Exploring the efficacy of acupuncture for tension-type headache: a literature review and insights from traditional Chinese medicine

Tension-type headache represents one of the most common types of primary headache affecting millions of people worldwide. Characterized by a sensation of pressure or tension in the head, this condition can cause mild to moderate intensity pain, significantly impacting quality of life, work performance, and daily activities. In Brazil and China, studies show that prevalence varies between 10% and 78% of the population, being more frequent in women. In addition to personal suffering, this condition generates a considerable economic burden for families and healthcare systems.

Conventional treatments include antidepressants and anti-inflammatories, but these medications often present unwanted side effects, especially in older patients, including gastrointestinal problems and hepatic and renal toxicity.

This study aimed to analyze the efficacy of acupuncture in the treatment of tension-type headache through a systematic literature review, incorporating perspectives from Traditional Chinese Medicine and its mechanisms of action. The investigators conducted a comprehensive search across the PubMed and Web of Science databases through January 2024, using specific terms related to acupuncture and tension-type headache. Clinical studies involving adults diagnosed with tension-type headache according to international criteria, who received treatment exclusively with acupuncture, compared with control groups, were included. After a rigorous selection process, twelve clinical studies were included in the analysis, totaling 659 participants who received traditional acupuncture, electroacupuncture, or laser acupuncture.

The investigators analyzed in detail aspects such as selection of acupuncture points, types of techniques used, duration of treatment, and needle retention time.

The results demonstrated that acupuncture showed significant efficacy in the treatment of tension-type headache without causing serious adverse effects. Eleven of the twelve studies showed consistent benefits, including improvement in treatment response rate, reduction in pain intensity measured by visual analog scales, decrease in pain episode duration, and improvement in patient quality of life. Follow-up studies indicated that beneficial effects were maintained for prolonged periods after treatment ended. A specific study with electroacupuncture showed not only a reduction in pain scores and decreased need for analgesics, but also an increase in serum levels of brain-derived neurotrophic factor, suggesting specific neurobiologic mechanisms of action.

Regarding treatment protocols, most studies used 20- to 30-minute sessions, applied over periods of five to twelve weeks, with a frequency of one to two sessions per week.

For patients suffering from tension-type headache, these findings offer a promising treatment perspective. Acupuncture emerges as a safe and effective therapeutic option, especially valuable for those who experience side effects with conventional medications or seek more natural approaches. For healthcare professionals, the study provides important practical guidelines: point selection should be based both on Traditional Chinese Medicine syndrome differentiation and on each patient's individual characteristics, treatment should extend for at least four weeks to ensure efficacy, and each session should last at least twenty minutes, with thirty minutes recommended to optimize therapeutic outcomes. Proposed mechanisms include inhibition of myofascial trigger points and modulation of central sensitization, processes that contribute to pain chronification.

However, some important limitations should be considered when interpreting these results. The study was constrained by a relatively small sample size and overall quality of evidence considered low, which may affect the reliability of conclusions. Significant variability was observed in the selection of acupuncture points across different studies, reflecting different diagnostic approaches and lack of consensus on which points are most effective. In addition, there was a scarcity of research examining the quantitative effects of the number of sessions, needle retention duration, and comparative efficacy among different types of acupuncture.

The absence of standardized guidelines for acupuncture treatment and the lack of high-quality multicenter studies also represent important limitations that should be addressed in future research to establish more defined and reliable protocols for the treatment of tension-type headache through acupuncture.