Acupuncture in patients with tension-type headache: randomised controlled trial

Abstract

Objective: To investigate the effectiveness of acupuncture compared with minimal acupuncture and with no acupuncture in patients with tension-type headache.

Design: Three armed randomised controlled multicentre trial.

Setting: 28 outpatient centres in Germany.

Participants: 270 patients (74% women, mean age 43 (SD 13) years) with episodic or chronic tension-type headache.

Interventions: Acupuncture, minimal acupuncture (superficial needling at non-acupuncture points), or waiting list control. Acupuncture and minimal acupuncture were administered by specialised physicians and consisted of 12 sessions per patient over eight weeks.

Main outcome measure: Difference in numbers of days with headache between the four weeks before randomisation and weeks 9-12 after randomisation, as recorded by participants in headache diaries.

Results: The number of days with headache decreased by 7.2 (SD 6.5) days in the acupuncture group compared with 6.6 (SD 6.0) days in the minimal acupuncture group and 1.5 (SD 3.7) days in the waiting list group (difference: acupuncture v minimal acupuncture, 0.6 days, 95% confidence interval -1.5 to 2.6 days, P = 0.58; acupuncture v waiting list, 5.7 days, 3.9 to 7.5 days, P < 0.001). The proportion of responders (at least 50% reduction in days with headache) was 46% in the acupuncture group, 35% in the minimal acupuncture group, and 4% in the waiting list group.

Conclusions: The acupuncture intervention investigated in this trial was more effective than no treatment but not significantly more effective than minimal acupuncture for the treatment of tension-type headache.

Trial registration number: ISRCTN9737659.

Fig 1

Flowchart of trial (ITT=intention to treat; MOM=main outcome measure; PP=per protocol). ^*Before starting analyses the data from one trial centre were excluded from the main analysis owing to severe protocol violations and suspicion of data manipulation; the data were included in an additional sensitivity analysis (see methods section)

Fig 2

Mean (95% confidence interval) number of days with headache. Patients in the waiting list group received acupuncture after week 12 (dotted bars)