Research Review by Dr. Shawn Thistle©


Sept. 2005

Study Title:

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


Melchart D et al.

Publication Information:

British Medical Journal 2005; 331: 376-382.


Tension-type headaches are very common, and generally present as a bilateral headache in the forehead/temporal region of pressing or "tightening" quality. Many people suffer headaches like this daily. Even though they are not considered life-threatening, they can impact quality of life significantly.

Traditional treatment for this type of headache consists primarily of oral pain medication, but recently many patients are turning to acupuncture for relief. Although there is a multitude of anecdotal evidence supporting this treatment for TTH, there is still a paucity of high quality scientific data.

This study aimed to determine whether acupuncture is an effective treatment for tension type headache in a randomized controlled trial.

In order to be included in the study, patients had to have a diagnosis of either episodic or chronic TTH according to the criteria of the International Headache Society, and be between the ages of 18 and 65. After a baseline period of four weeks, patients were randomized into 3 groups as follows:
  1. acupuncture group - 132 patients received twelve 30 minute semi-standardized treatments over an 8 week period consisting of needle acupuncture at a predetermined set of points and any other points the treatment provider deemed appropriate (total number of needles was limited to 25 per session). "De qi" sensation was desirable and manual stimulation of the needles was performed at least once during the treatment
  2. minimal acupuncture group - 63 patients received the same number, length, and frequency of treatments as group 1 but with at least 5/10 predetermined non-acupuncture points needled superficially with "de qi" sensation and manual stimulation of needles avoided
  3. waiting list control - 75 patients did not receive any prophylactic treatments for their headaches during the 12 week period after randomization. After that time they received 12 acupuncture sessions as in group
The primary outcome measure in this study was number of days with headache in weeks 9-12 after the treatment period versus during the four week baseline. Headache diaries were also completed from weeks 21-24 after randomization.

Pertinent Results:

  1. from baseline to weeks 9-12, the number of days with headache decreased by 7.2 days in the acupuncture group and 6.6 days in the minimal acupuncture group, and only 1.5 days in the waiting list group
  2. the proportion of responders (defined as a 50% reduction in days with headache) was 46% in the acupuncture group, and 35% in the minimal acupuncture group
  3. overall, patients receiving acupuncture or minimal acupuncture faired significantly better than the waiting list group
  4. the improvements in the acupuncture and minimal acupuncture groups persisted throughout the follow-up period

Conclusions & Practical Application:

In this study, both the acupuncture and minimal acupuncture groups showed significant improvement. The authors suggest that this indicates that acupuncture as a therapy is more effective than no treatment, but not significantly more effective that the minimal acupuncture intervention.

I feel interpreting the results in this manner negates the fact that both acupuncture groups improved, whether precise Chinese points were utilized or distant, general points considered non-relevant to this condition in the Chinese model.

As I have suggested in my research reviews in the past, this may suggest that acupuncture has a GENERAL systemic effect that tends to relive pain syndromes such as tension-type headache. I feel that this type of result can no longer be ignored, and should not continue being reported negatively. Both acupuncture groups improved, period.

This study is one of the largest of this nature performed to date, and provides solid evidence that acupuncture can provide a safe, effective treatment alternative for patients with tension-type headache.