Manual acupuncture for migraine

The same pathways that transmit the caress of a lover can backfire and cause neuropathic pain. This pain is due to damage or disease affecting the sensory systems.1 Migraine is one of the most common and disabling neuropathic pains, affecting at least 10-20% of the population and causing billions of lost days each year. In a linked paper, Xu and colleagues (doi:10.1136/bmj.m697) show that manual acupuncture significantly reduces migraine headaches, compared to both sham acupuncture and usual care.2

One strength of this study is the authors’ choice of control intervention. This is a major hurdle for non-pharmacological studies. Only these authors and one previous study of acupuncture have demonstrated successful masking of the sham procedure.3

Xu and colleagues’ used a non-penetrating needle for sham acupuncture—essential because penetrative sham acupuncture is not inert, and activates pathways involved in pain.4 Choice of control intervention could be one reason why Cochrane meta-analyses of acupuncture studies have found little difference between acupuncture and controls. …