BMJ, 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 ¹, Rebecca W Rees ², Catherine E Zollman ³, Rob McCarney ⁴, Claire M Smith ⁵, Nadia Ellis ⁶, Peter Fisher ⁷, Robbert Van Haselen ⁷

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

Objective To determine the effects of a policy of "use acupuncture" on headache, health status, days off sick, and use of resources in 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, predominantly migraine.

Interventions Patients were randomly allocated to receive up to 12 acupuncture treatments over three months or to a control intervention offering usual care.

Main outcome measures Headache score, SF-36 health status, and use 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 difference between means is 4.6 (95% confidence interval 2.2 to 7.0; P=0.0002). This result is robust to sensitivity analysis incorporating imputation for missing data. Patients in the acupuncture group experienced the equivalent of 22 fewer days of headache per year (8 to 38). SF-36 data favoured acupuncture, although differences reached significance only for physical role functioning, energy, and change in health. Compared with controls, patients randomised to 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 relevant benefits for primary care patients with chronic headache, particularly migraine. Expansion of NHS acupuncture services should be considered.

---

(Accepted 21 January 2004)
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Articles

Acupuncture in patients with tension-type headache: randomised controlled trial

Dieter Melchart, Andrea Streng, Andrea Hoppe, Benno Brinkhaus, Claudia Witt, Stefan Wagenpfeil, Volker Pfaffenrath, Michael Hammes, Josef Hummelsberger, Dominik Irnich, Wolfgang Weidenhammer, Stefan N Willich, and Klaus Linde
BMJ 2005 331: 376-382. [Abstract] [Full Text] [PDF]

Acupuncture improves headache and saves money
BMJ 2004 328: 0. [Full Text]

Related external webpages:

NHS Health Technology Assessment Programme

This article has been cited by other articles:

• Shang, C. (2007). Prospective Tests on Biological Models of Acupuncture. Evid Based Complement Alternat Med 0: nem122v1-nem122 [Abstract] [Full text]  
• Doyle, D. J. (2007). Understanding the open access data movement. Canadian J. Anesthesia 54: 949-950 [Full text]  
• Johnston, M. F., Yang, C., Hui, K.-K., Xiao, B., Li, X., Rusiewicz, A. (2007). Acupuncture for Chemotherapy-Associated Cognitive Dysfunction: A Hypothesis-Generating Literature Review to Inform Clinical Advice. Integr Cancer Ther 6: 36-41 [Abstract]  
• Price, S., Lewith, G., Thomas, K. (2006). Acupuncture care for breast cancer patients during chemotherapy: a feasibility study.. Integr Cancer Ther 5: 308-314 [Abstract]  
• Macklin, E. A., Wayne, P. M., Kalish, L. A., Valaskatgis, P., Thompson, J., Pian-Smith, M. C.M., Zhang, Q., Stevens, S., Goertz, C., Prineas, R. J., Buczynski, B., Zusman, R. M. (2006). Stop Hypertension With the Acupuncture Research Program (SHARP): Results of a Randomized, Controlled Clinical Trial. Hypertension 48: 838-845 [Abstract] [Full text]  
• Hui, K.-K., Hui, E. K., Johnston, M. F. (2006). The potential of a person-centered approach in caring for patients with cancer: a perspective from the UCLA center for East-west medicine.. Integr Cancer Ther 5: 56-62 [Abstract]  
• Scheller, J. (2005). Role for Complementary and Alternative Treatments in Epilepsy. Arch Neurol 62: 1471-1472 [Full text]  
• Melchart, D., Streng, A., Hoppe, A., Brinkhaus, B., Witt, C., Wagenpfeil, S., Pfaffenrath, V., Hammes, M., Hummelsberger, J., Irnich, D., Weidenhammer, W., Willich, S. N, Linde, K. (2005). Acupuncture in patients with tension-type headache: randomised controlled trial. BMJ 331: 376-382 [Abstract] [Full text]  
• Ruggie, M. (2005). Mainstreaming Complementary Therapies: New Directions In Health Care. Health Aff (Millwood) 24: 980-990 [Abstract] [Full text]  
• Linde, K., Streng, A., Jurgens, S., Hoppe, A., Brinkhaus, B., Witt, C., Wagenpfeil, S., Pfaffenrath, V., Hammes, M. G., Weidenhammer, W., Willich, S. N., Melchart, D. (2005). Acupuncture for Patients With Migraine: A Randomized Controlled Trial. JAMA 293: 2118-2125 [Abstract] [Full text]  
• (2004). Acupuncture Helps Chronic Headache. Journal Watch Dermatology 2004: 7-7 [Full text]  
• (2004). Acupuncture Helps Chronic Headache. JWatch Psychiatry 2004: 10-10 [Full text]  
• (2004). Acupuncture Helps Chronic Headache. JWatch General 2004: 1-1 [Full text]  

Rapid Responses:

Read all Rapid Responses

Acupuncture is not a placebo intervention.

Edwin H Klimek
bmj.com, 16 Mar 2004 [Full text]

Yes It's True

Ned Hoke
bmj.com, 18 Mar 2004 [Full text]

Acupuncture and clinical outcome

Edzard Ernst
bmj.com, 19 Mar 2004 [Full text]

Re: Acupuncture and clinical outcome

John P Heptonstall
bmj.com, 19 Mar 2004 [Full text]

A lowering of standards

David W. Ramey
bmj.com, 19 Mar 2004 [Full text]

Disapointment at lack of genuine control limb

Nicholas Charles Mansfield
bmj.com, 24 Mar 2004 [Full text]

The salubrious effect of needle sticks.

Robert A. Da Prato, M.D.
bmj.com, 24 Mar 2004 [Full text]

Re: The salubrious effect of needle sticks.

John P Heptonstall
bmj.com, 25 Mar 2004 [Full text]

Reducing the cost of headaches

Ellen CG Grant
bmj.com, 26 Mar 2004 [Full text]

Acupuncture for headache: Questionable conclusions

Alan H. Morris
bmj.com, 26 Mar 2004 [Full text]

NNTs matter

Carlos Cuello
bmj.com, 26 Mar 2004 [Full text]

Re: Reducing the cost of headaches

John P Heptonstall
bmj.com, 27 Mar 2004 [Full text]

Pleasure and headache

Tom Hughes-Davies
bmj.com, 28 Mar 2004 [Full text]

Acupunture but Design Studies....

Felipe C. Cepeda, et al.
bmj.com, 29 Mar 2004 [Full text]

Placebo ethics

David Brookman
bmj.com, 29 Mar 2004 [Full text]

Acupuncture for chronic headache in primary care: patients' attitude towards acupuncture must not be forgotten

Ulrich Ronellenfitsch
bmj.com, 29 Mar 2004 [Full text]

Re: Placebo ethics

John P Heptonstall
bmj.com, 30 Mar 2004 [Full text]

not scientifically convincing at all

Daniel K Ng, et al.
bmj.com, 30 Mar 2004 [Full text]

not scientifically convincing at all: updated

Dainel K Ng, et al.
bmj.com, 30 Mar 2004 [Full text]

High Type 1 error of a pragmatic trial

Jongbae Park
bmj.com, 31 Mar 2004 [Full text]

Re: not scientifically convincing at all: updated

John P Heptonstall
bmj.com, 1 Apr 2004 [Full text]

Would this trial design be acceptable for a medicine?

Malccolm J VandenBurg
bmj.com, 4 Apr 2004 [Full text]

Re: Would this trial design be acceptable for a medicine?

John P Heptonstall
bmj.com, 4 Apr 2004 [Full text]

Weekly Visits for 3 months help patients with chronic headache?

Victor Patterson, et al.
bmj.com, 7 Apr 2004 [Full text]

Re: Weekly Visits for 3 months help patients with chronic headache?

John P Heptonstall
bmj.com, 9 Apr 2004 [Full text]

Acupuncture as prophylactic treatment for 'chronic headache'

Guus G Schoonman, et al.
bmj.com, 13 Apr 2004 [Full text]

Re: Acupuncture as prophylactic treatment for 'chronic headache'

John P Heptonstall
bmj.com, 20 Apr 2004 [Full text]

What was trialed?

John Parkinson
bmj.com, 5 May 2004 [Full text]

Correction

David W. Ramey
bmj.com, 19 May 2004 [Full text]

Response from the authors

Andrew J Vickers, et al.
bmj.com, 19 May 2004 [Full text]

Banjo lessons, and other interventions

David W. Ramey
bmj.com, 20 May 2004 [Full text]

Accurate Accupuncture Study

Donald Hall
bmj.com, 4 Jan 2005 [Full text]