Acupuncture versus tricyclic antidepressants in the prophylactic treatment of tension-type headaches: an indirect treatment comparison meta-analysis.
Study Goal
The researchers aimed to compare the effectiveness of acupuncture versus tricyclic antidepressants (TCAs) in reducing tension-type headache (TTH) frequency and intensity.
Results Summary
Acupuncture showed similar effectiveness to TCAs in reducing TTH frequency and intensity but had a lower adverse event rate compared to amitriptyline. The evidence certainty was rated as very low.
Population
Adults with tension-type headache.
Effective Dosage
Not specified
Duration
Not specified
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
Acupuncture | decrease | attack frequency of tension-type headache | - | - | showed better improvement | #1 |
Acupuncture | decrease | TTH frequency | adults | mean difference -1.29, 95% CI -5.28 to 3.02 (vs amitriptyline) | had similar effect with TCAs | #2 |
Acupuncture | decrease | TTH frequency | adults | mean difference -0.05, 95% CI -6.86 to 7.06 (vs amitriptylinoxide) | had similar effect with TCAs | #3 |
Acupuncture | decrease | TTH intensity | adults | mean difference 2.35, 95% CI -1.20 to 5.78 (vs amitriptyline) | had similar effect with TCAs | #4 |
Acupuncture | decrease | TTH intensity | adults | mean difference 1.83, 95% CI -4.23 to 8.20 (vs clomipramine) | had similar effect with TCAs | #5 |
Amitriptyline | increase | adverse events | adults | OR 4.73, 95% CI 1.42 to 14.23 | had a higher rate | #6 |
Acupuncture | decrease | adverse events | adults | - | had a lower adverse events rate | #7 |
BACKGROUND: Acupuncture showed better improvement than sham acupuncture in reducing attack frequency of tension-type headache (TTH), but its effectiveness relative to first-line drugs for TTH is unknown, which impedes the recommendation of acupuncture for patients who are intolerant to drugs for TTH. We aimed to estimate the relative effectiveness between acupuncture and tricyclic antidepressants (TCAs) through indirect treatment comparison (ITC) meta-analysis. METHODS: We searched Ovid Medline, Embase, and Cochrane Library from database inception until April 13, 2023. Randomized controlled trials of TCAs or acupuncture in the prevention of TTH in adults were included. The primary outcome was headache frequency. The secondary outcomes were headache intensity, responder rate, and adverse event rate. Bayesian random-effect models were used to perform ITC meta-analysis, and confidence of evidence was evaluated by using the GRADE approach. RESULTS: A total of 34 trials involving 4426 participants were included. Acupuncture had similar effect with TCAs in decreasing TTH frequency (amitriptyline: mean difference [MD] -1.29, 95% CI -5.28 to 3.02; amitriptylinoxide: MD -0.05, 95% CI -6.86 to 7.06) and reducing TTH intensity (amitriptyline: MD 2.35, 95% CI -1.20 to 5.78; clomipramine: MD 1.83, 95% CI -4.23 to 8.20). Amitriptyline had a higher rate of adverse events than acupuncture (OR 4.73, 95% CI 1.42 to 14.23). CONCLUSION: Acupuncture had similar effect as TCAs in reducing headache frequency of TTH, and acupuncture had a lower adverse events rate than amitriptyline, as shown by very low certainty of evidence.