Trinh Kien V, Diep Dion, Chen Kevin Jia Qi
Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Med Acupunct. 2019 Apr 1;31(2):85-97. doi: 10.1089/acu.2019.1337. Epub 2019 Apr 19.
A Cochrane Systematic Review published by Linde et al. in 2016 found moderate evidence suggesting that acupuncture is "at least non-inferior" to conventional prophylactic drug treatments (flunarizine, metoprolol, and valproic acid) for episodic migraine prophylaxis. The evidence for the efficacy of these conventional treatments must be verified to strengthen and validate the original comparison made in Linde et al.'s 2016 review. The aim of the current authors' systematic review was to verify the efficacy of the conventional treatments used in Linde et al.'s 2016 comparison with acupuncture. Search strategies were applied to find studies that could verify the efficacy of conventional treatments for treating episodic migraines. Relevant outcomes and dosages were extracted from the retrieved studies. Each study's quality was assessed, using the Cochrane's collaboration tool for assessing risk of bias and the Cochrane GRADE [Grading of Recommendations Assessment, Development, and Evaluation] scale. There is high-quality evidence suggesting that prophylactic drug treatment, at the treatment dosage ranges used in Linde et al.'s 2016 review, reduced headache frequency at a 3-month follow-up, compared to placebo. Headache frequency at a 6-month follow-up, and responses (at least 50% reduction of headache frequency) at 3-month and 6-month follow-ups could not be assessed. These findings strengthened Linde et al.'s 2016 comparison of conventional treatments and acupuncture for reducing headache frequency at a 3-month follow-up. For episodic migraine prophylaxis, moderate evidence suggests that acupuncture is "at least non-inferior," to now-, conventional treatments. This raises significant questions in the debate concerning claims that acupuncture is a placebo-based treatment and the prescriptions of proven conventional treatments that have similar effects as acupuncture.
林德等人于2016年发表的一篇Cochrane系统评价发现，有中等证据表明，在发作性偏头痛预防方面，针灸“至少不劣于”传统预防性药物治疗（氟桂利嗪、美托洛尔和丙戊酸）。这些传统治疗方法的疗效证据必须得到验证，以加强和证实林德等人2016年综述中的原始比较。当前作者进行系统评价的目的是验证林德等人2016年将针灸与之比较的传统治疗方法的疗效。应用检索策略来寻找能够验证传统治疗方法对发作性偏头痛疗效的研究。从检索到的研究中提取相关结果和剂量。使用Cochrane协作组评估偏倚风险的工具和Cochrane GRADE（推荐分级评估、制定和评价）量表对每项研究的质量进行评估。有高质量证据表明，在林德等人2016年综述中使用的治疗剂量范围内，预防性药物治疗与安慰剂相比，在3个月随访时降低了头痛频率。无法评估6个月随访时的头痛频率以及3个月和6个月随访时的反应（头痛频率至少降低50%）。这些发现强化了林德等人2016年关于传统治疗方法与针灸在3个月随访时降低头痛频率的比较。对于发作性偏头痛预防，中等证据表明针灸“至少不劣于”目前的传统治疗方法。这在关于针灸是一种基于安慰剂的治疗方法的说法以及与针灸有相似效果的已证实传统治疗方法处方的辩论中引发了重大问题。
