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Abstrackt background : An aura involves temporary visual disturbances like temporary loss of vision, flashing lights, or zigzag lines that precede the headache, and it serves as a predictor of migraine attacks in about 30% of patients. In the 2017 Global Disease Burden (GBD) survey, it was revealed that approximately 1.25 billion people were afflicted by migraines, ranking it as the fifth most widespread condition globally and the seventh most incapacitating illness worldwide. According to the 2019 GBD study, migraine ranks as the second most prevalent cause of disability among young females.
AbstractBackground (en)
wo reviewers collected and analyzed the data independently. For assessment of the robustness of the results, a sensitivity analysis was executed. An iterative meta-analysis was done by systematically eradicating one study at a time. Relative risk (RR) was employed for analyzing dichotomous outcome data to determine treatment effects. When dealing with continuous outcomes, standard mean differences (SMD) were utilized. Point estimates, along with their 95% confidence intervals (CI), were used to represent both dichotomous and continuous data.
Result : The results' graph only depicted the pain score, but it was categorized as a VAS measure based on its mention in the methodology section. Unfortunately, the absence of standard deviation (SD) values prevented the conductance of a meta-analysis of the VAS.
Owing to the restricted sample size, it was unfeasible to investigate the drugs and their dosages separately.
While the authors mentioned the implementation of the MTAQ, they did not provide any corresponding results, leaving uncertainty as to whether other parameters, such as work absence rates and the ability to carry out daily activities, were used instead.
Disappointingly, the work absence rates did not display profound differences, and the study lacked clear criteria for classifying the experimental and control groups.
Additionally, when comparing scalp acupuncture to ordinary acupuncture, no profound differences were observed. Consequently, this study requires a comprehensive reorganization.
Owing to the limited number of studies included and the restricted availability of relevant literature, the quality of some studies appeared somewhat subpar.
Conclistion
Medical history : Questionnaires related to migraine: The migraine therapy assessment questionnaire (MTAQ) and migraine disability assessment questionnaire (MIDAS) are commonly employed for migraine evaluation. The MIDAS questionnaire helps gauge how headaches affect an individual's life, assess the pain and disability levels, and identify the most effective treatment options. The MTAQ is used to evaluate the degree of migraine management both before and after the intervention.
Examin lab investigation : For assessing the risk of bias, the RoB 2.0 tool was employed. A meta-analysis was executed utilizing RevMan software (Version 5.4). Determination of the certainty of the evidence was done with the aid of the GRADEpro Guideline Development Tool. Various factors were taken into account to assess the confidence in the evidence, including imprecision, indirectness, inconsistency, risk of bias, and study design.
The level of confidence in the evidence was graded as high, moderate, low, or very low. Study bias was categorized into one of three levels: 'some concerns,' 'low risk,' or 'high risk,' based on the following criteria: random sequence generation, deviations from intended interventions, missing or incomplete outcome data, measurement of the outcome, selection of the reported results, and overall bias.
Two reviewers collected and analyzed the data independently. For assessment of the robustness of the results, a sensitivity analysis was executed. An iterative meta-analysis was done by systematically eradicating one study at a time. Relative risk (RR) was employed for analyzing dichotomous outcome data to determine treatment effects. When dealing with continuous outcomes, standard mean differences (SMD) were utilized. Point estimates, along with their 95% confidence intervals (CI), were used to represent both dichotomous and continuous data. management
To ensure the reliability of the meta-analysis findings, the robustness of the findings was investigated using two critical metrics: the fragility index (FI) and fragility quotient (FQ) for statistically significant outcomes. The FI was calculated using an online calculator available at http://clinicalepidemio.fr/frgility_ma/. The results were categorized as highly fragile if their FI was less than or equal to 1 or if the FQ was less than or equal to 0.01.- Discussion
RevMan software was utilized to perform all the meta-analyses. A quantitative synthesis was carried out with the aid of a standard effects model when there was no statistical heterogeneity. The effect sizes were presented with 95% CIs. The findings were deemed statistically significant if P < 0.05. Q and I² tests were employed to assess heterogeneity presence. A fixed effects model was chosen when P > 0.1 and I² was less than 50%, indicating the absence of significant heterogeneity. - LeARNINGS
Scalp acupuncture seems to outperform alternative migraine treatments in terms of effectiveness. But, its safety remains unclear. - Single View Content (en)
or assessing the risk of bias, the RoB 2.0 tool was employed. A meta-analysis was executed utilizing RevMan software (Version 5.4). Determination of the certainty of the evidence was done with the aid of the GRADEpro Guideline Development Tool. Various factors were taken into account to assess the confidence in the evidence, including imprecision, indirectness, inconsistency, risk of bias, and study design.
The level of confidence in the evidence was graded as high, moderate, low, or very low. Study bias was categorized into one of three levels: 'some concerns,' 'low risk,' or 'high risk,' based on the following criteria: random sequence generation, deviations from intended interventions, missing or incomplete outcome data, measurement of the outcome, selection of the reported results, and overall bias.
Study outcomes
Inclusion criteria
(a) Study types
RCTs that specifically addressed the application of scalp acupuncture to relieve migraine were considered for inclusion.
(b) Participants
Participants who had received a migraine diagnosis according to the International Classification of Headache Disorders and had been treated with scalp acupuncture, without any limitations based on gender, race, or age were eligible for inclusion.
(c) Interventions
Those studies were included that primarily focused on scalp acupuncture as the main intervention, along with other treatments like thrombosis therapy, body acupuncture, and electrical stimulation as supplementary therapies. The inclusion criteria were based on the definition of scalp acupuncture, which encompasses the treatment of specific zones on the scalp linked with various body functions and broader regions of the body.
This technique involves inserting needles into a thin layer of loose tissue just beneath the surface of the scalp at a low angle of approximately 15–30 degrees. The insertion depth is typically about 1 cm, followed by rapid stimulation through various methods like pulling, thrusting, twirling, and electro-stimulation. In this analysis, two forms of scalp acupuncture were taken into account: Yamamoto's new scalp acupuncture (YNSA) and Qinshi scalp acupuncture.
(d) Comparison
Those studies were included in which the control group included patients who received alternative treatments, like medications, physical therapy, or sham therapy, as well as those who did not receive any form of therapy.
Exclusion criteria
RCTs that did not adhere to the principles of scalp acupuncture theory, such as those that did not involve needling or did not target specific points according to the scalp acupuncture lines, were eliminated.
Studies that incorporated scalp acupuncture as a part of the control group and those with unclear descriptions of their control groups were not considered for inclusion.
Study selection and Data extraction
Following the elimination of irrelevant studies through title and abstract reviews, two independent reviewers thoroughly assessed the full texts of each included article. These reviewers systematically extracted, analyzed, and organized data pertaining to the study design, participants, interventions administered, control group treatments, outcomes, and other relevant factors.
The results of the search were subsequently cross-verified. In instances where data were found to be insufficient, efforts were made to reach out to the authors for additional information. If such data could not be procured, the study was expelled from the investigation.
Data and Statistical Analysis
Two reviewers collected and analyzed the data independently. For assessment of the robustness of the results, a sensitivity analysis was executed. An iterative meta-analysis was done by systematically eradicating one study at a time. Relative risk (RR) was employed for analyzing dichotomous outcome data to determine treatment effects. When dealing with continuous outcomes, standard mean differences (SMD) were utilized. Point estimates, along with their 95% confidence intervals (CI), were used to represent both dichotomous and continuous data.
To ensure the reliability of the meta-analysis findings, the robustness of the findings was investigated using two critical metrics: the fragility index (FI) and fragility quotient (FQ) for statistically significant outcomes. The FI was calculated using an online calculator available at http://clinicalepidemio.fr/frgility_ma/. The results were categorized as highly fragile if their FI was less than or equal to 1 or if the FQ was less than or equal to 0.01.
RevMan software was utilized to perform all the meta-analyses. A quantitative synthesis was carried out with the aid of a standard effects model when there was no statistical heterogeneity. The effect sizes were presented with 95% CIs. The findings were deemed statistically significant if P < 0.05. Q and I² tests were employed to assess heterogeneity presence. A fixed effects model was chosen when P > 0.1 and I² was less than 50%, indicating the absence of significant heterogeneity.
In cases where P < 0.1 and I² exceeded 50%, indicating substantial heterogeneity, a random-effects model was employed. Owing to the restricted number of studies in each comparison, a subgroup analysis was not conducted.
Clinical take away : The results' graph only depicted the pain score, but it was categorized as a VAS measure based on its mention in the methodology section. Unfortunately, the absence of standard deviation (SD) values prevented the conductance of a meta-analysis of the VAS.
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