Traditional Acupuncture in Migraine: A Controlled, Randomized Study

Headache represents a significant public health problem, affecting an important portion of working-age adults and causing major day-to-day limitations. Migraine, in particular, affects a large number of people and, despite advances in pharmacologic treatment, many patients are unable to adequately control their symptoms or face undesirable side effects. As a result, there is growing interest in alternative treatments, including acupuncture. Studies show that approximately 19% of headache patients use acupuncture and consider it the most effective non-conventional treatment.

In the specific case of migraine, about 12% of patients have already tried acupuncture and 73% would be willing to try this treatment. Although several scientific reviews indicate the potential of acupuncture in migraine prevention, the evidence is still considered weak, mainly due to the wide variability in study methods used across different research.

The researchers conducted a randomized, controlled trial aimed at assessing the efficacy of traditional Chinese acupuncture in the treatment of migraine without aura, comparing it with different types of placebo treatments and untreated controls. The study included 160 patients diagnosed with migraine without aura who had between 3 and 8 attacks per month and had tried at least one previous preventive treatment without success. Participants were randomly divided into four groups: true acupuncture based on traditional Chinese medicine plus rescue medication (rizatriptan), ritualized sham acupuncture plus medication, standard sham acupuncture plus medication, and rescue medication only. The methodology included evaluating patients according to the principles of traditional Chinese medicine, selecting specific acupuncture points for the different syndromes identified.

Treatments were performed twice a week in two courses of 10 sessions each, with a one-week interval. To measure outcomes, the MIDAS questionnaire was used—a validated tool that assesses the degree of disability caused by headache—administered before treatment and after 3 and 6 months.

Of the 160 patients initially enrolled, 127 completed the study. Results showed that all groups improved relative to baseline, but only the true acupuncture group maintained consistent and lasting benefits over the six months of follow-up. The true acupuncture group showed significant reduction both in the disability index (from 22.2 to approximately 2.2 points) and in the use of rescue medication. The ritualized sham acupuncture group showed only temporary improvement at 3 months, returning to previous levels at 6 months, suggesting a transient placebo effect.

The other groups did not show significant improvements beyond those explainable by the use of rescue medication. Interestingly, the study also verified that the consumption of rescue medication tracked the disability questionnaire results in all groups, being lowest in the true acupuncture group.

For patients suffering from migraine, these results suggest that traditional Chinese acupuncture may be an effective option for prevention, providing reduction both in the frequency and intensity of attacks and in the need for medication. The study is particularly relevant because it used an authentically TCM-based approach, including specific diagnosis and individualized acupuncture point selection according to the different types of syndromes identified. For health professionals, the findings indicate the importance of properly applying traditional acupuncture principles, suggesting that efficacy may depend significantly on appropriate point selection and correct evaluation according to Chinese medicine criteria. The transient placebo effect observed in the ritualized sham acupuncture group also highlights the importance of the therapeutic relationship and the ritual of care in traditional medicine.

The study has some limitations that should be considered when interpreting the results. First, there was a considerable dropout rate (33 of 160 participants), which may influence the generalizability of the findings. In addition, the researchers did not administer questionnaires to assess whether patients could distinguish between true and sham acupuncture, which could help better understand the role of placebo effect. Patient classification according to traditional Chinese medicine also varies between different texts and schools, which may affect study reproducibility.

The authors acknowledge that this represents a first effort to appropriately combine the principles of Western medicine and traditional Chinese medicine in acupuncture research. Despite these limitations, the study represents an important advance in the scientific validation of acupuncture for migraine, providing evidence that the correct application of traditional principles can result in significant and lasting clinical benefits for patients.