Acupuncture helped reduce the frequency of chronic tension-type headaches (CTTH), a randomised controlled trial in China found.
More than two-thirds (68.2%) of people with CTTH who received true acupuncture reported at least a 50% reduction in the number of monthly headache days at week 16, compared with 48.1% who had superficial acupuncture (OR 2.65, 95% CI 1.5-4.77), reported Dr Ying Li, PhD, of Chengdu University of Traditional Chinese Medicine in China, and colleagues in Neurology.
At week 16, those who had true acupuncture had 13.1 fewer headache days a month, while those with superficial acupuncture had 8.8 fewer monthly headache days (mean difference of 4.5 days, 95% CI 2.1-6.8, P<0.001).
Despite the effect seen in the superficial acupuncture group, the trial was “rigorous” and had a “really strong design”, said Peter Wayne, PhD, of Harvard Medical School in Boston, who wasn’t involved with the study.
“Any encounter with a healthcare provider, whether it’s a physician or a surgeon, has some therapeutic effects,” Wayne told MedPage Today.
“People inherently are hard-wired to want to get better,” he added, noting that participants in both groups received “the ritual of acupuncture and a mild stimulation”.
Some headache patients are shifting away from pharmaceuticals, Wayne observed. “I think many pain centres are already using acupuncture for headaches,” he said. “I think this will just add to the evidence to support that.”
Tension-type headaches, which cause pressing and tightening on both sides of the head, are commonly treated with over-the-counter drugs. Previous studies have suggested that acupuncture may reduce the overall burden of these.
“Tension headaches are one of the most common types of headaches and people who have a lot of these may be looking for alternatives to medication,” Li said. “Our study found that acupuncture reduces the average number of headache days per month for those struggling with these painful and disruptive attacks.”
The trial included 218 patients with CTTH with a mean age of 43.1, recruited from the Teaching Hospital of Chengdu University of Traditional Chinese Medicine from June 2017 to September 2020. Participants had experienced CTTH for 130 months and had 21.5 episodes per month at baseline, on average.
Chronic headache was defined as 15 or more headaches per month. People who took prophylactic medications in the three months leading up to the study were not included. One-third of participants took drugs for acute headache treatment at baseline.
Each participant was assigned to either true acupuncture (n=110) or superficial acupuncture (n=108). Participants in the true acupuncture group were needled to experience deqi sensation, which leads to a tingling, numbness, or heaviness feeling. The superficial acupuncture group were needled in a way to avoid deqi.
“We found that deqi sensation made (a) difference in clinical effect even when the acupuncture points were the same in both groups, which might indicate that deqi sensation might be an independent contributor to the acupuncture effect,” Li and colleagues wrote.
“The mechanism of how deqi sensation affects the effect of acupuncture is unclear.”
Both cohorts received 20 sessions over eight weeks, and each treatment session lasted 30 minutes. The primary outcome was the responder rate – defined as at least a 50% reduction in the monthly number of headache days – at week 16, with follow-up to week 32. Headache data were self-reported.
The overall effect lasted for at least eight months. At week 32, the responder rate was 68.2% in the true acupuncture group and 50% in the superficial acupuncture group (OR 2.4, 95% CI 1.36-4.3, P<0.001).
From week four to week 32, the percentage of participants who reported no headache intensity on a visual analogue scale increased from 0.91% to 30.91% in the true acupuncture group, and from 0% to 10.2% in the superficial acupuncture group.
Four mild adverse events were reported, which did not require treatment. One participant from each group experienced subcutaneous haematoma and two patients from the true acupuncture group had pain at the needle site.
Li and co-authors noted that all participants came from one hospital and results may not be generalisable to other communities.
The research underscores that not all acupuncture treatments are equal when it comes to providing pain relief, said Ayla Wolf, a licensed acupuncturist who specialises in neurological disorders, concussions and traumatic brain injuries, and who was not involved in the study, reports CNN.
“When you go to an acupuncturist who is properly trained and has those techniques, you definitely are going to get better results than somebody who learns where a point is and kind of taps the needle and then doesn’t touch it again,” she said.
For patients who do not want to use prescription pain medication, acupuncture offers a hopeful alternative. However, there are still some unknowns.
“The mechanisms of how acupuncture provides sustained relief of headaches are unclear,” Li said.
More research is needed on the cost-effectiveness of acupuncture as it can be expensive. Additionally, acupuncture is similar to physical therapy in the sense that patients will get the best results by coming in for treatment multiple times a week, Wolf said.
A study published in 2017 found that, in some cases, acupuncture was linked to organ and tissue injuries, infection and other adverse reactions.
However, recent studies and data have made it more difficult to criticise acupuncture, said Dr Tesha Monteith, associate professor of clinical neurology and chief of the headache division at the University of Miami’s Miller School of Medicine. She was not involved in the study.
The side effects experienced by participants in the newly published study were mild and did not require treatment, the report said.
Since the study was conducted at a single hospital in China, the results may not apply to all populations. However, the thorough design and analysis of this study provides a springboard for further research to be done on the connection between acupuncture and chronic tension headaches, Wolf said.
“Several studies conducted in other countries showed also good effects of acupuncture, so we assume that the generalisation of acupuncture to tension-type headaches might not be a big problem,” Li said.
Treating chronic pain is a multidisciplinary approach, and acupuncture is one of several treatment options that should be considered, Monteith said.
Many patients in the study have dealt with chronic tension headaches for at least a decade, meaning they have possibly tried and failed to respond to other treatment, she added.
“I think this is one of several options,” Monteith said. “A tailored treatment regimen, possibly considering multiple interventions, is certainly something to consider, especially for these refractory patients that have been suffering for a long time.”
Medical News Today spoke to Dr Deena Kuruvilla, medical director and neurologist at the Westport Headache Institute in Westport, Connecticut, about this study, who said that although there are existing studies about acupuncture for the management of migraine and tension-type headaches, results have been conflicting.
“Less is known about the use of acupuncture for chronic tension-type headache so this study offers insight into that population,” Kuruvilla added. “I view all integrative treatments such as acupuncture as a welcome addition to mainstream pharmacological medications. These study results aid in adding to the existing evidence that acupuncture may be helpful for patients with tension-type headache.”
Study details
Acupuncture for Patients With Chronic Tension-Type Headache: A Randomized Controlled Trial
Hui Zheng, Tao Gao, Qian-Hua Zheng, Ling-Yun Lu, Ting-Hui Hou, Shu-Sen Zhang, Si-Yuan Zhou, Xin-Yu Hao, Lu Wang, Ling Zhao, Fan-Rong Liang, Ying Li.
Published in Neurology on 22 June 2022
Abstract
Background and Objectives
Whether acupuncture is effective for chronic tension-type headache (CTTH) is inconclusive. We aimed to examine the effectiveness of acupuncture with a follow-up period of 32 weeks.
Methods
We conducted a randomised controlled trial, and 218 participants who were diagnosed with CTTH were recruited from June 2017 to September 2020. The participants in the intervention group received 20 sessions of true acupuncture (TA group) over eight weeks. The acupuncture treatments were standardised across participants, and each acupuncture site was needled to achieve deqi sensation. Each treatment session lasted 30 minutes. The participants in the control group received the same sessions and treatment frequency of superficial acupuncture (SA group) – defined as a type of sham control by avoiding deqi sensation at each acupuncture site. The main outcome was the responder rate at 16 weeks after randomisation (week 16) and was followed up at week 32. A responder was defined as a participant who reported at least a 50% reduction in the monthly number of headache days (MHDs).
Results
Our study included 218 participants (mean age: 43.1 years, mean disease duration: 130 months, MHDs: 21.5 days). The responder rate was 68.2% in the TA group (n=110) versus 48.1% in the SA group (n=108) at week 16 (odds ratio, 2.65; 95%CI, 1.5 to 4.77; p<0.001); and it was 68.2% in the TA group versus 50% in the SA group at week 32 (odds ratio, 2.4; 95%CI, 1.36 to 4.3; p<0.001). The reduction in MHDs was 13.1±9.8 days in the TA group versus 8.8±9.6 days in the SA group at week 16 (mean difference, 4.3 days; 95%CI, 2.0 to 6.5; p<0.001), and the reduction was 14±10.5 days in the TA group versus 9.5±9.3 days in the SA group at week 32 (mean difference, 4.5 days; 95%CI, 2.1 to 6.8; p<0.001). Four mild adverse events were reported; three in the TA group versus one in the SA group.
Conclusion
The eight-week TA treatment was effective for the prophylaxis of CTTH. Further studies might focus on the cost-effectiveness of the treatment.
MedPage Today article – Fewer Headache Days With Acupuncture (Open access)
CNN article – An ancient practice may offer relief from chronic tension headaches (Open access)
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