By Mary Beth Nierengarten
July 7, 2022
Article in brief
Acupuncture given two or three sessions per week for a total of 20 sessions was effective in managing chronic tension headaches for at least 32 weeks.
The results of a randomized clinical trial showing the effectiveness of acupuncture for chronic tension headaches (TTH) build on the growing body of evidence supporting the therapy as an effective treatment for some patients with this type of headache. headache.
A study by Chinese investigators, published online ahead of print June 22 in Neurologyfound that acupuncture given two or three sessions per week for a total of 20 sessions was effective in managing chronic tension headaches for at least 32 weeks.
Previous data, including a Cochrane systematic review, have shown that acupuncture may be effective for TTH, but questions remain such as its comparative effectiveness with other treatment options, duration of treatment effect, and specific efficacy for chronic TTH.
The aim of the present study was to fill in some of the gaps in the evidence, in particular the duration of treatment effect and efficacy for chronic TTH. To do this, the researchers only included patients with chronic TTH in the trial and evaluated the effectiveness of acupuncture for at least eight months.
Lead study author Ying Li, MD, PhD, of the School of Acupuncture and Tuina at Chengdu University of Traditional Chinese Medicine in Chengdu, Sichuan, China, explained that the randomized trials prior acupuncture for TTH had a follow-up of less than six months and most included patients with both episodic and chronic TTH.
“Our study showed that acupuncture was effective for chronic TTH and could provide persistent relief for at least eight months,” she said.
Study results show that acupuncture can be adopted as a non-pharmaceutical option for chronic TTH, she said, especially for people with intractable headaches who respond poorly to current drug treatments. .
Why acupuncture is effective for TTH is unclear, the study authors wrote. They hypothesized that, among several potential mechanisms, the needles could stimulate the release of endorphins or neurotransmitters.
The study included 218 participants with chronic TTH randomized to either the intervention group, called true acupuncture (TA) (n=109), or a sham control group, called superficial acupuncture (SA) (n-109). Participants were recruited from the outpatient settings of Chengdu Traditional Chinese Medicine University Teaching Hospital between June 2017 and September 2020. Participants eligible for inclusion were between the ages of 18 and 65, had a history of Chronic TTH for at least a year and had headache attacks at least 15 days a month for at least three months. Exclusions for study eligibility included people with chronic migraine, headaches caused by other medical conditions, those taking prophylactic medications in the three months prior to study enrollment and being pregnant or breastfeeding.
Participants receiving TA underwent 20 sessions of acupuncture over eight weeks, three sessions per week for the first four weeks and two sessions per week for the last four weeks. Each session lasted 30 minutes. Needles were administered manually to stimulate and achieve deqi sensation – a feeling of numbness, pain, heaviness, or irritating pain – considered essential to the success of acupuncture via traditional Chinese acupuncture theory and supported by functional MRI and clinical studies. Participants in the SA group received similar sessions but with the placement of needles intended to avoid deqi sensation. Three different acupuncturists administered the treatment.
The responder rate at 16 weeks after randomization was the primary outcome of the study, defined as a reduction of at least 50% in monthly headache days. The result was based on each participant’s self-report keeping a headache diary from week 4 to week 32 in which they recorded the frequency, duration, intensity and accompanying symptoms of their headaches. headaches as well as any use of painkillers or other medications to treat acute ones. symptoms.
Overall, the average age of all participants was 43 years, with an average duration of chronic TTH of 130 months and monthly headache days of 21.5 days.
The study found that significantly more participants receiving TA had a 50% or greater reduction in monthly headache days, compared to those receiving AS at 16 weeks (68, 2% versus 48.1%, respectively, pp
Over time, the number of monthly headache days decreased after treatment in both groups, but significantly more in the TA group. At week 16, the reduction in monthly headache days was 13.1 days in the AT group versus 8.8 days in the AS group (mean difference 4.3 days, pp
The study researchers concluded that more data was needed on the comparative effectiveness of acupuncture, as well as its cost-effectiveness compared to other treatment options.
Niushen Zhang, MD, clinical assistant professor of neurology and neurological sciences and head of the division of headaches at Stanford Medicine, thinks the study is a useful addition to better understand the effectiveness of acupuncture for preventive treatment. chronic TTH. “Until now, there has been very little research on the effectiveness of acupuncture for the treatment of chronic tension headaches,” she said, adding that most of the evidence was for the preventative treatment of episodic migraine.
“This study further supports acupuncture as a treatment, with a growing evidence base, that may be considered for some headache patients,” she said. “When considering acupuncture in clinical practice, it is essential to base this decision on the individual needs of patients.”
However, she would like to see more studies evaluating the effectiveness of acupuncture for treating acute migraine, episodic tension headaches, as well as preventive treatment for chronic migraine.
Carolyn A. Bernstein, MD, a neurologist at the Brigham and Women’s Osher Clinical Center for Integrative Medicine in Chestnut Hill, MA, agreed that the study results support the evidence showing the potential of acupuncture as a complementary or integrative component. non-pharmaceutical for pain. “There is evidence to support the use of acupuncture in the treatment of various types of pain, including migraine and possibly other types of headaches,” said Dr. chair of the AAN Neurohealth and Integrative Neurology Section. “It’s worth considering it as a treatment option,” adding that it may be covered by health insurance.
Mason Dyess, DO, who specializes in general neurology and headache medicine at Ochsner Medical Center in New Orleans, said the study expands the scope of most previous studies by including patients with chronic TTH and looking at longer cycles of acupuncture. He agreed that this supports the benefits of acupuncture for tension-type headaches.
“Acupuncture may be a relatively safe and useful adjunctive therapy for some patients with tension headaches,” he said. “However, given the lack of direct studies on the superiority of acupuncture over other standard TTH treatments, I generally recommend trying acupuncture as an add-on treatment within a broader multimodal approach to headache prevention.
Drs. Zhang and Dyess did not disclose anything. Dr. Bernstein consulted for Percept and Neurolytic, companies unrelated to the subject of the article.