title: Verum versus sham manual acupuncture for migraine: a systematic review of randomised controlled trials.
abstract: BACKGROUND
  Manual acupuncture (MA) is commonly used as a treatment for migraine in China. However, its specific clinical effects have been challenged on the basis that some of its effects may relate to psychological or 'placebo' mechanisms.
  
  
  OBJECTIVE
  To identify the effectiveness of verum MA compared with sham acupuncture for the treatment of migraine.
  
  
  METHODS
  Eight electronic databases were searched for randomised controlled trials (RCTs) evaluating the effect of verum versus sham MA on migraine. The quality of included trials was assessed using the 'risk of bias' tool provided by the Cochrane Handbook for Systematic Review of Intervention. RevMan 5.2 software was used for data analysis.
  
  
  RESULTS
  Ten trials with 997 participants were included. Most trials had high methodological quality and were at low risk of bias. Meta-analysis showed superior effects of verum MA over sham acupuncture on the total effective rate, reflected by a reduction in the 'not effective' rate (relative risk (RR) 0.24, 95% CI 0.15 to 0.38; p<0.0001, four trials) and a reduced recurrence rate (RR 0.47, 95% CI 0.28 to 0.81; p=0.006, two trials), but no significant differences in headache intensity, frequency or duration, accompanying symptoms and use of medication. No severe adverse events related to acupuncture occurred during treatment with either verum or sham MA.
  
  
  CONCLUSIONS
  Current clinical evidence suggests that verum acupuncture is superior to sham acupuncture in migraine, reflected by a higher total effective rate and decreased recurrence rate. Nevertheless, further large-scale RCTs with a rigorous design are required to confirm these findings in view of the relative paucity of eligible RCTs and small sample sizes of those included.
authors.affiliation: College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Affiliated Rehabilitation Hospital, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China.
authors.forename: Qinghui
authors.initials: Q
authors.lastname: Que
authors.affiliation: College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China.
authors.forename: Xiaode
authors.initials: X
authors.lastname: Ye
authors.affiliation: College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China.
authors.forename: Guo hua
authors.initials: Gh
authors.lastname: Zheng
mesh_terms: D015670:Acupuncture Therapy / Q000379:methods*; D000328:Adult; D002681:China; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000628:therapy*; D010919:Placebos; D016032:Randomized Controlled Trials as Topic
chemical_list: D010919:Placebos
keywords: ACUPUNCTURE; PAIN MANAGEMENT; SYSTEMATIC REVIEWS