A Bibliometric Analysis of Acupuncture Treatment of Tension-Type Headache from 2003 to 2022

This study represents the first comprehensive bibliometric analysis on the use of acupuncture in the treatment of tension-type headache, offering a broad view of what scientific research has uncovered about this important therapeutic application over the past two decades. Tension-type headache is the most common type of headache in clinical practice, characterized by mild to moderate pressing or constricting pain that usually affects both sides of the head and does not worsen with routine daily activities.

The public health relevance of this condition is striking. Epidemiological studies show that the lifetime prevalence of tension-type headache in the general population ranges from 30% to 78%, reaching 87% in some groups, with a global prevalence of 42% in adults. The disease typically begins around age 20, peaks between 35 and 40 years, and is slightly more common in women. According to an analysis from the global burden of disease system published in The Lancet, among the eight main chronic diseases that affect more than 10% of the world's population, tension-type headache ranks second.

This condition causes a significant impact on work efficiency and the social life of patients, substantially increasing the socioeconomic burden on society.

The researchers conducted a systematic bibliometric analysis using CiteSpace software, examining all publications related to the treatment of tension-type headache with acupuncture between 2003 and 2022. They collected data from the Web of Science Core Collection database, analyzing 231 publications that met the established criteria. The bibliometric method allows for a quantitative analysis of the scientific literature, using mathematical and statistical tools to study the distribution, relationships, and trends of documentary information. CiteSpace, developed by Professor Chen Chaomei at Drexel University, is a software specialized in visual analysis of scientific knowledge, capable of identifying research trends, hot spots, and disciplinary development through citation networks.

The results revealed encouraging trends in the field of research. Although there were annual fluctuations, the total number of publications showed consistent growth over the 20 years analyzed, with notable peaks in 2009 (18 articles) and 2021 (19 articles). The journal Cephalalgia led in number of articles published (14 articles), followed by Headache (11 articles). The United States emerged as the most productive country with 69 publications, followed by Germany with 43 articles.

Interestingly, the research showed that Western countries have demonstrated growing interest in acupuncture as a treatment for tension-type headache. Professor Klaus Linde, of the University of Munich, Germany, was identified as the most prolific and cited researcher in the field, having published 12 articles and received 119 citations, establishing himself as a recognized authority in the area.

The clinical implications of this analysis are substantial for both patients and health professionals. The steady growth of research suggests that acupuncture is gaining recognition as a valid therapeutic option for tension-type headache. Traditionally, treatment of this condition has been based on three types of medications: acute analgesics (mainly nonsteroidal anti-inflammatory drugs), preventive medications (mainly antidepressants), and medications for symptomatic relief (mainly muscle relaxants). Although these medications have some efficacy, their duration of action is relatively short, they have evident side effects with prolonged use, and they frequently lead to recurrence or even worsening of symptoms after discontinuation.

This scenario has led researchers and patients toward non-pharmacological therapies, where acupuncture stands out as a safe and effective option. German studies from 2009 and 2016, through meta-analyses of high-quality clinical research, demonstrated that acupuncture is an effective non-pharmacological treatment for frequent and chronic tension-type headache, significantly reducing the number of episodes and the intensity of pain when compared with conventional treatment or sham acupuncture.

It is important to recognize the limitations identified in the study. The analysis revealed that, although many researchers and institutions are involved in this field, there is a relatively low density of collaboration among them, suggesting a lack of effective cooperation that could accelerate scientific progress. In addition, controversy still exists about the efficacy of acupuncture, with some studies finding no significant differences between real and sham acupuncture, while others defend its effectiveness. The study also identified that current research focuses mainly on randomized clinical trials assessing clinical efficacy, with relatively few studies investigating the mechanisms of action of acupuncture and basic animal research, limiting full understanding of how the therapy works.

This bibliometric analysis provides a solid foundation for future research directions and offers valuable insights into potential collaborators, leading institutions, and emerging trends in the field. For patients suffering from tension-type headache, the results suggest that acupuncture represents a promising therapeutic option that has been gaining increasing scientific support. For health professionals, the study indicates the need for greater international and interdisciplinary collaboration, as well as the development of more rigorous experimental protocols to definitively establish the efficacy of acupuncture. The future of research in this area appears promising, with growing global interest and an expanding scientific base that may benefit millions of people who suffer from this debilitating condition.