Review article
Cupping therapy for migraine: A protocol for a systematic review of controlled trials

https://doi.org/10.1016/j.eujim.2017.09.003Get rights and content

Abstract

Introduction

Migraine is a common and disabling primary headache disorder. Cupping is a traditional medical treatment used in several societies in East Asia and it is frequently used for controlling pain including migraine. There have been no systematic reviews on the treatment effects of cupping on migraine. Furthermore, related studies have had many limitations, making it unclear whether cupping intervention is beneficial for migraine. We propose to conduct a systematic review and meta-analysis to consider the evidence related to the effect of cupping on migraine.

Methods

We developed a protocol describing the essential reporting items based on the PRISMA for systematic review protocols 2015 (PRISMA-P 2015) (Registration number: CRD42017054979). We will search eight databases and include data from prospective randomized controlled clinical trials or quasi-randomized controlled trials that used cupping interventions for the treatment of migraine. The risk of bias will be assessed with the “Risk of bias” tool from the Cochrane Handbook. Using improved effectiveness and the change in headache pain intensity as graded on the visual analogue scale as the primary outcomes, we will compare these outcomes between the cupping intervention and control groups.

Conclusion

There have been no systematic reviews of cupping therapy for migraine headaches to date. This systematic review will assess the effectiveness and safety of cupping therapy for migraine. This systematic review will inform and help healthcare practitioners to treat migraine and will be disseminated electronically and in print in a peer-reviewed journal.

Introduction

Migraine is a common and disabling primary headache disorder with a high prevalence and high socio-economic and personal impacts.

In population-based studies, the prevalence of headache and migraine in children and adolescents are 58.4% and 7.7–9.1%, respectively [1], [2]. Migraines are characterized by attacks of unilateral pulsating moderate-to-severe headaches that can be associated with nausea and/or photophobia or phonophobia [3]. The headache intensity and associated symptoms often cause the patient to avoid some routine physical activities. About 90% of migraine patients with severe symptoms have some headache-related disability, and about half are severely disabled or require bed rest. Migraine lowers the health-related quality of life and social function. As such, it is a public health problem that places a considerable burden on individuals and society [4], [5]. Appropriate diagnosis and first-line acute and prophylactic treatments are needed to relieve this burden.

The American Academy of Neurology guidelines for migraine headaches address the pharmacologic management of acute attacks, migraine-preventive drugs, and behavioral and physical treatments for migraine [6]. However, frequent acute therapy may increase the risk of drug-induced rebound headache and medication overuse. The latter is a major risk of chronic migraine, and one of the long-term migraine treatment goals is to avoid acute headache medication escalations.

Many kinds of migraine treatments including acupuncture, herbal medicine, moxibustion, blood-letting, and cupping are used clinically in various forms and combinations according to the cause and symptoms of the migraine [7].

Cupping therapy has been practiced in both the East and the West. Wet or dry cupping therapy has long been mentioned as a prescription for the treatment of headaches [8]. It is known to be effective for blood circulation disorders and nervous and immune system diseases. In addition, it can be used in the treatment and prevention of headaches [9].

Several systematic reviews on cupping therapy for hypertension, pain, low back pain, and herpes zoster have been published [10], [11], [12], [13], [14]. The efficacy of cupping for migraine has also been evaluated in several case reports and randomized clinical trials (RCTs) [15], [16], [17]. However, there has been no systematic review on the effectiveness of cupping therapy on migraine. Therefore, we propose the current protocol to investigate the evidence related to the effectiveness of cupping therapy for migraine.

Section snippets

Methods

We developed a protocol describing the rationale, hypothesis, and planned methods of the systematic review. The detailed reporting items for this systematic review protocol were based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for systematic review protocols (PRISMA-P) (http://www.prisma-statement.org). It includes the review objective, study registration, types of studies, types of participants and interventions, data sources and search methods, study

Discussion

Promising non-pharmacological treatments and alternative approaches such as acupuncture, herbal medicine, and cognitive therapy have been developed to treat migraine [20], [21].

Cupping therapy uses a cup to create a partial vacuum over a painful area in order to mobilize the blood flow and to promote effective healing [8]. It is effective for many kinds of diseases, including migraine [22].

There has been a systematic literature review of cupping therapy in China [23] and a meta-analysis of

Conflicts of interest

None declared.

Acknowledgments

This study was supported by the Traditional Korean Medicine R&D program funded by the Ministry of Health & Welfare through the Korea Health Industry Development Institute (KHIDI) (HB16C0043).

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