Furthermore, given that sham acupuncture provides a therapeutic effect in some patients, unknown factors independent

of acupuncture methodology must exist that provide a reduction in migraine symptoms.148 EVIDENCE SUPPORTING THE USE OF ACUPUNCTURE IN HEADACHE TREATMENT In a 2001 Cochrane review149 Erismodegib concentration of 16 randomized studies on acupuncture in the treatment of idiopathic headache, the authors concluded that evidence in support of acupuncture for migraine prophylaxis was considered promising but insufficient. A meta-analysis of the studies could not be performed because of the heterogenous nature of the available data, differences in the choice of acupuncture points used, small sample sizes, methodological problems, and insufficient reporting of study details. In the intervening years between 2001 and an updated Cochrane review in 2009, several large trials were published. The largest of these studies,150 which enrolled 15,056 patients with

primary headache, compared the effectiveness of acupuncture in addition to routine care with routine care alone. The effect of acupuncture in randomized compared to nonrandomized patients was also studied. After 6 months, patients randomized to the acupuncture group showed a decrease in the number of headache days (P < .001) as well as improvements in pain intensity and quality Gefitinib cell line of life (P < .001). Non-randomized subjects showed outcome changes that were similar to those in the randomized group. There were, however, some methodological limitations of this study. It was randomized but not blinded, and real acupuncture was not compared with a sham acupuncture procedure. Also, the study groups included MCE公司 patients with migraine, TTH, and a combination of both, and did not differentiate between the headache types when reporting the results. The updated Cochrane review published in 2009 was split into

separate reviews on migraine137 and TTH151 because of the increased number of studies and clinical differences observed amongst study subjects. The migraine review137 included randomized trials comparing the clinical effects of acupuncture with a control (no prophylactic treatment or routine care only), a sham acupuncture intervention, or another intervention in migraineurs. Results from the 22 trials, comprising 4419 participants, showed consistent evidence that acupuncture provides more benefit than routine care or acute treatment alone. The available studies also indicated that acupuncture is at least as effective as, or possibly more effective than, traditional prophylactic therapy such as metoprolol, with fewer side effects. Furthermore, there is no evidence that “true” acupuncture is more effective than sham interventions.