Twenty-four RCTs involving 1,472 patients were included .
The agreement between quality raters was high (reliability coefficient 0.72; p=0.0015) and scores were averaged for the review.
Acupuncture (8 RCTs): the quality score ranged from 44 to 69%.
1. High-quality trials (4 RCTs with 99 patients): the quality scores ranged from 61 to 69%, and the average treatment duration was 52.2 days. Three RCTs compared acupuncture with sham treatment and reported inconsistent results: 1 RCT reported equivalence of outcome, the other 2 small RCTs reported a significant reduction in headache frequency with acupuncture but involved only 39 patients.
2. Other trials (4 RCTs with 173 patients): the quality scores ranged from 44 to 50%, and the average treatment duration was 99 days. Control interventions were: sham (1 RCT), no-treatment or occlusal splint control (1 RCT), medication (1 RCT) and physiotherapy (1 RCT). Three RCTs reported less frequent headaches in the acupuncture treatment groups.
3. Tension-type headaches (264 patients): results were inconsistent.
Spinal manipulation (6 RCTs with 286 patients): the quality scores ranged from 56 to 80%. The efficacy of spinal manipulation could not be determined.
Patients suffered from: tension-type headache (3 RCTs), cervicogenic headache (2 RCTs) and post-traumatic headache (1 RCT). No trial included an exclusively sham or placebo-type control and five different control therapies were used. There was some inconsistency regarding diagnostic classification.
Electrotherapy (4 RCTs, including 507 patients with tension-type headaches): the quality scores ranged from 39 to 61%. Three RCTs (1 high and 2 moderately high quality) reported greater benefit from electrotherapy than placebo.
Physiotherapy (3 RCTs with 147 patients): the quality scores ranged from 33 to 58%. Physiotherapy involved multi-modality programmes (all including TENS) making it impossible to determine the effect of individual treatment components. Control therapies were: acupuncture, attention control, and medication and biofeedback. All 3 RCTs reported greater benefit from additional physiotherapy.
Massage: no RCTs were found.
Homeopathy (1 RCT with 98 patients, of which approximately half had tension-type headache): the quality score was high (86%). The study was methodologically rigorous with double-blinded placebo control. No difference in efficacy between treatments was found.
Tiger Balm (1 RCT with 57 patients): the quality score was high (72%). Tiger Balm and paracetamol produced significantly greater pain relief than a topic placebo for one episode of headache. There was no difference between Tiger Balm and paracetamol.
Therapeutic touch (1 RCT with 60 patients): the quality score was moderately high (47%). After a 5-minute intervention, those patients who received the intervention experienced twice as much pain relief as the control group, both immediately and after 4 hours.
The included studies were hampered by a lack of provider blinding, monitoring of adverse effects, long-term follow-up and intention to treat analysis.