Abstract
Objective
To systematically review published prospective trials relating to the homeopathic treatment of tension type, cervicogenic, and migraine headache.
Data Sources
Pre-MEDLINE, MEDLINE, MANTIS, Cochrane Database of Systematic Reviews, and AMED were searched from the initial indexing year of each database through May 2002. Studies were further identified through a manual search of obtained article references.
Study Selection
English and non-English randomized clinical trials and prospective observational trials were included if there were at least ten subjects in the homeopathic portion of the trial and, for randomized clinical trials, if there was a placebo group. Treatment in these studies included single dose and individualized homeopathic prescription. Case studies, homeopathic provings, unpublished material, non-peer reviewed papers, and studies that combined multiple homeopathic remedies, introduced other complementary and alternative medicine therapies and/or introduced additional medical therapy for patients in the homeopathic treatment groups were excluded.
Data Extraction
Qualitative data were extracted from each paper and entered into an evidence table.
Data Synthesis
A critical evaluation list of 20 methodological items and their operational definitions was used, resulting in a validity score determined for each paper.
Results
Six papers met criteria for inclusion. Three out of the six papers studied migraine headache, two studied cervicogenic and tension type headache, and one included all types of headaches. Four studies were randomized clinical trials, and two were prospective observational studies. Validity scores ranged from 25.0% to 63.4%. Homeopathy was superior to placebo in one randomized clinical trial and equal to placebo in three randomized trials. In no study was homeopathy less effective than placebo in treating headache, or harmful. Two prospective observational studies demonstrated improvement in patients receiving homeopathic care.
Conclusion
There is insufficient evidence to support or refute the use of homeopathy for managing tension type, cervicogenic, or migraine headache. The studies reviewed possessed several flaws in design. Given these findings, further research is warranted to better investigate the effectiveness of homeopathic treatment of headaches.
Key Words: Homeopathy, Headache, Review of the Literature
Footnotes
The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government.
References
- 1.Rasmussen BK. Epidemiology of headache in a general population-a prevalence study. J Clin Epidemiol. 1991;44:1147–1157. doi: 10.1016/0895-4356(91)90147-2. [DOI] [PubMed] [Google Scholar]
- 2.Castillo J, Munoz P, Guitera V, Pascual J. Epidemiology of chronic daily headache in a population sample. Headache. 1999;39:190–196. doi: 10.1046/j.1526-4610.1999.3903190.x. [DOI] [PubMed] [Google Scholar]
- 3.Scher A, Stewart W, Liberman J, Lipton R. Prevalence of frequent headache in a population sample. Headache. 1998;38:497–506. doi: 10.1046/j.1526-4610.1998.3807497.x. [DOI] [PubMed] [Google Scholar]
- 4.Current estimates for the National Heath Interview Survey United States, 1984. Vital & Health Statistics-Series 10: Data From the National Health Survey. 1986;156:1–191. [PubMed] [Google Scholar]
- 5.Edmeads J, Findlay H, Tugwell P, Pryse-Phillips W. Impact of migraine and tension-type headache on life-style, consulting behavior, and medication use: A Canadian population survey. Can J Neurol Sci. 1993;20:131–137. doi: 10.1017/s0317167100047697. [DOI] [PubMed] [Google Scholar]
- 6.Pollmann W, Keide M, Pfaffenrath V. Headache and the cervical spine: a critical review. Cephalgia. 1991;17:801–816. doi: 10.1046/j.1468-2982.1997.1708801.x. [DOI] [PubMed] [Google Scholar]
- 7.Pryse-Phillips W, Dodick D, Edmeads J. Guidelines for nonpharmacologic management of migraine in clinical practice. Can Med Assoc J. 1997;156:1273–1287. [PMC free article] [PubMed] [Google Scholar]
- 8.Kessler RC, Davis R, Foster D. Long-term trends in the use of complementary and alternative medical therapies in the United States. Ann Int Med. 2001;135:262–268. doi: 10.7326/0003-4819-135-4-200108210-00011. [DOI] [PubMed] [Google Scholar]
- 9.Eisenberg D, Kessler R, Van Rompay M. Perceptions about complementary therapies relative to conventional therapies among adults who use both: Results from a national survey. Ann Int Med. 2001;135:344–351. doi: 10.7326/0003-4819-135-5-200109040-00011. [DOI] [PubMed] [Google Scholar]
- 10.Hahnemann S. Organon of medicine. 5th ed. B Jain Publishers; New Dehli, India: 1994. [Google Scholar]
- 11.Clarke J. A dictionary of practical materia medica, vol 1–3. B Jain Publishers; New Dehli, India: 1994. [Google Scholar]
- 12.IHS, Headache Classification Committee Classification for headache disorders, cranial neuralgias and facial pain. Cephalgia. 1988;7(Suppl):1–96. [PubMed] [Google Scholar]
- 13.Bronfort G, Assendelft W, Evans R, Haas M, Bouter L. Efficacy of spinal manipulation for chronic headache: a systematic review. J Manipulative Physiol Ther. 2001;24:457–466. [PubMed] [Google Scholar]
- 14.Koes BW, Assendelft W, van der Hejiden GH, Bouter LM, Kinpschild PG. Spinal manipulation and mobilization for back and neck pain: a blinded review. BMJ. 1991;303:1298–1303. doi: 10.1136/bmj.303.6813.1298. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Assendelft W, Koes BW, Geert JMG, van der Heijden GH, Bouter LM. The effectiveness of chiropractic for treatment of low back pain: An update and attempt at statistical pooling. J Manipulative Physiol Ther. 1995;19:499–507. [PubMed] [Google Scholar]
- 16.Brigo B, Serpelloni G. Homeopathic treatment of migraine: A sixty case, double-blind, controlled study (homeopathic remedy vs. placebo) Berlin J Research Homeo. 1991;1:98–102. [Google Scholar]
- 17.Muscari-Tomaioli G, Allegri F, Miali E. Observational study of quality of life in patients with headache, receiving homeopathic treatment. Br Hom J. 2001;90:189–197. doi: 10.1054/homp.1999.0511. [DOI] [PubMed] [Google Scholar]
- 18.Straumsheim P, Borchgrevink C, Mowinckel P, Kierulf H, Hafslund C. Homeopathic treatment of migraine: a double blind, placebo controlled trial of 68 patients. Br Hom J. 2000;89:4–7. doi: 10.1054/homp.1999.0332. [DOI] [PubMed] [Google Scholar]
- 19.Walach H, Haeusler W, Lowes T. Classical homeopathic treatment of chronic headaches. Cephalgia. 1997;17:119–126. doi: 10.1046/j.1468-2982.1997.1702119.x. [DOI] [PubMed] [Google Scholar]
- 20.Walach H, Lowes T, Mussbach W. The long-term effects of homeopathic treatment of chronic headaches: one year follow-up and single case time series analysis. Br Hom J. 2001;90:63–72. doi: 10.1054/homp.1999.0473. [DOI] [PubMed] [Google Scholar]
- 21.Whitmarsh T, Coleston-Shields D, Steiner T. Double-blind randomized placebo-controlled study of homeopathic prophylaxis of migraine. Cephalgia. 1997;17:600–604. doi: 10.1046/j.1468-2982.1997.1705600.x. [DOI] [PubMed] [Google Scholar]
- 22.Linde K, Melchart D. Randomized controlled trials of individualized homeopathy: a state-of-the-art review. J Alt Comp Med. 1998;4:371–374. doi: 10.1089/acm.1998.4.371. [DOI] [PubMed] [Google Scholar]
- 23.Linde K, Clausius N, Ramirez G. Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials. Lancet. 1997;350:834–843. doi: 10.1016/s0140-6736(97)02293-9. [DOI] [PubMed] [Google Scholar]
- 24.Ernst E. Homeopathic prophylaxis of headaches and migraine? A systematic review. J Pain Symptom Management. 1999;18:353–357. doi: 10.1016/s0885-3924(99)00095-0. [DOI] [PubMed] [Google Scholar]
- 25.Gaus W, Hogel J. Studies on the efficacy of unconventional therapies. Problems and designs. Arzneimittelforshung. 1995;45:88–92. [PubMed] [Google Scholar]
- 26.Altman D, Shultz K, Moher D. The revised CONSORT statement for reporting randomized trials: explanation and elaboration. Ann Int Med. 2001;134:663–694. doi: 10.7326/0003-4819-134-8-200104170-00012. [DOI] [PubMed] [Google Scholar]
- 27.Whitmarsh T. More lessons from migraine. Br Homeo J. 1989;1:1–2. doi: 10.1054/homp.1999.0319. [DOI] [PubMed] [Google Scholar]