Acupuncture should now be considered an acceptable evidence-based treatment to reduce migraine headaches say researchers following the publication of results in the BMJ showing it was effective compared to both sham (placebo) acupuncture and usual care.

Clinicians from China investigated the efficacy of acupuncture in 147 patients with a history of migraine without aura who were recruited from seven hospitals.

The patients were randomly allocated to receive either 20 sessions of manual acupuncture at true acupuncture points, 20 sessions of non-penetrating sham acupuncture at non-acupuncture points, or usual care (including advice on lifestyle and self-management) over eight weeks.

None of the patients had received acupuncture before, and all were instructed not to take any analgesics or start any other treatments during the 20-week trial.

Compared with sham acupuncture, manual acupuncture resulted in a greater reduction in migraine days (3.9 v 2.2) at weeks 13 to 20 and migraine attacks (2.3 v 1.6) at weeks 17 to 20, with an apparent increasing trend.

The adjusted difference between manual and sham acupuncture was 1.4 fewer migraine days at weeks 13 to 16, and 2.1 fewer migraine days and at weeks 17 to 20.

Sham acupuncture resulted in a minor reduction in migraine attacks compared with usual care (1.6 v 0.4) during weeks 17 to 20, with a slightly decreasing trend over this period.

The researchers acknowledged the relatively short (20 week) study duration and it was not known if the reduction in migraine would be maintained with repeat treatments in the long term.

But they concluded that acupuncture “can be recommended as a prophylactic treatment” and clinicians “should provide patients with information about acupuncture as an option when discussing prophylactic treatment strategies.”

In a linked commentary Dr Heather Angus-Leppan, a consultant neurologist at the Royal Free London NHS Foundation Trust, said the effects of acupuncture in the trial (2.1 fewer migraine days per month) were modest and it was difficult for clinicians to know whether this level of benefit would be noticeable to patients

But she said that since that almost 90% of people with frequent migraine have no effective preventive treatment, acupuncture could provide “a useful additional tool in our therapeutic armoury.”

“We now have good evidence that acupuncture is an effective treatment for episodic migraine … [the] study helps to move acupuncture from having an unproven status in complementary medicine to an acceptable evidence based treatment,” she wrote.