A Systematic Review and Meta-Analysis of Fu’s Subcutaneous Needling for Tension-Type and Cervicogenic Headache

Objective This study aimed to systematically evaluate the clinical efficacy and safety of Fu’s Subcutaneous Needling (FSN) in the treatment of tension-type headache (TTH) and cervicogenic headache (CEH) via a systematic review and meta-analysis, so as to provide evidence-based medical evidence for the clinical application of FSN in managing these two common headaches. Methods We electronically searched Chinese databases (CNKI, Wanfang, VIP, CBM) and English databases (PubMed, EMbase, the Cochrane Library, ClinicalTrials.gov) for randomized controlled trials (RCTs) on FSN for TTH and CEH from database inception to March 31, 2025. Two independent reviewers screened eligible studies, extracted data, and assessed the risk of bias using the Cochrane Risk of Bias Tool. Meta-analysis was performed with RevMan 5.4 software. Results A total of 12 RCTs were included (6 for TTH and 6 for CEH), involving 756 patients (379 in the FSN group and 377 in the control group). Meta-analysis results showed that FSN was significantly superior to the control interventions in improving the total effective rate (RR = 3.74, 95%CI [2.22, 6.32], P  < 0.00001) and reducing the Visual Analogue Scale (VAS) score for pain (MD=-0.92, 95%CI [-1.28, -0.57], P  < 0.00001). FSN also significantly decreased the headache attack frequency (MD=-1.39, 95%CI [-1.75, -1.03], P  < 0.00001). However, no significant difference was found in improving cervical range of motion (ROM) for CEH (MD=-0.33, 95%CI [-0.83, 0.17], P  = 0.20). Adverse events related to FSN were mild and self-limiting, indicating good safety. Conclusion FSN is a safe and effective therapeutic approach for TTH and CEH, which can significantly improve clinical efficacy and alleviate pain intensity. However, its effect on improving cervical ROM in CEH is not obvious. More high-quality, large-sample, multi-center RCTs are needed to further verify the efficacy of FSN.