Acupuncture for tension-type headache
Background
Acupuncture is often used for prophylaxis of tension-type headaches, but its effectiveness remains controversial. This study (along with a review of “Acupuncture for migraine prophylaxis”) represents an updated version of the Cochrane review first published in number 1, 2001, the Cochrane Library .
Objectives
To investigate whether acupuncture is a) more effective than just prophylactic treatment or care that the simple standard of care, b) more effective than sham acupuncture or use of placebo, and c) as effective as other interventions in reducing the frequency of headache in patients with headache or chronic tension-type episodes.
Search strategy
We used the major databases among which: The Cochrane Pain, Palliative & Supportive Care Trials Register, CENTRAL, MEDLINE, EMBASE and the Cochrane Complementary Medicine Field Trials . The review study began in January 2008.
Selection criteria
Randomised trials randomized after an observation period of at least 8 weeks comparing the clinical effects of acupuncture with a control intervention (acute treatment of headaches or usual care only), an intervention sham acupuncture or other interventions in patients with type headache, episodic or chronic tension.
Data collection and analysis
Two reviewers checked eligibility; extracted information on patients, interventions, methods and results, and assessed risk of bias and the quality of the acupuncture intervention. Extracted results included in the responses (at least 50% reduction in headache frequency, results of primary interest), days of headache, pain intensity and analgesic use.
Main results
Eleven trials with 2317 participants (median 62, range 10 to 1265) met the inclusion criteria. Two large trials compared acupuncture to treat acute headaches or routine care only. Both found statistically significant and clinically relevant short-term (up to 3 months) the benefits of acupuncture in controlling the response, the number of days of headache and pain intensity. The long-term (beyond 3 months) were investigated.
Six trials compared acupuncture with sham acupuncture intervention, and five of the six provided data for meta-analysis. We found small but statistically significant benefit of acupuncture over sham acupuncture for the response, as well as several other results. Three of the four trials comparing acupuncture with physiotherapy, massage or relaxation had major methodological flaws or reporting. Their results were difficult to interpret, but together they suggest slightly better than some results in the control groups.
Conclusions
In the previous version of this review, evidence supporting acupuncture for headache tension-type were considered insufficient. Now, with six additional tests, the authors concluded that acupuncture could be a valuable non-pharmacological tool in patients with frequent episodes of pain or chronic tension-type headache.