocated to receive up to 12 acupuncture treatments over 3 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, 3, and 12 months. Use of resources was assessed every 3 months.

Results: Headache score at 12 months, the primary endpoint, 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% CI: 2.2 to 7.0; P= .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 favored acupuncture, although differences reached significance only for physical role functioning, energy, and change in health. Compared with controls, patients randomized to acupuncture used 15% less medication (P= .02), made 25% fewer visits to general practitioners (P= .10), and took 15% fewer days off sick (P= .2).

Conclusions: Acupuncture leads to persisting, clinically relevant benefits for primary care patients with chronic headache, particularly migraine. Expansion of National Health Service acupuncture services should be considered.
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Document Type: Research Article

Publication date: September 1, 2004

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