Is acupuncture just a placebo for headache?

Acupuncture can help prevent migraines and tension-type headaches, two large reviews of studies have found. But sham acupuncture, where needles are inserted incorrectly, can work just as well. How and where the needles are placed may not be that important. There may also be a strong ‘placebo effect’ at work.

What do we know already?

Migraines and tension-type headaches are very common. Migraines typically affect one side of the head and cause severe pain, whereas tension-type headaches usually affect both sides and cause mild to moderate pain. Most people get headaches only occasionally and treat them with painkillers. Some people, however, get headaches frequently and use medicines or other treatments to try to prevent them.

One such treatment is acupuncture. Therapists use very fine needles placed into specific points around the body. Some doctors think acupuncture may help the body to release natural chemicals that block the feeling of pain.

Several studies have compared acupuncture with usual treatment (taking painkillers only when a headache develops), with other treatments to prevent headaches and with sham acupuncture. To get a better picture of how acupuncture measures up, researchers have now combined the results of these studies into two summaries called systematic reviews, one on migraines and one on tension-type headaches.

What do the reviews say?

The reviews found that people having acupuncture for at least eight weeks had fewer headaches than those who only had usual treatment. Acupuncture was also better at preventing migraines than drugs designed to treat migraine, such as rizatriptan. For tension-type headaches, acupuncture didn’t work as well as physiotherapy, massage or relaxation, but the difference was slight.

Interestingly, sham acupuncture was as effective as real acupuncture at preventing migraines, and nearly as effective at preventing tension-type headaches. The researchers don’t know why sham acupuncture also worked, but offer a few theories.

One is that ‘needling’ in nonspecific points may still have an effect on how people feel pain. Improvements might also come from people’s belief that the treatment will work (this is called the ‘placebo effect’). Researchers think the placebo effect might be particularly strong with acupuncture, because it involves repeated sessions and close contact with therapists. Such intense, frequent treatment might boost people’s expectations that the treatment will help them.

How reliable are the findings?

The overall findings that acupuncture can help prevent migraines and tension-type headaches should be fairly reliable. Both reviews included many good-quality studies with large numbers of people. In total, the migraine review looked 22 studies with 4,419 people, and the tension-type headache review looked at 11 studies with 2,317 people.

However, the research does have some problems.

* There were many differences in how the studies were done. For example, they used various types of acupuncture and sham acupuncture, and the treatments were sometimes performed by doctors and sometimes by acupuncturists. These differences make it difficult to pool the studies’ results and draw firm conclusions.

* The studies relied on participants to keep track of how many headaches they got. This isn’t a very dependable way to gather information, as people may not have remembered their headaches completely or accurately.

* In many of the studies, people knew what treatment they were receiving. This could have affected how well they thought a treatment was working. For example, a few people dropped out of studies once they learned they’d be receiving drug treatment rather than acupuncture. This suggests that some people were inclined to think acupuncture was a better treatment.

Where does the study come from?

The reviews were done by researchers in Germany, Italy, the US and the UK. They were published in the Cochrane Library by the Cochrane Collaboration, an independent international organisation that evaluates medical research.
What does this mean for me?

If you get frequent migraines or tension-type headaches, you may want to consider acupuncture. These reviews show that it helps some people get fewer headaches. It can also work better than some medicines for preventing migraines, so you may find it an appealing option if you’re worried about the side effects of drugs.

But it’s good to keep in mind that many questions still need to be answered. For example, we don’t yet know how acupuncture helps prevent headaches or why sham acupuncture also works well. It’s also not clear how long the effects of acupuncture last once you stop treatment.

What should I do now?

If you’d like to try acupuncture, be sure to find a qualified practitioner. Acupuncture is usually a safe treatment, but it’s possible to get an infection if the needle hasn’t been properly sterilised.