A randomized controlled clinical study of acupuncture at acupoints selected along the meridian for the treatment of migraine

OBJECTIVE: Through standardized randomized controlled clinical trials in patients with migraine, to explore the clinical efficacy of acupuncture at acupoints selected along the meridian for migraine, and to preliminarily clarify the research hypothesis that "the effect of meridian acupoints is specific, and its specificity is closely related to the course of the meridian". METHODS: 1. In a multicenter randomized controlled design, 180 patients with migraine in the acute attack phase who met the inclusion criteria were randomly assigned through a central randomization system to an acupoints-of-the-same-meridian group (treatment group), non-meridian non-acupoint group 1 (control group 1) and non-meridian non-acupoint group 2 (control group 2); 175 obtained a randomization number (5 were randomization errors due to network signal failure), 163 completed the whole study, and 12 cases dropped out or were excluded. The treatment group received acupuncture at Shaoyang meridian acupoints, and the control groups at non-meridian non-points selected by two different methods commonly used in China and abroad, for 30 min. Efficacy assessment included VAS scores before acupuncture and at 0.5 h, 1 h, 2 h and 4 h after treatment. 2. In a multicenter randomized controlled design, 153 patients with migraine who met the inclusion criteria were randomly assigned through a central randomization system to an acupoints-of-the-same-meridian group (treatment group), an acupoints-of-another-meridian group (control group 1) and a non-meridian non-acupoint group (control group 2); 142 completed the whole study and 11 dropped out. The treatment group received acupuncture at Shaoyang meridian acupoints, control group 1 at Yangming meridian acupoints and control group 2 at non-meridian non-points; points were used unilaterally, alternating sides, once a day, 30 min per session, 5 sessions per course with 2 days of rest between courses, for 4 courses; efficacy was evaluated at the end of treatment, with 2 follow-ups at 4 and 12 weeks after treatment. Outcomes included days with headache, days with headache affecting daily life, number of attacks, VAS score and the Migraine-Specific Quality of Life Questionnaire (MSQ), before and after treatment. RESULTS: 1. Randomized controlled study of acupuncture at meridian acupoints versus non-meridian non-points for acute migraine attacks: (1) Meridian acupoint group vs non-meridian non-acupoint groups: VAS scores at 2 h and 4 h after acupuncture, and VAS improvement at 1 h, 2 h and 4 h, differed significantly between groups (P<0.05); 24 h headache relief rate, 24 h headache recurrence/aggravation rate and the participants' global assessment also differed significantly (P<0.05). (2) Between the two non-meridian non-acupoint groups: VAS scores at 0.5 h, 1 h, 2 h and 4 h did not differ significantly (P>0.05). (3) Before vs after treatment: VAS scores at 0.5 h, 1 h, 2 h and 4 h after acupuncture differed significantly from baseline in all three groups (P<0.01). 2. Randomized controlled study of acupuncture at acupoints of the same meridian versus another meridian for migraine: (1) Same-meridian group (treatment) vs other-meridian group (control 1): at the end of treatment and at 4 and 12 weeks after treatment there were no significant differences in headache days, number of attacks, headache severity or quality of life (P>0.05). (2) Same-meridian group (treatment) vs non-meridian non-acupoint group (control 2): headache days at 4 weeks after treatment, number of attacks, VAS score and VAS improvement at 12 weeks, and days with accompanying symptoms at 4 and 12 weeks differed significantly (P<0.05). (3) Before vs after treatment: at the end of treatment and at 4 and 12 weeks, all three groups differed significantly from baseline in headache days, number of attacks, headache severity and quality of life (P<0.01). CONCLUSIONS: 1. For acute migraine attacks, the meridian acupoint group was superior to the non-meridian non-acupoint group in relieving headache, and in preventing 24 h headache recurrence/aggravation and in the participants' global assessment; these results indicate that the effect of meridian acupoints is specific. 2. Both selecting non-meridian non-points at the midpoint between two meridians and selecting them distal to meridian acupoints are valid methods, the distal selection being more appropriate. 3. Acupuncture at acupoints selected along the meridian is an effective treatment for preventing migraine attacks, reducing headache days, number of attacks and headache severity and improving quality of life. For headache days, number of attacks, days with accompanying symptoms and headache severity at 4 or 12 weeks after treatment, the same-meridian group was superior to the non-meridian non-acupoint group, while whether it differs from the other-meridian group needs further study. 4. The clinical efficacy of acupuncture at acupoints selected along the meridian for migraine is confirmed, preliminarily supporting the hypothesis that "the effect of meridian acupoints is specific, and its specificity is closely related to the course of the meridian".