A systematic review of Acupuncture for the management of Chronic Headaches
Study: Conducted by Department of Anethesiology, Duke University Medical centre.
This was a review of efficacy of acupuncture to treat chronic headaches. The review involved looking at clinical trials that used true acupuncture over a course ranging from 6 to 12 weeks and one more treatment sessions a week. The majority of the selected trials used sham acupuncture in the control group. A few trials compared true acupuncture with other treatments including physiotherapy, massage and relaxation and commonly used medication.
Chronic headaches including migraines and tension-type headaches.
Thirty one trials consisting of 3916 patients met the inclusion criteria. The review only chose trials where participants were randomised for acupuncture or control receiving sham acupuncture , medication or other non pharmacological treatments.
17 trials were for treatment of migraine
10 trials were for treatment of tension type headaches
4 trials were for mixed headaches
Headache intensity and frequency of headache, and health related QoL questionnaires were the primary information to determine efficacy of acupuncture treatments. These measurements were reviewed in a defined follow-up early period of close to 8 weeks and no more than 3 months and also a late follow-up period of close to 6 months but longer than 3 months. The treatment response rate was based on a minimum improvement of 33% in headache frequency or headache index.
Thirty-one studies were included in this review. The majority of included trials comparing true acupuncture and sham acupuncture showed a trend in favor of acupuncture. The combined response rate in the acupuncture group was significantly higher compared with sham acupuncture either at the early follow-up period (risk ratio [RR]: 1.19, 95% confidence interval [CI]: 1.08, 1.30) or late follow-up period (RR: 1.22, 95% CI: 1.04, 1.43). Combined data also showed acupuncture was superior to medication therapy for headache intensity (weighted mean difference: -8.54 mm, 95% CI: -15.52, -1.57), headache frequency (standard mean difference: -0.70, 95% CI: -1.38, -0.02), physical function (weighted mean difference: 4.16, 95% CI: 1.33, 6.98), and response rate (RR: 1.49, 95% CI: 1.02, 2.17).
Needling acupuncture is superior to sham acupuncture and medication therapy in improving headache intensity, frequency, and response rate.
Cochrane Quality and Risk Rating (if available)
The quality of the selected studies was not rated. However quality was independently assessed by two independent reviewers who based their assessment on a criteria for selecting quality of controlled trials. See paper for more details.
The paper did not discuss point locations or provide any analysis of commonality of points used across the selected trials.
Sun and Gan (2008) Acupuncture of the management of Chronic Headache: A systematic Review. Journal of Anesthesia and Analgesia. 2008, Vol 107 (6) International Anesthesia Research Society