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Gravidez/Parto/Obstetrícia

Acupuntura para cefaléia idiopática

11/07/2004

 

Melchart D, Linde K, Fischer P, Berman B, White A, Vickers A, Allais G

Contexto: acupuntura é extensamente utilizada para o tratamento da cefaléia, entretanto existem controvérsias em relação a efetividade do procedimento

Objetivo: determinar a efetividade da acupuntura em relação ao não tratamento, a acupuntura sham (placebo) e a outras intervenções usadas para o tratamento da cefaléia idiopática (primária).

Resultados principais: vinte e seis ensaios com 1.151 pacientes (mediana 37; faixa de 10-150) abordaram o assunto e obedeciam o critério de inclusão de estudos randomizados e controlados. Dezesseis estudos eram conduzidos em pacientes com migrânea, seis em pacientes com cefaléia tensional, e quatro em pacientes com tipos variados de cefaléias. A maioria dos ensaios tinham imperfeições metodológicas. Em oito de dezesseis ensaios que comparavam acupuntura real e sham (placebo) em pacientes com migrânea e cefaléia tensional, acupuntura real foi significativamente superior; em quatro ensaios existiu uma tendência favorecendo a acupuntura, e em dois ensaios não houve diferenças entre as intervenções. Os dez ensaios comparando acupuntura com outras formas de tratamento apresentaram resultados contraditórios.

Conclusão: em geral, existe evidência que apoia o valor da acupuntura no tratamento da cefaléia idiopática. Entretanto, a qualidade e quantidade da evidência não é totalmente convincente. Existe necessidade urgente de estudos bem planejados e de maior escala para avaliação da efetividade e custo-efetividade da acupuntura em condições clínicas habituais.

Acupuncture for idiopathic headache (Cochrane Review). In: The Cochrane Library, Issue 3 2002

From The Cochrane Library, Issue 2, 2004. Chichester, UK: John Wiley & Sons, Ltd. All rights reserved.

Acupuncture for idiopathic headache (Cochrane Review)

Melchart D, Linde K, Fischer P, Berman B, White A, Vickers A, Allais G

ABSTRACT

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A substantive amendment to this systematic review was last made on 27 November 2000. Cochrane reviews are regularly checked and updated if necessary.

Background: Acupuncture is widely used for the treatment of headache, but its effectiveness is controversial.

Objectives: To determine whether acupuncture is:more effective than no treatmentmore effective than 'sham' (placebo) acupunctureas effective as other interventions used to treat idiopathic (primary) headaches.

Search strategy: Electronic searches were performed in MEDLINE, EMBASE, the Cochrane Controlled Trials Register, and the database of the Cochrane Field for Complementary Medicine. We also contacted researchers in the field and checked the bibliographies of all articles obtained.

Selection criteria: Randomized or quasi-randomized clinical trials comparing acupuncture with any type of control intervention for the treatment of idiopathic (primary) headaches were included.

Data collection and analysis: Information on patients, interventions, methods, and results was extracted by at least two independent reviewers using a pre-tested standard form. Results on headache frequency and intensity were summarized descriptively. Responder rate ratios (responder rate in treatment group/responder rate in control group) were calculated as a crude indicator of results for sham-acupuncture-controlled trials. Quantitative meta-analysis was not possible due to trial heterogeneity and insufficient reporting.

Main results: Twenty-six trials including a total of 1151 patients (median, 37; range, 10-150) met the inclusion criteria. Sixteen trials were conducted among patients with migraine, six among patients with tension-type headache, and four among patients with various types of headaches. The majority of trials had methodological and/or reporting shortcomings. In eight of the 16 trials comparing true and sham (placebo) acupuncture in migraine and tension-type headache patients, true acupuncture was reported to be significantly superior; in four trials there was a trend in favor of true acupuncture; and in two trials there was no difference between the two interventions. (Two trials were uninterpretable.) The 10 trials comparing acupuncture with other forms of treatment yielded contradictory results.

Reviewers' conclusions: Overall, the existing evidence supports the value of acupuncture for the treatment of idiopathic headaches. However, the quality and amount of evidence are not fully convincing. There is an urgent need for well-planned, large-scale studies to assess the effectiveness and cost-effectiveness of acupuncture under real-life conditions.

Citation: Melchart D, Linde K, Fischer P, Berman B, White A, Vickers A, Allais G. Acupuncture for idiopathic headache (Cochrane Review). In: The Cochrane Library, Issue 2, 2004. Chichester, UK: John Wiley & Sons, Ltd.

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