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Efficacy of acupuncture for tension-type headache prophylaxis: systematic review and meta-analysis with trial sequential analysis

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Abstract

Background

Acupuncture has been shown to reduce tension-type headache (TTH) frequency in previous studies. Nevertheless, repeated significance testing might inflate type I error. We aimed to verify the effectiveness and safety of acupuncture in reducing TTH frequency by meta-analysis and trial sequential analysis (TSA).

Methods

Ovid Medline, Embase, and Cochrane Library were searched until September 29, 2022. Randomized controlled trials comparing acupuncture with sham acupuncture, no acupuncture, or other active therapies in adults with TTH were included. The primary outcome was TTH frequency. The secondary outcomes were responder rate and adverse event.

Results

Fourteen studies involving 2795 participants were included. Acupuncture had more reduction than sham acupuncture in TTH frequency, both after treatment (standardized mean difference [SMD] − 0.80, 95% CI − 1.36 to − 0.24, P = 0.005) and at the follow-up period (SMD − 1.33, 95% CI − 2.18 to − 0.49, P = 0.002), while TSA showed the included sample size did not exceed required information size (RIS). Acupuncture was superior over no acupuncture after treatment (SMD − 0.52, 95% CI − 0.63 to − 0.41, P < 0.001), and cumulative sample size reached RIS. In terms of responder rate, acupuncture had a higher responder rate compared with sham acupuncture both after treatment (relative ratio [RR] 1.28, 95% CI 1.12 to 1.46, P = 0.0003) and the follow-up period (RR 1.37, 95% CI 1.19 to 1.58, P < 0.0001), but the sample size is inadequate.

Conclusion

Acupuncture is an efficacious and safe treatment for TTH prevention, but this conclusion might be limited by the generally very low to low quality evidence. TSA suggested that high-quality trials are needed to verify the efficacy and safety of acupuncture compared to sham acupuncture.

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Data availability statement

The data that supports our study are shown in the article and supplementary material, further inquiries can be directed to the corresponding author.

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Funding

HZ received a grant from the Sichuan Youth Science and Technology Innovation Research Team (No.2021JDTD0007). YZ-S received a grant from National Natural Science Foundation of China Youth Project (No. 82105026). YZ-S also received a grant from China Postdoctoral Science Foundation (No. 2021M693787). Role of the funding source: These sponsors did not participate in the study design; the collection, analysis, and interpretation of data; the writing of the manuscript; and the decision to submit the article for publication.

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Authors and Affiliations

  1. The Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 1166 Liutai Avenue, Wenjiang District, Chengdu, 611100, China

    Qing-Feng Tao, Xiao-Ying Wang, Si-Jia Feng, Xin-Yu Xiao, Yun-Zhou Shi, Chao-Rong Xie & Hui Zheng

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  1. Qing-Feng Tao
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  2. Xiao-Ying Wang
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Contributions

QF-T: study selection, analyzed and interpreted the data, drafted the manuscript for intellectual content. XY-W: study selection, data extraction, quality assessment, critical revision of the manuscript for important intellectual content. SJ-F: data extraction, quality assessment, critical revision of the manuscript for important intellectual content. XY-X, YZ-S, CR-X: critical revision of the manuscript for important intellectual content. HZ: study design and conceptualization, critical revision of the manuscript for important intellectual content. All authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors have also agreed to submit for publication.

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Correspondence to Hui Zheng.

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Our study was a systematic review and meta-analysis with trial sequential analysis of published researches and was exempt from review and approval by the research ethics committee.

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Tao, QF., Wang, XY., Feng, SJ. et al. Efficacy of acupuncture for tension-type headache prophylaxis: systematic review and meta-analysis with trial sequential analysis. J Neurol 270, 3402–3412 (2023). https://doi.org/10.1007/s00415-023-11695-1

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