Objectives We aimed to assess the methodological qual ity of RCT on acupuncture for migraine prophylaxis. Methods With the searching terms including acupuncture, migraine, prophylaxis and prevent, etc, the database of the Cochrane Library (Issue 4, 2007), MEDLINE (1966-2007), EMBase (1966-2007), CBM (1978-2007) and CMCC (1994-2007) were searched from their date of start publ ication. Chinese medical journals and relevant academic conference proceedings were hand searched as well. Several items in included trials were assessed, including methodology, diagnostic criteria, inclusion/exclusion criteria, acupuncture/control interventions, outcome measures and follow-up, etc. Result Among the 12 included trials, 9 trials overseas were high-qual ity and 3 in China were low-quality. Frequency or days of migraine attacks and SF-36/SF-12 were often evaluated as outcome measures in western countries, while headache index was used in China. Among the 12 trials, 9 reported the follow-up outcomes and 8 mentioned adverse events. Conclusion There was no high qual ity trial on acupuncture for migraine prophylaxis in China. The outcome measures in trials published in China by now can not evaluate the outcomes of acupuncture for migraine prophylaxis accurately. To study designs, advantages of trials oversea can be used for reference. To Chinese cl inical physicians, prophylactic therapy and abortive therapy of migraine should be distinguished in order to design high-qual ity study on acupuncture for migraine prophylaxis.
Objective To improve care and outcomes for all migraine suffers, the USHC created these evidence-based guidelines for migraine headache. Methods Firstly, 5 relative Technical reviews were done according to the Methods used in the AHCPR Technical Reviews. Secondly, based on the results of the 5 technical reviews, the 4 treatment guidelines were developed in direction of the USHC’S Methods used in developing clinical guidelines. Results Evidence supporting the acute treatment and preventive treatment were exclusively Class 1 studies, evidence supporting the diagnostic testing were either Class 2 or Class 3 studies , only very few expert judgment was given on some compelling issues without evidence. The recommendations they supporting were high-qualified, middle-qualified, and poor-qualified respectively. Conclusion This Evidence-Based Guidelines is one of the first and most extensive cooperative projects available for creating guidelines. The guideline was developed with systematical and scientific methods and stroven to base all of its recommendations on evidence.
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.
Objective To evaluate the evidence-based prevention and treatment of post-dural puncture headache (PDPH) for parturient women. Methods We searched The Cochrane Library (Issue 3, 2006), Medline (Jan. 1980 to Oct. 2006) and CBM-disc (Jan. 1980 to Oct. 2006) to identify current best evidence on the prevention and treatment of PDPH for parturient women. The quality of available evidence was critically appraised.Results We identified 2 Cochrane systematic reviews, 2 meta-analyses and 9 randomized controlled trials. Evidence indicated that posture, fluid, and pharmacological managements had no significant effect on PDPH except epidural blood patch. The selection of appropriate spinal needle and the technique of needle insertion may reduce the incidence of PDPH, whereas the effect of intrathecal saline infusion and catheter insertion need further clinical validation. Conclusions Epidural blood patch has definite therapeutic effect on PDPH. Appropriate spinal needle and insertion technique may effectively prevent PDPH for parturient women.
Objective To evaluate the efficacy of Yangxue Qingnao Grain for migraine. Methods We searched The Cochrane Library (Issue 3, 2007), EMBASE (1974 to June 2007), PubMed (1966 to June 2007), VIP (1989 to June 2007), CNKI (1979 to June 2007) and CBM (1978 to June 2007) to identify randomized controlled trials or quasirandomized controlled trials comparing Yangxue Qingnao Grain versus sibeline for migraine. The quality of included studies was critically assessed and data analyses were performed with The Cochrane Collaboration’s RevMan 4.2.7. Results Eight studies were included, involving 5 randomized trials and 3 quasi-randomized trials. Meta-analyses showed that the total response rate (RR=1.07, 95%CI 1.00 to 1.15, P=0.06), the duration of headache (WMD 1.33, 95%CI – 0.87 to 3.52, P=0.24), and the frequency of headache episodes (WMD 0.93, 95%CI –1.00 to 2.86, P=0.35) were similar between Yangxue Qingnao Grain and sibeline. One study reported that the changes of ACA (WMD 3.70, 95%CI –3.46 to 10.86), MCA (WMD 0.60, 95%CI –10.37 to 11.57), ICA (WMD 3.40, 95%CI –4.35 to 11.15) and DCA (WMD – 2.30, 95%CI –9.52 to 4.92) revealed by transcranial doppler sonography were also comparable between the two groups. Conclusion Yangxue Qingnao Grain is effective in the treatment of migraine, but its superiority over sibeline is not demonstrated. Due to the poor quality and small sample of the included trials, more large-scale multi-center randomized trials are needed.