Acupuncture for tension-type headache.
Acupuncture for tension-type headache.
复制标题
DOI：
10.1002/14651858.cd007587
复制
发表时间：
2009-01-21
影响因子：
8.4
通讯作者：
White, Adrian R.
中科院分区：
文献类型：
--
作者：
Linde, Klaus;Allais, Gianni;Brinkhaus, Benno;Manheimer, Eric;Vickers, Andrew;White, Adrian R.
针灸常用于预防紧张型头痛，但其有效性仍有争议。这篇综述（沿着一篇关于“针灸治疗偏头痛性肌松”的综述）是科克伦图书馆2001年第1期发表的科克伦综述的更新版本。研究针灸是否a）比无预防性治疗/仅常规护理更有效; B）比“假”（安慰剂）针灸更有效; c）在减少发作性或慢性紧张型头痛患者头痛频率方面与其他干预措施一样有效。检索了科克伦疼痛、姑息和支持治疗试验注册中心、CENTRAL、MEDLINE、EMBASE和科克伦补充医学田间试验注册中心，截止日期为2008年1月。我们纳入了随机试验，随机化后观察期至少为8周，比较了针灸干预与对照（仅治疗急性头痛或常规护理），假针灸干预或其他干预对发作性或慢性紧张型头痛患者的临床效果。两名审评员核查资格;提取有关患者、干预措施、方法和结果的信息;并评估偏倚风险和针灸干预的质量。提取的结局包括反应（头痛频率至少减少50%;主要关注的结局）、头痛天数、疼痛强度和镇痛剂使用。11项试验（2317例受试者，中位数62，范围10 - 1265）符合纳入标准。两项大型试验比较了针灸治疗急性头痛或常规护理。两人都发现针灸对反应、头痛天数和疼痛强度的控制有统计学显著性和临床相关的短期（长达3个月）益处。未研究长期影响（超过3个月）。六项试验比较了针灸与假针灸干预，其中五项为荟萃分析提供了数据。针灸与假手术相比，在反应和其他几个结果方面都有统计学意义上的小益处。四项比较针灸与物理疗法、按摩或放松的试验中有三项存在重要的方法学或报告缺陷。他们的发现很难解释，但总体上表明，对照组的某些结果略好。在本综述的前一版本中，支持针灸治疗紧张型头痛的证据被认为是不足的。现在，通过六项额外的试验，作者得出结论，针灸可能是一种有价值的非药物工具，用于频繁发作或慢性紧张型头痛患者。
Acupuncture is often used for tension-type headache prophylaxis but its effectiveness is still controversial. This review (along with a companion review on ‘Acupuncture for migraine prophylaxis’) represents an updated version of a Cochrane review originally published in Issue 1, 2001, of The Cochrane Library. To investigate whether acupuncture is a) more effective than no prophylactic treatment/routine care only; b) more effective than ‘sham’ (placebo) acupuncture; and c) as effective as other interventions in reducing headache frequency in patients with episodic or chronic tension-type headache. The Cochrane Pain, Palliative & Supportive Care Trials Register, CENTRAL, MEDLINE, EMBASE and the Cochrane Complementary Medicine Field Trials Register were searched to January 2008. We included randomized trials with a post-randomization observation period of at least 8 weeks that compared the clinical effects of an acupuncture intervention with a control (treatment of acute headaches only or routine care), a sham acupuncture intervention or another intervention in patients with episodic or chronic tension-type headache. Two reviewers checked eligibility; extracted information on patients, interventions, methods and results; and assessed risk of bias and quality of the acupuncture intervention. Outcomes extracted included response (at least 50% reduction of headache frequency; outcome of primary interest), headache days, pain intensity and analgesic use. Eleven trials with 2317 participants (median 62, range 10 to 1265) met the inclusion criteria. Two large trials compared acupuncture to treatment of acute headaches or routine care only. Both found statistically significant and clinically relevant short-term (up to 3 months) benefits of acupuncture over control for response, number of headache days and pain intensity. Long-term effects (beyond 3 months) were not investigated. Six trials compared acupuncture with a sham acupuncture intervention, and five of the six provided data for meta-analyses. Small but statistically significant benefits of acupuncture over sham were found for response as well as for several other outcomes. Three of the four trials comparing acupuncture with physiotherapy, massage or relaxation had important methodological or reporting shortcomings. Their findings are difficult to interpret, but collectively suggest slightly better results for some outcomes in the control groups. In the previous version of this review, evidence in support of acupuncture for tension-type headache was considered insufficient. Now, with six additional trials, the authors conclude that acupuncture could be a valuable non-pharmacological tool in patients with frequent episodic or chronic tension-type headaches.