Migraine prophylaxis: acupuncture vs propranolol therapy

  • Chen YY & al.
  • J Neurol
  • 21 Aug 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • This meta-analysis suggests that acupuncture was superior to propranolol in reducing migraine episodes and was associated with less harmful adverse events in indirect comparison.

Why this matters

  • Propranolol is recommended for migraine prevention in multiple guidelines; acupuncture has not been compared with propranolol directly.
  • National Institute for Health and Care Excellence (NICE) guideline recommends acupuncture for preventing migraine attacks.

Study design

  • 19 randomised controlled trials (n=3656) comparing the effect of acupuncture or propranolol vs sham acupuncture, placebo, waiting-list control or usual care were included.
  • Primary outcome: migraine episodes (the number of migraine days and frequency during a 4-week assessment period).
  • Secondary outcomes: number of migraine days, migraine frequency, responder rate, and adverse event rate.
  • Funding: None disclosed.

Key results

  • Acupuncture vs propranolol was associated with significantly fewer migraine episodes over a 4-week period (standardised mean difference [SMD], −0.74; 95% CI, −1.04 to −0.44).
  • Acupuncture (SMD, −1.57; 95% CI, −2.08 to −1.06) and propranolol (SMD, −0.83; 95% CI, −1.42 to −0.24) showed significant reduction in migraine frequency vs waiting-list control.
  • Acupuncture vs propranolol was associated with fewer adverse events (OR, 0.82; 95% CI, 0.11-5.94).

Limitations

  • Evidence was indirect.
  • Variation in the doses of propranolol (60-180 mg/day) may underestimate its efficacy.
  • Acupuncture prescriptions were not consistent in 12 trials which included acupuncture.

Please confirm your acceptance

To gain full access to GPnotebook please confirm:

By submitting here you confirm that you have accepted Terms of Use and Privacy Policy of GPnotebook.

Submit