Observation On The Clinical Effect Of Fire Needle Combined With Filiform Needle On Tension-type Headache

Objective:To evaluate the clinical efficacy of fire needle combined with filiform needle in the treatment of tension-type headache,by the aspects of significant headache improvement rate,headache frequency,headache severity,emotion and quality of life.To observe the variation trend of muscle tension in pericranial spasm by using shear wave elastography(SWE),so as to explore the possible approaches of acupuncture therapy.Methods:The type of study is prospective randomized controlled trial,which is used to enroll subjects according to strict inclusion and exclusion criteria.This study was part of a multi-center clinical trial,total of 62 patients with tension-type headache were observed in this study.Using the central random grouping method,62 cases of frequent tension-type headache or chronic tension-type headache were randomly divided into experimental group(31 cases)and control group(31 cases).Intervening measure:The study group was treated with fire needle combined filiform needle therapy,the subject's cervical occipital area was palpated to detect tenderness,and using He's fire needle,pricked the tenderness points quickly,and then using filiform needle therapy,for acupoints such as Baihui(DU20),Sishencong(EX-HN 1),Shenting(DU24),Fengchi(GB20),Taiyang(EX-HN4),Touwei(ST8),and according to different location of headache,selected the corresponding distal meridians to match points and retained needles for 30 minutes.Treatment was performed 3 times a week for 4 weeks consecutively,with total 12 times acupuncture.The control group was treated with only filiform needle,by the same acupoint selection,manipulation and course of treatment as the study group.Therapeutic evaluation:the main efficacy index was the significant improvement rate of headache(response rate);the secondary efficacy indices were headache frequency,visual analogue scale(VAS),simplified McGill Pain Questionnaire(SF-MPQ),headache impact questionnaire(HIT-6),and the trend of pericranial muscle tenderness was observed by shear wave elastography.Safety evaluation:Needle-related adverse reactions were recorded at any time during the study.Results:(1)Main efficacy index:After 4 weeks of treatment,the significant improvement rate of headache in study group was 88.9%,higher than 42.3%in control group(P<0.01).(2)Secondary efficacy index:1)the frequency of headache:After 4 weeks of treatment,the decrease of 4 weeks headache days in the two groups both significantly lower than before treatment(P<0.01);The frequency of headache decreased more in study group than control group(P<0.05).2)severity of headache:After 2 weeks of treatment,VAS,sensory PRI and PPI scores of two groups were decreased slightly,among study group decreased more significantly than those in control group(all P<0.01).After 4 weeks of treatment,VAS,sensory PRI and PPI scores of two groups were significantly decreased compared with that before treatment(all P<0.01).VAS,sensory PRI and PPI scores in study group also decreased more significantly than those in control group(all P<0.01),though the decrease amplitude of PRI score was not significantly different with that of the control group(P>0.05).3)Emotion:After 2 weeks of treatment,the emotional PRI scores of two groups were decreased slightly,and the study group showed no significant difference compared with the control group(P>0.05);After 4 weeks of treatment,the emotional PRI scores of two groups were both significantly lower than before treatment(all P<0.01),and the emotional PRI score of the study group decreased more significantly than that of the control group(P<0.05).4)Quality of life:After 4 weeks of treatment,the hit-6 score in two groups were both significantly lower than before treatment(all P<0.01),the quality of life in study group improved more than that in control group(P<0.01).5)degree of pericranial muscle tenderness:it was found that the muscle strip spasm and sensitive tenderness were distributed in different areas around the skull,such as superior trapezius,suboccipital and sternocleidomastoid muscle,indicating that the tension and tenderness of pericranial muscle were mainly distributed in the cervical occipital region.Through SWE observation,it was found that the Yang's modulus value of bilateral superior trapezius in TTH patients was significantly higher than that of healthy volunteers(P<0.01).A total of 20 subjects were selected from two groups.After 4 weeks of treatment,the mean Yang's modulus value of the superior trapezius showed a downward trend compared with that of the baseline,and the downward trend of the hardness of the superior trapezius tissue in the study group was more obvious than that in the control group,but there was no statistical difference.There was no significant correlation between the difference of Yang's modulus value of bilateral superior trapezius compared with baseline and the difference of clinical efficacy index compared with baseline(P>0.05).(3)Safety index:1 patient in the study group was found with local redness after puncturing the fire needle at the tenderness point of the superior trapezius.The next day,the acupoint was slightly raised,without bleeding or exudation,and didn't prick again.After rest,the symptom totally disappeared.No adverse reactions of acupuncture occurred in the control group.Conclusion:(1)Both of two acupuncture methods are effective in the treatment of tension-type headache,which is mainly reflected in the improvement of the frequency and severity of headache,the improvement of patient's emotional state,and the improvement of the quality of life,etc.In addition,the effect of acupuncture treatment can be shown in a short period of time.(2)By analyzing the VAS,SF-MPQ,HIT-6 score of headache duration before and after treatment,it was confirmed that the clinical efficacy of fire needle combined filiform needle therapy in treatment of tension-type headache was better than that of filiform needle alone,with good safety and no serious adverse reactions.(3)Through the shear wave elastrography,it was found that tension-type headache patients with superior trapezius tissue hardness significantly higher than healthy people,two acupuncture methods can relieve spasm of muscle tenderness,especially the decline of muscle hardness was more obvious after the fire needle pricking.However,the correlation with clinical efficacy is not clear.