Effects on neuromodulation, acupuncture, and aerobic exercises on migraine and tension-type headache outcomes: A systematic review and meta-analysis

Headache disorders are common diseases that cause a social burden. This systematic review and meta-analysis aimed to evaluate the effects of various non-pharmacological treatments to address or prevent acute headaches, including neuromodulation, acupuncture, and aerobic exercises in patients with episodic migraine and tension-type headache (TTH). METHODS: We performed a systematic search of the electronic databases PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure, WANFANG MEDICINE ONLINE, and Chinese Medical Journal database using Stata/SE 14.0 to obtain weighted mean differences (WMDs). The outcomes included monthly headache days, headache intensity, headache duration, days per month of acute medication use, and the Medical Outcomes Study 36-Item Short-Form Health Survey. RESULTS: Of 872 identified articles, 27 were included in the meta-analysis. Neuromodulation was associated with reduced headache days (WMD: −1.274, 95% CI [−1.914, −0.634], P < .001), duration (WMD: −2.2, 95% CI [−3.32, −0.107], P < .001) and medication consumption (WMD: −1.808, 95% CI [−2.546, −1.071], P < .001) in cases of migraine. Acupuncture was associated with the alleviation of headache days (WMD: −0.677, 95% CI [−0.932, −0.422], P < .001) and intensity (WMD: −0.893, 95% CI [−1.573, −0.212], P = .01) in cases of migraine and acute medication use (WMD: −3.29, 95% CI [−4.86, −1.72], P < .001) in cases of TTH. Aerobic exercise was associated with reduced headache duration (WMD: −5.1, 95% CI [−8.97, −1.22], P = .01) in cases of TTH. The risk of bias for included articles was moderate. CONCLUSIONS: There is low- and moderate-quality evidence that neuromodulation, acupuncture, and aerobic exercises are associated with attenuated headache symptoms in patients with episodic migraine or TTH. However, high-quality studies are needed to draw more detailed conclusions.