Is manual acupuncture effective in reducing the frequency of headaches as compared to routine care?
Date of publication of the systematic review: January 2009
Design
Systematic review of 6 randomized controlled trials (RCTs).
Participants
3743 migraine patients (age range: 14 to 68 years, male % range: 12% to 46%). Patients with additional tension-type headache were also included. However, studies including patients with headaches of various types (e.g., migraine, tension-type headache) were included only if findings for migraine patients were presented separately or if more than 90% of patients suffered from migraine.
Intervention
Acupuncture that involved needle insertion at acupuncture points, pain points or trigger points with a range from 7 to 20 sessions, at the frequency of 1 to 2 sessions per week for 4 weeks to 3 months. Studies investigating other methods of stimulating acupuncture points without needle insertion (for example, laser stimulation or transcutaneous electrical stimulation) were excluded.
Comparator
Comparison: Manual acupuncture versus control receiving routine care.
Major Outcomes
Outcome 1: Headache frequency, measured 3 to 4 months after randomization;
Outcome 2: Headache days, measured 3 to 4 months after randomization;
Outcome 3: Headache intensity, measured 3 to 4 months after randomization.
Settings
The included trials were conducted in outpatient settings.
Comparison    Manual acupuncture versus routine care
Main Results
Compared to routine care, manual acupuncture showed significant reduction in headache frequency (pooled standardized mean difference (pooled SMD): -0.43, 95% CI: -0.60 to -0.27), headache days (pooled weighted mean difference (pooled WMD) in days: -2.09, 95% CI: -20.60 to -1.58), as well as headache intensity (pooled SMD:-0.77, 95% CI: -0.94 to -0.61).
Comparison: Manual acupuncture versus routine care amongst migraine patients
Outcomes (units) No. of studies (Total number of participants) Standardized mean/ No. of participants Heterogeneity test (I2) Pooled SMD (95% CI) Overall quality of evidence*
Intervention Comparator
1 (NA) 4 (2087) 1.01/ 1108 1.54/ 979 Not reported -0.43 (-0.60 to -0.27) Moderate
3 (NA) 2 (1652) Not reported Not reported Not reported -0.77 (-0.94 to -0.61) Moderate
Outcomes (units) No. of studies (Total number of participants) Mean/ No. of participants Heterogeneity test (I2) Pooled WMD (95% CI) Overall quality of evidence*
Intervention Comparator
2 (Days) 3 (2046) Not reported Not reported Not reported -2.09 (-20.60 to -1.58) High
Keys: SMD = standardized mean difference; WMD = weighted mean difference; CI = confidence interval.
Comparison    Manual acupuncture versus routine care
Main Results
Compared to routine care, manual acupuncture showed significant reduction in headache frequency (pooled standardized mean difference (pooled SMD): -0.43, 95% CI: -0.60 to -0.27), headache days (pooled weighted mean difference (pooled WMD) in days: -2.09, 95% CI: -20.60 to -1.58), as well as headache intensity (pooled SMD:-0.77, 95% CI: -0.94 to -0.61).
Comparison: Manual acupuncture versus routine care amongst migraine patients
Outcomes (units) 1 (NA) 3 (NA)
No. of studies (Total number of participants) 4 (2087) 2 (1652)
Standardized mean/ No. of participants Intervention 1.01/ 1108 Not reported
Comparator 1.54/ 979 Not reported
Pooled SMD (95% CI) -0.43 (-0.60 to -0.27) -0.77 (-0.94 to -0.61)
Overall quality of evidence* Moderate Moderate
Outcomes (units) 2 (Days)
No. of studies (Total number of participants) 3 (2046)
Mean/ No. of participants Intervention Not reported
Comparator Not reported
Pooled WMD (95% CI) -2.09 (-20.60 to -1.58)
Overall quality of evidence* High
Keys: SMD = standardized mean difference; WMD = weighted mean difference; CI = confidence interval.
Conclusion
Benefits
Compared to routine care, manual acupuncture was effective in reducing headache frequency, headache days as well as headache intensity amongst migraine patients. For outcomes 1 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. For outcome 2, the overall quality of evidence is high. Further research is unlikely to have an important impact on our confidence in this estimate of effect.
Harms
In two trials, respectively 8% and 11% of patients receiving manual acupuncture reported minor adverse effects such as fatigue or temporary aggravations.
Link to Original Article
http://www.ncbi.nlm.nih.gov/pubmed/19160193
The synopsis is based on the following article:
Linde K, Allais G, Brinkhaus B, Manheimer E, Vickers A, White AR. Acupuncture for migraine prophylaxis. Cochrane Database Syst Rev. 2009 Jan 21;(1):CD001218.


* 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.