**5.1 Migraine prophylaxis**

Migraine is characterized by recurrent, pulsating headaches, and increased intracranial blood flow, which are caused by vasomotor and cerebrocortical dysfunction, vasospasm, and excessive stress. Stimuli such as light, sound, or physical activity can set it off [30]. Pharmacological treatment, which includes propranolol, sodium valproate, topiramate, flunarizine, and metoprolol, has been proven to be effective for migraine prophylaxis. However, all of these treatments have significant and often intolerable adverse effects [31, 32]. Because of these adverse effects, people are becoming more interested in and using complementary health approaches to treat migraines, and because of its measurable effects on the duration and frequency of migraine attacks, acupuncture has received increasing attention as a worthy adjunct to migraine therapeutic interventions [33].

#### *5.1.1 Previous quality of evidence*

Migraine frequency can be reduced with acupuncture. Acupuncture is superior to sham and may be as effective as prophylactic drugs, according to evidence of moderate quality [34]. Acupuncture appears to be at least as effective as conventional migraine preventative medication, and it's also safer, lasts longer, and expenses less – (A narrative review of high-quality RCTs with a large sample size) [35]. Acupuncture is superior to sham in terms of effectiveness and risk of recurrence, according to moderate to high-quality evidence [36].

#### *5.1.2 Current quality of evidence*

Even though there are some inconsistencies in the results of current RCTs comparing the efficacy of acupuncture vs. sham or no treatment or western

*The Use of Evidence-Based Acupuncture: Current Evidence DOI: http://dx.doi.org/10.5772/intechopen.100519*

medicine, the most recent evidence shows that acupuncture improves migraine patients significantly. Xu et al. conducted 14 RCTs for migraine without aura that met all inclusion criteria and data standards of quality from 1467 studies based on an electronic database and found that when acupuncture therapy was compared to medical therapy, the evidence supporting the difference in migraine frequency was very low, whereas the evidence supporting the difference in migraine days, effective rate, and VAS scores was low. Because of the risk of bias, inconsistency, and inaccuracy, the quality of evidence supporting the primary outcome is low (to very low) [13]. At three months of follow-up, moderate evidence suggests that acupuncture is "at least non-inferior" to the now-proven, conventional treatment for reducing headache frequency, when compared to placebo [15]. Giovanardi et al. concluded that acupuncture was more effective and safer than medication or sham acupuncture in the treatment of migraines based on high-quality evidence [16]. Furthermore, acupuncture has benefits in terms of pain management and safety for acute migraine treatment and prevention, but the quality of evidence for SR/MA acupuncture for migraine even now needs to be improved [14].

#### *5.1.3 Conclusion*

Despite some limitations to acupuncture therapy, the quality of recent evidence from the SRs/MAs suggests that acupuncture is more effective and safer than medication or sham acupuncture for migraine prophylaxis in reducing headache frequency.

## **5.2 Headache (chronic tension type and chronic episodic)**

The most common type of primary headache in the general population is the tension-type headache (TTH) [37]. Chronic tension-type headache (CTTH) is a disorder that arises from episodic tension-type headaches, with daily or highly frequent headache bouts lasting hours or days [38]. Simple analgesics and nonsteroidal anti-inflammatory drugs are the drugs of choice for episodic treatment, with combination analgesics containing caffeine showing their effect in seconds; however, nonpharmacological care should always be attempted despite a lack of scientific evidence [39]. Psychotherapy, behavior therapy, physical therapy, and acupuncture therapy are common nonpharmacological treatments that are frequently used in conjunction with other pharmacological treatments, and their efficacy has been proven [40]. In previous investigations, acupuncture support for tension-type headaches was shown to be insufficient. However, the Cochrane review has identified it as a beneficial, non-pharmacologic therapy for episodic-type and chronic stress–type headaches, based on newly added data [41].

#### *5.2.1 Previous quality of evidence*

Linde et al. have looked at 12 trials with a total of 2349 individuals and found that the GRADE quality of evidence is moderate to low, owing to the lack of blinding and varying effect sizes, but suggested that acupuncture is effective in treating episodic-type or chronic tension-type headaches [42]. Acupuncture can improve the intensity, frequency, and disability associated with headaches in the workplace. However, the evidence seems to be of low quality [43].

#### *5.2.2 Current quality of evidence*

Acupuncture has been shown to be more effective than other treatments for some THH outcomes, according to Huang et al. and Kolokotsios et al., who conducted investigations and assessed the quality of evidence in RCTs on the effectiveness of acupuncture over sham acupuncture, non-acupuncture therapy, Chinese patent medicine, nonsteroidal anti-inflammatory drugs, and drug therapy for some THH outcomes. In this study, Huang et al. assessed the methodological quality, reliability, and outcome measures of SRs/MAs on the use of acupuncture for TTH [18]. The GRADE results revealed that 69.4% of the results provided low- or very-low-quality evidence, 11.1% provided moderate-quality evidence, and 19.4% provided high-quality evidence, further recommending that acupuncture appears to be an effective treatment modality for TTH, but the credibility of the results is limited due to the methodological quality and generally low quality of evidence [18]. The results of four studies with 557 participants found that the acupuncture group had lower quality evidence in terms of headache frequency and visual analog scale (VAS) scores when compared to the control group after their last treatment, whereas Kolokotsios et al. found low-quality evidence in terms of headache frequency and VAS scores when compared to the control group after their last treatment. Both the severity and the frequency of headaches were reduced over the long term, with the results being statistically significant only in the case of the pain intensity reduction [19].
