Cupping Therapy Eases Migraine Pain but Fails to Enhance Quality of Life

A new study shows cupping therapy is an effective treatment to relieve migraine headaches but does not improve quality of life.¹

“The benefits appeared to be significant only with the wet cupping technique,” wrote investigators, led by Bushra Mohandes, from Sulaiman AlRajhi University College of Medicine in Saudi Arabia. “Cupping therapy significantly reduced pain intensity; however, adding acupuncture or collateral pricking did not improve overall treatment success compared to cupping alone.”

Cupping therapy, where therapists place heated cups on the skin to suction fluid, breaks open tiny blood vessels and the body replenishes the cupped areas with a heathier blood flow.² The method is a popular traditional Chinese medicine technique used widely in East Asia, Southeast Asia, and Middle Eastern regions for centuries to alleviate pain, reduce inflammation, increase blood circulation, manage stress, and help respiratory ailments.

Many studies have assessed the safety and efficacy of cupping therapy for treating migraine headaches but reached conflicting results.¹ For instance, 1 study discovered participants who had wet cupping therapy experienced a 66% reduction in headache severity, but another study found no significant difference between cupping therapy and conventional treatment in treating and preventing migraines.

A systematic review and meta-analysis, published in 2021, supported the effectiveness of cupping therapy for treating migraines.³ Still, the research had numerous limitations, including analyzing only a few randomized controlled trials (RCTs), a small sample size, and the inability to assess for publication bias.

Mohandes and colleagues sought to assess the effectiveness of cupping therapy for treating migraine headaches in a more robust study.¹ They conducted a meta-analysis and systematic reviews with a larger sample size than the 2021 study and did not place language limitations.

Investigators screened the databases PubMed/MEDLINE, Clinicaltrials.gov, Cochrane CENTRAL, ScienceDirect, ProQuest, SinoMed, and the National Science and Technology Library up to June 30, 2024, for the keywords: migraine, migraine headache, cupping, blood cupping, hijama, hijamah. Trials were included if they were RCTs or non-randomized, had participants with migraine headaches who either had or did not have an aura, had cupping therapy as the intervention, a control group, and participants diagnosed with other types of headaches.

The primary endpoints were the elimination of migraines (“migraine cure”) and the mean change in pain intensity based on either the visual analog scale (VAS) or the equivalent comparative pain scale tool. Secondary endpoints included safety, determined by the incidence of adverse events, and improving quality of life, measured by the MIDAS tool.

The study included 18 studies for the quantitative analysis, published between 2002 – 2024, with most conducted in China (n = 12), followed by Iran (n = 3), Turkey (n = 2), and Iraq (n = 1). Among 1446 participants, approximately 55% (n = 797) received cupping therapy. Most participants were female (60%), and the mean age was 31.7 to 42.5 years.

Studies had a follow-up period range between 1 to 12 months. Participants had migraine headaches lasted an average of 2.34 to 9.2 years, and most studies did not identify the type of migraine headache.

The meta-analysis only included 16 studies as the team excluded 2 single-arm studies.

Among the 11 studies that reported successful migraine treatment, investigators observed a significant headache improvement of 83% in participants who underwent cupping therapy compared with controls (risk ratio [RR], 1.83; 95% confidence interval [CI], 1.52 to 2.21). A subgroup analysis revealed participants who had cupping alone and adjunctive treatments had significant headache improvements, but wet cupping alone brought the greatest success (RR, 2.98; 95% CI, 2.00 to 4.46). However, dry cupping did not improve treatment success (RR, 1.57; 95% CI, 0.97 to 2.55).

Additionally, participants receiving cupping therapy had greater migraine pain reduction compared with controls (95% CI, 0.20 to 1.04) but those who had adjunctive therapy with collateral picking did not experience a significant reduction (95% CI, 0.20 to 1.04). Participants who had all 3—cupping, collateral pricking, and acupuncture—had the greatest pain reduction (95% CI, 1.15 to 2.25). One study saw cupping therapy reduced the VAS score by 2.23 compared with controls (95% CI, 0.63 to 3.83).

“This suggests that adding adjunctive complementary therapy may not produce a more robust impact on efficacy outcomes compared to cupping alone,” the team wrote. “However, our findings revealed more improvement in efficacy outcomes when acupuncture is combined with cupping.”

Investigators found patients who received cupping therapy had a 75% lower risk of adverse events than those on conventional treatment (95% CI, 0.09 to 0.71). Among people who received cupping therapy, 1 had nausea and 1 had dizziness, showing how adverse events were low.

Participants receiving cupping therapy did not have a significant change in quality of life (95% CI, - 11.82 to – 13.63). However, one study reported a significant difference in MIDAS score compared to baseline, showing the benefits of cupping therapy (95% CI, - 8.96 to – 2.04). One study was excluded from the quantitative analysis because both the intervention and control arms received cupping therapy at different lunar phases also found a significantly greater reduction in the MIDAS scale score when cupping took place in the second half of the month.

Ultimately, the study had robust findings and had a non-significant risk of publication bias (P = .09).

“This meta-analysis suggests that cupping therapy is efficacious and safe in treating migraine headaches,” investigators concluded.

References

1. ^{Mohandes B, Bayoumi FEA, AllahDiwaya AA, et al. Cupping Therapy for the Treatment of Migraine Headache: a systematic review and meta-analysis of clinical trials. J Pharmacopuncture. 2024;27(3):177-189. doi:10.3831/KPI.2024.27.3.177}
2. ^{Cupping Therapy. Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/16554-cupping. Accessed October 9, 2024.}
3. ^{Seo J, Chu H, Kim CH, Sung KK, Lee S. Cupping Therapy for Migraine: A PRISMA-Compliant Systematic Review and Meta-Analysis of Randomized Controlled Trials. Evid Based Complement Alternat Med. 2021;2021:7582581. Published 2021 Mar 24. doi:10.1155/2021/7582581}