Acupuncture vs Valproic Acid in Migraine Prevention
Migraines are not ordinary headaches. As one who suffered migraines himself, I can definitely testify to the horrific pain that migraine sufferers have to endure. Not only is the pain excruciating, but things as mundane as the slightest sound or the littlest light can magnify such pain tenfold. In this case, prevention is definitely to be valued.
The medical management of migraine consists of two aspects. Several drugs exist to relieve pain when it is there. Fortunately, acupuncture can be used to relieve attacks while they happen. Of course, we would also love to be able to prevent migraines from happening in the first place.
Can Acupuncture Help Prevent Migraines? Photo by Stuart Miles / freedigitalphotos.net
An Ounce of Prevention
Several drugs exist to help with this cause. The online website of the American Family Physician (link) lists propranolol, timolol, amitriptyline, divalproex, sodium valproate, and topiramate as having evidence for use for migraine prevention. Valproate in particular is useful at low doses according to a study by Kinze, et al. (link).
The problem with these drugs is side effects. These include:
According to the Cochrane review,the NNH for nausea is 6.6 (95% CI, 5.0 to 9.8); for fatigue, 12.3 (95% CI, 7.6 to 31.8); for tremor, 12.4 (95% CI, 8.9 to 20.1); for weight gain, 16.0 (95% CI, 8.5 to 154.4); and for dizziness, 16.3 (95% CI, 9.5 to 57.9). Drug levels must be monitored if toxicity or compliance are in question. Gastrointestinal side effects generally diminish with continued use. (from http://www.aafp.org/afp/2006/0101/p72.html)
And even worse, these drugs are forbidden in pregnant women because of their ability to cause birth defects.
Because of their teratogenicity, valproic acid (Depakene) and derivatives should not be used in patients who are pregnant. They also should not be used in patients with a history of pancreatitis or hepatic disorder, such as cirrhosis or chronic hepatitis. (ibid)
This brings us to this study: Acupuncture versus valproic acid in the prophylaxis of migraine without aura: a prospective controlled study by Facco, et al. Minerva Anestesiol. 2013 Jun;79(6):634-42. Epub 2013 Mar 19. (abstract link)
Here’s what they did:
A prospective, controlled study was performed in 100 patients affected by migraine without aura lasting for over one year. The patients were stratified for sex and randomly divided into two groups of 50 patients each. Patients belonging to Group A (acupuncture) were submitted to 20 sessions of acupuncture, while patients belonging to Group V valproate) were administered Valproic acid (Depakin Chrono®) at a dose of 600 mg/day; 10 mg Rizatriptan wafers were allowed as needed to treat the attacks. The Midas Index (MI) and pain intensity (PI, by VAS) were recorded before treatment (T0), at three (T1) and six (T2) months; a six-point scale Pain Relief score (PRS), the Rizatriptan intake and adverse events were recorded at T1 and T2.
What this means is that they got fifty patients to have acupuncture and the other fifty to take valproic acid. The researchers then used the MIDAS Index. This index is short for Migraine Disability Assessment Test. According to Dr. Mark Foley on about.com, this test is designed to try to measure the effect migraines have on the patient’s daily functions. (link)
Here is the questionnaire:
On how many days in the last 3 months did you miss work or school because your headaches?
How many days in the last 3 months was your productivity at work or school reduced by half or more because of your headaches? (Do not include days you counted in question 1 where you missed work or school.)
On how many days in the last 3 months did you not do household work because of your headaches?
How many days in the last three months was your productivity in household work reduced by half of more because of your headaches? (Do not include days you counted in question 3 where you did not do household work.)
On how many days in the last 3 months did you miss family, social or leisure activities because of your headaches?
Here is the scale:
Once you’ve answered these questions, add up the total number of days to determine your level of “disability.”
0 to 5, MIDAS Grade I, Little or no disability
6 to 10, MIDAS Grade II, Mild disability
11 to 20, MIDAS Grade III, Moderate disability
21+, MIDAS Grade IV, Severe disability
Not very objective, but not too subjective either. These, along with the Pain Index, were recorded at times before treatment, at three months and six months.
There were also “rescue medications” used to treat any migraines that DID occur.
The abstract records the results as follows:
Eighty-two out of 100 patients completed the study (9 dropouts in each group). In both groups the MI improved at T1 and T2 (P<0.0001). Pain intensity was better at T1 in group V (P<0.0001), but PI and PRS (P=0.02) as well as rizatriptan intake (P=0.001) were better in group A at T2. The rate of adverse events was 47.8% in group V and 0% in group A.
What this means is that the MIDAS index showed improved conditions for the patients in both groups at three and six months. At three months, the patients taking Valproic Acid had less pain at three months. However, patients on acupuncture had less pain attacks and less intake of rescue medications. Most importantly, nearly half of those taking valproic acid had side effects.
None for acupuncture.
What this study thus shows is that there exists the option to use acupuncture to try to prevent migraine headaches. In my case, I went eight years migraine free.
Facco et al. “Acupuncture versus valproic acid in the prophylaxis of migraine without aura: a prospective controlled study.” Minerva Anestesiol. 2013 Jun;79(6):634-42. Epub 2013 Mar 19. http://www.ncbi.nlm.nih.gov/pubmed/23511357 (December 13, 2013)
Foley, Mark. “The Migraine Disability Assessment (MIDAS) Questionnaire” About.com Headaches and Migraines. Updated July 21, 2009. (http://headaches.about.com/od/understandingyourrisk/a/MIDAS.htm) accessed December 13, 2013
Kinze, et al. “Valproic acid is effective in migraine prophylaxis at low serum levels: a prospective open-label study.” Headache. 2001 Sep;41(8):774-8. http://www.ncbi.nlm.nih.gov/pubmed/11576201 accessed December 13, 2013.
Modi, Seema and Lowder, Dionne. “Medications for Migraine Prophylaxis”Am Fam Physician. 2006 Jan 1;73(1):72-78. (http://www.aafp.org/afp/2006/0101/p72.html) accessed December 13, 2013