Electroacupuncture Helpful for Tension-Type Headache

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http://www.medscape.com/viewarticle/474713?src=mp

News Author: Laurie Barclay, MD

CME Author: Vega, MD, FAAFP

Authors and http://www.medscape.com/viewarticle/474713_author> Disclosures

To earn CME credit, read the news brief, the paragraphs that follow, and

answer the questions below.

Release Date: April 29, 2004; Valid for credit through April 29, 2005

Credits Available

Physicians - up to 0.25 AMA PRA category 1 credit(s)

April 29, 2004 — Electroacupuncture to distal points alone is effective for

the treatment of tension-type headache (TTH), according to the results of a

randomized trial published in the April issue of Headache.

" Electroacupuncture is commonly used for tension-type headache, but when

applied to distal acupoints only, evidence of its efficacy [has been]

lacking, " write Charlie Changli Xue, PhD, from RMIT University in Bundoora,

, Australia, and colleagues. " To the best of our knowledge, the

current study is the first of its kind using distal acupoints only for

treating TTH. "

This single-blinded, sham-controlled, crossover trial had five stages:

baseline for two weeks; phases I and II, each four weeks; washout period for

two weeks; and follow-up for three months after phase II. Of 40 patients

randomized to receive real electroacupuncture during phase I, then sham

electroacupuncture in phase II, or to receiving the treatments in reverse

order, 37 patients completed the trial. Both groups were similar at

baseline.

After phase I, the group receiving real electroacupuncture had significant

improvements in mean headache frequency (3.0 ± 0.3 per month vs. 12.0 ± 1.7

per month, duration, 13.3 ± 3.5 hours vs. 32.0 ± 6.2 hours), pain intensity

using a visual analog scale (32.8 ± 4.1 mm vs. 47.5 ± 2.7 mm), mechanical

pain threshold, headache disability score (6.0 ± 1.0 vs. 16.3 ± 1.6), and

sickness impact score (288.7 ± 48.0 vs. 687.1 ± 77.2).

For each parameter, both groups also had significant differences between

baseline and phase II, and between baseline and follow-up. At the end of

follow-up, there were no significant differences between groups.

Study limitations include possibly insufficient length of washout, because

there was no regression to baseline during the washout period.

" Electroacupuncture to distal points alone is effective for short-term

symptomatic relief of tension-type headache, " the authors write. " The

treatment is relatively safe, as no side effects were reported throughout

the study. "

The authors recommend additional research on the long-term effect of distal

acupuncture by repeated measurements during follow-up, and on the methods

employed for acupoint selection.

Headache. 2004;44(4):333-341

Learning Objectives

Upon completion of this activity, participants will be able to:

* List treatments available for tension headache.

* Describe the efficacy of electroacupuncture in the management of

tension headache.

Clinical Context

Tension headache is a common condition that can be difficult to treat.

According to the authors of the current study, first-line medications such

as aspirin and ibuprofen may be effective but can have deleterious effects

on the gastric mucosa. Other treatments, including biofeedback-assisted

relaxation and cognitive therapy, have fewer adverse effects but can require

considerable time and expense.

Acupuncture has a mixed record in treating tension headache. In a study of

69 patients diagnosed with tension headache, Karst and colleagues noted no

difference in frequency or severity of headaches between groups treated with

either acupuncture or sham acupuncture. The results of their study,

published in the July 2001 issue of Cephalalgia, also showed that

quality-of-life scores improved somewhat in the acupuncture group compared

with placebo.

The Karst study used needles producing pressure without breaking the skin as

their placebo treatment. The current study used misplaced needles and lower

levels of electric current to create a placebo treatment and compare it with

standard electroacupuncture.

Study Highlights

* Study subjects were recruited to a research clinic in Australia. All

participants fulfilled the International Headache Society criteria for

episodic or chronic tension headache. Those with a history of migraine

headache, hypertension, eye problems related to headache, or pregnancy were

excluded from participation.

* A 2-week evaluation was performed at baseline to judge headache

intensity, frequency, and duration. A mechanical pain threshold was also

conducted, as were measures of the headaches' impact on quality of life. All

of these values constituted the main outcomes of the trial.

* The study was conducted as a double-crossover trial. One group of

participants underwent active treatment twice a week for 4 weeks, while

another received placebo treatment. After a 2-week washout period, the 2

groups switched treatments for another 4 weeks.

* Both real and sham electroacupuncture were applied only to distal

sites on the upper and lower limbs. Continuous electrical stimulation, with

frequencies ranging from 2 to 100 Hz and 0.2 to 1.5 volts, was applied in

the active treatment group at every other visit to prevent tolerance to the

therapy. In the sham treatment group, needles were applied 5 to 10 mm away

from the correct insertion point, and lower levels of current were applied.

* Outcomes were measured at baseline, after both treatment periods,

and at 3 months after treatment.

* 40 patients entered the study, and 3 left the trial. Baseline data

from both treatment groups were similar. The average age of study subjects

was 42 years. There were nearly twice as many women as men in the study

cohort, and the mean frequency of headaches was 12.9 per month. There were

no data available on the mean or total amount of current applied between the

2 groups.

* After the first treatment phase, electroacupuncture produced an

88.3% reduction in headache frequency compared with a 4% reduction for sham

treatment. After crossover of treatment, both groups had similarly reduced

frequencies of headache. At 3 months, both groups had reduced headache

frequency compared with baseline, but headache incidence had increased since

the last treatment.

* Duration of headache was also improved with electroacupuncture

compared with sham treatment and also was reduced by up to 86.1% compared

with baseline values. Again, at 3 months after treatment, both groups

experienced trends approaching their baseline values for headache duration.

* Headache intensity also improved with active treatment over placebo,

with scores again worsening 3 months after therapy compared with scores

immediately following the treatment periods.

* The mechanical pain threshold was significantly improved in the

first group to undergo electroacupuncture compared with the placebo group

after both treatment periods.

* Quality-of-life scores were also improved with active treatment

compared with placebo after the first phase of treatment. Improvement was

similar between the 2 groups after both treatment periods. Quality-of-life

scores appeared to be approaching baseline values at the 3-month follow-up

visit.

Pearls for Practice

* Several treatment options are available for tension headaches.

* Electroacupuncture is an effective means to manage tension headaches

for at least two months. However, it does not appear to produce a lasting

salutary effect if stopped following this treatment period.

Love Lana 0 :-)