TOPLINE:

Real acupuncture was associated with greater improvement in pain scores and quality of life than sham acupuncture in patients with migraine without aura, a new study showed. Additionally, distinct brain connectivity patterns predicted acupuncture response, with low default mode network-subcortical connectivity linked to pain relief.

METHODOLOGY:

• A single-blinded randomized clinical trial was conducted between 2021 and 2023 in Beijing and included 120 participants with migraine without aura (mean age, 36.8 years; 79% women).
• After a 4-week period following baseline clinical assessments and functional MRI, participants were randomly assigned to receive real or sham acupuncture for 12 sessions, each lasting 30 minutes, over 4 weeks. Real acupuncture targeted eight specific acupoints, whereas sham treatment involved superficial needling at nonmeridian sites.
• The primary outcome was the change from baseline in monthly migraine days (MMDs) during weeks 1-4, with migraine days defined as days with headaches lasting ≥ 4 hours or requiring migraine-specific medication.
• Secondary outcomes included a ≥ 50% reduction in MMDs; changes in monthly headache days, acute medication use days, pain scores on the Visual Analog Scale (VAS), disability scores on the Six-item Headache Impact Test (HIT-6), and Migraine-Specific Quality of Life Questionnaire (MSQ) scores; and safety outcomes. Acupuncture-response brain connectivity patterns were assessed with connectome-based predictive modeling (CPM) analysis of baseline functional MRI data.

TAKEAWAY:

• Real acupuncture was associated with greater improvements in MMDs (median difference [MD], -1.0; P = .02), monthly headache days (MD, -1.0; P = .01), acute medication use days (MD, -1.0; P = .02), and VAS pain scores (MD, -1.0; P = .02) than sham treatment; however there were no significant between-group differences in achieving a ≥ 50% reduction in MMDs.
• Disability reduction and quality of life improvement were greater in the real acupuncture group, with larger reductions in HIT-6 scores (MD, -2.9; P = .02) and higher scores on the MSQ for Role Function-Restrictive (MD, 8.6; P < .001), Role Function-Preventive (MD, 5.0; P = .02), and Emotional Function (MD, 6.7; P = .001) domains.
• Patient satisfaction was also higher in the real acupuncture group than in the sham group (97% vs 73%; P = .01). Safety profiles were similar, with mild adverse events occurring in 4% of each group.
• CPM showed that negative connectivity predicted VAS score reductions (P = .04) and positive connectivity predicted HIT-6 score improvement (P = .02). Key connectivity patterns included default mode network and subcortical-cerebellum hypoconnectivity for pain relief and subcortical-motor hyperconnectivity for disability reduction.

IN PRACTICE:

“Clinical results demonstrated acupuncture’s efficacy in pain relief and functional improvement,” the investigators wrote.

The findings also “uncovered baseline functional connectivity markers of better outcomes and offered objective neuroimaging biomarkers for personalized treatment,” they added.

SOURCE:

This study was led by Xinyu Zhang, MD, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China. It was published online on January 27 in JAMA Network Open.

LIMITATIONS:

The study sample was selected to maximize homogeneity by excluding other migraine types, which limited generalizability to broader populations of people with migraine. Additionally, the absence of posttreatment MRI data limited the ability to assess temporal changes in brain functional connectivity following acupuncture treatment.

DISCLOSURES:

This study was funded by the Beijing Natural Science Foundation, the China National Natural Science Foundation, Capital’s Funds for Health Improvement and Research, the Outstanding Young Talents Program of Capital Medical University, and the Beijing Hospital Management Center. The investigators reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.