Treatment of Frequent or Chronic Primary Headaches in Children and Adolescents: Focus on Acupuncture

**Acupuncture in the Treatment of Headaches in Children and Adolescents: A Scientific Review**

Headaches are extremely common in childhood and adolescence, affecting between 5.9% and 58.4% of young people under age 20. Migraine and tension-type headache are the most frequent types of primary headache in this age group. These conditions can have a significant impact on children's quality of life, frequently persisting into adulthood and, in many cases, evolving into chronic conditions. Children with chronic headaches constitute the most debilitated subgroup of the headache population, requiring specialized care.

Conventional treatments for patients with chronic headaches can be expensive, frequently requiring intravenous access and hospitalization. In addition, studies indicate that response to treatment tends to decrease in children with chronic headache disorders, and recurrences are common after acute intravenous treatments.

This study aimed to collect and analyze all relevant research on the use, efficacy, and tolerability of acupuncture in the treatment of primary headaches in children and adolescents. The researchers conducted a narrative review based on eight selected studies from 135 articles that included pediatric cases treated with acupuncture for headache. The search was conducted in the PubMed, Cochrane, and Mendeley databases, using terms such as "acupuncture headache" and "complementary and alternative medicine headache." Only studies with children and adolescents aged 0 to 18 years were included. The methodology of the analyzed studies varied, including retrospective, prospective, and case–control studies, some with placebo groups.

The study population consisted mainly of pediatric and adolescent patients, the majority being female (58% to 89%). The main diagnoses were migraine (50–82% of cases) and tension-type headache (18–50%), frequently in chronic forms. The duration of headache history ranged from 1 to 9 years. The studies used different acupuncture techniques, including traditional needle acupuncture, electroacupuncture, auricular acupuncture, laser acupuncture, and moxibustion.

Application points were chosen according to traditional Chinese medicine criteria and individualized for each patient. The mean number of sessions varied across studies, with protocols including from 4 to 10 weekly sessions.

The results showed that acupuncture had a positive effect on both the frequency and intensity of headaches. In one controlled study, 63.7% of patients had complete migraine resolution after placement of auricular needles. Another study showed a statistically significant reduction in frequency (from 9.3 to 1.4 episodes per month) and intensity (from 8.7 to 3.3 on a pain scale) of migraine before and after treatment. Laser acupuncture also showed promising results, with a significant decrease in the number of headache days compared with the placebo group.

The studies also revealed that acupuncture may have beneficial effects beyond pain reduction, including improvements in sleep, appetite, and reduction of anxiety. Children and their parents reported positive experiences with treatment, with 67% of patients and 60% of parents describing the experience as beneficial.

The clinical implications of this study are significant for patients and health professionals. Acupuncture appears as an efficient treatment alternative for children with frequent or chronic headaches, offering a non-pharmacological approach that can avoid the side effects of conventional medications. For patients, this means a treatment option that is well tolerated, with few adverse effects reported in the analyzed studies. Acupuncture may be particularly valuable as preventive therapy, helping to reduce the need for costly hospitalizations and intravenous treatments.

For health professionals, these findings suggest that acupuncture should be considered as part of an integrated approach in the treatment of pediatric headaches, especially in cases where conventional treatments have not been effective or have caused unwanted side effects.

However, it is important to recognize the significant limitations of this review and of the analyzed studies. Most of the included studies were retrospective, with relatively small sample sizes, ranging from 7 to 174 patients. There was considerable variation in the acupuncture methods used, application points, and treatment protocols, making it difficult to establish standardized guidelines. In addition, not all studies had adequate control groups, and methods for assessing efficacy varied between studies.

A particularly important limitation is the lack of data on the long-term efficacy of acupuncture, since most studies did not follow patients for prolonged periods after treatment. Some studies also included patients with different types of chronic pain, not just headaches, without differentiating the results.

In conclusion, although the available studies show encouraging results for the use of acupuncture in the treatment of headaches in children and adolescents, additional research with more rigorous methodology is needed. Future studies should include larger samples, standardized protocols, adequate control groups, and long-term follow-up to better establish the efficacy, safety, and durability of the effects of acupuncture. Despite the limitations, the current evidence suggests that acupuncture is a safe and promising treatment option that deserves consideration in the management of pediatric headaches, especially in an integrative medicine context that combines conventional and complementary approaches.