Akupunktur bei Migräne ohne Aura und konnektivitätsbasierte Wirksamkeitsvorhersage: Eine randomisierte klinische Studie
Abstract
Importance
Connectome-based predictive modeling (CPM) uses a data-driven whole-brain framework to identify connectivity patterns predicting clinical outcomes. However, CPM’s application to acupuncture in migraine without aura (MWOA) remains novel.
Objective
To evaluate the clinical efficacy of real acupuncture and sham acupuncture in MWOA, and to identify acupuncture-response brain connectivity patterns using CPM analysis of baseline functional magnetic resonance imaging (fMRI) data.
Design, setting and participants
This single-blinded randomized clinical trial was conducted from June 2021 to June 2023 at Beijing Hospital of Traditional Chinese Medicine in China. It enrolled participants aged 18 to 65 years who met the MWOA criteria of the International Classification of Headache Disorders, 3rd edition. Eligible participants were randomly assigned to receive real acupuncture or sham acupuncture, and underwent baseline clinical assessments and baseline fMRI scans.
Interventions
Both treatment groups received 12 sessions of 30-minute acupuncture over 4 weeks. Real acupuncture involved 8 acupoints with deqi sensation, while sham acupuncture used sham acupoints without deqi.
Main outcomes and measures
Primary outcome was the change from baseline in monthly migraine days (MMDs) during weeks 1 to 4. Secondary outcomes included 50% or greater reduction in MMDs and change from baseline in monthly headache days (MHDs), acute medication use days, pain score (visual analog scale [VAS] score range: 0 [indicating no pain] to 10 [indicating severe pain]), disability score (6-item Headache Impact Test [HIT-6] score range: 36 to 78, with the higher scores indicating severe headache effect), and quality-of-life score (Migraine-Specific Quality of Life Questionnaire [MSQ] score range: 0 to 100, with the higher scores indicating superior quality of life) during 4 weeks. Neuroimaging analyses used fMRI data to predict outcome changes via CPM.
Results
Among the 120 participants (mean [SD] age, 36.8 [10.0] years; 95 females [79.2%]), 60 were randomly assigned to real acupuncture and 60 to sham acupuncture. The change from baseline in MMDs significantly improved for the real acupuncture group compared with the sham acupuncture group (median difference, −1.0; 95% CI, −2.0 to 0; P = .02). Significant differences were also observed in MHDs, acute medication use days, VAS score, HIT-6 score, and MSQ score. CPM revealed distinct neural signatures: negative connectivity predicted VAS score reduction (r = 0.23, P = .04) and positive connectivity predicted HIT-6 score improvement (r = 0.29, P = .02). DMN-SC hypoconnectivity and SC-motor hyperconnectivity were identified as key connectivity patterns.
Conclusions and relevance
This trial demonstrated acupuncture’s efficacy for MWOA pain relief and functional improvement. CPM identified DMN-SC hypoconnectivity as predicting pain relief and SC-motor hyperconnectivity as predicting reduced disability, providing a personalized treatment framework.
Autoren
Xinyu Zhang, Qiuyi Chen, Yuhan Liu, Jingyi Li, Limin Nie, Quan Miao, Feiyu Fu, Tianli Lyu, Zhongjian Tan, Yazhuo Kong, Bin Li, Lu Liu
Journal
JAMA Network Open
Link: https://doi.org/10.1001/jamanetworkopen.2025.55454
DOI: 10.1001/jamanetworkopen.2025.55454
Verwendete Punkte:
- Lenkergefäß 20 (GV20)
- Lenkergefäß 16 (GV16)
- Gallenblase 20
- Extrapunkt Kopf/Nacken 5
- Dickdarm 4
QUELLE: Zhang, X., Chen, Q., Liu, Y., Li, J., Nie, L., Miao, Q., Fu, F., Lyu, T., Tan, Z., Kong, Y., Li, B., & Liu, L. (2026). Acupuncture for migraine without aura and connection-based efficacy prediction: a randomized clinical trial. JAMA Network Open, 9(1), e2555454. https://doi.org/10.1001/jamanetworkopen.2025.55454
Zusatzinfo
- klinische Wirksamkeit von Akupunktur bei Migräne (Schmerzreduktion, weniger Migränetage, bessere Lebensqualität)
- Ruhezustands-fMRT zur Vorhersage des Akupunktur-Therapieerfolgs