Tension-type headache is the everyday kind of headache most people know. It brings pain on both sides of your head, face or neck, and it can feel as if something is pressing on your head or tightening around it. For some people these headaches come often enough to wear them down. So what does the research show about acupuncture as a way of preventing them?
What a Cochrane review is
Cochrane reviews are among the most trusted summaries in medicine. Rather than leaning on a single study, the authors search for every suitable randomised trial, judge how reliable each one is, and combine the results. The review on tension-type headache came out in April 2016, written by Linde and colleagues, including Andrew Vickers and Adrian White.
It brought together 12 trials with 2,349 adults who had frequent episodic or chronic tension-type headache. In each trial people had a course of acupuncture, and the researchers then looked at whether their headaches became less frequent.
Acupuncture compared with usual care
Two large trials compared acupuncture added to usual care with usual care alone. The main measure was how many people had their number of headache days cut by at least half.
- With acupuncture: about 48 in every 100 people
- With usual care alone: fewer than 20 in every 100 people
That's a clear difference. But people knew whether they were having acupuncture or not, and knowing you're getting extra attention can colour how you rate your symptoms.
Acupuncture compared with sham acupuncture
To get round that, seven trials compared real acupuncture with "sham" acupuncture, a fake version designed to look and feel similar. Here the gap was smaller. With real acupuncture, 51 in 100 people had their headache frequency halved, against 43 in 100 with sham. The reviewers judged this a modest difference, and the results looked similar six months after treatment. The number of side effects, and of people dropping out because of them, was similar in both groups.
You see this pattern a lot in acupuncture research. People in sham groups often improve too, which suggests that part of the benefit comes from the whole experience of treatment, not just the needles themselves.
Compared with other treatments
Four trials compared acupuncture with physiotherapy, massage or exercise. These had important weaknesses and were poorly reported. None showed acupuncture to be clearly better, and some results slightly favoured the other treatments.
How strong is the evidence?
Overall the authors rated the quality of evidence as moderate or low, mainly because many trials couldn't blind people to their treatment and the size of the effects varied between studies. They concluded that "a course of acupuncture consisting of at least six treatment sessions can be a valuable option for people with frequent tension-type headache".
NICE's headache guideline (CG150) lands in a similar place, advising clinicians to "consider a course of up to 10 sessions of acupuncture over 5 to 8 weeks for the prophylactic treatment of chronic tension-type headache".
Before you book
If you get headaches several times a week, or they're severe, see your GP. Get urgent help for a headache that comes on suddenly and is extremely painful, or comes with problems such as changes to your vision or speech. Acupuncture sits alongside medical care, not in place of it.
If you decide to try it, I'll talk you through the evidence frankly and agree with you how many sessions make sense before reviewing progress. In the meantime, you might find my guided acupressure routines a relaxing thing to try at home.
I've also written a dedicated page on acupuncture for headaches, with what a session involves.