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The acupuncture randomised trial (ART) for tension-type headache - details of the treatment
  1. Dieter Melchart, director1,
  2. Andrea Streng, clinical researcher1,
  3. Andrea Hoppe, clinical researcher1,
  4. Benno Brinkhaus, specialist in internal medicine2,
  5. Claudia Becker-Witt, epidemiologist2,
  6. Michael Hammes, specialist in neurology and medical acupuncturist3,
  7. Dominic Irnich, specialist in anaesthesiology and medical acupuncturist4,
  8. Josef Hummelsberger, specialist in internal medicine and medical acupuncturist5,
  9. Stefan N Willich, professor2,
  10. Klaus Linde, epidemiologist1
  1. 1
    Centre for Complementary Medicine Research Technische Universität, München, Munich, Germany
  2. 2
    Institute of Social Medicine, Epidemiology, and Health Economics, Charité, University Medical Center, Berlin, Germany
  3. 3
    Department of Neurology, Technische Universität, München, Munich, Germany
  4. 4
    Department of Anesthesiology, Ludwig-Maximilians-Universität, München, Munich, Germany
  5. 5
    International Society for Chinese Medicine, Munich, Germany
  1. Klaus.Linde{at}


Objective The goal of this paper is to describe the characteristics of physicians and their interventions in a large, multicentre randomised trial of acupuncture for tension-type headache known as ARTTTH, in order to enable acupuncturists to assess the study interventions.

Methods Participating physicians were recruited whose qualifications met or surpassed those of physicians currently accredited for providing acupuncture by state health funding agencies in Germany. Semi-standardised treatment strategies for acupuncture and minimal acupuncture were developed in a consensus process with acupuncture experts. A total of 270 patients suffering from episodic or chronic tension-type headache were randomised to 12 sessions of semi-standardised acupuncture (three predefined ‘basic’ points, recommendations for additional points given, but individual choice of additional points possible), standardised minimal acupuncture (superficial needling of at least 5 of 10 predefined, bilateral, distant non-acupuncture points) or a waiting list. Forty two physicians, trained and experienced in acupuncture, from 28 centres in Germany participated in the trial.

Results The median duration of acupuncture training of trial physicians was 500 hours (range 140 to 1350 hours). Physicians had 10 (<1 to 25) years acupuncture experience. The three ‘basic’ points (GB20, GB21 and LR3) were treated in 96%, 82% and 97% of sessions, respectively. Frequently treated optional points included LI4 (67%), SP6 (50%) and ST36 (46%). Ten of the 42 physicians stated that they would have treated patients differently outside the trial. The trial found a significant effect of acupuncture over waiting list but not over minimal acupuncture.

Conclusions In general, trial physicians complied well with the predefined interventions. A relevant minority of participating trial physicians stated that they would have treated patients differently outside the trial.

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