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Journal of Neurology

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05-04-2023 | Acupuncture | Review

Efficacy of acupuncture for tension-type headache prophylaxis: systematic review and meta-analysis with trial sequential analysis

Authors: Qing-Feng Tao, Xiao-Ying Wang, Si-Jia Feng, Xin-Yu Xiao, Yun-Zhou Shi, Chao-Rong Xie, Hui Zheng

Published in: Journal of Neurology | Issue 7/2023

Abstract

Background

Acupuncture has been shown to reduce tension-type headache (TTH) frequency in previous studies. Nevertheless, repeated significance testing might inflate type I error. We aimed to verify the effectiveness and safety of acupuncture in reducing TTH frequency by meta-analysis and trial sequential analysis (TSA).

Methods

Ovid Medline, Embase, and Cochrane Library were searched until September 29, 2022. Randomized controlled trials comparing acupuncture with sham acupuncture, no acupuncture, or other active therapies in adults with TTH were included. The primary outcome was TTH frequency. The secondary outcomes were responder rate and adverse event.

Results

Fourteen studies involving 2795 participants were included. Acupuncture had more reduction than sham acupuncture in TTH frequency, both after treatment (standardized mean difference [SMD] − 0.80, 95% CI − 1.36 to − 0.24, P = 0.005) and at the follow-up period (SMD − 1.33, 95% CI − 2.18 to − 0.49, P = 0.002), while TSA showed the included sample size did not exceed required information size (RIS). Acupuncture was superior over no acupuncture after treatment (SMD − 0.52, 95% CI − 0.63 to − 0.41, P < 0.001), and cumulative sample size reached RIS. In terms of responder rate, acupuncture had a higher responder rate compared with sham acupuncture both after treatment (relative ratio [RR] 1.28, 95% CI 1.12 to 1.46, P = 0.0003) and the follow-up period (RR 1.37, 95% CI 1.19 to 1.58, P < 0.0001), but the sample size is inadequate.

Conclusion

Acupuncture is an efficacious and safe treatment for TTH prevention, but this conclusion might be limited by the generally very low to low quality evidence. TSA suggested that high-quality trials are needed to verify the efficacy and safety of acupuncture compared to sham acupuncture.

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GBD 2019 Diseases and Injuries Collaborators (2020) Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 396:1204–1222. https://doi.org/10.1016/S0140-6736(20)30925-9CrossRef

GBD 2017 US Neurological Disorders Collaborators, Feigin VL, Vos T et al (2021) Burden of neurological disorders across the US from 1990–2017: A Global Burden of Disease Study. JAMA Neurol 78:165–176. https://doi.org/10.1001/jamaneurol.2020.4152CrossRef

Ashina S, Mitsikostas DD, Lee MJ et al (2021) Tension-type headache. Nat Rev Dis Primers 7:24. https://doi.org/10.1038/s41572-021-00257-2CrossRefPubMed

Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edn. Cephalalgia. 2018;38:1–211. https://doi.org/10.1177/0333102417738202

Stovner LJ, Hagen K, Linde M, Steiner TJ (2022) The global prevalence of headache: an update, with analysis of the influences of methodological factors on prevalence estimates. J Headache Pain 23:34. https://doi.org/10.1186/s10194-022-01402-2CrossRefPubMedPubMedCentral

GBD 2015 Disease and Injury Incidence and Prevalence Collaborators (2016) Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 388:1545–1602. https://doi.org/10.1016/S0140-6736(16)31678-6CrossRef

Andlin-Sobocki P, Jönsson B, Wittchen H-U, Olesen J (2005) Cost of disorders of the brain in Europe. Eur J Neurol 12(Suppl 1):1–27. https://doi.org/10.1111/j.1468-1331.2005.01202.xCrossRefPubMed

Cassidy EM, Tomkins E, Hardiman O, O’Keane V (2003) Factors associated with burden of primary headache in a specialty clinic. Headache 43:638–644. https://doi.org/10.1046/j.1526-4610.2003.03106.xCrossRefPubMed

Bigal ME, Bigal JM, Betti M et al (2001) Evaluation of the impact of migraine and episodic tension-type headache on the quality of life and performance of a university student population. Headache 41:710–719. https://doi.org/10.1046/j.1526-4610.2001.041007710.xCrossRefPubMed

10.

Robbins MS (2021) Diagnosis and management of headache: a review. JAMA 325:1874–1885. https://doi.org/10.1001/jama.2021.1640CrossRefPubMed

11.

Bendtsen L, Evers S, Linde M et al (2010) EFNS guideline on the treatment of tension-type headache—report of an EFNS task force. Eur J Neurol 17:1318–1325. https://doi.org/10.1111/j.1468-1331.2010.03070.xCrossRefPubMed

12.

Bendtsen L, Jensen R (2004) Mirtazapine is effective in the prophylactic treatment of chronic tension-type headache. Neurology 62:1706–1711. https://doi.org/10.1212/01.wnl.0000127282.90920.8cCrossRefPubMed

13.

Fernando Prieto Peres M, Prieto Peres Mercante J, Belitardo de Oliveira A (2019) Non-pharmacological treatment for primary headaches prevention and lifestyle changes in a low-income community of Brazil: a randomized clinical trial. Headache 59:86–96. https://doi.org/10.1111/head.13457CrossRefPubMed

14.

Martin PR, Forsyth MR, Reece J (2007) Cognitive-behavioral therapy versus temporal pulse amplitude biofeedback training for recurrent headache. Behav Ther 38:350–363. https://doi.org/10.1016/j.beth.2006.10.004CrossRefPubMed

15.

Melchart D, Streng A, Hoppe A et al (2005) Acupuncture in patients with tension-type headache: randomised controlled trial. BMJ (Clinical research ed) 331:376–382. https://doi.org/10.1136/bmj.38512.405440.8FCrossRefPubMed

16.

Zheng H, Gao T, Zheng Q-H et al (2022) Acupuncture for patients with chronic tension-type headache: a randomized controlled trial. Neurology. https://doi.org/10.1212/WNL.0000000000200670CrossRefPubMedPubMedCentral

17.

Jena S, Witt C, Brinkhaus B et al (2008) Acupuncture in patients with headache. Cephalalgia 28:969–979. https://doi.org/10.1111/j.1468-2982.2008.01640.xCrossRefPubMed

18.

Linde K, Allais G, Brinkhaus B et al (2016) Acupuncture for the prevention of tension-type headache. Cochrane Database Syst Rev 4:CD007587. https://doi.org/10.1002/14651858.CD007587.pub2CrossRefPubMed

19.

Linde K, Allais G, Brinkhaus B, et al (2009) Acupuncture for tension-type headache. Cochrane Database Syst Rev CD007587. https://doi.org/10.1002/14651858.CD007587

20.

Pi C, Liu Y, Li L et al (2022) Effects on neuromodulation, acupuncture, and aerobic exercises on migraine and tension-type headache outcomes: a systematic review and meta-analysis. Medicine (Baltimore) 101:e30530. https://doi.org/10.1097/MD.0000000000030530CrossRefPubMed

21.

Borm GF, Donders ART (2009) Updating meta-analyses leads to larger type I errors than publication bias. J Clin Epidemiol 62:825-830.e10. https://doi.org/10.1016/j.jclinepi.2008.08.010CrossRefPubMed

22.

Wetterslev J, Thorlund K, Brok J, Gluud C (2008) Trial sequential analysis may establish when firm evidence is reached in cumulative meta-analysis. J Clin Epidemiol 61:64–75. https://doi.org/10.1016/j.jclinepi.2007.03.013CrossRefPubMed

23.

Shah A, Smith AF (2020) Trial sequential analysis: adding a new dimension to meta-analysis. Anaesthesia 75:15–20. https://doi.org/10.1111/anae.14705CrossRefPubMed

24.

Pogue JM, Yusuf S (1997) Cumulating evidence from randomized trials: utilizing sequential monitoring boundaries for cumulative meta-analysis. Control Clin Trials 18:580–593. https://doi.org/10.1016/s0197-2456(97)00051-2. (discussion 661-666)CrossRefPubMed

25.

Thorlund K, Devereaux PJ, Wetterslev J et al (2009) Can trial sequential monitoring boundaries reduce spurious inferences from meta-analyses? Int J Epidemiol 38:276–286. https://doi.org/10.1093/ije/dyn179CrossRefPubMed

26.

Page MJ, McKenzie JE, Bossuyt PM et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372:n71. https://doi.org/10.1136/bmj.n71CrossRefPubMedPubMedCentral

27.

Sterne JAC, Savović J, Page MJ et al (2019) RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 366:l4898. https://doi.org/10.1136/bmj.l4898CrossRefPubMed

28.

Higgins JPT, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560. https://doi.org/10.1136/bmj.327.7414.557CrossRefPubMedPubMedCentral

29.

Guyatt GH, Oxman AD, Vist GE et al (2008) GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 336:924–926. https://doi.org/10.1136/bmj.39489.470347.ADCrossRefPubMedPubMedCentral

30.

Ebneshahidi NS, Heshmatipour M, Moghaddami A, Eghtesadi-Araghi P (2005) The effects of laser acupuncture on chronic tension headache—a randomised controlled trial. Acupunct Med 23:13–18. https://doi.org/10.1136/aim.23.1.13CrossRefPubMed

31.

Endres HG, Böwing G, Diener H-C et al (2007) Acupuncture for tension-type headache: a multicentre, sham-controlled, patient-and observer-blinded, randomised trial. J Headache Pain 8:306–314. https://doi.org/10.1007/s10194-007-0416-5CrossRefPubMedPubMedCentral

32.

Gildir S, Tuzun EH, Eroglu G, Eker L (2019) A randomized trial of trigger point dry needling versus sham needling for chronic tension-type headache. Medicine (Baltimore) 98:e14520. https://doi.org/10.1097/MD.0000000000014520CrossRefPubMed

33.

Karst M, Reinhard M, Thum P et al (2001) Needle acupuncture in tension-type headache: a randomized, placebo-controlled study. Cephalalgia 21:637–642. https://doi.org/10.1046/j.1468-2982.2001.00198.xCrossRefPubMed

34.

Kwak B, Kim M, Kim Y et al (2008) Persisting effects of acupuncture method for chronic tension-type headache; a randomized controlled trial. Journal of Korean Acupuncture & Moxibustion Society [taehan chimgu hakhoe chi] 25:165–177

35.

Schiller J, Karst M, Kellner T et al (2021) Combination of acupuncture and medical training therapy on tension type headache: results of a randomised controlled pilot study. Cephalalgia 41:879–893. https://doi.org/10.1177/0333102421989620CrossRefPubMedPubMedCentral

36.

Söderberg E, Carlsson J, Stener-Victorin E (2006) Chronic tension-type headache treated with acupuncture, physical training and relaxation training. Between-group differences. Cephalalgia 26:1320–1329. https://doi.org/10.1111/j.1468-2982.2006.01209.xCrossRefPubMed

37.

Tavola T, Gala C, Conte G, Invernizzi G (1992) Traditional Chinese acupuncture in tension-type headache: a controlled study. Pain 48:325–329. https://doi.org/10.1016/0304-3959(92)90080-UCrossRefPubMed

38.

Wang K, Svensson P, Arendt-Nielsen L (2007) Effect of acupuncture-like electrical stimulation on chronic tension-type headache: a randomized, double-blinded, placebo-controlled trial. Clin J Pain 23:316–322. https://doi.org/10.1097/AJP.0b013e318030c904CrossRefPubMed

39.

White AR, Resch K-L, Chan JCK et al (2000) Acupuncture for episodic tension-type headache: a multicentre randomized controlled trial. Cephalalgia 20:632–637. https://doi.org/10.1046/j.1468-2982.2000.00097.xCrossRefPubMed

40.

Xue CCL, Dong L, Polus B et al (2004) Electroacupuncture for tension-type headache on distal acupoints only: a randomized, controlled, crossover trial. Headache 44:333–341. https://doi.org/10.1111/j.1526-4610.2004.04077.xCrossRefPubMed

41.

Bot MN, de Wijer A, Pool J et al (2020) Physical treatments reduce pain in children with tension-type headache: a systematic review and meta-analysis. J Oral Facial Pain Headache 34:240–254. https://doi.org/10.11607/ofph.2575CrossRefPubMed

42.

Zhang J, Zhang Z, Huang S et al (2022) Acupuncture for cancer-related insomnia: a systematic review and meta-analysis. Phytomedicine 102:154160. https://doi.org/10.1016/j.phymed.2022.154160CrossRefPubMed

43.

Li M, Niu J, Yan P et al (2020) The effectiveness and safety of acupuncture for depression: an overview of meta-analyses. Complement Ther Med 50:102202. https://doi.org/10.1016/j.ctim.2019.102202CrossRefPubMed

44.

Meissner K, Fässler M, Rücker G et al (2013) Differential effectiveness of placebo treatments: a systematic review of migraine prophylaxis. JAMA Intern Med 173:1941–1951. https://doi.org/10.1001/jamainternmed.2013.10391CrossRefPubMed

45.

Fan S-Q, Jin S, Tang T-C et al (2021) Efficacy of acupuncture for migraine prophylaxis: a trial sequential meta-analysis. J Neurol 268:4128–4137. https://doi.org/10.1007/s00415-020-10178-xCrossRefPubMed

46.

Tian H, Huang L, Sun M et al (2022) Acupuncture for knee osteoarthritis: a systematic review of randomized clinical trials with meta-analyses and trial sequential analyses. Biomed Res Int 2022:6561633. https://doi.org/10.1155/2022/6561633CrossRefPubMedPubMedCentral

47.

Lin X, Huang K, Zhu G et al (2016) The effects of acupuncture on chronic knee pain due to osteoarthritis: a meta-analysis. J Bone Joint Surg Am 98:1578–1585. https://doi.org/10.2106/JBJS.15.00620CrossRefPubMed

48.

Lu L, Zhang Y, Tang X et al (2022) Evidence on acupuncture therapies is underused in clinical practice and health policy. BMJ 376:e067475. https://doi.org/10.1136/bmj-2021-067475CrossRefPubMedPubMedCentral

49.

Mu J, Furlan AD, Lam WY et al (2020) Acupuncture for chronic nonspecific low back pain. Cochrane Database Syst Rev 12:CD013814. https://doi.org/10.1002/14651858.CD013814CrossRefPubMed

50.

McGeeney BE (2015) Acupuncture is all placebo and here is why. Headache 55:465–469. https://doi.org/10.1111/head.12524CrossRefPubMed

Title: Efficacy of acupuncture for tension-type headache prophylaxis: systematic review and meta-analysis with trial sequential analysis
Authors: Qing-Feng Tao
Xiao-Ying Wang
Si-Jia Feng
Xin-Yu Xiao
Yun-Zhou Shi
Chao-Rong Xie
Hui Zheng
Publication date: 05-04-2023
Publisher: Springer Berlin Heidelberg
Keywords: Acupuncture
Tension Headache
Published in: Journal of Neurology / Issue 7/2023
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-023-11695-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Efficacy of acupuncture for tension-type headache prophylaxis: systematic review and meta-analysis with trial sequential analysis

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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