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Meta-Analysis
. 2016 Apr 19;4(4):CD007587.
doi: 10.1002/14651858.CD007587.pub2.

Acupuncture for the prevention of tension-type headache

Klaus Linde  1 , Gianni Allais, Benno Brinkhaus, Yutong Fei, Michael Mehring, Byung-Cheul Shin, Andrew Vickers, Adrian R White
Affiliations
Meta-Analysis

Acupuncture for the prevention of tension-type headache

Klaus Linde et al. Cochrane Database Syst Rev. .

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the World Health Organization (WHO) International Clinical Trials Registry Platform to 10 February 2016 for ongoing and unpublished trials.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 headache frequency compared to 133 of 312 (43%) in the sham group after treatment (RR 1.3; 95% CI 1.09 to 1.5; four trials; moderate quality evidence). Results six months after randomisation were similar. Withdrawals were low: 1 of 420 participants receiving acupuncture dropped out due to adverse effects and 0 of 343 receiving sham (six trials; low quality evidence). Three trials reported the number of participants reporting adverse effects: 29 of 174 (17%) with acupuncture versus 12 of 103 with sham (12%; odds ratio (OR) 1.3; 95% CI 0.60 to 2.7; low quality evidence).Acupuncture was compared with physiotherapy, massage or exercise in four trials of low to moderate quality (high risk of bias); study findings were inadequately reported. No trial found a significant superiority of acupuncture and for some outcomes the results slightly favoured the comparison therapy. None of these trials reported the number of participants dropping out due to adverse effects or the number of participants reporting adverse effects.Overall, the quality of the evidence assessed using GRADE was moderate or low, downgraded mainly due to a lack of blinding and variable effect sizes.

Authors' conclusions: The available results suggest that acupuncture is effective for treating frequent episodic or chronic tension-type headaches, but further trials - particularly comparing acupuncture with other treatment options - are needed.

PubMed Disclaimer

Conflict of interest statement

This review includes trials in which some of the review authors were involved: Jena 2008 ‐ Benno Brinkhaus; Melchart 2005 ‐ Benno Brinkhaus and Klaus Linde; White 1996 and White 2000 ‐ Adrian White. These trials were reviewed by at least two other members of the review team.

Gianni Allais, Benno Brinkhaus, Yutong Fei, Byung‐Cheul Shin, Michael Mehring and Adrian White use acupuncture in their clinical work.

Within the last three years (January 2013 to December 2015): Gianni Allais received fees for teaching acupuncture in private schools; Klaus Linde once received a fee from the German Medical Acupuncture Society for speaking about research at a conference; Benno Brinkhaus has received fees for presenting research findings at meetings of acupuncture societies in various countries; Adrian White is employed by the British Medical Acupuncture Society as a journal editor and has received fees for lecturing on acupuncture on several occasions.

Andrew Vickers' contribution to this review was supported by the NIH grant R01AT006794 (see Sources of support).

We believe that none of the statements above constitute a potential conflict of interest in relation to this review.

Figures

1
1
Flow diagram.
2
2
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
3
3
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
4
4
Forest plot of comparison: 2 Acupuncture versus sham interventions, outcome: 2.1 Response.
5
5
Forest plot of comparison: 2 Acupuncture versus sham interventions, outcome: 2.2 Number of headache days.
1.1
1.1. Analysis
Comparison 1 Acupuncture versus no acupuncture, Outcome 1 Response.
1.2
1.2. Analysis
Comparison 1 Acupuncture versus no acupuncture, Outcome 2 Number of headache days.
1.3
1.3. Analysis
Comparison 1 Acupuncture versus no acupuncture, Outcome 3 Headache intensity.
1.4
1.4. Analysis
Comparison 1 Acupuncture versus no acupuncture, Outcome 4 Safety/acceptability.
2.1
2.1. Analysis
Comparison 2 Acupuncture versus sham interventions, Outcome 1 Response.
2.2
2.2. Analysis
Comparison 2 Acupuncture versus sham interventions, Outcome 2 Number of headache days.
2.3
2.3. Analysis
Comparison 2 Acupuncture versus sham interventions, Outcome 3 Headache intensity.
2.4
2.4. Analysis
Comparison 2 Acupuncture versus sham interventions, Outcome 4 Analgesic use.
2.5
2.5. Analysis
Comparison 2 Acupuncture versus sham interventions, Outcome 5 Safety/acceptability.
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References to other published versions of this review

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