AUTHOR=Kang Wen-lin , Xiao Xian-jun , Fan Rong , Zhong Dong-ling , Li Yu-xi , She Jian , Li Juan , Feng Yue , Jin Rong-jiang 

TITLE=Acupuncture for tension-type headache: a systematic review and meta-analysis of randomized controlled trials

JOURNAL=Frontiers in Neurology

VOLUME=Volume 13 - 2022

YEAR=2023

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.943495

DOI=10.3389/fneur.2022.943495

ISSN=1664-2295

ABSTRACT=Background: 
Tension-type headache (TTH) is the most common neurologic disease worldwide. Acupuncture is commonly applied to treat TTH, but evidence of acupuncture for TTH is contradictory according to the previous meta-analyses. Therefore, we conducted this systematic review and meta-analysis to update the evidence of acupuncture for TTH and aimed to provide a valuable reference for clinical application.

Methods: 
We searched nine electronic databases from their inceptions to July 2022 for randomized controlled trials (RCTs) of acupuncture for TTH. We also manually searched reference lists and relevant websites, and the experts in this field were consulted for possible eligible studies. Two independent reviewers conducted literature screening, data extraction, and risk of bias assessment. The revised Cochrane risk-of-bias tool (ROB 2) was used to assess the risk of bias of included studies. Subgroup analyses were carried out based on treatment duration, follow-up, and drug category. Data synthesis was performed using Stata SE 16.0. The Grading of Recommendations Assessment, Development and Evaluation Approach (GRADE) was used to evaluate the certainty of evidence of each outcome. 

Results: 
31 RCTs involving 2,705 participants were included. According to ROB 2, four studies were considered as low risk, and the rest studies were some concerns. Compared with sham acupuncture, acupuncture had greater effect in improvement of responder rate [4 RCTs, RR=1.31, 95%CI (1.14, 1.50), I2=0%, moderate certainty], headache frequency [8 RCTs, SMD=−0.77, 95%CI (−1.24, −0.29), I2= 90.6%, low certainty], pain intensity [9 RCTs, SMD=−0.46, 95%CI (−0.89, −0.03), I2=84.5%, very low certainty]. In contrast to medication, acupuncture was more effective in reducing pain intensity [9 RCTs, SMD=−0.57, 95%CI (−0.81, −0.32), I2=65.4%, moderate certainty]. However, acupuncture was not superior to exercise in relieving pain intensity [2 RCTs, SMD=0.15, 95% CI (−0.23, 0.53), I2=33.4%, low certainty]. Adverse events were evaluated in 16 trials and no serious event associated with acupuncture occurred. 

Conclusions: 
Acupuncture may be an effective and safe treatment for TTH patients. Due to low or very low certainty of evidence for most outcomes and high heterogeneity of the included studies, more rigorous RCTs are needed to verify the effect and safety of acupuncture in the management of TTH.