Acupuncture for tension-type headache

Abstract

Background Acupuncture is often used for tension-type headache prophylaxis but its effectiveness is still controversial. This review (along with a companion review on ‘Acupuncture for migraine prophylaxis’) represents an updated version of a Cochrane review originally published in Issue 1, 2001, 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 patients with episodic or chronic tension-type headache. Search strategy The Cochrane Pain, Palliative & Supportive Care Trials Register, CENTRAL, MEDLINE, EMBASE and the Cochrane Complementary Medicine Field Trials Register were searched to January 2008. Selection criteria We included randomized trials with a post-randomization observation period of at least 8 weeks that 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 intervention in patients with episodic or chronic tension-type headache. Data collection and analysis Two reviewers checked eligibility; extracted information on patients, interventions, methods and results; and assessed risk of bias and quality of the acupuncture intervention. Outcomes extracted included response (at least 50% reduction of headache frequency; outcome of primary interest), headache days, 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 treatment of acute headaches or routine care only. Both found statistically significant and clinically relevant short-term (up to 3 months) benefits of acupuncture over control for response, number of headache days and pain intensity. Long-term effects (beyond 3 months) were not investigated. Six trials compared acupuncture with a sham acupuncture intervention, and five of the six provided data for meta-analyses. Small but statistically significant benefits of acupuncture over sham were found for response as well as for several other outcomes. Three of the four trials comparing acupuncture with physiotherapy, massage or relaxation had important methodological or reporting shortcomings. Their findings are difficult to interpret, but collectively suggest slightly better results for some outcomes in the control groups. Authors’ conclusions In the previous version of this review, evidence in support of acupuncture for tension-type headache was considered insufficient. Now, with six additional trials, the authors conclude that acupuncture could be a valuable non-pharmacological tool in patients with frequent episodic or chronic tension-type headaches.

Effects of Acupuncture on Sensory Perception: A Systematic Review and Meta-Analysis

“…3). Thus, these findings provide a physiological basis for the growing body of evidence for the effectiveness of acupuncture in locomotor conditions associated with tenderness [111][112][113].…”

Combination of acupuncture and spinal manipulative therapy: management of a 32-year-old patient with chronic tension-type headache and migraine

“…3,4 Headache pain relief has been obtained from needling both acupuncture points and sham points. [3][4][5][6][7][8][9] It is interesting to question, however, whether the sham acupuncture points used were actual acupuncture points in acupuncture traditions other than Traditional Chinese Medicine and whether the neurological input that occurred during the sham acupuncture treatment was sufficient to trigger the central and peripheral changes associated with acupuncture analgesia.…”

“…1,2 Acupuncture has been found to be clinically beneficial for patients with chronic headaches, particularly migraines [3][4][5][6] and tension-type headaches (TTHs). 7,8 Acupuncture has also been suggested to be an effective first-line complementary alternative medicine modality to treat migraines. 9 Chiropractic care has also demonstrated evidence to manage adults with headaches.…”

Complementary and alternative medicine therapies for the anesthesiologist and pain practitioner: a narrative review

“…For example, in 2011, Lee and Ernst published an analysis of Cochrane reviews that thoroughly addresses the specific evidence on acupuncture for pain. 12,[15][16][17][18][19][20] They found that most of the evidence for the effect of acupuncture in pain related to migraines, neck disorders, tension-type headaches, and peripheral joint osteoarthritis. They also noted a lack of effect for rheumatoid arthritis and inconclusive results for some other types of pain, suggesting that acupuncture is effective for some types of pain but clearly not all.…”