Acupuncture for chronic headache in primary care: large, pragmatic, randomised trial

doi:10.1136/bmj.38029.421863.EB

BMJ 2004;328:744 (27 March), doi:10.1136/bmj.38029.421863.EB (published 15 March 2004)

Primary care

Acupuncture for chronic headache in primary care: large, pragmatic, randomised trial

Andrew J Vickers, assistant attending research methodologist¹, Rebecca W Rees, research officer², Catherine E Zollman, general practitioner³, Rob McCarney, research officer⁴, Claire M Smith, senior trials coordinator⁵, Nadia Ellis, lecturer⁶, Peter Fisher, director of research⁷, Robbert Van Haselen, deputy director of research⁷

¹ Integrative Medicine Service, Biostatistics Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, NY, NY 10021, ² Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), Social Science Research Unit, Institute of Education, London WC1H 0NS, ³ Montpelier Health Centre, Bristol BS6 5PT, ⁴ Department of Psychological Medicine, Imperial College London, London W2 1PD, ⁵ Academic Rheumatology, Weston Education Centre, King's College, London SE5 9RJ, ⁶ Department of Health and Social Sciences, Coventry University, Coventry CV1 5FB, ⁷ Royal London Homeopathic Hospital, London W1W 5PB

Correspondence to: A J Vickers vickersa{at}mskcc.org

Objective To determine the effects of a policy of "use acupuncture"on headache, health status, days off sick, and use of resourcesin patients with chronic headache compared with a policy of"avoid acupuncture."

Design Randomised, controlled trial.

Setting General practices in England and Wales.

Participants 401 patients with chronic headache, predominantlymigraine.

Interventions Patients were randomly allocated to receive upto 12 acupuncture treatments over three months or to a controlintervention offering usual care.

Main outcome measures Headache score, SF-36 health status, anduse of medication were assessed at baseline, three, and 12 months.Use of resources was assessed every three months.

Results Headache score at 12 months, the primary end point,was lower in the acupuncture group (16.2, SD 13.7, n = 161,34% reduction from baseline) than in controls (22.3, SD 17.0,n = 140, 16% reduction from baseline). The adjusted differencebetween means is 4.6 (95% confidence interval 2.2 to 7.0; P= 0.0002). This result is robust to sensitivity analysis incorporatingimputation for missing data. Patients in the acupuncture groupexperienced the equivalent of 22 fewer days of headache peryear (8 to 38). SF-36 data favoured acupuncture, although differencesreached significance only for physical role functioning, energy,and change in health. Compared with controls, patients randomisedto acupuncture used 15% less medication (P = 0.02), made 25%fewer visits to general practitioners (P = 0.10), and took 15%fewer days off sick (P = 0.2).

Conclusions Acupuncture leads to persisting, clinically relevantbenefits for primary care patients with chronic headache, particularlymigraine. Expansion of NHS acupuncture services should be considered.

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