Acupuncture good at controlling tension headaches: Cochrane review

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CM NEWS – A Cochrane review of recent large-scale acupuncture studies suggests that acupuncture could be a valuable option for patients suffering from frequent tension-type headache.

Patients with tension-type headache suffer from episodes of pain which is typically bilateral (affects both sides of the head), pressing or tightening in quality, mild to moderate in intensity, and which does not worsen with routine physical activity.

In most patients tension-type headache occurs infrequently and there is no need for further treatment beyond over-the-counter pain killers. In some patients, however, tension-type headache occurs on several days per month or even daily. Acupuncture is a therapy in which thin needles are inserted into the skin at defined points; it originates from China. Acupuncture is used in many countries for tension-type headache prophylaxis – that is, to reduce the frequency and intensity of tension-type headaches.

In this review, the researchers want 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.

The review is spearheaded by researchers at the Centre for Complementary Medicine Research, at Technische Universitaet Muenchen in Germany.

Acupuncture studies were selected in this review based on 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.

11 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 basic care (which usually involves only treating unbearable pain with pain killers) only. Both found that those patients who received acupuncture had fewer headaches. 47% of patients receiving acupuncture reported a decrease in the number of headache days by at least 50%, compared to 16% of patients in the control groups.

In addition, 6 trials compared acupuncture with a sham or “fake” acupuncture (needles were either inserted at incorrect points or did not penetrate the skin) intervention, and 5 of the 6 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. 3 of the 4 trials comparing acupuncture with physiotherapy, massage or relaxation had important methodological or reporting shortcomings.

50% of patients receiving true acupuncture reported a decrease of the number of headache days by at least 50%, compared to 41% of patients in the groups receiving inadequate or ‘fake’ acupuncture. Three of the four trials in which acupuncture was compared to physiotherapy, massage or relaxation had important methodological shortcomings.

Their findings are difficult to interpret, the researchers say, but collectively suggest slightly better results for some outcomes with the latter therapies.The researchers conclude that the available evidence suggests that acupuncture could be a valuable option for patients suffering from frequent tension-type headache.

[Cochrane Database of Systematic Reviews, Issue 1, 2009; DOI: 10.1002/14651858.CD007587]