Copyright 2017 American Medical Association. All rights reserved.
The L ong-term Eff ect of Acupuncture for Migr aine Prophylaxis
A Randomized Clinical Trial
Ling Zhao, PhD; Jiao Chen, PhD; Ying Li, PhD; Xin Sun, PhD; Xiaorong Chang, MD; Hui Zheng, PhD; Biao Gong, MD;
Yinlan Huang, PhD; Mingxiao Yang, PhD; Xi Wu, PhD; Xuezhi Li, PhD; Fanrong Liang, MD
IMPORTANCE
The long-term prophylactic effects of acupuncture for migraine are uncertain.
OBJECTIVE To investigate the long-term effects of true acupuncture compared with sham
acupuncture and being placed in a waiting-list control group for migraine prophylaxis.
DESIGN, SETTING, AND PARTICIPANTS This was a 24-week randomized clinical trial (4 weeks of
treatment followed by 20 weeks of follow-up). Participants were randomly assigned to true
acupuncture, sham acupuncture, or a waiting-list control group. The trial was conducted from
October 2012 to September 2014 in outpatient settings at 3 clinical sites in China. A total of
249 participants 18 to 65 years old with migraine without aura based on the criteria of the
International Headache Society, with migraine occurring 2 to 8 times per month.
INTERVENTIONS Participants in the true acupuncture and sham acupuncture groups received
treatment 5 days per week for 4 weeks for a total of 20 sessions. Participants in the
waiting-list group did not receive acupuncture but were informed that 20 sessions of
acupuncture would be provided free of charge at the end of the trial.
MAIN OUTCOMES AND MEASURES Participants used diaries to record migraine attacks. The
primary outcome was the change in the frequency of migraine attacks from baseline to week
16. Secondary outcome measures included the migraine days, average headache severity, and
medication intake every 4 weeks within 24 weeks.
RESULTS A total of 249 participants 18 to 65 years old were enrolled, and 245 were included
in the intention-to-treat analyses. One hundred eighty-nine (77.1%) were women. Baseline
characteristics were comparable across the 3 groups. The mean (SD) change in frequency of
migraine attacks differed significantly among the 3 groups at 16 weeks after randomization
(P < .001); the mean (SD) frequency of attacks decreased in the true acupuncture group by
3.2 (2.1), in the sham acupuncture group by 2.1 (2.5), and the waiting-list group by 1.4 (2.5);
a greater reduction was observed in the true acupuncture than in the sham acupuncture
group (difference of 1.1 attacks; 95% CI, 0.4-1.9; P = .002) and in the true acupuncture vs
waiting-list group (difference of 1.8 attacks; 95% CI, 1.1-2.5; P < .001). Sham acupuncture was
not statistically different from the waiting-list group (difference of 0.7 attacks; 95% CI,
−0.1 to 1.4; P =.07).
CONCLUSIONS AND RELEVANCE Among patients with migraine without aura, true
acupuncture may be associated with long-term reduction in migraine recurrence compared
with sham acupuncture or assigned to a waiting list.
TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01687660
JAMA Intern Med. 2017;177(4):508-515. doi:10.1001/jamainternmed.2016.9378
Published online February 20, 2017.
Invited Commentary page 516
Supplemental content
CME Quiz at
jamanetwork.com/learning
and CME Questions page 604
Author Affiliations: Acupuncture
and Tuina School, Chengdu University
of Traditional Chinese Medicine,
Chengdu, Sichuan, China (Zhao,
Chen, Y. Li, Zheng, Yang, Wu, Liang);
The Chinese Cochrane Centre, West
China Hospital, Sichuan University,
Chengdu, Sichuan, China (Sun);
Acupuncture and Tuina School,
Hunan University of Traditional
Chinese Medicine, Hunan, Changsha,
China (Chang); Department of
Traditional Chinese Medicine,
Chongqing Medical University,
Chongqing, China (Gong, X. Li);
Department of Traditional Chinese
Medicine, Ningxia Medical University,
Ningxia, Yinchuan, China (Huang).
Corresponding Author: Fanrong
Liang, MD, Acupuncture and Tuina
School, Chengdu University of
Traditional Chinese Medicine,
No. 37 Shi’er Qiao Rd, Chengdu,
Sichuan 610075, China
(acuresearch@126.com).
Research
JAMA Internal Medicine | Original Investigation
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A
mong neurological disorders, migraine is a leading
cause of disability and significantly contributes to in-
dividual and societal burdens owing to pain and envi-
ronmental sensitivities. The prevalence of migraine is 14.9%
in the United States,
1
and 8.4% to 12.7% in Asia.
2
Approxi-
mately 25% to 38% of migraineurs need preventive therapy,
3,4
and pharmacotherapies, such as divalproex sodium, topira-
mate, metoprolol, and propranolol, are recommended for mi-
graine prevention. However, such treatments are often asso-
ciated with an increased risk of adverse events (AEs), including
weight gain, fatigue, sleep disturbance, and gastrointestinal
intolerance.
4,5
Excessive use of analgesics or specific antimi-
graine treatments could cause medication overuse–induced
headache and an increase in headache frequency.
3,6
Because
of the limitations associated with these conventional treat-
ments, efforts have been made to identify effective, low-risk
interventions.
Acupuncture is widely used for managing migraine in
China and western countries, especially for drug-refractory
patients.
7,8
The goals of acupuncture are usually 2-fold: relief
of pain during migraine (acute effect)
9,10
and prevention of
future migraine attacks (long-term effect). Several trials with
a small sample size
11-14
have shown that true acupuncture (TA)
may be more effective than sham acupuncture (SA) (simu-
lated, or needling at nonacupoint locations) in the reduction
of migraine intensity, frequency of migraine attacks, and num-
ber of migraine days; others,
15-18
however, have reported no
differences. The inconsistency of these findings may result
from variations in the design characteristics (eg, length of
follow-up, interventions used) and study population.
The long-term effect of acupuncture is critical to success-
ful prophylaxis and reduction of migraine recurrence. One im-
portant unanswered question is whether TA is superior to SA
in preventing future migraine attacks. Therefore, we further
conducted a 24-week, multicenter, 3-arm, parallel random-
ized clinical trial (RCT) to compare the long-term effect of TA
vs SA or waiting list (WL) in migraineurs.
Methods
Study Population and Protocol
We recruited patients who had migraine without aura from
the outpatient unit of the Departments of Acupuncture and
Neurology in 3 clinical centers: the teaching hospital of
Chengdu University of Traditional Chinese Medicine (TCM),
the First Affiliated Hospital of Hunan University of TCM, and
the Affiliated Hospital of Chongqing Medical University.
Migraine without aura was diagnosed according to the clas-
sification criteria of the International Headache Society.
19
Patients who complained of recurrent headaches lasting 4 to
72 hours, unilateral headaches with pulsating quality, and
also headaches aggravated by routine physical activity were
recruited for further evaluation. Patients were enrolled in
the study from October 2012 to September 2014. Patients
were not reimbursed, but did receive free treatment. The
protocol was approved by the local institutional ethics
review boards and was performed in accordance with the
Declaration of Helsinki and the Chinese version of the Inter-
national Conference on Harmonization–Good Clinical Prac-
tice. The protocol was published previously and is available
in the Supplement.
20
The inclusion criteria were as follows: men or women 18
to 65 years old with initial onset of migraines prior to the age
of 50 years; experience of acute migraine attacks at a fre-
quency of 2 to 8 times per month 3 months before inclusion;
experience of migraine attacks for at least 1 year; completion
of a baseline headache diary; and provision of written,
informed consent by the patients.
Patients with any of the following conditions were ex-
cluded: headache caused by organic disorders (eg, subarach-
noid hemorrhage, cerebral hemorrhage, cerebral embolism,
cerebral thrombosis, vascular malformation, arteritis, hyper-
tension, or arteriosclerosis); the presence of neurological
diseases, immunodeficiency, bleeding disorders, or allergies;
prophylactic headache treatment with drugs during the pre-
vious 3 months; pregnancy, lactation, or plans to become preg-
nant within 6 months; or involvement in other clinical trials.
Randomization and Blinding
A total of 249 eligible patients were recruited and were ran-
domly assigned at a 1:1:1 ratio to receive TA treatment or SA
treatment, or to be place on a WL. Central randomization, using
an online or messaging system, was performed by the Bright-
ech Magnsoft Data Services. Randomization sequence was gen-
erated in blocks of varying sizes and stratified by centers.
The participants in the TA group and SA group were
blinded, while those in the WL group were not. Acupunctur-
ists could not be blinded to the treatment assignments given
the nature of the interventions. Outcome assessors, data col-
lectors, and statisticians were blinded to the treatment allo-
cation.
Interventions
Electrostimulation generates an analgesic effect, as manual
acupuncture does.
21
All acupuncturists were trained for at least
5 years and licensed with at least 4 years of clinical experi-
ence. Patients in the TA group and the SA group received 20
sessions of electroacupuncture treatment (once per day for 5
consecutive days followed by a 2-day break), each lasting 30
minutes, for 4 weeks. Migraineurs were not allowed to take any
prophylactic medications. In cases of intolerable headache, the
Key Points
Question What is the long-term efficacy of acupuncture for
prophylaxis of migraine?
Findings In this 24-week, randomized clinical trial that included
249 patients with migraine without aura, we found that true
acupuncture significantly reduced the frequency of migraine
attacks, compared with sham acupuncture and being placed on a
waiting list for treatment.
Meaning Among patients with migraine without aura, true
acupuncture may be associated with long-term reduction in migraine
recurrence compared with sham acupuncture or waiting list.
Long-term Effect of Acupuncture for Migraine Prophylaxis Original Investigation Research
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patients were instructed to take ibuprofen (300-mg capsules
with sustained release) as a rescue medication, and the usage
of ibuprofen was documented in the headache diary.
Four acupoints were used per treatment. All patients
received acupuncture on 2 obligatory points, including GB20
and GB8. The 2 other points were chosen according to the
syndrome differentiation of meridians in the headache
region. The potential acupoints included SJ5, GB34, BL60,
SI3, LI4, ST44, LR3, and GB40.
20
The use of additional acu-
points other than the prescribed ones was not allowed. We
chose the prescriptions as a result of a systematic review of
ancient and modern literature,
22,23
consensus meetings with
clinical experts, and experience from our previous study.
18
Sterile, single-use filiform acupuncture needles, each with a
length of 25 to 40 mm and a diameter of 0.25 mm, were
used in the treatment. Acupuncturists applied therapy uni-
laterally by alternatively using the left and right acupoints.
Each point was acupunctured to achieve the Deqi sensation
(a sensation of soreness, numbness, distention, or radiating
that indicates effective needling). The HANS acupoint nerve
stimulator (model LH 200A; Han Institute, TENS, Nanjing,
China) was used after needle insertion. The stimulation
frequency was 2/100 Hz (alternating every 3 seconds), and
the intensity varied from 0.1 to 1.0 mA until the patients felt
comfortable. This stimulation method was optimal for
obtaining an analgesic effect
21
and was used successfully in
our previous study.
18
In addition, more details of the proce-
dure have been published.
20
The number of needles, electric stimulation, and dura-
tion of treatment in the SA group were identical in the TA group
except that an attempt was not made to induce the Deqi sen-
sation. Four nonpoints were chosen according to our previ-
ous studies.
20,24
Patients in the WL group did not receive acupuncture from
the beginning of the clinical trial but were informed that they
would be provided with 20 sessions of acupuncture treat-
ment for free after 24 weeks.
Measures
Data Collection
All patients were instructed to complete headache diary rec-
ords every 4 weeks after inclusion. The headache diary docu-
mented the time of migraine onset, duration, severity (evalu-
ated by the visual analog scale [VAS] score), and rescue
medication use. The frequency of migraine attacks over 24
weeks, migraine days, and the intensity of each attack were
calculated every 4 weeks. At each follow-up, 2 blinded evalu-
ators at each clinical center reminded patients by phone calls
or text messages to return the headache diary to the trial
offices via emails or to outpatient offices at follow-up visits.
Outcome Measures
The primary outcome was the change in the frequency of mi-
graine attacks between baseline and 16 weeks after random-
ization. Secondary outcome measures included the number
of days with migraine (migraine days), average headache se-
verity, and medication intake every 4 weeks within 24 weeks.
In addition, migraine-specific quality-of-life questionnaire
(MSQ), and pain-related impairment of emotion (the Zung self-
rating anxiety scale [SAS] and Zung self-rating depression scale
[SDS]) were assessed at baseline and at the 4-week visit. Re-
searchers documented acupuncture treatment and reasons for
dropouts during the study period. Acupuncture-associated
AEs, including bleeding, subcutaneous hemorrhage, hema-
toma, fainting, serious pain, and local infection, were re-
corded at each treatment session.
Figure 1. Flowchart of the Screening, Enrollment, Randomization,
and Follow-up
662 Patients screened
during the baseline
period
413 Excluded
205 Did not meet
inclusion criteria
78 Lacked interest in
participation
71 Feared acupuncture
59 Did not complete the
diary during the
baseline period
4 Excluded
1 Assigned erroneously
because of misdiagnosis
3 With primary outcome
missing
Weeks 1-4
82 Assigned to
waiting list
group
83
0
Assessed
Dropped out
Weeks 5-8
83
0
Assessed
Dropped out
Weeks 9-12
83
0
Assessed
Dropped out
Weeks 13-16
82
1
Assessed
Dropped out
1 Changed the
phone number
Weeks 17-20
81
1
Assessed
Dropped out
1 With inter-
current illness
Weeks 21-24
81
0
Assessed
Dropped out
Analysis
83 Analyzed
with ITT
77
3
Assessed
Dropped out
2 Unsatisified
1 With time
restriction
77
0
Assessed
Dropped out
77
0
Assessed
Dropped out
77
0
Assessed
Dropped out
77
0
Assessed
Dropped out
77
0
Assessed
Dropped out
80 Analyzed
with ITT
82
0
Assessed
Dropped out
82
0
Assessed
Dropped out
82
0
Assessed
Dropped out
82
0
Assessed
Dropped out
81
1
Assessed
Dropped out
1 Unwilling to
follow up
81
0
Assessed
Dropped out
82 Analyzed
with ITT
83 Assigned to true
acupuncture
group
80 Assigned
to sham
acupuncture
group
249 Randomized
ITT indicates intention to treat.
Research Original Investigation Long-term Effect of Acupuncture for Migraine Prophylaxis
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Sample Size Calculation and Statistical Analysis
We designed our trial to determine whether there was a differ-
ence among the TA group, the SA group, and the WL group in
terms of the frequency of migraine attacks. According to our pre-
vious study,
18
we anticipated that the frequency of migraine at-
tacks over 16 weeks would be 2.7 in the TA group and 3.7 in the
SA group, considering a mean clinically relevant difference of
1.0 and a standard deviation (SD) of 1.81. With a 2-sided signifi-
cance level of 5% and power of 90%, 70 participants per group
would be required, as calculated by NQuery Advisor software
(version 4.0; Statistical Solutions). With an estimated loss-to-
follow-up rate of 15%, we planned to enroll 249 participants in
the 3 groups, with 83 participants in each group.
The baseline characteristics and clinical outcomes de-
scribed are based on the intention-to-treat (ITT) population,
which included participants who had at least 1 treatment and
1 primary outcome measure (n = 245). Continuous variables
are presented as the mean (SD) with 95% CIs. Categorical vari-
ables are described as numbers and percentages. The missing
data of participants who dropped out were replaced by the last
observation carried forward method. The significance level
used for the statistical analysis with 2-tailed testing was 5%.
The analysis plan was determined before the study was
conducted. If the data were normally distributed, we planned
to use the analysis of covariance to detect differences among
the 3 groups; if not, we planned to use the Kruskal-Wallis test.
Secondary outcome measures were evaluated using the χ
2
test
for categorical data, and analysis of variance or Kruskal-
Wallis tests were used for quantitative variables according to
the data distribution. If the global test among 3 arms was sig-
nificant, the least significant difference (LSD) test was used for
pairwise comparisons when the data were normally distrib-
uted; otherwise, the LSD was applied after rank-transforma-
tion when the variables showed nonnormality.
All data in this trial were commissioned to Brightech-
Magnsoft Data Services for analysis using SAS statistical soft-
ware (version 9.3; SAS Institute Inc).
Results
Participants and Baseline Characteristics
After the screening of 662 patients, 249 participants 18 to 65
years old were randomized. One hundred eighty-nine (77.1%)
were women. A total of 245 patients (83 in the TA group, 80
in the SA group, and 82 in the WL group) were included in the
ITT population (Figure 1). Table 1 shows the patient charac-
teristics at baseline and acupuncture expectation before treat-
ment. They were comparable across the 3 groups. Six pa-
tients (2.4%) were unable to undergo follow-up (2 in the TA
group, 3 in the SA group, and 1 in the WL group). During the
treatment period, the mean number of treatments was 19.31
in the TA group and 19.23 in the SA group.
Primary Outcome
The change in frequency of migraine attacks differed signifi-
cantly among the 3 groups at 16 weeks after randomization
(Table 2). The frequency of attacks decreased in the TA group
by 3.2, in the SA group by 2.1, and the WL group by 1.4; a greater
reduction was observed in the TA than in the SA group (dif-
ference of 1.1 attacks; 95% CI, 0.4-1.9; P = .002) and in the TA
vs WL group (difference of 1.8 attacks; 95% CI, 1.1 to 2.5;
P < .001). The SA group was not statistically different from the
WL group (difference of 0.7 attacks; 95% CI, −0.1 to 1.4; P =.07)
(Table 2). The per-protocol analysis showed similar results.
Secondary Outcomes
The effects of acupuncture on the secondary outcomes seemed
to be persistent during follow-up. The frequency of migraine
attacks (Figure 2), migraine days, and VAS scores were signifi-
cantly lower in the TA group than in the other 2 control groups
in each interview during weeks 4 to 24 (Table 2). Significant
differences in frequency of migraine and migraine days be-
tween the 2 control groups were only found at weeks 8, 12, and
20 after inclusion within the follow-up period (Table 2).
Table 1. Baseline Characteristics of 245 Patients Included in the Intention-to-Treat Analysis
a
Characteristic
Group
All Patients
(n = 245)
TA
(n = 83)
SA
(n = 80)
WL
(n = 82)
Women 65 (78.3) 63 (78.8) 61 (74.4) 189 (77.1)
Age, mean (SD), y 36.4 (14.2) 39.1 (14.6) 38.8 (13.4) 38.1 (14.1)
Duration of illness, mean (SD), mo 115.7 (99.5) 113.0 (104.2) 104.6 (82.0) 111.1 (95.4)
Family history, yes vs no 19 (22.9) 16 (20.0) 21 (25.6) 56 (22.9)
Previous use of acupuncture 17 (20.5) 15 (18.8) 21 (25.6) 53 (21.6)
Use of acute pain medication 36 (43.4) 24 (28.9) 29 (34.9) 89 (36.3)
Accompanying symptoms
Nausea or vomiting 55 (66.3) 52 (65.0) 45 (54.9) 152 (62.0)
Photophobia or phonophobia 22 (26.5) 23 (28.8) 33 (40.2) 78 (31.8)
Others 6 (7.2) 5 (6.3) 4 (4.9) 15 (6.1)
Acupuncture expectation of improvement
None 0 0 1 (1.2) 1 (0.4)
Slight 6 (7.2) 9 (11.3) 9 (11.0) 24 (9.8)
Some 28 (33.7) 24 (30.0) 25 (30.5) 77 (31.4)
Significant 49 (59.0) 47 (58.8) 47 (57.3) 143 (58.4)
Abbreviations: SA, sham
acupuncture; TA, true acupuncture;
WL, waiting list.
a
Data are given as No. (%) except
where noted.
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Table 2. Headache Diary–Based Outcome Measurements During the Entire Study
Outcome Measure
TA
(n = 83)
SA
(n = 80)
WL
(n = 82) P Value
Pairwise Comparison
TA vs SA TA vs WL SA vs WL
Effect Size (95% CI) P Value
a
Effect Size (95% CI) P Value
a
Effect Size (95% CI) P Value
a
Difference From Baseline in Frequency of Migraine Attacks, Mean (SD), No.
b,c
Baseline 4.8 (2.3) 5.0 (2.4) 4.9 (2.5) .85
NA NA NA
Treatment, 1-4 wk 2.7 (2.4) 1.5 (2.5) 0.8 (1.9) <.001 0.5 (0.2 to 0.8) .001 0.9 (0.6 to 1.2) <.001 0.3 (0.0 to 0.6) .07
After treatment, wk
5-8 3.1 (2.1) 2.0 (2.2) 1.0 (2.4) <.001 0.5 (0.2 to 0.8) .002 0.9 (0.6 to 1.3) <.001 0.4 (0.1 to 0.7) .006
9-12 3.0 (2.0) 2.1 (2.5) 1.1 (2.1) <.001 0.4 (0.1 to 0.7) .005 0.9 (0.6 to 1.2) <.001 0.4 (0.1 to 0.7) .005
13-16 3.2 (2.1) 2.1 (2.5) 1.4 (2.5) <.001 0.5 (0.2 to 0.8) .002 0.8 (0.5 to 1.1) <.001 0.3 (0.0 to 0.6) .07
17-20 3.1 (1.8) 2.2 (2.5) 1.4 (2.3) <.001 0.4 (0.1 to 0.7) .008 0.8 (0.5 to 1.1) <.001 0.3 (0.0 to 0.6) .03
21-24 3.0 (2.0) 2.1 (2.4) 1.4 (2.6) <.001 0.4 (0.1 to 0.7) .01 0.7 (0.4 to 1.0) <.001 0.3 (0.0 to 0.6) .05
Days With Migraine per 4 Weeks, Mean (SD), No.
b,d
Baseline 5.9 (3.9) 6.2 (4.4) 6.0 (4.6) .80
NA NA NA
Treatment, 1-4 wk 2.4 (1.7) 4.0 (2.9) 4.5 (2.4) <.001 −0.7 (−1.0 to −0.4) <.001 −1.0 (−1.3 to −0.7) <.001 −0.2 (−0.5 to 0.1) .18
After treatment, wk
5-8 1.8 (1.9) 3.3 (2.3) 4.4 (2.3) <.001 −0.7 (−1.0 to −0.4) <.001 −1.2 (−1.6 to −0.9) <.001 −0.5 (−0.8 to −0.2) .001
9-12 2.1 (3.2) 3.2 (2.3) 4.2 (2.2) <.001 −0.4 (−0.7 to −0.1) .008 −0.8 (−1.1 to −0.4) <.001 −0.4 (−0.8 to −0.1) .01
13-16 2.0 (3.2) 3.1 (2.1) 3.8 (2.1) <.001 −0.4 (−0.7 to −0.1) .005 −0.7 (−1.0 to −0.4) <.001 −0.3 (−0.6 to 0.0) .06
17-20 2.0 (3.2) 3.0 (2.3) 3.9 (2.2) <.001 −0.4 (−0.7 to −0.1) .01 −0.7 (−1.0 to −0.4) <.001 −0.4 (−0.7 to −0.1) .03
21-24 2.1 (3.3) 3.1 (2.2) 3.8 (1.8) <.001 −0.4 (−0.7 to −0.1) .01 −0.6 (−0.9 to −0.3) <.001 −0.3 (−0.7 to 0.0) .07
VAS Score, Mean (SD)
b
Baseline 5.7 (1.9) 5.6 (1.6) 5.1 (1.5) .10
NA NA NA
Treatment, 1-4 wk 3.6 (1.9) 4.2 (1.7) 4.9 (1.6) .001 −0.3 (−0.6 to 0.0) .04 −0.7 (−1.1 to −0.4) <.001 −0.4 (−0.7 to −0.1) .02
After treatment, wk
5-8 3.7 (2.3) 4.3 (1.9) 5.0 (1.8) .002 −0.3 (−0.6 to 0.0) .04 −0.6 (−0.9 to −0.3) <.001 −0.4 (−0.7 to −0.1) .04
9-12 3.4 (2.1) 4.1 (1.9) 5.1 (1.5) <.001 −0.3 (−0.7 to −0.0) .01 −0.9 (−1.2 to −0.6) <.001 −0.6 (−0.9 to −0.3) .001
13-16 3.4 (2.3) 4.2 (1.9) 4.9 (1.4) <.001 −0.4 (−0.7 to −0.1) .01 −0.8 (−1.1 to −0.5) <.001 −0.4 (−0.7 to −0.1) .01
17-20 3.4 (2.0) 4.3 (1.8) 4.9 (1.4) <.001 −0.5 (−0.8 to −0.2) <.001 −0.9 (−1.2 to −0.5) <.001 −0.4 (−0.7 to −0.1) .03
21-24 3.2 (2.0) 4.2 (1.7) 4.9 (1.3) <.001 −0.5 (−0.8 to −0.2) <.001 −1.0 (−1.3 to −0.7) <.001 −0.5 (−0.8 to −0.1) .01
Use of Acute Pain Medication, No. (%)
e
Baseline 36 (43.4) 24 (28.9) 29 (34.9) .15
NA NA NA
Treatment, 1-4 wk 5 (6.0) 4 (4.8) 13 (8.8) .03
NA NA NA
After treatment, wk
5-8 3 (3.6) 3 (3.6) 15 (18.1) .001 NA NA NA
9-12 5 (6.0) 4 (4.8) 13 (8.8) .03 NA NA NA
13-16 5 (6.0) 5 (6.0) 16 (19.3) .006 NA NA NA
17-20 5 (6.0) 7 (8.4) 18 (21.7) .004 NA NA NA
21-24 5 (6.0) 7 (8.4) 19 (22.9) .002 NA NA NA
Abbreviations: NA, not applicable; SA, sham acupuncture; TA, true acupuncture; VAS, visual analog scale;
WL, waiting list.
a
P value based on the least significant difference.
b
P values based on Kruskal-Wallis analysis among the 3 groups.
c
The frequency of migraine attack was defined as the number of episodes of migraine attack separated by
pain-free intervals of at least 48 h, as recorded in the headache diary.
d
Number of days with migraine was defined as the duration of migraine attacks.
e
P values based on χ
2
test among the 3 groups.
Research Original Investigation Long-term Effect of Acupuncture for Migraine Prophylaxis
512 JAMA Internal Medicine April 2017 Volume 177, Number 4 (Reprinted) jamainternalmedicine.com
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