The Effectiveness of Acupuncture on Headache Intensity and Frequency in Patients With Tension-Type Headache: A Systematic Review and Meta-Analysis

Introduction Headache disorders are one of the most common health problems. Tension-type headache (TTH) is the most prevalent type of primary headache in adults. Several conservative treatments have been used for the management of TTH, such as analgesics, acupuncture, manual therapy, spinal mobilization. This study aims to examine the effectiveness of acupuncture in patients with TTH. Methods and materials PubMed, PEDro database, Cochrane Library, and Google Scholar were searched from January 2000 until February 2021, as well as the reference lists from identified articles. Studies of various acupuncture types were included, but only randomized controlled trials and clinical trials were selected. The studies were screened using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) question. Details about the type of acupuncture, sample size, outcome measures, results, and statistical significance were extracted from the selected studies. A short-term (after the last treatment) and long-term meta-analysis for pain intensity and frequency of headaches was conducted. The I(2) index, as well as the x(2) test, were used to determine the heterogeneity between studies. A random-effects meta-analysis was carried out. Results From all the studies found in the mentioned databases, only 15 studies with 1272 participants met the criteria. In the meta-analysis, four studies with 557 participants were included. The headaches' frequency after the last treatment was not significantly lower in the acupuncture group than in the placebo/sham group (mean difference: -1.53 [CI: -4.73, 1.67]). However, acupuncture seems to improve the frequency of headaches in the long term, although the results were not statistically significant p=0.06. Furthermore, there was a reduction of 1.55 days per month of headaches in the acupuncture group versus placebo (mean difference: -1.55 [CI: -3.19, 0.09]), but it was not statistically significant. The visual analog scale (VAS) score of the acupuncture group slightly reduced (-0.29) compared with the control group after the last treatment (mean difference: -0.29 [CI: -1.21, 0.62]), although the two groups were not statistically significant p=0.53. In the long term, acupuncture demonstrated a statistical (p=0.009) and clinical benefit compared with placebo/sham. Statistical analyses between the two groups showed a reduction of 0.41 in the VAS scale at the acupuncture group (mean difference: -0.41 [CI: -0.72, -0.10]). Conclusion Overall, after the meta-analysis of articles with high methodological quality, acupuncture's effectiveness compared to sham seems to be statistically non-significant on headache intensity and frequency in patients with TTH after the treatment. Both headache intensity and frequency were reduced in the long term, although only in the pain intensity, the results were statistically significant. Therefore, more studies on this topic should be conducted to examine its effectiveness in headache frequency and intensity.