Effects on neuromodulation, acupuncture, and aerobic exercises on migraine and tension-type headache outcomes A systematic review and meta-analysis

Background: Headache disorders are common diseases that cause a social burden. This systematic review and meta-analysis aimed to evaluate the effects of various non-pharmacological treatments to address or prevent acute headaches, including neuromodulation, acupuncture, and aerobic exercises in patients with episodic migraine and tension-type headache (TTH). Methods: We performed a systematic search of the electronic databases PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure, WANFANG MEDICINE ONLINE, and Chinese Medical Journal database using Stata/SE 14.0 to obtain weighted mean differences (WMDs). The outcomes included monthly headache days, headache intensity, headache duration, days per month of acute medication use, and the Medical Outcomes Study 36-Item Short-Form Health Survey. Results: Of 872 identified articles, 27 were included in the meta-analysis. Neuromodulation was associated with reduced headache days (WMD: -1.274, 95% CI [-1.914, -0.634], P<.001), duration (WMD: -2.2, 95% CI [-3.32, -0.107], P<.001) and medication consumption (WMD: -1.808, 95% CI [-2.546, -1.071], P<.001) in cases of migraine. Acupuncture was associated with the alleviation of headache days (WMD: -0.677, 95% CI [-0.932, -0.422], P<.001) and intensity (WMD: -0.893, 95% CI [-1.573, -0.212], P=.01) in cases of migraine and acute medication use (WMD: -3.29, 95% CI [-4.86, -1.72], P<.001) in cases of TTH. Aerobic exercise was associated with reduced headache duration (WMD: -5.1, 95% CI [-8.97, -1.22], P=.01) in cases of TTH. The risk of bias for included articles was moderate. Conclusions: There is low- and moderate-quality evidence that neuromodulation, acupuncture, and aerobic exercises are associated with attenuated headache symptoms in patients with episodic migraine or TTH. However, high-quality studies are needed to draw more detailed conclusions.