University of Michigan
Department of Pediatrics
Evidence-Based Pediatrics Web Site

Question

• Is laser acupuncture an effective treatment option to decrease headache frequency in pediatric patients with chronic headaches?

Clinical Bottom Lines

1. Chronic headaches are a common problem in children and sometimes can not be managed with a combination of abortive and/or prophylactic medications.
2. NNT cannot be calculated from available data.
3. Laser acupuncture is painless, free of side effects and nontraumatic alternative therapy option for pediatric patients with headache. Describe clinical actions to be taken based on the results of your critical appraisal

Summary of Key Evidence

1. Inpatients with a diagnosis of headache personally contacted a study coordinator to participate in study.
2. Pre-randomization selection began with all patients receiving a headache diary and documenting headache frequency, severity and duration. Patients were included if they were  17yrs of age, had unilateral or bilateral headache, migraine (2-8/month) w/ or w/o aura, or tension type headache (8 days/month), present for 12 months. Exclusion included  18yrs of age, headache other than migraine or tension type, frequency less than that noted to include, use of analgesics > 10days/month, prophylactic migraine treatment w/ drugs, relevant organic or mental disorders, history of seizures.
3. Forty three patients were randomly assigned to receive either active laser acupuncture or placebo acupuncture once weekly for four weeks from 1 of 3 blinded, experienced acupuncturists.
4. Acupuncturist was allowed to individualize therapy (e.g. uni- or bilateral, the number of points stimulated).
5. Patients were to document headache frequency, severity and duration in a headache diary for sixteen weeks after therapy cessation.
6. Primary outcome measure was the difference in number of days with headache between the placebo versus active acupuncture groups. Secondary outcome measures included a change in the headache duration or severity.
7. The difference in the number of headaches days between the active acupuncture and placebo groups were 5.4 days (p < 0.001). Summarize the key evidence so that others can see it for themselves.

Additional Comments

• The population studied limits the applicability of this data to a number of pediatric patients with chronic headaches. There is a limited number of patients with such severe headaches that they will not be on a daily prophylactic medication, especially if these headaches have been present for > 12months.
• Mechanisms for acupuncture and not clear. Several hypothesis exist, including the neurohumoral hypothesis, role of polymodal receptors, and the activation of regional brain activity seen by functional MRI and PET. Provides a wide range of systemic effects including changes in blood flow regulation, both central and peripheral, changes in neurotransmitter and neurohormone secretion, alteration in immune function, acceleration of nerve generation and neuroplasticity.
• Laser acupuncture is inexpensive and has no known side effects. It presents a safe alternative treatment, especially when compared to needle acupuncture, which includes side effects of bleeding, local infection as well as more serious complications such as sepsis, and pneumothorax. Laser acupuncture also seems to be a better option of children, as it is painless and no needles are involved.
• Acupuncture tends to be well accepted in the pediatric population, with most patients (67%) reporting it as a positive experience. ²

Citation

1. Gottschling, Sven et. al. Laser Acupuncture in Children with Headache: A Double-blind, Randomized, Bicenter, Placebo-controlled Trial. Pain. 2008; 137: 405-412.
2. Kemper, Kathi J. et. al. On Pins and Needles? Pediatric Pain Patients Experience with Acupuncture. Pediatrics. 2000; 105: 941-947.
3. Kundu, Anjana and Berman, Brian. Acupuncture of Pediatric Pain and Symptom Management. Pediatric Clinics of North America. 2007; 54: 885-899

CAT Author: Lindsey Foy, MD

CAT Appraisers: Robert Schumacher, MD,

Date appraised: March 4, 2009