Melchart D, Linde K, Fischer P, Berman B, White A, Vickers A, Allais G
Centre for Complementary Medicine Research, Department of Internal Medicine II, Technische Universität, Kaiserstr. 9, Munich, Germany, 80801.
Cochrane Database Syst Rev. 2001(1):CD001218. doi: 10.1002/14651858.CD001218.
Acupuncture is widely used for the treatment of headache, but its effectiveness is controversial.
To determine whether acupuncture is: - more effective than no treatment - more effective than 'sham' (placebo) acupuncture - as effective as other interventions used to treat idiopathic (primary) headaches.
Electronic searches were performed in MEDLINE, EMBASE, the Cochrane Controlled Trials Register, and the database of the Cochrane Field for Complementary Medicine. We also contacted researchers in the field and checked the bibliographies of all articles obtained.
Randomized or quasi-randomized clinical trials comparing acupuncture with any type of control intervention for the treatment of idiopathic (primary) headaches were included.
Information on patients, interventions, methods, and results was extracted by at least two independent reviewers using a pre-tested standard form. Results on headache frequency and intensity were summarized descriptively. Responder rate ratios (responder rate in treatment group/responder rate in control group) were calculated as a crude indicator of results for sham-acupuncture-controlled trials. Quantitative meta-analysis was not possible due to trial heterogeneity and insufficient reporting.
Twenty-six trials including a total of 1151 patients (median, 37; range, 10-150) met the inclusion criteria. Sixteen trials were conducted among patients with migraine, six among patients with tension-type headache, and four among patients with various types of headaches. The majority of trials had methodological and/or reporting shortcomings. In eight of the 16 trials comparing true and sham (placebo) acupuncture in migraine and tension-type headache patients, true acupuncture was reported to be significantly superior; in four trials there was a trend in favor of true acupuncture; and in two trials there was no difference between the two interventions. (Two trials were uninterpretable.) The 10 trials comparing acupuncture with other forms of treatment yielded contradictory results.
REVIEWER'S CONCLUSIONS: Overall, the existing evidence supports the value of acupuncture for the treatment of idiopathic headaches. However, the quality and amount of evidence are not fully convincing. There is an urgent need for well-planned, large-scale studies to assess the effectiveness and cost-effectiveness of acupuncture under real-life conditions.
针灸被广泛用于治疗头痛，但其疗效存在争议。
确定针灸是否：- 比不治疗更有效 - 比“假”（安慰剂）针灸更有效 - 与用于治疗特发性（原发性）头痛的其他干预措施效果相同。
在MEDLINE、EMBASE、Cochrane对照试验注册库以及补充医学Cochrane领域数据库中进行电子检索。我们还联系了该领域的研究人员，并查阅了所有获取文章的参考文献。
纳入比较针灸与任何类型对照干预措施治疗特发性（原发性）头痛的随机或半随机临床试验。
至少两名独立评审员使用预先测试的标准表格提取有关患者、干预措施、方法和结果的信息。对头痛频率和强度的结果进行描述性总结。计算反应率比（治疗组反应率/对照组反应率）作为假针灸对照试验结果的粗略指标。由于试验异质性和报告不足，无法进行定量荟萃分析。
26项试验共纳入1151例患者（中位数为37例；范围为10 - 150例）符合纳入标准。16项试验在偏头痛患者中进行，6项在紧张型头痛患者中进行，4项在各种类型头痛患者中进行。大多数试验存在方法学和/或报告方面的缺陷。在16项比较偏头痛和紧张型头痛患者真针灸与假（安慰剂）针灸的试验中，8项试验报告真针灸明显更优；4项试验有真针灸更优的趋势；2项试验两种干预措施无差异。（2项试验无法解读。）10项比较针灸与其他治疗形式的试验得出相互矛盾的结果。
总体而言，现有证据支持针灸治疗特发性头痛的价值。然而，证据的质量和数量并不完全令人信服。迫切需要精心设计的大规模研究，以评估现实生活条件下针灸的有效性和成本效益。
