There are several effective drug treatments available for the prophylaxis of migraine. However, despite poor evidence from randomised controlled trials, acunpuncture is the most frquently used preventive therapy for migraine in Germany.
In their Article, Hans-Christoph Diener (University Duisburg-Essen, Germany) and colleagues present the results of the German Acupuncture Trials (GERAC) migraine study. In this prospective, randomised, multicentre, controlled clinical trial they showed that the number of days on which a patient suffered from migraine was significantly reduced after treatment with either acupuncture or standard therapy. However, the improvement was the same whether the patient was treated with a sham acupuncture technique, which was done on areas of the skin in which no traditional Chinese medicine acupuncture points are known; verum acupuncture, which consisted of obligatory needling points and additional points individually chosen by the physicians on the basis of traditional Chinese medicine diagnosis for syndromes; or standard migraine prophylactic treatment.
These results are surprising and, since the underlying mechanisms are unknown, difficult to explain. "Ultimately, one could argue that the efficacy of a treatment, especially a treatment with almost no adverse events or contraindications, is more important than the knowledge of the mechanism of action of this particular therapy", concludes Diener. "The decision whether acupuncture should be used in migraine prevention remains with the treating physician."
Hans-Christoph Diener, Department of Neurology, University Duisburg-Essen, Hufelandstr 55, D45122 Essen, Germany. T)+49 201 723 2460/61
The Lancet Neurology