By Marcello Cherchi, MD PhD
For patients
Acupuncture may help some people with migraines and tinnitus.
For clinicians
Overview
Acupuncture has been studied in randomized controlled trials for a variety of ailments. In otoneurology the evidence of acupuncture’s efficacy for migraine and tinnitus is mixed. Acupuncture is very low risk.
Introduction
Acupuncture was in use in China for millennia before reaching Western countries (Zhuang et al. 2013). In recent decades it has been studied in randomized controlled trials as a treatment for a very broad range of illnesses (Wen et al. 2021).
Mechanism
Acupuncture probably has multiple mechanisms of action, including muscle relaxation, anti-inflammatory activity, immunomodulation, neural modulation, oxidative stress and others (Zhang et al. 2022).
Adverse effects, cautions and contraindications
Acupuncture is reported to be safe when performed by a trained professional for migraine (Li et al. 2020) or tinnitus (Wu et al. 2023).
Relevance in otoneurology
Probably the main application of acupuncture in otoneurology is in the management of migraine (Natbony and Zhang 2020), though evidence in support of its efficacy is evolving (Li et al. 2020). Studies suggest that acupuncture is effective both for migraine abortive therapy (Wang et al. 2012) and for migraine prophylaxis (Chessman 2016; Linde et al. 2016; Linde et al. 2009). The frequency and duration of acupuncture treatment as prophylaxis for migraine remain to be clarified, though a review recommended two sessions per week for 10 weeks (Zheng et al. 2010).
Acupuncture has also been explored as a treatment for tinnitus. The literature about this is mixed, with some studies concluding that acupuncture has some efficacy (de Azevedo et al. 2007; Doi et al. 2016; Jackson et al. 2006; Kim et al. 2017; Laureano et al. 2016; Liu et al. 2016; Naderinabi et al. 2018; Okada et al. 2006; Rogha et al. 2011), and other studies concluding that acupuncture is not superior to placebo (Axelsson et al. 1994; Hansen et al. 1982; Jeon et al. 2012; Kim et al. 2017; Kim et al. 2012; Marks et al. 1984; Nilsson et al. 1992; Park et al. 2000; Thomas et al. 1988; Vilholm et al. 1998; Wang et al. 2010).
Other notes
In the United States acupuncture usually does not require a referral, and is rarely covered by insurance.
References
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Chessman AW (2016) Review: Acupuncture reduces migraine frequency more than usual care, sham acupuncture, or prophylactic drugs. Ann Intern Med 165: JC44. doi: 10.7326/ACPJC-2016-165-8-044
de Azevedo RF, Chiari BM, Okada DM, Onishi ET (2007) Impact of acupuncture on otoacoustic emissions in patients with tinnitus. Braz J Otorhinolaryngol 73: 599-607.
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