Acupuncture and dementia risk in migraine

Inspired by Huang et al 2022.[1]

NHIRD – National Health Insurance Research Database (Taiwan)
HR – hazard ratio
aHR – adjusted hazard ratio
SR – systematic review
NMA – network meta-analysis
EA – electroacupuncture
MA – manual acupuncture

key to acronyms

It has been a while since I have seen one of these huge retrospective observational studies. Most of them come from Taiwan, as in this case, where some 99% of the population are on the same National Health Insurance Research Database (NHIRD). I now have 30 such papers listed in my database, of which 21 are from Taiwan.

The papers I have highlighted to date can all be found by clicking on the category Retrospective cohorts on the right of the blog in desktop view, or by scrolling down below the recent posts in tablet or mobile view. A summary of the key findings of these can be found towards the end of the clinical evidence document on the BMAS website.

As is often the case with papers like this I learn something new about the conditions in question. Before seeing this paper, I did not realise that there was an increased relative risk of developing dementia if you suffer from migraine. It is an increased risk of about 33%, otherwise stated as a hazard ratio (HR) of 1.33.[2] The data evaluating this increased risk also comes from the Taiwanese NHIRD.

In 2017 a similar paper was published assessing the relative risk of dementia associated with use of Chinese medicine, including herbs, acupuncture, and tuina.[3] This paper demonstrated a reduced risk associated with the combination of all treatments (aHR 0.62) but an increased risk associated with the physical treatments (acupuncture and tuina) alone (aHR 2.19). This estimate was probably unreliable because it was based on only one 50^th of the data used to estimate the risk associated with Chinese medicine use as a whole.

In the current paper, more than 3 times as many eligible patients (4813 in each cohort) were found after propensity score matching for the usual factors:

• Age
• Sex
• Year of migraine diagnosis
• Index year (when first treated with acupuncture)
• Insurance amount
• Urbanisation level
• Baseline co-morbidities
• Medication use

Patients who received more than 6 acupuncture treatments after their migraine diagnosis had a lower risk of dementia (aHR 0.51). This risk was found to be dose dependent – that is to say, more acupuncture was associated with lower risk. For patients receiving 24 or more treatments the aHR was 0.42 (a 58% reduction in risk).

a 58% reduction in risk

Note that this is a bigger reduction in risk than the increased risk of dementia associated with a diagnosis of migraine, leaving me to hypothesise that acupuncture could be associated with an overall reduced risk of dementia in the general population, with or with migraine. This is a rather speculative suggestion, and the data does not support a causal link, but from a mechanistic point of view, the anti-inflammatory and neuroprotective effects of acupuncture demonstrated in laboratory experiments may well confer benefits in terms of dementia risk.

Indeed, an SR and NMA (just out in August) of acupuncture treatment in laboratory models of vascular dementia demonstrates improved cognitive function and identifies the main mechanisms involved to be reduced oxidative stress, neuronal inflammation and apoptosis, as well as increased synaptic plasticity and neurotransmitters.[4] The points most often used in these experiments were GV20, ST36 and GV14.

Given that my own father is now suffering the dreaded condition, it might be sensible for me to self-treat with my favourite EA protocol a couple of times a week from now on! MA to ST36 with 20 minutes of toe tapping or toe wiggling is probably just as good for those without access to an EA device.

References

 1         Huang C-H, Lin M-C, Chou I-C, et al. Acupuncture Treatment is Associated with Reduced Dementia Risk in Patients with Migraine: A Propensity-Score-Matched Cohort Study of Real-World Data. Neuropsychiatr Dis Treat 2022;18:1895–906. doi:10.2147/NDT.S372076

2          Chuang C-S, Lin C-L, Lin M-C, et al. Migraine and risk of dementia: a nationwide retrospective cohort study. Neuroepidemiology 2013;41:139–45. doi:10.1159/000353559

3          Liu C-T, Wu B-Y, Hung Y-C, et al. Decreased risk of dementia in migraine patients with traditional Chinese medicine use: a population-based cohort study. Oncotarget 2017;8:79680–92. doi:10.18632/oncotarget.19094

4          Li G, Shi Y, Zhang L, et al. Efficacy of acupuncture in animal models of vascular dementia: A systematic review and network meta-analysis. Front Aging Neurosci 2022;14:952181. doi:10.3389/fnagi.2022.952181

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Declaration of interests MC