GRADE Working Group grades of evidence. High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.a Of the 33 included RCTs, the acupuncture treatment type and period were heterogeneous. The acupuncture treatment period ranged from one to three months. The acupoints varied across trials. The needling sensation could be provoked by manual stimulation or electrical stimulation. b Downgraded one level for serious inconsistency: variation in the definition of dependency and acupuncture treatment type and duration. c Downgraded two levels for very serious risk of bias: Among the 11 included trials, eight had risk of performance bias and seven had risk of detection bias; the result was not consistent with the sensitivity analysis using only sham controls. d Downgraded two levels for very serious risk of bias: Among the eight included trials, six had risk of performance bias and four had risk of detection bias; the result was not consistent with the sensitivity analysis using only sham controls. e Downgraded two levels for very serious risk of bias: Among the five included trials, four had risk of performance bias; the result was not consistent with the sensitivity analysis using only sham controls. f Downgraded two levels for very serious inconsistency: considerable statistical heterogeneity (I 2 > 50%) and variation in acupuncture treatment type and duration. g Downgraded two levels for very serious risk of bias: Among the 13 included trials, at least eight trials had risk of allocation bias, performance bias, or detection bias; the result was not consistent with the sensitivity analysis using only sham controls. h Downgraded two levels for very serious risk of bias: Among the 11 included trials, at least six had risk of allocation bias, performance bias, or detection bias; the result was not consistent with the sensitivity analysis using only sham controls. i Downgraded two levels for very serious risk of bias: Among the 18 included trials, at least 10 trials had risk of allocation bias, performance bias, or detection bias; the result was not consistent with the sensitivity analysis using only sham controls. j Downgraded two levels for very serious risk of bias: Among the 22 included trials, at least 11 trials had risk of allocation bias, performance bias, or detection bias; the result was not consistent with the sensitivity analysis using only sham controls. k Downgraded two levels for very serious inconsistency: variation between trials in reporting of adverse events and in acupuncture treatment type and duration. Summary of findings 2. Acupuncture compared with sham control for patients with acute stroke Acupuncture com...
Objective The purpose of this study was to identify the prevalence of severe headache or migraine and the association between dietary thiamine and riboflavin intake with headache history using a large, nationally representative population sample. Background Severe headache and migraine are common and disabling neurological disorders worldwide. Previous studies revealed that the B vitamin group, as an important nutrient of diet, can reduce migraine disability. Methods We performed a cross‐sectional study of American adults surveyed in the National Health and Nutrition Examination Survey (NHANES) 1999–2004. Information on headache history was collected in the Miscellaneous Pain section of the Questionnaire Data. Dietary intake data of thiamine and riboflavin were obtained by 24‐h dietary recall interview. Results The present study included 13,439 participants and indicated that 2745/13,439 (21.6%) adults (aged ≥20 years) experienced severe headache or migraine in the past 3 months. Dietary thiamine intake was significantly inversely associated with severe headache or migraine (odds ratio [OR] = 0.93, 95% confidence interval [CI] = 0.88–1.00, p = 0.046). In the stratified analysis, the relationship was maintained in the female group (OR = 0.90, 95% CI = 0.82–0.98, p = 0.022), and the sex interaction term was significant (p = 0.020). However, no significant interaction was found between the age groups (p = 0.352). For dietary riboflavin, no significant negative association was observed between dietary riboflavin intake and headache history (OR = 0.98, 95% CI = 0.94–1.02, p = 0.367). After stratifying by sex or age, there remained no significant relationship between dietary riboflavin and migraine. Conclusions We found that high intake of thiamine was significantly associated with lower odds of migraine, especially in females. In the future, more clinical studies are needed to confirm our conclusions, and additional experiments are needed to explore the possible mechanisms of prevention and treatment for migraine.
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