Acupuncture in the Prophylactic Treatment of Migraine Without Aura: A Comparison with Flunarizine

Migraine affects millions of people worldwide and is one of the leading causes of chronic headache. This neurologic condition causes recurrent episodes of intense pain, frequently accompanied by nausea, vomiting, and sensitivity to light and sound, significantly impacting patients' quality of life. For preventive control of migraine, physicians traditionally prescribe medications such as flunarizine, a calcium channel blocker widely used. However, these medications can cause undesired side effects such as drowsiness, weight gain, and depression.

In this context, acupuncture has emerged as a promising therapeutic alternative, offering a non-pharmacologic approach to migraine prevention. Despite the encouraging results of previous studies, more rigorous research was needed to directly compare the efficacy of acupuncture with conventional medications.

This randomized controlled study was conducted over six months with the objective of evaluating whether acupuncture would be effective in the prevention of migraine without aura and comparing its results with drug treatment using flunarizine. The researchers recruited 160 women with a diagnosis of migraine, aged 18 to 59 years, who had at least two attacks per month. Participants were randomly divided into two groups: 80 received acupuncture treatment and 80 were treated with flunarizine. In the acupuncture group, sessions were performed weekly for the first two months and then monthly for another four months.

The researchers used the same acupuncture points in all patients, including points on the feet, legs, abdomen, hands, arms, neck, and head. Needles remained inserted for 20 minutes in each session. In the flunarizine group, patients took 10 mg daily for the first two months, followed by 20 days per month over the subsequent four months. Throughout the period, participants kept detailed diaries recording attack frequency, pain intensity, and use of pain-relief medications.

Results demonstrated that both treatments were effective in reducing the frequency of migraine attacks. However, acupuncture proved superior to flunarizine in several important aspects. In the first four months of treatment, the acupuncture group showed a significantly greater reduction in the number of migraine attacks compared with the flunarizine group. After two months of treatment, patients treated with acupuncture also used significantly less pain-relief medication than those who received flunarizine.

A particularly relevant finding was that only acupuncture was able to significantly reduce pain intensity, whereas flunarizine did not show this benefit. At the end of treatment, approximately 13% of patients in the acupuncture group were completely pain-free, compared with about 9% in the flunarizine group. In addition, 23% of patients treated with acupuncture stopped using pain-relief medications altogether, compared with 15% in the flunarizine group. At six months, the differences between groups diminished, suggesting that the benefits of acupuncture are more pronounced in the early stages of treatment.

From a clinical standpoint, these results have important implications for both patients and healthcare professionals. Acupuncture proved to be a viable and effective option for migraine prevention, offering significant advantages in terms of tolerability. While the flunarizine group showed side effects such as drowsiness, weight gain, and depression, the acupuncture group reported mainly mild local pain and temporary sedation after treatment. The total number of patients with side effects was significantly lower in the acupuncture group.

For patients who do not tolerate preventive medications well or who prefer non-pharmacologic approaches, acupuncture represents a safe and effective alternative. The results also suggest that acupuncture may be especially beneficial in the first months of treatment, a period during which many patients abandon conventional treatments due to side effects. The ability of acupuncture to reduce both the frequency and intensity of attacks, in addition to decreasing the use of pain-relief medications, offers a comprehensive approach to migraine management.

The study has some important limitations that should be considered when interpreting the results. The researchers used a standardized acupuncture approach, applying the same points to all patients, which differs from traditional Chinese medicine practice, where treatment is individualized according to each patient's specific pattern. This approach may have limited the full therapeutic potential of acupuncture. In addition, the acupuncture group naturally received more attention and direct contact with therapists, which may have contributed to a greater placebo effect.

The number of sessions used was also lower than what is ideally recommended in traditional clinical practice. Despite these limitations, acupuncture demonstrated efficacy even under these restrictive conditions. The researchers conclude that acupuncture should be considered more often as a first-line treatment for migraine prevention, especially considering its superior safety profile and comparable or superior efficacy to conventional medications in the early stages of treatment.