Acupuncture for Tension-type Headache: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

LI Yang ¹ , LUO Chun ²

1 Department of Acupuncture; Tradition Chinese Medicine Hospital of Guangdong Province; Guangzhou 510120; China2 Guangxi Mingzu Hospital; Nanning 530001;

Corresponding author：

Keywords：

Acupuncture; Tension-type headache; Systematic review; Randomized controlled trial

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Objective 　To assess the effectiveness of acupuncture for tension-type headache.
Methods 　A systematic review of the relevant randomized controlled trials (RCTs) of acupuncture for tension-type headache was performed using the methods of The Cochrane Collaboration. Trials were collected from The Cochrane Library, Issue 4, 2003, MEDLINE (1966 to March 2004), CBM (1978 to August 2003), VIP (1989 to April 2003) and handsearched all related articles published in Chinese in 2003. The quality of literature was reviewed, and data were extracted by two reviewers independently. Meta-analysis was conducted using RevMan 4.2 software.
Results 　Thirteen RCTs involving 571 patients were included, of the thirteen RCTs, six were of high methodological quality according to Jadad scale (the Jadad score≥3), and “sham acupuncture” was used as controlled intervention in eight trials. Meta-analysis indicated that no statistical difference was detected between acupuncture and sham acupuncture groups on effectiveness with RR 1.55, 95%CI 0.97 to 2.47 and P=0.07 at the end of treatment. No statistical difference was detected between acupuncture and sham acupuncture groups on visual analogue scale at the end of treatment with WMD －0.55, 95%CI －1.20 to 0.09 and P=0.09; at the end of follow-up of less than 2 months with WMD －0.22, 95%CI －0.87 to 0.42 and P= 0.50 and at the end of follow-up of more than 2 months with WMD －0.65, 95% CI －1.41 to 0.11 and P=0.09.
Conclusions 　Comparing acupuncture with sham acupuncture and other treatments, current evidence can not evaluate whether acupuncture is significantly effective for tension-type headache, more RCTs of high methodological quality are required.

Citation： LI Yang,LUO Chun. Acupuncture for Tension-type Headache: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2005, 05(2): 117-124. doi: Copy

1.	彭建民. 电针加拔罐治疗紧张性头痛82例临床观察[J]. 河北中医, 2002;24(9): 686.
2.	李大年. 紧张性头痛的发病机制及诊断和治疗.网址: http://www.sasp.sdu.edu.cn/tout.htm.
3.	黄学军, 许行健, 罗仁浩. 针刺和安定单用或合用治疗肌肉收缩性头痛的比较[J]. 广州医药, 2001;32(4): 69～70.
4.	江勇, 王敏华, 王敏, 华启海, 李震宇, 孙涛. 针刺推拿治疗紧张性头痛临床研究[J]. 针灸临床杂志, 2003;19(4): 7～9.
5.	孟冬祥, 樊碧发, 周书元. 传统针刺与安慰针刺治疗紧张性头痛的初步比较研究[J]. 疼痛学杂志, 1996;4(1): 6～7.
6.	王尚臣, 孙淑芬, 单文哲, 纪树梅, 孙志梅. 小针刀与针刺治疗发作性紧张性头痛疗效观察[J]. 中国临床医生, 2002;35(5): 47.
7.	王家良, 刘鸣主编. 循证医学[M]. 第1版. 北京: 人民卫生出版社, 2002.p.177～188.
8.	针刺临床对照试验中干预措施报告的标准: STRICTA(建议)[J]. 中国循证医学杂志, 2003;3(3): 235～237.
9.	Schwartz BS, Stewart WF, Simon D, Lipton RB. Epidemiology of tension-type headache[J]. JAMA, 1998;279(4): 381-383.
10.	Rasmussen BK. Epidemiology of headache[J]. Cephalalgia, 1995;15: 45-68.
11.	Peng JM. Clinical oberservation of 82 cases of tension type headache with electric needle and cupping[J]. Hebei TCM, 2002;24(9): 686.
12.	Li DN.Mechanism, diagnose and treatment of tension type headache. Pain Research Conference of Shan Dong Province. Availabe from: URL: http://www.sasp.sdu.edu.cn/tout.htm.
13.	Graff-Radford SB, Reevs JL, Jaeger B. Management of chronic head and neck pain: effectiveness of altering factors perpetuating myofacial pain[J]. Headache, 1987;27(8): 186-190.
14.	Langemark M, Jensen K, Jensen TS, Olesen J. Pressure pain thresholds and thermal nociceptive thresholds in chronic tension-type headache[J]. Pain, 1989;38(7): 203-210.
15.	Silberstein SD. Tension-type headaches[J]. Headache, 1994;34(8): s2-s7.
16.	Blanchard EB, Andrassik F, Ahles TA, Teders ST, O’Keefe D. Migraine and tension headache: a meta-analytic review[J]. Behav Ther, 1980;11(5): 613-631.
17.	Pryse-Phillips W, Findlay H, Tugwell P, Edmeads J, Murray TJ, Nelson RF. A Canadian population survey on the clinical, epidemiologic and societal impact of migrane and tension-type headache [J]. Can J Neurol Sci, 1992;19(4): 333-359.
18.	Melchart D, Linde K, Fischer P, Berman B, White A, Vickers A, Allais G. Acupuncture for idiopathic headache, Cochrane review[M/CD]. In The Cochrane Library. Issue 4. 2001. Oxford: update software.
19.	Pryse-Phillips WEM, Dodick DW, Edmeads JG, Gawel MJ, Nelson RF, Purdy RA. Guidelines for the nonpharmacologic management of migrane in clinical practice[J]. Can Med Assoc J, 1998;159(1): 47-54.
20.	Jadad AR, Mcquay HJ. Meta-analysis to evaluate analgestic intervations:a systematic qualitative review of there methodology[J]. J Chin Epidemiol, 1996;49(2): 235-243.
21.	Bogaads MC, ter Kuile MM. Treatment of recurrent tension headache: a meta-analytic review[J]. Clin J Pain, 1994;10(3): 174-190.
22.	Haddock CK, Rowan AB, Andrasik F, Wilson PG, Talcott GW, Stein RJ. Home-based behavioral treatments for chronic benign headache: a meta-analysis of controlled trials[J]. Cephalalgia, 1997;17(2): 113-118.
23.	Whitmarsh T. Evidence in Complementary and alternative therapies:lessons from clinic trials of homeopathy in headache[J]. J Altern Complement Med, 1997;3(4): 307-310.
24.	Penzien DB, Rains JC, Holroyd KA. A review of alternative behavioural treatments for headache[J]. Mississippi Psychol, 1992;17(1): 8-9.
25.	Penzien DB, Holroyd KA. The behavioral treatment of migrane: a Meta-analytic review of the literature[J]. Diss Abs Int, 1987;47(9): DA 8629941.
26.	Vernon H, McDermaid CS, Hagino C. Systematic review of randomized clinical trials of complementary/alternative therapies in the treatment of tension-type and cervicogenic headache[J]. Complement Ther Med, 1999;7(3): 142-145.
27.	Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ. Assessing the quality of reports of randomazied clinical trials: is blinding necessary[J]? Control Clin Trials, 1996;17(1): 1-12.
28.	Ahonon E, Hakumki M, Mahlmki S, Partanen P, Sivenius J. Effectiveness of acupuncture and physiotherapy on myogenic headache:a comparative study[J]. Acupuncture & Electro-Therapeutics Research, 1984;9(3): 141-150.
29.	Carlsson J, Augustinsson LE, Blomstrand C, Sullivan M. Health status in patients with tension headache treated with acupuncture or physiotherapy[J]. Headache, 1990;30(9): 593-599.
30.	Hansson PE, Hansen JH. Acupuncture treatment of chronic tension headache-a controlledcross-over trial[J]. Cephalalgia, 1985;5(3): 137-142.
31.	Huang XJ, Xu XJ, Luo RH. Comparison of single or combining use of acupuncture and diazepam for musclular contractive headache[J]. Guangzhou Medicine, 2001;32(4): 69-70.
32.	Jiang Y, Wang MH, Wang M, Hua QH, Li ZY, Sun T. Clinical research of acupuncture and tuina for tension-type headache[J]. J of Clinical Acupuncture and Moxibustion, 2003;19(4): 7-9.
33.	Johansson V, Kosic S, Lindahl O, Lindwall L, Tibbling L. In: Bonica JJ, Albe-Fessard DG, editor (s). Advances in pain research and therapy[M]. Vol. 1. New York:Raven Press. 1976.p.839-841.
34.	Karst M, Rollnik J, Fink M, Reinhard M, Piepenbroke S. Pressure pain threshold and needle acupuncture in chronic tension-type headache-a double-blind placebo-controlled study[J]. Pain, 2002;88(2): 199-203.
35.	Karst M, Reinhard M, Thum P, Wiese B, Rollnik J & Fink M. Needle acupuncture in tension-type headache:a randomized ,placebo-controlled study[J]. Cephalalgia, 2001;21(6): 637-642.
36.	Meng DX, Fan BF, Zhou SY. Primary comprison of traditional acupuncture and placebo acupuncture for tension-type headache[J]. J of Pain, 1996;4(1): 6-7.
37.	Tavola T, Gala C, Conte G, Invernizzi G. Traditional Chinese acupuncture in tension-type headache: a controlled study[J]. Pain, 1992;48(3): 325-329.
38.	Wang SC, Sun SF, Shan WZ, Ji SM, Sun ZM. Effect observation of little needle-scalpel and acupuncture for episodic tension-type headache[J]. Chinese Clinical Doctor, 2002;35(5): 47.
39.	White AR, Resch KL, Ernst E, Eddleston C, Hardie R. A pilot study of acupuncture for tension headache, using a novel placebo[J]. Acupuncture in Medicine, 1996;14(1): 11-15.
40.	White AR, Resch K-L, Chan JCK, Norris CD, Modi SK, Patel JN & Ernst E. Acupuncture for episodic tension-type headache: a multicentre randomized controlled trial[J]. Cephalalgia, 2000;20(7): 632-637.
41.	Wang JL, Liu M. Evidenced Based Medicine[M]. 1st edition. Beijing: People’s Med Care Press, 2002.p.177-188.
42.	Hugh MP, Adrian W, Mike C. Standards for reporting interventions in controlled trials of acupuncture: The STRICTA Recommendations[J]. Chi J EBM, 2003;3(3): 235-237.Hugh MP, Adrian W, Mike C.

1. 彭建民. 电针加拔罐治疗紧张性头痛82例临床观察[J]. 河北中医, 2002;24(9): 686.
2. 李大年. 紧张性头痛的发病机制及诊断和治疗.网址: http://www.sasp.sdu.edu.cn/tout.htm.
3. 黄学军, 许行健, 罗仁浩. 针刺和安定单用或合用治疗肌肉收缩性头痛的比较[J]. 广州医药, 2001;32(4): 69～70.
4. 江勇, 王敏华, 王敏, 华启海, 李震宇, 孙涛. 针刺推拿治疗紧张性头痛临床研究[J]. 针灸临床杂志, 2003;19(4): 7～9.
5. 孟冬祥, 樊碧发, 周书元. 传统针刺与安慰针刺治疗紧张性头痛的初步比较研究[J]. 疼痛学杂志, 1996;4(1): 6～7.
6. 王尚臣, 孙淑芬, 单文哲, 纪树梅, 孙志梅. 小针刀与针刺治疗发作性紧张性头痛疗效观察[J]. 中国临床医生, 2002;35(5): 47.
7. 王家良, 刘鸣主编. 循证医学[M]. 第1版. 北京: 人民卫生出版社, 2002.p.177～188.
8. 针刺临床对照试验中干预措施报告的标准: STRICTA(建议)[J]. 中国循证医学杂志, 2003;3(3): 235～237.
9. Schwartz BS, Stewart WF, Simon D, Lipton RB. Epidemiology of tension-type headache[J]. JAMA, 1998;279(4): 381-383.
10. Rasmussen BK. Epidemiology of headache[J]. Cephalalgia, 1995;15: 45-68.
11. Peng JM. Clinical oberservation of 82 cases of tension type headache with electric needle and cupping[J]. Hebei TCM, 2002;24(9): 686.
12. Li DN.Mechanism, diagnose and treatment of tension type headache. Pain Research Conference of Shan Dong Province. Availabe from: URL: http://www.sasp.sdu.edu.cn/tout.htm.
13. Graff-Radford SB, Reevs JL, Jaeger B. Management of chronic head and neck pain: effectiveness of altering factors perpetuating myofacial pain[J]. Headache, 1987;27(8): 186-190.
14. Langemark M, Jensen K, Jensen TS, Olesen J. Pressure pain thresholds and thermal nociceptive thresholds in chronic tension-type headache[J]. Pain, 1989;38(7): 203-210.
15. Silberstein SD. Tension-type headaches[J]. Headache, 1994;34(8): s2-s7.
16. Blanchard EB, Andrassik F, Ahles TA, Teders ST, O’Keefe D. Migraine and tension headache: a meta-analytic review[J]. Behav Ther, 1980;11(5): 613-631.
17. Pryse-Phillips W, Findlay H, Tugwell P, Edmeads J, Murray TJ, Nelson RF. A Canadian population survey on the clinical, epidemiologic and societal impact of migrane and tension-type headache [J]. Can J Neurol Sci, 1992;19(4): 333-359.
18. Melchart D, Linde K, Fischer P, Berman B, White A, Vickers A, Allais G. Acupuncture for idiopathic headache, Cochrane review[M/CD]. In The Cochrane Library. Issue 4. 2001. Oxford: update software.
19. Pryse-Phillips WEM, Dodick DW, Edmeads JG, Gawel MJ, Nelson RF, Purdy RA. Guidelines for the nonpharmacologic management of migrane in clinical practice[J]. Can Med Assoc J, 1998;159(1): 47-54.
20. Jadad AR, Mcquay HJ. Meta-analysis to evaluate analgestic intervations:a systematic qualitative review of there methodology[J]. J Chin Epidemiol, 1996;49(2): 235-243.
21. Bogaads MC, ter Kuile MM. Treatment of recurrent tension headache: a meta-analytic review[J]. Clin J Pain, 1994;10(3): 174-190.
22. Haddock CK, Rowan AB, Andrasik F, Wilson PG, Talcott GW, Stein RJ. Home-based behavioral treatments for chronic benign headache: a meta-analysis of controlled trials[J]. Cephalalgia, 1997;17(2): 113-118.
23. Whitmarsh T. Evidence in Complementary and alternative therapies:lessons from clinic trials of homeopathy in headache[J]. J Altern Complement Med, 1997;3(4): 307-310.
24. Penzien DB, Rains JC, Holroyd KA. A review of alternative behavioural treatments for headache[J]. Mississippi Psychol, 1992;17(1): 8-9.
25. Penzien DB, Holroyd KA. The behavioral treatment of migrane: a Meta-analytic review of the literature[J]. Diss Abs Int, 1987;47(9): DA 8629941.
26. Vernon H, McDermaid CS, Hagino C. Systematic review of randomized clinical trials of complementary/alternative therapies in the treatment of tension-type and cervicogenic headache[J]. Complement Ther Med, 1999;7(3): 142-145.
27. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ. Assessing the quality of reports of randomazied clinical trials: is blinding necessary[J]? Control Clin Trials, 1996;17(1): 1-12.
28. Ahonon E, Hakumki M, Mahlmki S, Partanen P, Sivenius J. Effectiveness of acupuncture and physiotherapy on myogenic headache:a comparative study[J]. Acupuncture & Electro-Therapeutics Research, 1984;9(3): 141-150.
29. Carlsson J, Augustinsson LE, Blomstrand C, Sullivan M. Health status in patients with tension headache treated with acupuncture or physiotherapy[J]. Headache, 1990;30(9): 593-599.
30. Hansson PE, Hansen JH. Acupuncture treatment of chronic tension headache-a controlledcross-over trial[J]. Cephalalgia, 1985;5(3): 137-142.
31. Huang XJ, Xu XJ, Luo RH. Comparison of single or combining use of acupuncture and diazepam for musclular contractive headache[J]. Guangzhou Medicine, 2001;32(4): 69-70.
32. Jiang Y, Wang MH, Wang M, Hua QH, Li ZY, Sun T. Clinical research of acupuncture and tuina for tension-type headache[J]. J of Clinical Acupuncture and Moxibustion, 2003;19(4): 7-9.
33. Johansson V, Kosic S, Lindahl O, Lindwall L, Tibbling L. In: Bonica JJ, Albe-Fessard DG, editor (s). Advances in pain research and therapy[M]. Vol. 1. New York:Raven Press. 1976.p.839-841.
34. Karst M, Rollnik J, Fink M, Reinhard M, Piepenbroke S. Pressure pain threshold and needle acupuncture in chronic tension-type headache-a double-blind placebo-controlled study[J]. Pain, 2002;88(2): 199-203.
35. Karst M, Reinhard M, Thum P, Wiese B, Rollnik J & Fink M. Needle acupuncture in tension-type headache:a randomized ,placebo-controlled study[J]. Cephalalgia, 2001;21(6): 637-642.
36. Meng DX, Fan BF, Zhou SY. Primary comprison of traditional acupuncture and placebo acupuncture for tension-type headache[J]. J of Pain, 1996;4(1): 6-7.
37. Tavola T, Gala C, Conte G, Invernizzi G. Traditional Chinese acupuncture in tension-type headache: a controlled study[J]. Pain, 1992;48(3): 325-329.
38. Wang SC, Sun SF, Shan WZ, Ji SM, Sun ZM. Effect observation of little needle-scalpel and acupuncture for episodic tension-type headache[J]. Chinese Clinical Doctor, 2002;35(5): 47.
39. White AR, Resch KL, Ernst E, Eddleston C, Hardie R. A pilot study of acupuncture for tension headache, using a novel placebo[J]. Acupuncture in Medicine, 1996;14(1): 11-15.
40. White AR, Resch K-L, Chan JCK, Norris CD, Modi SK, Patel JN & Ernst E. Acupuncture for episodic tension-type headache: a multicentre randomized controlled trial[J]. Cephalalgia, 2000;20(7): 632-637.
41. Wang JL, Liu M. Evidenced Based Medicine[M]. 1st edition. Beijing: People’s Med Care Press, 2002.p.177-188.
42. Hugh MP, Adrian W, Mike C. Standards for reporting interventions in controlled trials of acupuncture: The STRICTA Recommendations[J]. Chi J EBM, 2003;3(3): 235-237.Hugh MP, Adrian W, Mike C.

Chinese Journal of Evidence-Based Medicine

Acupuncture for Tension-type Headache: A Systematic Review

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