Acupuncture for the prevention of tension-type headache

Abstract

Background Acupuncture is often used for prevention of tension-type headache but its effectiveness is still controversial. This is an update of our Cochrane review originally published in Issue 1, 2009 of The Cochrane Library. Objectives To investigate whether acupuncture is a) more effective than no prophylactic treatment/routine care only; b) more effective than ‘sham’ (placebo) acupuncture; and c) as effective as other interventions in reducing headache frequency in adults with episodic or chronic tension-type headache. Search methods We searched CENTRAL, MEDLINE, EMBASE and AMED to 19 January 2016. We searched the World Health Organization (WHO) International Clinical Trials Registry Platform to 10 February 2016 for ongoing and unpublished trials. Selection criteria We included randomised trials with a post-randomisation observation period of at least eight weeks, which compared the clinical effects of an acupuncture intervention with a control (treatment of acute headaches only or routine care), a sham acupuncture intervention or another prophylactic intervention in adults with episodic or chronic tension-type headache. Data collection and analysis Two review authors checked eligibility; extracted information on participants, interventions, methods and results; and assessed study risk of bias and the quality of the acupuncture intervention. The main efficacy outcome measure was response (at least 50% reduction of headache frequency) after completion of treatment (three to four months after randomisation). To assess safety/acceptability we extracted the number of participants dropping out due to adverse effects and the number of participants reporting adverse effects. We assessed the quality of the evidence using GRADE (Grading of Recommendations Assessment, Development and Evaluation). Main results Twelve trials (11 included in the previous version and one newly identified) with 2349 participants (median 56, range 10 to 1265) met the inclusion criteria. Acupuncture was compared with routine care or treatment of acute headaches only in two large trials (1265 and 207 participants), but they had quite different baseline headache frequency and management in the control groups. Neither trial was blinded but trial quality was otherwise high (low risk of bias). While effect size estimates of the two trials differed considerably, the proportion of participants experiencing at least 50% reduction of headache frequency was much higher in groups receiving acupuncture than in control groups (moderate quality evidence; trial 1: 302/629 (48%) versus 121/636 (19%); risk ratio (RR) 2.5; 95% confidence interval (CI) 2.1 to 3.0; trial 2: 60/132 (45%) versus 3/75 (4%); RR 11; 95% CI 3.7 to 35). Long-term effects (beyond four months) were not investigated. Acupuncture was compared with sham acupuncture in seven trials of moderate to high quality (low risk of bias); five large studies provided data for one or more meta-analyses. Among participants receiving acupuncture, 205 of 391 (51%) had at least 50% reduction of ...

Complementary and integrative medicine in the management of headache

“…A systematic review (12 RCTs, 2349 patients) reported a ≥50% reduction in headache frequency in 48% and 45% of patients receiving acupuncture compared with nonacupuncture controls (4% and 19%) and in 51% of those receiving acupuncture compared with 43% of sham acupuncture controls (moderate quality evidence). 17 …”

Role of Acupuncture in the Treatment or Prevention of Migraine, Tension‐Type Headache, or Chronic Headache Disorders

“…The published literature pertaining to the effectiveness of acupuncture for tension‐type headache was summarized in a Cochrane Database systematic review published in 2016 . This review included 12 trials representing 2349 patients with tension‐type headache who participated in RCTs that compared acupuncture to routine care only (2 trials), sham acupuncture (7 trials), or physiotherapy, massage, or relaxation (4 trials).…”

Behavioral Approaches for Primary Headaches: Recent Advances

“…2,3 Between 1990 and 2013, the burden of migraine, medication overuse headache, and TTH, defined in terms of years lived with a disability (YLDs), increased by 46.1%, 45.5%, and 120.2%, respectively. [11][12][13][14][15] Behavioral approaches vary somewhat, both in descriptive terms and specific aims, but a common thread involves changing maladaptive behaviors and ways of thinking that contribute to headache-related burden and pain. 4 Current first-line treatments for primary headaches include medications for acute management, such as triptans and nonsteroidal anti-inflammatory drugs, and prophylactic drugs with a variety of options, including oral medications such as antidepressants, anti-epileptics, and b-blockers, and local injections such as onabotulinumtoxinA.…”