Cupping Therapy for Migraine: A PRISMA-Compliant Systematic Review and Meta-Analysis of Randomized Controlled Trials

Table 3

Summary of findings and quality of the evidence.

Outcomes	Anticipated absolute effects (95% CI)		Relative effect (95% CI)	Number of participants (studies)	Certainty of the evidence (GRADE)
	Comparison	Intervention
1. Wet-cupping compared to drugs for migraine
1–1. Wet cupping compared to flunarizine for migraine
TER	800 per 1,000	968 per 1,000; (800 to 1,000)	RR 1.21 (1.00 to 1.46)	60 (1 RCT)	⊕⊕○○; Low^a,b
1–2. Wet cupping compared to flunarizine plus ibuprofen at acute attack for migraine
TER	733 per 1,000	953 per 1,000; (792 to 1,000)	RR 1.30 (1.08 to 1.57)	90 (1 RCT)	⊕⊕○○; Low^a,c
HI assessed with: VAS scale from 0 to 10	—	MD 1.4 lower; (2.08 lower to 0.72 lower)	—	90 (1 RCT)	⊕⊕○○; Low^a,c
Migraine score	—	MD 5.87 lower; (7.66 lower to 4.08 lower)	—	90 (1 RCT)	⊕⊕○○; Low^a,c
1–3. Wet cupping compared to diclofenac sodium at acute attack for migraine
TER	800 per 1,000	968 per 1,000; (800 to 1,000)	RR 1.21 (1.00 to 1.46)	60 (1 RCT)	⊕⊕○○; Low^a,b
HI assessed with VAS scale from 0 to 10	—	MD 0.35 lower; (1.06 lower to 0.36 higher)	—	60 (1 RCT)	⊕⊕○○; Low^a,d
2. Dry cupping plus acupuncture compared to acupuncture for migraine
TER	941 per 1,000	988 per 1,000; (932 to 1,000)	RR 1.24 (0.99 to 1.12)	170 (2 RCTs)	⊕⊕○○; Low^a,b
HI assessed with VAS scale from 0 to 10	—	MD 2.29 lower; (2.62 lower to 1.96 lower)	—	70 (1 RCT)	⊕⊕○○; Low^a,c
ND	—	MD 1.98 lower; (2.91 lower to 1.05 lower)	—	100 (1 RCT)	⊕⊕○○; Low^a,c
Explanations
(a) Study had unclear risk of bias
(b) Small sample size and the CI crosses 1
(c) Small sample size
(d) Small sample size and the CI crosses 0
GRADE Working Group grades of evidence
Moderate certainty: we are moderately confident in the effect estimate. The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low certainty: our confidence in the effect estimate is limited. The true effect may be substantially different from the estimate of the effect.
Very low certainty: we have very little confidence in the effect estimate. The true effect is likely to be substantially different from the estimate of effect.

CI = confidence interval, HI = headache intensity, MD mean difference, ND the number of days the headache has completely disappeared, RCT randomized controlled clinical trial, RR risk ratio, SMD standard mean difference, TER total effective rate, and VAS visual analogue scale.