Protocol summary
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Study aim
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Determining the effectiveness of manual acupuncture and electroacupuncture on intensity and number of days of tension headaches, the amount of painkillers used in acute headaches, anxiety, depression and quality of life.
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Design
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Clinical trial with control group, with parallel groups, single-blind study, randomized, phase 3 on 75 patients. The online site https://www.sealedenvelope.com was used for randomization.
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Settings and conduct
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Patients visit the acupuncture clinic of Imam Reza Hospital 3 times a week for 4 weeks. Disposable sterile needles, size 0.25 x 25 mm, are placed in the specified place and depth according to Chinese medicine reference books.. Both groups Patients receive 12 treatment sessions. The follow-up period is 8 weeks
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Participants/Inclusion and exclusion criteria
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Patients with tension headaches aged 18 to 65 years with the onset of headache under the age of 50, whose treatment started 3 months before the study and continued without any changes during the study.
Exclusion criteria: Migraine headache more than one day a month or secondary headaches; severe physical or mental illness; pregnancy; breastfeeding; any type of addiction, acupuncture treatment in the last 6 months and continuous use of headache pain relievers more than 10 days a month for more than 3 months.
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Intervention groups
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Needles will be inserted in these points for both intervention groups:
GB20-GV20-LI4-LV3-EX HN 5-ST8-GB8-SP6-ST36-EX HN 3-SJ 5-LU 7-ST40-REN12-PC6-HT7-BL60.
In the electro-acupuncture group, the needles are stimulated with an electro-acupuncture device at points DU 20/EX-HN3-LI4/PC 6-LIV 3/SP 6.
Participants in the usual care group (control) continued their previous treatment and completed the questionnaires similarly to the two intervention groups.
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Main outcome variables
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Pain intensity
General information
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Reason for update
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1- Sampling has not yet ended, the date has been modified 2- Except for the care provider and investigator who do not have the possibility of blinding in acupuncture studies, the others are blinded 3- In the primary outcome: section of headache hours, the word "average" in this section was incorrect and I delete it.4- The name of the person responsible for general inquiries is modified.
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Acronym
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IRCT registration information
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IRCT registration number:
IRCT20230626058585N1
Registration date:
2023-10-17, 1402/07/25
Registration timing:
registered_while_recruiting
Last update:
2026-02-09, 1404/11/20
Update count:
2
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Registration date
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2023-10-17, 1402/07/25
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Registrant information
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Recruitment status
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Recruitment complete
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Funding source
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Expected recruitment start date
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2023-10-17, 1402/07/25
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Expected recruitment end date
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2026-03-20, 1404/12/29
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Actual recruitment start date
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empty
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Actual recruitment end date
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empty
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Trial completion date
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empty
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Scientific title
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Effectiveness of electroacupuncture and manual acupuncture in patients with tension-type headache: a randomized clinical trial
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Public title
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Investigating the effect of acupuncture on headache
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Purpose
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Treatment
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Inclusion/Exclusion criteria
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Inclusion criteria:
Patients suffering from chronic and episodic tension headache based on the criteria of the International Headache Society (ICHD 3beta) who suffer from headache for more than one year.
Age 18 to 65 years
Age of onset of headache below 50 years
Desire to participate in the study and sign an informed consent
Any headache treatment should be started at least 3 months before the study and continued without any changes (except the treatment of acute headache attack) in the last 3 months and during the intervention and follow-up period. These treatments include pain relievers when needed (such as acetaminophen and ibuprofen) and/or preventive medications (such as amitriptyline) or even non-pharmacological treatments (such as relaxation techniques).
Exclusion criteria:
Suffering from migraine headache for more than one day in a month
Secondary headaches related to organic disease (for example: cerebral hemorrhage, cerebral thrombosis, vascular malformation, hypertension)
Severe physical or mental illness such as seizures, coagulation disorders, heart disease, liver disease, kidney disease and other organs.
Pregnancy, breastfeeding or decision to become pregnant during the study period
Addiction to smoking, alcohol, drugs
Acupuncture treatment in the last 6 months (in order to blind the treatment method, he has never had a history of electro-acupuncture)
Continuous use of headache pain relievers more than 10 days a month for more than 3 months (Medication-overuse headache)
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Age
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From 18 years old to 65 years old
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Gender
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Both
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Phase
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3
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Groups that have been masked
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- Participant
- Outcome assessor
- Data analyser
- Data and Safety Monitoring Board
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Sample size
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Target sample size:
75
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Randomization (investigator's opinion)
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Randomized
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Randomization description
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Blocked
individual
using the online site https://www.sealedenvelope.com random allocation into three groups A (electroacupuncture), group B (manual acupuncture) and group C (usual care). Randomization will be done based on Block Randomization with blocks of 6. A block size of 6 will be used for random allocation. The prepared blocks will be placed inside the envelope. According to the order of arrival of patients, one of the envelopes will be randomly selected and based on the obtained blocks, patients will be allocated to groups.
Allocation Concealment method:
Using sealed and waxed opaque envelopes:
In this way, the envelopes will be prepared and printed by one of the team members and random numbers will be placed inside the envelope. The lid of the envelopes will be closed and its contents will not be visible from the outside. Then, first, the purpose of the study is explained to the person who meets the stated conditions, and if the person wishes, he signs the informed consent form and takes an envelope, then opens it and enters one of the three groups based on the contents of the envelope.
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Blinding (investigator's opinion)
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Single blinded
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Blinding description
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1- in order to know whether electroacupuncture is superior to manual acupuncture or not, blinding will be done in the intervention groups, so that in both groups, the electrodes are connected to the needles, but in the manual acupuncture group, there is no current in wire and only the blinking diode that simulates the electric stimulus can be seen and its sound can be heard.
2- Those who collect and analyze the information and the safety monitoring board do not know the names of the patients and the division of the groups and the assignment of each patient to each group.
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Placebo
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Not used
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Assignment
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Parallel
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Other design features
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However, due to the fact that we do not have any intervention in the control group, we do not have blinding. But in order to know whether electroacupuncture is superior to manual acupuncture or not, blinding will be done in the intervention groups, so that in both groups, the electrodes are connected to the needles, but in the manual acupuncture group, there is no current in wire and only the blinking diode that simulates the electric stimulus can be seen and its sound can be heard.
Ethics committees
1
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Ethics committee
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Approval date
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2023-09-09, 1402/06/18
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Ethics committee reference number
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IR.MUMS.REC.1402.173
Health conditions studied
1
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Description of health condition studied
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Tension-type headache
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ICD-10 code
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G44.2
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ICD-10 code description
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Tension-type headache
Primary outcomes
1
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Description
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Average tension headache intensity over 4 weeks
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Timepoint
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Initially before randomization and 4, 8, 12, weeks after randomization
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Method of measurement
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Using a visual analog scale (VAS ) includes a straight horizontal line marked from 0-10. 0 means no pain and 10 means very severe pain. The participants are asked to Answer the question: How severe was your worst pain in the past 24 hours?, and then mark the point on the line that corresponds to the pain level.
Secondary outcomes
1
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Description
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The dosage of painkillers for acute headache attacks
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Timepoint
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Total dose consumed during 4 weeks (time interval: initially before randomization, 4, 8, 12 weeks after randomization)
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Method of measurement
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The name, number and dose of acute pain reliever are recorded every day, the total dosage is checked every 4 weeks.
2
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Description
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Assessment of quality of life
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Timepoint
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At baseline before randomization, 4, 8, 12 weeks after randomization
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Method of measurement
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Using a 36-item short form survey instrument (SF-36) questionnaire that is used to evaluate people's quality of life, which includes 36 questions for physical and mental health, which are divided into 0-100 scores (0 = worst health condition and 100 = best health condition). .. The average score of 50 is expressed as the normative value for all scales.
3
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Description
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Assessment of anxiety score
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Timepoint
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At baseline before randomization, 4, 8, 12 weeks after randomization
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Method of measurement
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Beck's anxiety questionnaire
4
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Description
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Assessment of depression status
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Timepoint
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At baseline before randomization, 4, 8, 12 weeks after randomization
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Method of measurement
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Beck depression questionnaire
5
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Description
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Number of headache days
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Timepoint
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It will be daily recorded by patients. For statistical analysis: Initially, before randomization, and 4, 8, 12 weeks after randomization
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Method of measurement
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Headaches lasting more than 30 minutes per day are recorded in the headache diary. The response rate is defined as a reduction of more than 50% in the number of headache days.
6
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Description
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duration of pain attacks
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Timepoint
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Every day, the hours that the patient had a headache are recorded. for statistical analysis: Initially before randomization and 4, 8, 12, weeks after randomization
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Method of measurement
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By recording the start and end time of the headache in the diary, the total pain hours in 4 weeks will be calculated
Intervention groups
1
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Description
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First intervention group: electroacupuncture: after disinfecting the skin, disposable sterile needles size 25 x 0.25 in points (GB20-GV20-LI4-LV3-EX HN 5-ST8-GB8-SP6-ST36-EX HN 3-SJ 5 -LU 7-ST40-REN12-PC6-HT7-BL60) with a certain depth based on the instructions of Chinese medicine ،are placed on both sides. The needles remain in place for 30 minutes. The needles are connected to the electro device in the distal points of both hands and feet and a local point and are stimulated for 30 minutes. The points that are connected to the electro include: DU 20 /EX-HN3 in head- LI4 / PC 6 in both hands - in both legs LIV 3 / SP 6
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Category
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Treatment - Devices
2
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Description
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The second intervention group: manual acupuncture - needles in points (GB20-GV20-LI4-LV3-EX HN 5-ST8-GB8-SP6-ST36-EX HN 3-SJ 5-LU 7-ST40-REN12-PC6-HT7- BL60) with a certain depth according to Chinese medicine instructions, will be placed on both sides and will remain in place for 30 minutes. In order to blind the electrodes, they are connected to the needles, but the passage of the electric current is interrupted and only the flashing diode that simulates the electric stimulus can be seen and its sound can be heard.
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Category
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Treatment - Devices
3
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Description
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Control group: The participants in the usual care group continued their previous treatment without any intervention and completed the questionnaires similar to the two intervention groups. After the follow-up period, as a reward, they were treated with acupuncture with or without electro, based on the treatment result. will be placed
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Category
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Other
1
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Sponsor
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Grant name
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Grant code / Reference number
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Is the source of funding the same sponsor organization/entity?
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Yes
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Title of funding source
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Mashhad University of Medical Sciences
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Proportion provided by this source
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100
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Public or private sector
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Public
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Domestic or foreign origin
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Domestic
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Category of foreign source of funding
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empty
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Country of origin
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Type of organization providing the funding
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Academic
Sharing plan
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Deidentified Individual Participant Data Set (IPD)
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Undecided - It is not yet known if there will be a plan to make this available
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Study Protocol
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Undecided - It is not yet known if there will be a plan to make this available
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Statistical Analysis Plan
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Undecided - It is not yet known if there will be a plan to make this available
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Informed Consent Form
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Undecided - It is not yet known if there will be a plan to make this available
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Clinical Study Report
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Undecided - It is not yet known if there will be a plan to make this available
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Analytic Code
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Undecided - It is not yet known if there will be a plan to make this available
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Data Dictionary
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Undecided - It is not yet known if there will be a plan to make this available