Summary
Background: This study aimed to explore the effectiveness of acupuncture combined with tuina therapy in patients with migraine. Methods: A prospective, randomized controlled assessor-blind clinical trial was performed between January 2017 and May 2018, and 135 patients were assigned into acupuncture combined with tuina (A), acupuncture (B), and control (flunarizine hydrochloride) (C) groups, each with 45 patients. Treatments were performed for 12 weeks and a 4-week follow-up. Frequency of attacks, severity of pain, duration of migraine, associated symptoms, patient-reported outcome (PRO) scores, and frequency of analgesic consumption were assessed. Results: The total effective rate was 95.6, 88.9, and 75.6% for group A, B, and C, respectively, with a significant reduction in attack frequency, severity of pain, duration of migraine, and associated symptoms at post-treatment and follow-up compared to pre-treatment. The PRO scores and frequency of analgesic consumption were significantly improved (group A, p < 0.01; groups B and C, - p < 0.05). The differences in pre-/post-treatment and in pre-treatment/follow-up in groups A and B were significantly improved compared to group C (A vs. C, p < 0.01; B vs. C, A vs. B, p < 0.05). No significant adverse events occurred. Conclusion: Acupuncture combined with tuina could significantly increase the therapeutic effect of acupuncture in migraine treatment.
References
1.
Chu
H
, Seo
J
, Kim
C
, Moon
Y
, Kang
DG
, Lee
HS
, et al. Electroacupuncture for migraine protocol for a systematic review of controlled trials
. Medicine (Baltimore)
. 2018
Apr
;97
(17
):e9999
.
[PubMed]
0025-79742.
Headache Classification Committee of the International Headache Society (IHS)
. The International Classification of Headache Disorders, 3rd edition (beta version)
. Cephalalgia
. 2013
Jul
;33
(9
):629
–808
.
[PubMed]
0333-10243.
Vos
T
, Flaxman
AD
, Naghavi
M
, Lozano
R
, Michaud
C
, Ezzati
M
, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010
. Lancet
. 2012
Dec
;380
(9859
):2163
–96
.
[PubMed]
0140-67364.
Stovner
L
, Hagen
K
, Jensen
R
, Katsarava
Z
, Lipton
R
, Scher
A
, et al. The global burden of headache: a documentation of headache prevalence and disability worldwide
. Cephalalgia
. 2007
Mar
;27
(3
):193
–210
.
[PubMed]
0333-10245.
Burch
RC
, Loder
S
, Loder
E
, Smitherman
TA
. The prevalence and burden of migraine and severe headache in the United States: updated statistics from government health surveillance studies
. Headache
. 2015
Jan
;55
(1
):21
–34
.
[PubMed]
0017-87486.
Buse
DC
, Loder
EW
, Gorman
JA
, Stewart
WF
, Reed
ML
, Fanning
KM
, et al. Sex differences in the prevalence, symptoms, and associated features of migraine, probable migraine and other severe headache: results of the American Migraine Prevalence and Prevention (AMPP) Study
. Headache
. 2013
Sep
;53
(8
):1278
–99
.
[PubMed]
0017-87487.
Ayzenberg
I
, Katsarava
Z
, Sborowski
A
, Chernysh
M
, Osipova
V
, Tabeeva
G
, et al. Headache-attributed burden and its impact on productivity and quality of life in Russia: structured healthcare for headache is urgently needed
. Eur J Neurol
. 2014
May
;21
(5
):758
–65
.
[PubMed]
1351-51018.
Rees
DI
, Sabia
JJ
. The effect of migraine headache on educational attainment
. J Hum Resour
. 2011
;46
(2
):317
–32
. 0022-166X9.
Steiner
TJ
, Scher
AI
, Stewart
WF
, Kolodner
K
, Liberman
J
, Lipton
RB
. The prevalence and disability burden of adult migraine in England and their relationships to age, gender and ethnicity
. Cephalalgia
. 2003
Sep
;23
(7
):519
–27
.
[PubMed]
0333-102410.
Steiner
TJ
, Stovner
LJ
, Birbeck
GL
. Migraine: the seventh disabler
. Cephalalgia
. 2013
Apr
;33
(5
):289
–90
.
[PubMed]
0333-102411.
Zogopoulos
P
, Vretakos
G
, Venetikidis
A
, Rologis
D
. Acupuncture as a treatment modality for migraine - a systematic review of the literature
. J Syst Integr Neurosci
. 2016
;2
(1
):85
–6
. 2059-978112.
Gray
RN
, Goslin
RE
, McCrory
DC
, Eberlein
K
, Tulsky
J
, Hasselblad
V
. Drug treatments for the prevention of migraine headache: technical review 2.3. 1999
; Prepared for the Agency of Health Care Policy and Research under Contract No. 290-94-2025. Available from the National Technical Information Service; NTIS Accession No. 127953.13.
Roberto
G
, Raschi
E
, Piccinni
C
, Conti
V
, Vignatelli
L
, D’Alessandro
R
, et al. Adverse cardiovascular events associated with triptans and ergotamines for treatment of migraine: systematic review of observational studies
. Cephalalgia
. 2015
Feb
;35
(2
):118
–31
.
[PubMed]
0333-102414.
Ozpelit
E
, Ozpelit
ME
, Akdeniz
B
, Göldeli
Ö
. Ergotamine-induced takotsubo cardiomyopathy
. Am J Ther
. 2016
Mar-Apr
;23
(2
):e597
–600
.
[PubMed]
1075-276515.
Li
Y
, Liang
F
, Yang
X
, Tian
X
, Yan
J
, Sun
G
, et al. Acupuncture for treating acute attacks of migraine: a randomized controlled trial
. Headache
. 2009
Jun
;49
(6
):805
–16
.
[PubMed]
0017-874816.
World Health Organization
. Acupuncture: Review and Analysis of Reports on Controlled Clinical Trial. Geneva, Switzerland, 2002
.17.
Vickers
AJ
, Rees
RW
, Zollman
CE
, McCarney
R
, Smith
CM
, Ellis
N
, et al. Acupuncture for chronic headache in primary care: large, pragmatic, randomised trial
. BMJ
. 2004
Mar
;328
(7442
):744
–50
.
[PubMed]
0959-813818.
Musil
F
, Pokladnikova
J
, Pavelek
Z
, Wang
B
, Guan
X
, Valis
M
. Acupuncture in migraine prophylaxis in Czech patients: an open-label randomized controlled trial
. Neuropsychiatr Dis Treat
. 2018
May
;14
:1221
–8
.
[PubMed]
1176-632819.
Kristoffersen
ES
, Grande
RB
, Aaseth
K
, Lundqvist
C
, Russell
MB
. Management of primary chronic headache in the general population: the Akershus study of chronic headache
. J Headache Pain
. 2012
Mar
;13
(2
):113
–20
.
[PubMed]
1129-236920.
Fønnebø
V
, Launsø
L
. High use of complementary and alternative medicine inside and outside of the government-funded health care system in Norway
. J Altern Complement Med
. 2009
Oct
;15
(10
):1061
–6
.
[PubMed]
1075-553521.
Eisenberg
DM
, Davis
RB
, Ettner
SL
, Appel
S
, Wilkey
S
, Van Rompay
M
, et al. Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey
. JAMA
. 1998
Nov
;280
(18
):1569
–75
.
[PubMed]
0098-748422.
Rhee
TG
, Harris
IM
. Gender differences in the use of complementary and alternative medicine and their association with moderate mental distress in U.S. adults with migraines/severe headaches
. Headache
. 2017
Jan
;57
(1
):97
–108
.
[PubMed]
0017-874823.
Moore
CS
, Sibbritt
DW
, Adams
J
. A critical review of manual therapy use for headache disorders: prevalence, profiles, motivations, communication and self-reported effectiveness
. BMC Neurol
. 2017
Mar
;17
(1
):61
.
[PubMed]
1471-237724.
Chaibi
A
, Tuchin
PJ
, Russell
MB
. Manual therapies for migraine: a systematic review
. J Headache Pain
. 2011
Apr
;12
(2
):127
–33
.
[PubMed]
1129-236925.
Li
W
, Li
ZW
, Wu
H
. Observation on the therapeutic effect of acupuncture and tuina of 105 cases of headache
. J Jilin Med Coll
. 2008
;29
(6
):340
–1
.26.
World Medical Association declaration of Helsinki. Recommendations guiding physicians in biomedical research involving human subjects
. JAMA
. 1997
Mar
;277
(11
):925
–6
.
[PubMed]
0098-748427.
Schulz
KF
, Altman
DG
, Moher
D
; CONSORT Group
. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials
. BMC Med
. 2010
Mar
;8
(1
):18
.
[PubMed]
1741-701528.
MacPherson
H
, Altman
DG
, Hammerschlag
R
, Youping
L
, Taixiang
W
, White
A
, et al.; STRICTA Revision Group
. Revised standards for reporting interventions in clinical trials of acupuncture (STRICTA): extending the CONSORT statement
. J Evid Based Med
. 2010
Aug
;3
(3
):140
–55
.
[PubMed]
1756-539129.
Headache Classification Subcommittee of the International Headache Society
. The international classification of headache disorders
: 2nd edition. Cephalalgia 2004
; 24(Suppl 1): 9-160.30.
Sun
ZH
, Yang
YJ
. Therapeutic evaluation and diagnosis of migraine
. [in Chinese]
. J Apoplexy Nerv Dis
. 1995
;12
(1
):110
–1
.31.
Kesterke
N
, Egeter
J
, Erhardt
JB
, Jost
B
, Giesinger
K
. Patient-reported outcome assessment after total joint replacement: comparison of questionnaire completion times on paper and tablet computer
. Arch Orthop Trauma Surg
. 2015
Jul
;135
(7
):935
–41
.
[PubMed]
0936-805132.
Stover
A
, Irwin
DE
, Chen
RC
, Chera
BS
, Mayer
DK
, Muss
HB
, et al. Integrating patient-reported outcome measures into routine cancer care: cancer patients’ and clinicians’ perceptions of acceptability and value
. EGEMS (Wash DC)
. 2015
Oct
;3
(1
):1169
.
[PubMed]
2327-921433.
Brod
M
, Blum
SI
, Bushnell
DM
, Ramasamy
A
. Development and validation of the Diabetic Peripheral Neuropathic Pain Impact (DPNPI) measure, a patient-reported outcome measure
. Qual Life Res
. 2015
Dec
;24
(12
):3001
–14
.
[PubMed]
0962-934334.
Norquist
JM
, Girman
C
, Fehnel
S
, DeMuro-Mercon
C
, Santanello
N
. Choice of recall period for patient-reported outcome (PRO) measures: criteria for consideration
. Qual Life Res
. 2012
Aug
;21
(6
):1013
–20
.
[PubMed]
0962-934335.
Yu
L
, Cao
K
. Development of first draft of PRO scale of migraine
. [in Chinese]
. Zhonghua Zhongyiyao Xuekan
. 2014
;32
(6
):1331
–4
.1673-771736.
Ai
J
, Cao
K
, Yu
L
, Gao
Y
. Clinical research of migraine pain remission based on patients-reported outcomes
. [in Chinese]
. Glob Tradit Chin Med
. 2015
;8
(5
):535
–40
.37.
Cao
K
, Sun
F
, Gu
Z
, Liu
Z
, Hong
Y
, Chen
L
. Performance evaluation on patient reported outcome scale in migraine remission patients
. [in Chinese]
. World Clinic Drugs
. 2014
;35
(1
):15
–9
.38.
Liu
JF
. To investigate the clinical effect of acupuncture on migraine
. [in Chinese]
. China Health Stand Manag
. 2017
;8
(10
):95
–7
.39.
Börü
UT
, Koçer
A
, Lüleci
A
, Sur
H
, Tutkan
H
, Atli
H
. Prevalence and characteristics of migraine in women of reproductive age in Istanbul, Turkey: a population based survey
. Tohoku J Exp Med
. 2005
May
;206
(1
):51
–9
.
[PubMed]
0040-872740.
Eidlitz-Markus
T
, Haimi-Cohen
Y
, Zeharia
A
. Association of age at onset of migraine with family history of migraine in children attending a pediatric headache clinic: a retrospective cohort study
. Cephalalgia
. 2015
Jul
;35
(8
):722
–7
.
[PubMed]
0333-102441.
Al-Shimmery
EK
. Precipitating and relieving factors of migraine headache in 200 iraqi kurdish patients
. Oman Med J
. 2010
Jul
;25
(3
):212
–7
.
[PubMed]
1999-768X42.
Queiroz
LP
, Rapoport
AM
, Weeks
RE
, Sheftell
FD
, Siegel
SE
, Baskin
SM
. Characteristics of migraine visual aura
. Headache
. 1997
Mar
;37
(3
):137
–41
.
[PubMed]
0017-874843.
Katsarava
Z
, Schneeweiss
S
, Kurth
T
, Kroener
U
, Fritsche
G
, Eikermann
A
, et al. Incidence and predictors for chronicity of headache in patients with episodic migraine
. Neurology
. 2004
Mar
;62
(5
):788
–90
.
[PubMed]
0028-387844.
Bigal
ME
, Serrano
D
, Buse
D
, Scher
A
, Stewart
WF
, Lipton
RB
. Acute migraine medications and evolution from episodic to chronic migraine: a longitudinal population-based study
. Headache
. 2008
Sep
;48
(8
):1157
–68
.
[PubMed]
0017-874845.
Lipton
RB
, Fanning
KM
, Serrano
D
, Reed
ML
, Cady
R
, Buse
DC
. Ineffective acute treatment of episodic migraine is associated with new-onset chronic migraine
. Neurology
. 2015
Feb
;84
(7
):688
–95
.
[PubMed]
0028-387846.
Bigal
ME
, Lipton
RB
. Obesity is a risk factor for transformed migraine but not chronic tension-type headache
. Neurology
. 2006
Jul
;67
(2
):252
–7
.
[PubMed]
0028-387847.
Ashina
S
, Serrano
D
, Lipton
RB
, Maizels
M
, Manack
AN
, Turkel
CC
, et al. Depression and risk of transformation of episodic to chronic migraine
. J Headache Pain
. 2012
Nov
;13
(8
):615
–24
.
[PubMed]
1129-236948.
Scher
AI
, Stewart
WF
, Ricci
JA
, Lipton
RB
. Factors associated with the onset and remission of chronic daily headache in a population-based study
. Pain
. 2003
Nov
;106
(1-2
):81
–9
.
[PubMed]
0304-395949.
Liu
L
, Zhao
LP
, Zhang
CS
, Zeng
L
, Wang
K
, Zhao
J
, et al. Acupuncture as prophylaxis for chronic migraine: a protocol for a single-blinded, double-dummy randomised controlled trial
. BMJ Open
. 2018
May
;8
(5
):e020653
.
[PubMed]
2044-605550.
Zhou
P
, Wang
A
, Li
B
, Liu
C
, Wang
Y
. Effect of acupuncture at Fengchi (GB 20) on the activity of myosin light chain kinase in the middle meningeal artery of migraine modeled rats
. J Tradit Chin Med
. 2015
Jun
;35
(3
):301
–5
.
[PubMed]
0255-292251.
Li
K
, Zhang
Y
, Ning
Y
, Zhang
H
, Liu
H
, Fu
C
, et al. The effects of acupuncture treatment on the right frontoparietal network in migraine without aura patients
. J Headache Pain
. 2015
;16
(1
):518
.
[PubMed]
1129-236952.
Zhao
L
, Liu
J
, Zhang
F
, Dong
X
, Peng
Y
, Qin
W
, et al. Effects of long-term acupuncture treatment on resting-state brain activity in migraine patients: a randomized controlled trial on active acupoints and inactive acupoints
. PLoS One
. 2014
Jun
;9
(6
):e99538
.
[PubMed]
1932-620353.
Gündüztepe
Y
, Mit
S
, Geçioglu
E
, Gurbuz
N
, Salkaci
O
, Severcan
C
, et al. The impact of acupuncture treatment on nitric oxide (NO) in migraine patients
. Acupunct Electrother Res
. 2014
;39
(3-4
):275
–83
.
[PubMed]
0360-129354.
Cayir
Y
, Ozdemir
G
, Celik
M
, Aksoy
H
, Akturk
Z
, Laloglu
E
, et al. Acupuncture decreases matrix metalloproteinase-2 activity in patients with migraine
. Acupunct Med
. 2014
Oct
;32
(5
):376
–80
.
[PubMed]
0964-528455.
Gao
Z
, Liu
X
, Yu
S
, Zhang
Q
, Chen
Q
, Wu
Q
, et al. Electroacupuncture at acupoints reverses plasma glutamate, lipid, and LDL/VLDL in an acute migraine rat model: A (1) H NMR-based metabolomic study
. Evid Based Complement Alternat Med
. 2014
;2014
:659268
.
[PubMed]
1741-427X56.
Zogopoulos
P
, Vasileiou
I
, Patsouris
E
, Theocharis
SE
. The role of endocannabinoids in pain modulation
. Fundam Clin Pharmacol
. 2013
Feb
;27
(1
):64
–80
.
[PubMed]
0767-398157.
Zogopoulos
P
, Vasileiou
I
, Patsouris
E
, Theocharis
S
. The neuroprotective role of endocannabinoids against chemical-induced injury and other adverse effects
. J Appl Toxicol
. 2013
Apr
;33
(4
):246
–64
.
[PubMed]
0260-437X58.
McPartland
JM
, Guy
GW
, Di Marzo
V
. Care and feeding of the endocannabinoid system: a systematic review of potential clinical interventions that upregulate the endocannabinoid system
. PLoS One
. 2014
Mar
;9
(3
):e89566
.
[PubMed]
1932-620359.
Guo
Q
, Hua
Y
, Wang
H
, Li
Y
, Ji
Q
. Therapeutic effect observation on combining electroacupuncture and tuina for migraine
. J Acupunct Tuina Sci
. 2014
;12
(3
):174
–9
. 60.
Wang
Y
, Xue
CC
, Helme
R
, Da Costa
C
, Zheng
Z
. Acupuncture for frequent migraine: a randomized, patient/assessor blinded, controlled trial with one-year follow-up
. Evid Based Complement Alternat Med
. 2015
;2015
:920353
.
[PubMed]
1741-427X61.
Zhao
L
, Chen
J
, Li
Y
, Sun
X
, Chang
X
, Zheng
H
, et al. The long-term effect of acupuncture for migraine prophylaxis: a randomized clinical trial
. JAMA Intern Med
. 2017
Apr
;177
(4
):508
–15
.
[PubMed]
2168-610662.
Wang
ZP
. Clinical analysis and experience of acupuncture combined with tuina in treating migraine
. [in Chinese]
. J Clin Acupunct Moxibust
. 2003
;19
(8
):24
.63.
Zhu
XJ
. Clinical observation on 30 cases of migraine treated with tuina combined with acupuncture.
Chin J Ethnomed Ethnopharm 2014
; (21) : 38-38 (in Chinese).64.
Evers
S
, Afra
J
, Frese
A
, Goadsby
PJ
, Linde
M
, May
A
, et al.; European Federation of Neurological Societies
. EFNS guideline on the drug treatment of migraine—revised report of an EFNS task force
. Eur J Neurol
. 2009
Sep
;16
(9
):968
–81
.
[PubMed]
1351-510165.
Nuti
A
, Lucetti
C
, Pavese
N
, Dell’Agnello
G
, Rossi
G
, Bonuccelli
U
. Long-term follow-up after flunarizine or nimodipine discontinuation in migraine patients
. Cephalalgia
. 1996
Aug
;16
(5
):337
–40
.
[PubMed]
0333-102466.
Centonze
V
, Magrone
D
, Vino
M
, Caporaletti
P
, Attolini
E
, Campanale
G
, et al. Flunarizine in migraine prophylaxis: efficacy and tolerability of 5 mg and 10 mg dose levels
. Cephalalgia
. 1990
Feb
;10
(1
):17
–24
.
[PubMed]
0333-102467.
Louis
P
. A double-blind placebo-controlled prophylactic study of flunarizine (Sibelium) in migraine
. Headache
. 1981
Nov
;21
(6
):235
–9
.
[PubMed]
0017-8748© 2019 S. Karger AG, Basel
2019
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