Chronic Headache: When to Avoid Your Doctor

We should all practice evidence based medicine and use treatments that are proven in randomized clinical trials, right? Well, there are certain cases where you should avoid your general practicioner because clinical trials show you will get worse treatment. Lower backpain is one. Chronic headaches are another.

While electronic frequencies can often help with headaches, this has not been proven in clinical trials. Meanwhile, see your acupuncturist. Kudos to the British Medical Journal for being an open source publisher!

Acupuncture for chronic headache in primary care: large, pragmatic, randomised trial

Andrew J Vickers, assistant attending research methodologist, Rebecca W Rees, research officer, Catherine E Zollman, general practitioner, Rob McCarney, research officer, Claire M Smith, senior trials coordinator, Nadia Ellis, lecturer, Peter Fisher, director of research, Robbert Van Haselen, deputy director of research

BMJ 2004;328:744 (27 March), doi:10.1136/bmj.38029.421863.EB (published 15 March 2004)

Objective: To determine the effects of a policy of “use acupuncture” on headache, health status, days off sick, and use of resources in patients with chronic headache compared with a policy of “avoid acupuncture.”

Design: Randomised, controlled trial.

Setting: General practices in England and Wales.

Participants: 401 patients with chronic headache, predominantly migraine.

Interventions: Patients were randomly allocated to receive up to 12 acupuncture treatments over three months or to a control intervention offering usual care.

Main outcome measures: Headache score, SF-36 health status, and use of medication were assessed at baseline, three, and 12 months. Use of resources was assessed every three months.

Results: Headache score at 12 months, the primary end point, was lower in the acupuncture group (16.2, SD 13.7, n = 161, 34% reduction from baseline) than in controls (22.3, SD 17.0, n = 140, 16% reduction from baseline). The adjusted difference between means is 4.6 (95% confidence interval 2.2 to 7.0; P = 0.0002). This result is robust to sensitivity analysis incorporating imputation for missing data. Patients in the acupuncture group experienced the equivalent of 22 fewer days of headache per year (8 to 38). SF-36 data favoured acupuncture, although differences reached significance only for physical role functioning, energy, and change in health. Compared with controls, patients randomised to acupuncture used 15% less medication (P = 0.02), made 25% fewer visits to general practitioners (P = 0.10), and took 15% fewer days off sick (P = 0.2).

Conclusions: Acupuncture leads to persisting, clinically relevant benefits for primary care patients with chronic headache, particularly migraine. Expansion of NHS acupuncture services should be considered.

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