Is manual acupuncture effective in reducing headache frequency among patients with episodic or chronic tension-type headache, as compared to sham acupuncture?
Date of publication of the systematic review: January 2009
Design
Systematic review of 5 randomized controlled trials (RCTs).
Participants
784 adult patients (mean age range: 33 to 49 years, male % range: 13% to 45%) with episodic and/or chronic tension-type headache.
Intervention
Manual acupuncture defined as needle insertion at specific points of the body (including acupuncture points, pain points or trigger points) was provided by the acupuncturists at a frequency of 1 to 2 sessions per week and the number of total acupuncture sessions varied from 6 to 15 sessions. One trial selected acupuncture points in an individualized manner, and four in a semi-standardized manner. Studies investigating other methods of stimulating acupuncture points without needle insertion were excluded.
Comparator
Comparison: Manual acupuncture versus sham acupuncture.
Major Outcomes
Outcome 1: Number of headache days from randomization to 8 weeks;
Outcome 2: Headache intensity from randomization to 5 to 6 months;
Outcome 3: Analgesic use from randomization to 8 weeks.
Settings
All included trials were conducted in outpatient settings.
Comparison    Manual acupuncture versus sham acupuncture
Main Results
Compared to sham acupuncture, manual acupuncture showed significant effects on reducing the number of headache days measured from randomization to 8 weeks (pooled weighted mean difference (pooled WMD): -1.56 days, 95% CI: -3.02 to -0.10), headache intensity measured from randomization to 5 to 6 months (pooled standardized mean difference (pooled SMD: -0.20, 95% CI: -0.35 to -0.04), and use of analgesic from randomization to 8 weeks (pooled SMD: -0.31, 95% CI: -0.56 to -0.06).
Comparison: Manual acupuncture versus sham acupuncture amongst patients with tension-type headache
Outcomes (unit) No. of studies (Total number of participants) Mean/No. of participants Heterogeneity test (I2) Pooled WMD (95% CI) Overall quality of evidence*
Intervention Comparator
1 (Days) 4 (682) Not reported/380 Not reported/302 13% -1.56 (-3.02 to -0.10) High
Outcomes (units) No. of studies (Total number of participants) Mean/No. of participants Heterogeneity test (I2) Pooled SMD (95% CI) Overall quality of evidence*
Intervention Comparator
2 (NA) 4 (670) Not reported Not reported Not reported -0.20 (-0.35 to -0.04) Moderate
3 (NA) 3 (266) Not reported Not reported Not reported -0.31 (-0.56 to -0.06) Moderate
Keys: WMD = weighted mean difference; SMD = standardized mean difference; CI = confidence interval.
Comparison    Manual acupuncture versus sham acupuncture
Main Results
Compared to sham acupuncture, manual acupuncture showed significant effects on reducing the number of headache days measured from randomization to 8 weeks (pooled weighted mean difference (pooled WMD): -1.56 days, 95% CI: -3.02 to -0.10), headache intensity measured from randomization to 5 to 6 months (pooled standardized mean difference (pooled SMD: -0.20, 95% CI: -0.35 to -0.04), and use of analgesic from randomization to 8 weeks (pooled SMD: -0.31, 95% CI: -0.56 to -0.06).
Comparison: Manual acupuncture versus sham acupuncture amongst patients with tension-type headache
Outcomes (unit) 1 (Days)
No. of studies (Total number of participants) 4 (682)
Mean/No. of participants Intervention Not reported/380
Comparator Not reported/302
Pooled WMD (95% CI) -1.56 (-3.02 to -0.10)
Overall quality of evidence* High
Outcomes (units) 2 (NA) 3 (NA)
No. of studies (Total number of participants) 4 (670) 3 (266)
Mean/No. of participants Intervention Not reported Not reported
Comparator Not reported Not reported
Pooled SMD (95% CI) -0.20 (-0.35 to -0.04) -0.31 (-0.56 to -0.06)
Overall quality of evidence* Moderate Moderate
Keys: WMD = weighted mean difference; SMD = standardized mean difference; CI = confidence interval.
Conclusion
Benefits
Compared to sham acupuncture, manual acupuncture showed significant benefits for patients with episodic or chronic tension-type headache by reducing the number of headache days measured from randomization to 8 weeks, the headache intensity measured from randomization to 5 to 6 months, and use of analgesic from randomization to 8 weeks. For outcome 1, the overall quality of evidence is high. Further research is unlikely to have an important impact on our confidence in this estimate of effect. For outcomes 2 and 3, the overall quality of evidence is moderate. Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
Harms
No adverse effects regarding the use of manual acupuncture or sham acupuncture were reported in the included trials.
Link to Original Article
http://www.ncbi.nlm.nih.gov/pubmed/19160338
The synopsis is based on the following article:
Linde K, Allais G, Brinkhaus B, Manheimer E, Vickers A, White AR. Acupuncture for tension-type headache. Cochrane Database Syst Rev. 2009 Jan 21;(1):CD007587.


* Interpretation of quality assessment results:
• Very low: Further research is most likely to have an important impact on our confidence in this estimate of effect.
• Low: Further research is likely to have an important impact on our confidence in this estimate of effect.
• Moderate: Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
• High: Further research is unlikely to have an important impact on our confidence in this estimate of effect.
• Very high: Further research is most unlikely to have an important impact on our confidence in this estimate of effect.

Details of assessment method can be found at Chung VC, Wu XY, Ziea ET, Ng BF, Wong SY, Wu JC. Assessing internal validity of clinical evidence on effectiveness of CHinese and integrative medicine: Proposed framework for a CHinese and Integrative Medicine Evidence RAting System (CHIMERAS). European Journal of Integrative Medicine. 2015 Aug 31;7(4):332-41.