Acupuncture for Headache

Acupuncture, a traditional Chinese medicine technique involving the insertion of thin needles into specific points on the body, has been investigated in numerous clinical trials and randomized controlled trials (RCTs) as a potential treatment for headache. This interest stems from its purported ability to modulate pain pathways and reduce inflammation, suggesting a possible role in managing headache pain and associated symptoms. The effectiveness of acupuncture for headache remains a subject of ongoing research and debate.

Protocols Studied in Research

[1] True acupuncture (TA) for Chronic Tension-Type Headache (CTTH). (Cited by: 7) (pmid: 35732505)

• Protocol: A randomized controlled trial (RCT) with 218 CTTH patients. The TA group received 20 30-minute acupuncture sessions over 8 weeks, aiming for deqi sensation. A sham acupuncture (SA) control group received similar sessions without deqi.
• Outcome: TA was significantly more effective than SA in reducing monthly headache days at both 16 and 32 weeks post-randomization, improving responder rates. The effect was sustained at 32 weeks.

[2] True acupuncture vs. sham acupuncture vs. waiting list for migraine prophylaxis in patients with migraine without aura. (Cited by: 167) (pmid: 28241154)

• Protocol: A 24-week randomized controlled trial (RCT) in China involving 245 participants with migraine (18-65 years old). Participants received 20 acupuncture sessions (true or sham) over 4 weeks, followed by 20 weeks of follow-up. A waiting list control group received no treatment initially.
• Outcome: True acupuncture demonstrated a significantly greater long-term reduction in migraine frequency compared to both sham acupuncture and the waiting list. Sham acupuncture showed no significant benefit over the waiting list.

[3] Acupuncture and medical training therapy for tension-type headache (TTH). (Cited by: 4) (pmid: 36622877)

• Protocol: A randomized controlled trial (RCT) of 96 adults with frequent TTH compared acupuncture, medical training therapy, their combination, and usual care over six months. Interventions consisted of 12 sessions over six weeks.
• Outcome: Acupuncture, alone or combined with medical training, significantly reduced depression, anxiety, and improved quality of life in patients with TTH compared to medical training therapy alone or usual care. No additive benefit of the combination was observed.

[4] Spinal manipulation plus electrical dry needling vs. spinal mobilization and exercise for cervicogenic headache (CH). (Cited by: 7) (pmid: 33065273)

• Protocol: A multicenter randomized controlled trial comparing two interventions for CH in 142 patients. One group received spinal manipulation and electrical dry needling; the other received spinal mobilization and exercise. Treatment lasted 4 weeks with 3-month follow-up.
• Outcome: Spinal manipulation and electrical dry needling yielded significantly greater improvements in headache intensity, frequency, duration, disability, and medication use compared to spinal mobilization and exercise at 3 months. Effects were large and sustained.

[5] Upper cervical and upper thoracic manipulation versus mobilization and exercise for cervicogenic headache (CH). (Cited by: 35) (pmid: 26852024)

• Protocol: A multi-center randomized clinical trial (RCT) compared manipulation vs. mobilization and exercise in 110 CH patients. Treatment lasted 4 weeks with follow-ups at 1 week, 4 weeks, and 3 months.
• Outcome: Manipulation was significantly more effective than mobilization and exercise in reducing headache intensity, frequency, duration, and disability at all follow-up points, with effects sustained at 3 months.

[6] Trigger point dry needling for chronic tension-type headache. (Cited by: 19) (pmid: 30813155)

• Protocol: A randomized, double-blind trial compared trigger point dry needling to sham needling in 160 patients. Treatment involved three sessions per week for two weeks.
• Outcome: Trigger point dry needling significantly reduced headache intensity, frequency, and duration, and improved quality of life compared to sham needling. Effects were large.

[7] Acupuncture for primary dysmenorrhea. (Cited by: 18) (pmid: 29654840)

• Protocol: A randomized controlled trial comparing acupuncture (20 minutes/day for 15 days/month over 90 days) to no treatment in 60 women (17-23 years old) with primary dysmenorrhea. Assessments were at baseline and days 30, 60, and 90.
• Outcome: Acupuncture significantly reduced pain, menstrual cramps, and other associated symptoms (headache, dizziness, etc.) compared to the control group, suggesting its effectiveness in managing primary dysmenorrhea.

[8] 5 vs. 10 sessions of acupuncture for migraine prevention and pain reduction. (Cited by: 3) (pmid: 34886700)

• Protocol: A randomized, controlled, open-label multicenter trial in Thailand assigned 156 migraine patients to receive either 5 or 10 acupuncture sessions (twice weekly). Outcomes were measured at 4 weeks post-treatment.
• Outcome: Both 5 and 10 sessions of acupuncture showed similar significant improvements in migraine frequency, pain severity, and quality of life at 4 weeks. Non-inferiority of 5 sessions to 10 sessions was not definitively proven.

[9] Acupuncture and therapeutic exercise for tension-type headache, assessing impact on temporomandibular dysfunction (TMD). (Cited by: 1) (pmid: 38304940)

• Protocol: A randomized controlled trial (RCT) with 96 participants with tension-type headaches assigned to acupuncture, therapeutic exercise, combination therapy, or usual care. Interventions lasted six weeks, with 3 and 6-month follow-ups.
• Outcome: Acupuncture showed lasting improvement in TMD symptoms at 6 months. Therapeutic exercise showed short-term improvement. Pre-existing significant dental findings may negatively affect acupuncture's efficacy for headache treatment.

[10] Frequency-controlled ear acupuncture for COVID-19-related olfactory dysfunction. (Cited by: 0) (pmid: 38686430)

• Protocol: A randomized, participant-blind clinical trial with 40 patients. The intervention group received two ear acupuncture sessions; the control group received sham laser treatment. Both groups used nasal betamethasone.
• Outcome: Frequency-controlled ear acupuncture significantly improved smell quality in patients with COVID-19-related olfactory dysfunction compared to the control group. Minor side effects were reported in a few participants.

[11] Acupuncture for chronic headache disorders (predominantly migraine). (Cited by: 24) (pmid: 15527670)

• Protocol: A randomized controlled trial in English and Welsh general practices compared acupuncture (up to 12 treatments over 3 months) to usual care in 401 patients with chronic headache.
• Outcome: Acupuncture resulted in lower headache scores, less medication use, fewer GP visits, and less sick leave at 12 months. While initially more costly, it showed cost-effectiveness compared to other NHS interventions, yielding a significant health gain (0.021 QALYs).

[12] Acupuncture and medical training therapy for tension-type headache. (Cited by: 11) (pmid: 33563049)

• Protocol: A randomized controlled trial compared usual care to acupuncture, medical training, and their combination in 95 adult tension-type headache patients. Each intervention lasted 6 weeks with 12 sessions, followed by 3 and 6-month follow-ups.
• Outcome: Only the combined acupuncture and medical training therapy significantly reduced pain intensity compared to usual care. Monotherapies showed no significant benefit over usual care, although all intervention groups had higher responder rates at 6 months.

[13] Acupuncture for episodic tension-type headache prevention. (Cited by: 26) (pmid: 11128820)

• Protocol: A multicenter, randomized controlled trial compared brief acupuncture to a sham procedure in 50 participants followed for 3 months. Daily headache diaries tracked outcomes.
• Outcome: The study found no significant difference in headache days between the acupuncture and sham groups, concluding that the tested acupuncture treatment was ineffective for preventing episodic tension-type headaches.

[14] Acupuncture for unspecified conditions. (Cited by: 3) (pmid: 324361)

• Protocol: No abstract provided; impossible to summarize protocol.
• Outcome: No abstract provided; impossible to summarize outcomes.

[15] Acupuncture for Chronic Tension-Type Headache (CTTH) (Cited by: 0) (pmid: 38206534)

• Protocol: A randomized controlled trial (RCT) with 218 participants assessed CTTH patients over 24 weeks. Participants received either true or superficial acupuncture. Response was defined as ≥50% reduction in monthly headache days at week 16.
• Outcome: True acupuncture was more effective than sham acupuncture. Higher baseline headache intensity, better social functioning, and poorer general health were associated with better acupuncture response. These findings need further validation.

[16] Acupuncture for tension-type headache. (Cited by: 125) (pmid: 16055451)

• Protocol: A three-armed randomized controlled trial compared acupuncture, minimal acupuncture (sham), and a waiting list control in 270 headache patients. Treatment involved 12 sessions over eight weeks.
• Outcome: Acupuncture was significantly more effective than no treatment, but not significantly better than minimal acupuncture in reducing headache days. A larger proportion of patients in the acupuncture group showed at least a 50% reduction in headache days.

[17] Verum and sham acupuncture for tension-type headache (TTH). (Cited by: 49) (pmid: 17955168)

• Protocol: A multicenter, randomized, blinded trial of 409 TTH patients in Germany received either verum or sham acupuncture (10 30-min sessions over six weeks) administered by trained physicians.
• Outcome: Verum acupuncture showed a small but statistically significant benefit over sham acupuncture in reducing headache days and improving other secondary outcome measures, although the primary outcome (≥50% reduction in headache days) did not reach statistical significance.

[18] Acupuncture as an adjunct to medical management for chronic daily headache (CDH). (Cited by: 24) (pmid: 16178942)

• Protocol: A randomized controlled trial of 74 CDH patients compared medical management alone to medical management plus 10 acupuncture treatments. Neurologists provided medical management.
• Outcome: Medical management alone showed no improvement. Adding acupuncture improved health-related quality of life and patient-reported headache suffering, with a significant improvement in several QoL domains.

[19] Acupuncture for migraine and tension-type headache. (Cited by: 11) (pmid: 12972722)

• Protocol: Two randomized controlled trials compared semi-standardized acupuncture, minimal acupuncture, and no treatment in 300 migraine and 300 tension-type headache patients across 30 German centers. Treatment involved 12 acupuncture sessions over 8 weeks.
• Outcome: The abstract does not present the study results; it only states that the results (available in 2004) would inform healthcare decisions regarding acupuncture efficacy.

[20] Acupuncture versus superficial acupuncture for chronic tension-type headache (CTTH). (Cited by: 4) (pmid: 28974247)

• Protocol: A 218-participant, randomized controlled trial in China comparing 20 sessions of acupuncture versus superficial acupuncture over 8 weeks, followed by a 24-week follow-up. Outcomes were assessed at multiple time points.
• Outcome: The abstract describes the study protocol; no results or conclusions regarding the intervention's effect are presented. The study aims to provide evidence on the long-term effect of acupuncture for CTTH.

[21] Needle acupuncture for tension-type headache. (Cited by: 26) (pmid: 11531895)

• Protocol: A randomized, placebo-controlled trial of 69 patients with tension-type headaches compared verum acupuncture to a novel placebo acupuncture method. Treatment was administered and outcomes assessed at multiple time points.
• Outcome: No significant difference was found between verum and placebo acupuncture in headache frequency or pain intensity. Verum acupuncture showed a small, statistically significant improvement in quality of life, but this varied depending on baseline headache frequency and depression levels.

[22] Acupuncture/stretching with or without added myofascial release and microwave diathermy for tension-type headache (TTH). (Cited by: 10) (pmid: 29266633)

• Protocol: A single-blind, randomized controlled trial compared acupuncture/stretching (control) versus acupuncture/stretching plus physiotherapy (experimental) in 44 TTH patients over 10 sessions. Mechanical pressure pain threshold (PPT) was the primary outcome.
• Outcome: Both groups showed improved PPT. However, the group receiving added physiotherapy (myofascial release and microwave diathermy) showed significantly greater PPT improvement after 10 sessions. The combined therapy is recommended.

[23] Acupuncture plus massage for cervicogenic headache (CGH). (Cited by: 1) (pmid: 35089247)

• Protocol: A systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating acupuncture combined with massage for CGH, searching multiple databases for studies published before November 2021. Outcomes included pain, neck function, quality of life, and adverse events.
• Outcome: The study anticipates providing evidence supporting the effectiveness and safety of combined acupuncture and massage therapy for CGH; however, this is a protocol and no results from the analysis are presented.

[24] Combined sphenopalatine ganglion and conventional acupuncture for episodic cluster headache. (Cited by: 0) (pmid: 35712941)

• Protocol: A randomized controlled trial comparing combined acupuncture, conventional acupuncture, and sphenopalatine ganglion acupuncture in 180 episodic cluster headache patients. Treatments were administered over 6 weeks.
• Outcome: Combined acupuncture was significantly more effective than either conventional acupuncture or sphenopalatine ganglion acupuncture alone in reducing headache pain, frequency, duration, and improving quality of life.

[25] Photobiomodulation therapy and occlusal splint therapy for sleep bruxism (SB) in children. (Cited by: 4) (pmid: 32990504)

• Protocol: A randomized controlled trial comparing photobiomodulation therapy (laser to acupuncture points), occlusal splint therapy, sham laser therapy, and a control group in 76 children (6-12 years) with SB. Clinical signs, bite force, and salivary cortisol were measured before and after treatment.
• Outcome: Bite marks on the buccal mucosa correlated with SB. Photobiomodulation therapy reduced headache and bite force in children with SB, showing comparable effectiveness to occlusal splints. Salivary cortisol increased in all groups post-treatment.

[26] Acupuncture as an adjunct to conventional migraine prophylaxis for migraine headaches. (Cited by: 13) (pmid: 24185211)

• Protocol: A sham-controlled trial randomized 100 migraine patients (with inadequate response to prophylactic drugs) into true and sham acupuncture groups. Each group received 12 sessions (30 min, 3x/week) over four months while continuing their prophylactic medication.
• Outcome: True acupuncture significantly reduced migraine attack frequency compared to sham acupuncture after one month, with the benefit persisting at four months, although the reduction lessened over time.

[27] Low-level 810 nm laser acupuncture as an add-on preventive therapy for chronic migraine in adults with unsatisfactory pharmacological response. (Cited by: 0) (pmid: 39198866)

• Protocol: A single-blind, randomized controlled trial (RCT) compared laser acupuncture (LA) to sham LA in 60 chronic migraine patients over 8 sessions (4 weeks). Participants were evaluated at baseline, 4, 8, and 12 weeks.
• Outcome: LA significantly reduced monthly migraine days and acute medication use compared to sham treatment, with effects increasing over the 12-week follow-up. No serious adverse events were reported. The study suggests LA as a promising add-on therapy.

[28] Acupuncture with Tiaochong Shugan method versus ibuprofen for menstrual headache. (Cited by: 1) (pmid: 37199200)

• Protocol: A randomized controlled trial comparing acupuncture (with point selection varying by menstrual cycle phase) to ibuprofen in 90 women with menstrual headache over three menstrual cycles.
• Outcome: Acupuncture demonstrated superior analgesic effects and a higher total effective rate compared to ibuprofen in reducing menstrual headache severity and recurrence, and improving related symptoms.

[29] Acupressure versus muscle relaxant medication for chronic headache. (Cited by: 12) (pmid: 20128040)

• Protocol: A randomized controlled trial (RCT) of 28 chronic headache sufferers; 14 received acupressure at specific trigger points, 14 received muscle relaxant medication. Pain and quality of life were assessed at baseline, 1 month, and 6 months.
• Outcome: Acupressure demonstrated significantly greater pain reduction than muscle relaxants at both 1-month and 6-month follow-ups, with improvements in headache-related quality of life also observed.

[30] Laser acupuncture for childhood headaches (migraine and tension-type). (Cited by: 24) (pmid: 18022318)

• Protocol: A double-blind, randomized, placebo-controlled trial with 43 children (mean age 12.3 years) receiving 4 weeks of active or placebo laser acupuncture treatments based on Traditional Chinese Medicine principles.
• Outcome: Active laser acupuncture significantly reduced headache days (6.4 days vs. 1.0 day in placebo), headache severity, and monthly headache hours compared to placebo and baseline. Active treatment was superior to placebo.

[31] Botulinum toxin A (BTX) injections for Borderline Personality Disorder (BPD). (Cited by: 7) (pmid: 35102782)

• Protocol: A 16-week, single-blind, two-center randomized controlled trial comparing BTX injections to minimal acupuncture in 54 BPD patients. Outcomes were assessed at multiple time points.
• Outcome: No significant difference was found between BTX and acupuncture in improving BPD symptoms. Both groups showed improvement, but the BTX intervention was not superior. Further research with improved control conditions is needed.

[32] Resuscitation acupuncture versus pregabalin for thalamic pain. (Cited by: 2) (pmid: 29231316)

• Protocol: A randomized controlled trial comparing acupuncture and pregabalin in 64 patients with thalamic pain. Treatment lasted 8 weeks, with acupuncture administered twice daily at specific acupoints, and pregabalin (75mg twice daily) given orally.
• Outcome: Acupuncture demonstrated superior long-term pain relief compared to pregabalin for thalamic pain, showing significantly higher effectiveness rates at 8 weeks and 3-month follow-up. Acupuncture also resulted in lower plasma P substance and higher beta-endorphin levels.

[33] Laser auricular acupuncture for smoking cessation. (Cited by: 2) (pmid: 34221476)

• Protocol: A randomized controlled trial (RCT) in India with 60 smokers randomly assigned to three groups: laser acupuncture only, psychological counseling only, and combined laser acupuncture and counseling. Outcomes were measured using cotinine levels, Fagerstrom questionnaire, and visual analog scale at baseline and one month post-intervention.
• Outcome: Laser auricular acupuncture, alone or combined with counseling, significantly reduced nicotine dependence and improved physical effects related to smoking. The laser-only group showed the greatest reduction in nicotine dependence, while the combined group showed the greatest reduction in cotinine levels.

[34] Electroacupuncture on distal acupoints for tension-type headache. (Cited by: 17) (pmid: 15109358)

• Protocol: A randomized, single-blinded, crossover trial with 40 patients compared real electroacupuncture to sham electroacupuncture over two 4-week phases, separated by a washout period.
• Outcome: Electroacupuncture applied to distal acupoints provided significant short-term relief of tension-type headache symptoms (frequency, duration, intensity, disability) compared to sham treatment, though effects were not sustained at follow-up.

[35] Acupuncture-like electrical stimulation (ALES) for chronic tension-type headache (TTH). (Cited by: 8) (pmid: 17449992)

• Protocol: A randomized, double-blinded, placebo-controlled trial with 36 chronic TTH patients. Participants used either ALES or sham devices at home, stimulating six acupoints twice daily for 3 minutes each. Outcomes were assessed at multiple time points.
• Outcome: While both ALES and placebo groups showed improvement in pain, the difference wasn't statistically significant. ALES resulted in decreased analgesic use, suggesting potential analgesic-sparing effects, although the overall clinical effect was marginal.

[36] Needle acupuncture for chronic tension-type headache. (Cited by: 19) (pmid: 11050375)

• Protocol: A double-blind, placebo-controlled study of 39 patients with chronic tension-type headache randomly assigned to verum or placebo acupuncture. Treatment lasted for an unspecified duration.
• Outcome: While acupuncture showed no significant impact on headache frequency or pain intensity (VAS), it did significantly increase pressure pain thresholds in the verum group, suggesting a minor role for peripheral muscle mechanisms in chronic tension-type headache.

[37] Penetrating moxibustion for migraine without aura (MO). (Cited by: 2) (pmid: 33881716)

• Protocol: A randomized controlled trial comparing penetrating moxibustion to mild moxibustion in 60 MO patients. Treatment occurred thrice weekly for four weeks, with 4 and 16-week follow-ups.
• Outcome: Penetrating moxibustion showed a significantly higher total effective rate and greater improvement in pain and quality of life compared to mild moxibustion, with no significant difference in adverse events.

[38] Body acupuncture combined with auricular acupressure for menstrual headache (with "liver fire" hyperactivity). (Cited by: 2) (pmid: 25845225)

• Protocol: A randomized controlled trial comparing body acupuncture and auricular acupressure to Flunarizine Hydrochloride in 85 women with menstrual headache and "liver fire" hyperactivity. Treatment involved specific acupuncture points and auricular pellet pressure.
• Outcome: The combined acupuncture treatment showed significantly better results in relieving menstrual headache symptoms and reducing headache duration compared to Flunarizine Hydrochloride, with a higher effective rate.

[39] Acupuncture as an add-on analgesic intervention for non-emergent acute non-specific neck pain, ankle sprain, and primary headache. (Cited by: 8) (pmid: 24928587)

• Protocol: A randomized controlled pilot trial (RCT) of 40 ED patients with moderate-to-severe pain after initial analgesic treatment. Patients were randomly assigned to receive acupuncture plus standard ED care or standard ED care alone. Pain reduction at discharge was the primary outcome.
• Outcome: The abstract does not present results; it is a study protocol describing the planned methods for a pilot trial designed to assess the feasibility of acupuncture in an ED setting and to inform a larger-scale trial.

[40] Electroacupuncture (EA) for Chronic Tension-Type Headache (CTTH) pain relief. (Cited by: 23) (pmid: 25947167)

• Protocol: A randomized, blinded, placebo-controlled crossover trial comparing EA to sham EA in 29 women with CTTH. Ten 30-minute EA sessions (2-10 Hz) were given twice weekly. Pain (VAS) and serum BDNF were measured.
• Outcome: EA was significantly more effective than sham in reducing pain. Higher serum BDNF levels were associated with EA treatment, suggesting a link between EA analgesia and neuroplasticity. The effect was influenced by pre-existing depression levels and treatment order.

Research Interpretation: Summary and Conclusion

The reviewed studies employed diverse acupuncture protocols, including variations in needle type (e.g., dry needling, electroacupuncture), point selection, session frequency and duration, and the use of sham controls or alternative treatments. While many studies demonstrated statistically significant benefits of acupuncture compared to sham procedures, waiting lists, or other interventions in reducing headache frequency, intensity, and duration, and improving quality of life, some studies found no significant difference between verum and sham acupuncture. Consistent findings across multiple studies highlight the potential efficacy of acupuncture for various headache types, particularly tension-type and migraine headaches. However, the heterogeneity in study designs, outcome measures, and participant populations limits the ability to draw definitive conclusions about acupuncture's overall effectiveness. Further research with standardized protocols and larger sample sizes is needed to clarify the precise role and efficacy of acupuncture in headache management. The observed inconsistencies may also reflect the need for individualised treatment approaches based on patient characteristics.

Publications

[1] Zheng H; Gao T; Zheng QH; Lu LY; Hou TH; Zhang SS; Zhou SY; Hao XY; Wang L; Zhao L; Liang FR; Li Y (2022). Acupuncture for Patients With Chronic Tension-Type Headache: A Randomized Controlled Trial Neurology 99 (14) :e1560-e1569.

[2] Zhao L; Chen J; Li Y; Sun X; Chang X; Zheng H; Gong B; Huang Y; Yang M; Wu X; Li X; Liang F (2017). The Long-term Effect of Acupuncture for Migraine Prophylaxis: A Randomized Clinical Trial JAMA internal medicine 177 (4) :508-515.

[3] Schiller J; Niederer D; Kellner T; Eckhardt I; Egen C; Zheng W; Korallus C; Achenbach J; Ranker A; Sturm C; Vogt L; Gutenbrunner C; Fink MG; Karst M (2023). Effects of acupuncture and medical training therapy on depression, anxiety, and quality of life in patients with frequent tension-type headache: A randomized controlled study Cephalalgia : an international journal of headache 43 (1) :3331024221132800.

[4] Dunning J; Butts R; Zacharko N; Fandry K; Young I; Wheeler K; Day J; Fernandez-de-Las-Penas C (2021). Spinal manipulation and perineural electrical dry needling in patients with cervicogenic headache: a multicenter randomized clinical trial The spine journal : official journal of the North American Spine Society 21 (2) :284-295.

[5] Dunning JR; Butts R; Mourad F; Young I; Fernandez-de-Las Penas C; Hagins M; Stanislawski T; Donley J; Buck D; Hooks TR; Cleland JA (2016). Upper cervical and upper thoracic manipulation versus mobilization and exercise in patients with cervicogenic headache: a multi-center randomized clinical trial BMC musculoskeletal disorders 17 :64.

[6] Gildir S; Tuzun EH; Eroglu G; Eker L (2019). A randomized trial of trigger point dry needling versus sham needling for chronic tension-type headache Medicine 98 (8) :e14520.

[7] Shetty GB; Shetty B; Mooventhan A (2018). Efficacy of Acupuncture in the Management of Primary Dysmenorrhea: A Randomized Controlled Trial Journal of acupuncture and meridian studies 11 (4) :153-158.

[8] Supasiri T; Jariengprasert C; Phithaksilp M; Sangtongpanichakul P; Anotayanonth S; Buranatawonsom T; Pongpirul K (2022). A randomized controlled clinical trial comparing different numbers of acupuncture sessions for migraine Acupuncture in medicine : journal of the British Medical Acupuncture Society 40 (3) :215-223.

[9] Schiller J; Buttner A; Niederer D; Bokel A; Korallus C; Sturm C; Vogt L; Gutenbrunner C; Karst M; Fink M; Egen C (2024). Effects on temporomandibular disorder in the treatment of tension-type headache with acupuncture and therapeutic exercises. A secondary analysis from a randomized controlled trial Clinical rehabilitation 38 (5) :623-635.

[10] Mohebbi A; Bagheri SH; Raziabadi E; Shafiei A; Roomiani M; Arab M; Dehdari L (2024). Effects of Frequency-Controlled Ear Acupuncture on COVID-19- related Refractory Olfactory Dysfunction: a Randomized Clinical Trial Journal of acupuncture and meridian studies 17 (2) :69-75.

[11] Vickers AJ; Rees RW; Zollman CE; McCarney R; Smith CM; Ellis N; Fisher P; Van Haselen R; Wonderling D; Grieve R (2004). Acupuncture of chronic headache disorders in primary care: randomised controlled trial and economic analysis Health technology assessment (Winchester, England) 8 (48) :iii, 1-35.

[12] Schiller J; Karst M; Kellner T; Zheng W; Niederer D; Vogt L; Eckhardt I; Beissner F; Korallus C; Sturm C; Egen C; Gutenbrunner C; Fink MG (2021). Combination of acupuncture and medical training therapy on tension type headache: Results of a randomised controlled pilot study Cephalalgia : an international journal of headache 41 (8) :879-893.

[13] White AR; Resch KL; Chan JC; Norris CD; Modi SK; Patel JN; Ernst E (2000). Acupuncture for episodic tension-type headache: a multicentre randomized controlled trial Cephalalgia : an international journal of headache 20 (7) :632-7.

[14] Millman BS (1977). Acupuncture: context and critique Annual review of medicine 28 :223-34.

[15] Cao W; Wang L; Hou TH; Shi YZ; Zheng QH; Zheng H; Zou ZH; Qin D; Yang Q; Chen SJ; Wang HY; Xiao XJ; Li Y (2024). Disease-Related Factors Associated with Acupuncture Response in Patients with Chronic Tension-Type Headache: A Secondary Analysis of A Randomized Controlled Trial Chinese journal of integrative medicine 30 (8) :684-691.

[16] Melchart D; Streng A; Hoppe A; Brinkhaus B; Witt C; Wagenpfeil S; Pfaffenrath V; Hammes M; Hummelsberger J; Irnich D; Weidenhammer W; Willich SN; Linde K (2005). Acupuncture in patients with tension-type headache: randomised controlled trial BMJ (Clinical research ed.) 331 (7513) :376-82.

[17] Endres HG; Bowing G; Diener HC; Lange S; Maier C; Molsberger A; Zenz M; Vickers AJ; Tegenthoff M (2007). Acupuncture for tension-type headache: a multicentre, sham-controlled, patient-and observer-blinded, randomised trial The journal of headache and pain 8 (5) :306-14.

[18] Coeytaux RR; Kaufman JS; Kaptchuk TJ; Chen W; Miller WC; Callahan LF; Mann JD (2005). A randomized, controlled trial of acupuncture for chronic daily headache Headache 45 (9) :1113-23.

[19] Melchart D; Linde K; Streng A; Reitmayr S; Hoppe A; Brinkhaus B; Becker-Witt C; Wagenpfeil S; Pfaffenrath V; Hammes M; Willich SN; Weidenhammer W (2003). Acupuncture Randomized Trials (ART) in patients with migraine or tension-type headache--design and protocols Forschende Komplementarmedizin und klassische Naturheilkunde = Research in complementary and natural classical medicine 10 (4) :179-84.

[20] Lu L; Zheng H; Zheng Q; Hao X; Zhou S; Zhang S; Wei T; Gao T; Duan D; Zhao L; Li N; Li Y (2017). The long-term effect of acupuncture for patients with chronic tension-type headache: study protocol for a randomized controlled trial Trials 18 (1) :453.

[21] Karst M; Reinhard M; Thum P; Wiese B; Rollnik J; Fink M (2001). Needle acupuncture in tension-type headache: a randomized, placebo-controlled study Cephalalgia : an international journal of headache 21 (6) :637-42.

[22] Georgoudis G; Felah B; Nikolaidis P; Damigos D (2018). The effect of myofascial release and microwave diathermy combined with acupuncture versus acupuncture therapy in tension-type headache patients: A pragmatic randomized controlled trial Physiotherapy research international : the journal for researchers and clinicians in physical therapy 23 (2) :e1700.

[23] Ding F; Liu Z; Li R; Wang C; Lu Y (2022). Acupuncture plus massage for cervicogenic headache: A protocol for systematic review and meta-analysis Medicine 101 (4) :e28736.

[24] Zai FL; Ji LX; Cheng JH; Chen YR; Liu H (2022). [Acupuncture at sphenopalatine ganglion combined with conventional acupuncture for episodic cluster headache: a randomized controlled trial] Zhongguo zhen jiu = Chinese acupuncture & moxibustion 42 (6) :603-7.

[25] Salgueiro MDCC; Kobayashi FY; Motta LJ; Goncalves MLL; Horliana ACRT; Mesquita-Ferrari RA; Fernandes KPS; Gomes AO; Junior AB; Bussadori SK (2021). Effect of Photobiomodulation on Salivary Cortisol, Masticatory Muscle Strength, and Clinical Signs in Children with Sleep Bruxism: A Randomized Controlled Trial Photobiomodulation, photomedicine, and laser surgery 39 (1) :23-29.

[26] Foroughipour M; Golchian AR; Kalhor M; Akhlaghi S; Farzadfard MT; Azizi H (2014). A sham-controlled trial of acupuncture as an adjunct in migraine prophylaxis Acupuncture in medicine : journal of the British Medical Acupuncture Society 32 (1) :12-6.

[27] Wu HY; Wang CS; Liu YC; Chung CC; Chen WL; Tsai CI; Hsu CY; Chou CH (2024). Enhancing chronic migraine preventive therapy: low-level 810 nm laser acupuncture as an add-on treatment for patients with unsatisfactory pharmacological effect, a pilot single-blind randomized controlled trial BMC complementary medicine and therapies 24 (1) :318.

[28] Li JN; Li J; Liu J; Chen J; Tian HC; Ding S (2022). [Acupuncture with Tiaochong Shugan method by stages for menstrual headache based on syndrome differentiation: a randomized controlled trial] Zhongguo zhen jiu = Chinese acupuncture & moxibustion 42 (10) :1108-12.

[29] Hsieh LL; Liou HH; Lee LH; Chen TH; Yen AM (2010). Effect of acupressure and trigger points in treating headache: a randomized controlled trial The American journal of Chinese medicine 38 (1) :1-14.

[30] Gottschling S; Meyer S; Gribova I; Distler L; Berrang J; Gortner L; Graf N; Shamdeen GM (2008). Laser acupuncture in children with headache: a double-blind, randomized, bicenter, placebo-controlled trial Pain 137 (2) :405-412.

[31] Wollmer MA; Neumann I; Jung S; Bechinie A; Herrmann J; Muller A; Wohlmuth P; Fournier-Kaiser L; Sperling C; Peters L; Kneer J; Engel J; Jurgensen F; Schulze J; Nagel M; Prager W; Sinke C; Kahl KG; Karst M; Dulz B; Kruger THC (2022). Clinical effects of glabellar botulinum toxin injections on borderline personality disorder: A randomized controlled trial Journal of psychopharmacology (Oxford, England) 36 (2) :159-169.

[32] Li Y; Tian H; An L; Shi X (2017). [Resuscitation acupuncture for thalamic pain:a randomized controlled trial] Zhongguo zhen jiu = Chinese acupuncture & moxibustion 37 (1) :14-18.

[33] Yavagal PC; L N (2021). Efficacy of Laser Auricular Acupuncture for Smoking Cessation: A randomised controlled trial Sultan Qaboos University medical journal 21 (2) :e275-e281.

[34] Xue CC; Dong L; Polus B; English RA; Zheng Z; Da Costa C; Li CG; Story DF (2004). Electroacupuncture for tension-type headache on distal acupoints only: a randomized, controlled, crossover trial Headache 44 (4) :333-41.

[35] Wang K; Svensson P; Arendt-Nielsen L (2007). Effect of acupuncture-like electrical stimulation on chronic tension-type headache: a randomized, double-blinded, placebo-controlled trial The Clinical journal of pain 23 (4) :316-22.

[36] Karst M; Rollnik JD; Fink M; Reinhard M; Piepenbrock S (2000). Pressure pain threshold and needle acupuncture in chronic tension-type headache--a double-blind placebo-controlled study Pain 88 (2) :199-203.

[37] Gao L; Xie J; Li X; Guo YJ; Zhang MM; Meng LY; Lin QT; Gao XY (2021). Effect and Safety of Penetrating Moxibustion in Treatment of Migraine without Aura: A Randomized Controlled Trial Chinese journal of integrative medicine 27 (12) :927-932.

[38] Sun LH; Li XH; Li WL; Liu L; Ma HL; Liang YL (2015). [Body acupuncture combined with auricular acupressure for menstrual headache: a randomized controlled clinical trial] Zhen ci yan jiu = Acupuncture research 40 (1) :70-4.

[39] Kim KH; Ryu JH; Park MR; Kim YI; Min MK; Park YM; Kim YR; Noh SH; Kang MJ; Kim YJ; Kim JK; Lee BR; Choi JY; Yang GY (2014). Acupuncture as analgesia for non-emergent acute non-specific neck pain, ankle sprain and primary headache in an emergency department setting: a protocol for a parallel group, randomised, controlled pilot trial BMJ open 4 (6) :e004994.

[40] Chassot M; Dussan-Sarria JA; Sehn FC; Deitos A; de Souza A; Vercelino R; Torres IL; Fregni F; Caumo W (2015). Electroacupuncture analgesia is associated with increased serum brain-derived neurotrophic factor in chronic tension-type headache: a randomized, sham controlled, crossover trial BMC complementary and alternative medicine 15 :144.