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Predicting Prognostic Factors in a Randomized Controlled Trial of Acupuncture Versus Topiramate Treatment in Patients With Chronic Migraine

Yang, Chun-Pai MD*,†,‡; Chang, Ming-Hong MD§,∥; Li, Tsai-Chung MD, PhD¶,#; Hsieh, Ching-Liang MD, PhD**; Hwang, Kai-Lin MSc††; Chang, Hen-Hong MD, PhD‡‡

doi: 10.1097/AJP.0b013e31827eb511
Original Articles

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

Supported primarily by the Taiwan Department of Health Clinical Trial and Research Center for Excellence Taichung city, Taiwan, R.O.C. and a grant from the Kuang Tien General Hospital Taichung city, Taiwan, R.O.C. There is no additional external funding received for this study. The authors declare no conflict of interest.

Reprints: Hen-Hong Chang, MD, PhD, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, #123, Dinghu Rd., Guishan Township, Taoyuan County 33378, Taiwan, R.O.C. (e-mail: tcmchh55@gmail.com).

Received May 13, 2010

Accepted November 18, 2010

© 2013 by Lippincott Williams & Wilkins