Meta-Analysis: Acupuncture Reduces Frequency and Improves Relief in Tension-Type Headache

Tension-type headache (TTH) is the most prevalent primary headache in the world, affecting up to 78% of the population at some point in life. In its chronic form — defined as 15 or more headache days per month — TTH significantly compromises quality of life and productivity. Conventional pharmacologic options have important limitations: amitriptyline, the main prophylactic, causes sedation and weight gain; simple analgesics carry the risk of medication-overuse headache (rebound headache); and triptans, effective in migraine, are not indicated for TTH. In this scenario of unmet therapeutic need, a meta-analysis published in December 2025 in the Journal of Oral & Facial Pain and Headache (vol. 39, no. 4, pp. 60–69) gathered all available randomized clinical trials with sham comparators to assess the efficacy of acupuncture specifically for TTH — and the results offer the medical acupuncturist concrete data to guide clinical practice.

Methodology and inclusion criteria

The systematic review followed PRISMA guidelines and was prospectively registered in PROSPERO (CRD42024602270). The authors searched three databases — PubMed, EMBASE, and Cochrane Library — from inception through August 2024, including only randomized clinical trials that compared real acupuncture with sham acupuncture in patients with a diagnosis of tension-type headache. Statistical analysis was conducted with RevMan 5.4 software, using standardized mean difference (SMD) for continuous outcomes and odds ratio (OR) for dichotomous outcomes.

Six RCTs met the eligibility criteria, totaling 927 patients. The primary outcomes evaluated were: headache frequency (number of episodes or days with headache per month), pain intensity (visual analog or numerical scale), and global relief rate (proportion of patients with clinically significant improvement). Data were extracted for the 6-week post-treatment period, and subgroup analyses were performed by treatment duration and number of sessions.

Detailed results

The most robust outcome was the global relief rate: patients who received real acupuncture had 85% greater odds of obtaining significant headache relief compared with the sham group (OR = 1.85; 95% CI: 1.34–2.57; p < 0.001). This highly significant result reflects a real clinical effect that goes beyond placebo and therapeutic expectation.

For the frequency of headache episodes, the reduction was statistically significant in the 6-week post-treatment period (SMD = −0.23; 95% CI: −0.43 to −0.03; p = 0.03). Although the effect size is small to moderate by Cohen’s classification, the reduction in frequency is clinically relevant for patients with chronic TTH, in whom every fewer headache day represents a measurable functional gain.

The central finding: dose–response

The most clinically relevant finding is the dose–response relationship identified in the subgroup analysis. Pain intensity did not show a significant reduction in the global analysis, but when restricted to studies with treatment longer than one month or more than 10 sessions, the effect became robust and statistically significant (SMD = −0.32; 95% CI: −0.56 to −0.09; p = 0.006). This implies that short protocols — 4 to 6 sessions — are insufficient to produce relevant analgesia in TTH, and that the medical acupuncturist should plan structured cycles of at least 10 to 12 sessions over 4 to 6 weeks to obtain consistent response in pain intensity.

Implications for clinical practice

The results of this meta-analysis position medical acupuncture as an evidence-based therapeutic alternative for TTH, especially in patients with unsatisfactory response to conventional prophylaxis, intolerance to amitriptyline, or risk of medication-overuse headache. The safety profile — no serious adverse events in 927 patients — reinforces the feasibility of extended cycles without additional pharmacologic exposure. The existence of a dose–response relationship also offers the physician an objective argument to plan and justify more extensive protocols to the patient.