Predicting prognostic factors in a randomized controlled trial of acupuncture versus topiramate treatment in patients with chronic migraine.
BACKGROUND
This study aimed to identify predictive factors of outcome in patients with chronic migraine (CM) treated with acupuncture or topiramate in a randomized controlled trial.


METHODS
Sixty-six consecutive CM patients were treated with either acupuncture (n=33) or topiramate (n=33) in a 12-week period. Data on potential predictive factors were collected at baseline, and secondary data analysis was performed to identify factors associated with treatment response. Treatment prognosis was defined as the change in mean number of moderate/severe headache days per 4 weeks from the 4-week baseline periods.


RESULTS
The median change in mean number of moderate/severe headache days per 4 weeks for patients with higher baseline headache days (>20 d) was significantly greater than that for lower baseline headache days (≤ 20 d) (median ± interquartile range: -12 ± 2 vs. -10 ± 1 d, P=0.01) in acupuncture group. There was a greater change in mean number of moderate/severe headache days per 4 weeks for high moderate/severe headache days (>20 d) than in low days (≤ 20 d) (-12 ± 1 vs. -10 ± 2 d, P=0.015) in acupuncture group. patients with throbbing symptoms had better prognosis with acupuncture than those without throbbing (-12 ± 2 vs. -9.5 ± 2.5 d, P=0.004). Higher score (>5 points) in the general expectations for improvement predicted better response in both treatment groups (>5 vs. ≤ 5 points: -12 ± 2 vs. -9 ± 2 d for acupuncture group; -10 ± 3 vs. -7 ± 4 d for topiramate group; P<0.001).


CONCLUSIONS
Some variables can predict outcome in acupuncture or topiramate treatment of CM patients. Identifying predictors of prognosis of both treatments for CM may help improve outcomes in future work.
*Department of Neurology, Kuang Tien General Hospital ‡Department of Nutrition, Huang-Kuang University §Section of Neurology, Taichung Veterans General Hospital ¶Graduate Institute of Chinese Medical Science, College of Chinese Medicine, China Medical University #Department of Healthcare Administration, College of Health Science, Asia University **Graduate Institute of Acupuncture Science, College of Chinese Medicine, China Medical University ††Department of Public Health, Chung Shan Medical University, Taichung †Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University ‡‡Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan ∥Department of Neurology, National Yang-Ming University, Taipei, Taiwan, R.O.C.
Chun-Pai
CP
Yang
Ming-Hong
MH
Chang
Tsai-Chung
TC
Li
Ching-Liang
CL
Hsieh
Kai-Lin
KL
Hwang
Hen-Hong
HH
Chang
D015670:Acupuncture Therapy; D000328:Adult; D002908:Chronic Disease; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D005632:Fructose / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000175:diagnosis / Q000628:therapy*; D018696:Neuroprotective Agents / Q000627:therapeutic use*; D010147:Pain Measurement; D011237:Predictive Value of Tests; D011379:Prognosis; D011795:Surveys and Questionnaires; D000077236:Topiramate; D016896:Treatment Outcome
D018696:Neuroprotective Agents; D000077236:Topiramate; D005632:Fructose