Efficacy of acupuncture for migraine prophylaxis: a trial sequential meta-analysis
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REVIEW
Efficacy of acupuncture for migraine prophylaxis: a trial sequential meta‑analysis Shi‑Qi Fan1 · Song Jin2 · Tai‑Chun Tang2 · Min Chen2 · Hui Zheng1 Received: 27 June 2020 / Revised: 14 August 2020 / Accepted: 18 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Acupuncture is commonly used for migraine prophylaxis; however, evidence of its efficacy was equivocal. Aim We aimed to evaluated the efficacy of acupuncture in migraine prophylaxis and calculated the required information size (RIS) to determine whether further clinical studies are required. Methods We searched Cochrane library, EMBASE and PubMed from inception to April 23th, 2020. Randomized trials that compared acupuncture with conventional drug therapy or sham acupuncture were included. The primary outcome was migraine episodes. Secondary outcomes were responder rate and adverse event. Results Twenty studies (n = 3380) met the inclusion criteria. When it comes to migraine episodes, Acupuncture was superior over sham acupuncture [SMD = − 0.29, 95% CI (− 0.47 to − 0.11), P = 0.002] after treatment, while the difference between acupuncture and prophylactic drugs was not significant [SMD = − 0.21, 95% CI (− 0.42 to 0.00), P = 0.06].Both TSA graphs indicated that more RCTs are needed. As for responder rate, the results after treatment showed that acupuncture was statistically significantly better than sham acupuncture [RR 1.30, 95% CI (1.09–1.55), P = 0.003] as well as conventional drugs [RR 1.24, 95% CI (1.04–1.48), P = 0.01]. Both of their cumulative Z-curves intersected with the trial sequential monitoring boundaries favoring acupuncture. Compared to prophylactic medication, acupuncture can cause less adverse events [RR 0.34, 95% CI (0.14–0.81), P = 0.01]. Conclusion Acupuncture can reduce migraine episodes compared to sham one and can be an alternative and safe prophylactic treatment for conventional drugs therapy, but it should be further verified through more RCTs. Available studies suggested acupuncture was superior to sham acupuncture and conventional drugs in terms of responder rate as verified by TSA. Keywords Migraine prophylaxis · Acupuncture · Sham acupuncture · Conventional drug therapy
Introduction Migraine is a recurrent primary headache manifested by unilateral, throbbing pain lasting for 4–72 h each attack; migraine headaches with or without aura usually accompany Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00415-020-10178-x) contains supplementary material, which is available to authorized users.
nausea, photophobia, or phonophobia [1]. Migraine is the third most common disease globally, and it affects 14.7% of the general population [2, 3]. Migraine ranked as the thirdhighest cause of disability in males and females under the age of 50 (GBDS 2015) [1]. Migraine causes heavy economic burdens. In the United States, an annual cost of $9.2 billion was spent on the medical management of migraines between 2004 and 2013 [4].
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