Background
Methods
Literature search
Study selection
Inclusion and exclusion criteria
Outcome assessments
Data extraction
Risk of bias assessment
The certainty of the evidence
Statistical analysis
Results
Characteristics of the included RCTs
Study | Country | Diagnostic criteria | Type of TTH | Interventions | Treatment duration (weeks) | Follow-up duration (weeks) | Number of patients | Female (%) | Mean ages |
---|---|---|---|---|---|---|---|---|---|
TCAs | |||||||||
Bendtsen 1996 [42] | Denmark | IHS | Chronic | Amitriptyline 75 mg vs. placebo | 8 | 0 | 40 | 63 | 40 |
Bettucci 2006 [47] | Italy | IHS | Chronic | Amitriptyline 20 mg vs. amitriptyline 20 mg plus tizanidine 4 mg | 12 | 0 | 18 | 72 | 35.3 |
Boline 1995 [52] | USA | IHS | Episodic | Amitriptyline 30 mg vs. spinal manipulation | 6 | 4 | 150 | 61 | 42 |
Boz 2003 [6] | Turkey | IHS | Chronic | Amitriptyline 25 mg vs. sertraline 50 mg | 12 | 0 | 90 | 88 | 39.1 |
Damapong 2015 [43] | Thailand | IHS | Chronic | Amitriptyline 25 mg vs. massage | 4 | 2 | 60 | 87 | 49.8 |
Deodato 2019 [51] | Italy | IHS | Chronic | Amitriptyline 50 mg vs. osteopathic manipulative therapy | 12 | 0 | 24 | 60 | 47 |
Holroyd 1991 [41] | USA | IHS | Chronic | Amitriptyline 75 mg vs. cognitive-behavioral therapy | 12 | 0 | 41 | 80 | 32.3 |
Holroyd 2001 [5] | USA | IHS | Chronic | Amitriptyline 100 mg vs. placebo | 8 | 24 | 203 | 76 | 37 |
Indaco 1988 [45] | Italy | Ad Hoc criteria | Chronic | Amitriptyline 50 mg vs. placebo | 12 | 0 | 36 | 52 | 61.2 |
Langemark 1990 [24] | Denmark | IHS | Chronic | Clomipramine 150 mg vs. mianserin 60 mg vs. placebo | 6 | 0 | 114 | NA | 41 |
Mitsikostas 1997 [46] | Greece | IHS | Chronic | Amitriptyline 50 mg vs. buspirone 30 mg | 12 | 0 | 58 | 62 | 42.5 |
Mousavi 2011 [48] | Iran | IHS | Chronic | Imipramine 50 mg vs. TENS | 12 | 0 | 138 | 46 | 28.2 |
Okasha 1973 [53] | Egypt | Ad Hoc criteria | Psychogenic | Amitriptyline 30 mg vs. doxepin 30 mg vs. diazepam 6 mg vs. placebo | 8 | 0 | 80 | 28 | NA |
Pfaffenrath 1994 [50] | Germany, Austria, Switzerland | IHS | Mixed | Amitriptyline 75 mg vs. placebo | 12 | 8 | 197 | 56 | 38 |
Surbakti 2017 [49] | Indonesia | IHS | Chronic | Amitriptyline 12.5 mg vs. flunarizine 5 mg vs. flunarizine 10 mg | 2 | 0 | 95 | 82 | 44.6 |
Vernon 2009 [44] | Canada | IHS | Chronic | Amitriptyline 25 mg plus chiropractic vs. Amitriptyline 25 mg plus sham chiropractic vs. placebo plus sham chiropractic | 14 | 12 | 20 | 80 | 33.9 |
Acupuncture | |||||||||
Chassot 2015 [36] | Brazil | IHS | Chronic | Acupuncture, twice/week vs. sham acupuncture, twice/week | 5 | 0 | 34 | 100 | 40.3 |
Ebneshahidi 2005 [40] | Iran | IHS | Chronic | Acupuncture, 3 times/week vs. sham acupuncture, 3 times/week | 4 | 12 | 50 | 80 | 35.8 |
Endres 2007 [29] | Germany | IHS | Mixed | Acupuncture, twice/week vs. sham acupuncture, twice/week | 6 | 24 | 409 | 78 | 39.1 |
Gildir 2019 [26] | Turkey | IHS | Chronic | Acupuncture, 3 times/week vs. sham acupuncture, 3 times/week | 2 | 4 | 160 | 43 | 36.4 |
Guo 2020 [32] | China | IHS | Mixed | Acupuncture, once every other day vs. eperisone hydrochloride 150 mg plus flunarizine hydrochloride | 4 | 0 | 150 | 62 | 33.7 |
Jena 2008 [30] | Germany | IHS | Mixed | Acupuncture, 15 times/12w vs. usual care | 12 | 12 | 1265 | NA | NA |
Karst 2001 [38] | Germany | IHS | Mixed | Acupuncture, twice/week vs. sham acupuncture, twice/week | 5 | 20 | 69 | 55 | 48.1 |
Kawk 2007 [39] | Korea | IHS | Chronic | Acupuncture, twice/week vs. sham acupuncture, twice/week | 4 | 12 | 32 | NA | 81 |
Melchart 2005 [11] | Germany | IHS | Mixed | Acupuncture, 1–2 times/week vs. sham acupuncture, 1–2 times/week vs. waiting list | 8 | 16 | 270 | 74 | 42.7 |
Schiller 2021 [33] | Germany | IHS | Mixed | Acupuncture, twice/week vs. usual care vs. medical training therapy | 6 | 18 | 72 | 74 | 38.5 |
Silva 2012 [28] | Brazil | IHS | Mixed | Acupuncture, 8–12 times/8week vs. usual care | 8 | 0 | 43 | 100 | 27.3 |
Söderberg 2006 [31] | Sweden | IHS | Chronic | Acupuncture, once/week vs. physical training vs. relaxation training | 10–12 | 24 | 90 | 81 | 37.4 |
Wang 2007 [34] | Denmark | IHS | Chronic | Acupuncture, 14 times/week vs. sham acupuncture, 14 times/week | 4 | 6 | 40 | 50 | 45.3 |
White 1996 [25] | UK | IHS | Episodic | Acupuncture, once/week vs. sham acupuncture, once/week | 6 | 3 | 10 | 70 | 57.3 |
White 2000 [27] | UK | IHS | Episodic | Acupuncture, once/week vs. sham acupuncture, once/week | 5 | 12 | 50 | 76 | 49 |
Xu 2015 [35] | China | IHS | Mixed | Acupuncture, 3 times/week vs. head acupuncture, 3 times/week | 4 | 0 | 60 | 67 | NA |
Xue 2004 [37] | Australia | IHS | Mixed | Acupuncture, twice/week vs. sham acupuncture, twice/week | 4 | 0 | 40 | 65 | 42.1 |
Zheng 2022 [10] | China | IHS | Chronic | Acupuncture, 2–3 times/week vs. sham acupuncture, 2–3 times/week | 8 | 24 | 218 | 79 | 43.1 |
Headache frequency
Certainty of the evidence, and classification* of intervention | Intervention | Certainty of the evidence** |
---|---|---|
Low certainty (low to very low certainty evidence) | ||
Category 0: might be not convincingly different than acupuncture | Amitriptyline | Very low |
Amitriptylinoxide | Very low |