Sommaire

Migraine

Migraine : évaluation de l'acupuncture

Articles connexes : - céphalées - céphalées de tension - céphalées neurovasculaires - acupuncture expérimentale - Traitements de référence - Qigong -

1. Systematic review and Meta-analysis

1.1. Generic Acupuncture

1.1.1. Shi 2023 (durable effect)

Shi H, Miao R, Gao S, Zhu L, Fang J, Liu Z. The durable effect of acupuncture for episodic migraine: a systematic review and meta-analysis. Front Neurosci. 2023 Sep 8;17:1211438. https://doi.org/10.3389/fnins.2023.1211438

Background Migraine is a common and recurrent type of headache. Avoiding trigger factors is not often successful in reducing headache frequency, duration, and severity. Prophylactic medications may be effective but are limited by strict indications and daily medication intake. This review aimed to investigate the durable effect of acupuncture on episodic migraine.
Methods Seven databases including Medline, Embase, PubMed, etc., were searched for English and Chinese literature from their inception to 23 November 2022. Two independent reviewers screened the retrieved studies and extracted the data. Primary outcomes were monthly migraine days, monthly migraine attacks, and VAS score at 3 months post-treatment. The risk of bias in included studies was assessed using the Cochrane Risk of Bias 2.0 tool. Meta-analysis was conducted where applicable.
Results Fifteen studies were included in this review. Acupuncture reduced the number of migraine attacks (MD -0.68; 95% CI -0.93, -0.43; p < 0.001), the number of days with migraine (MD -0.86; 95% CI -1.18, -0.55; p < 0.001), and VAS score (MD -1.01; 95% CI -1.30, -0.72; p < 0.001) to a greater degree than sham acupuncture at 3 months after treatment. Significant differences in reducing pain intensity of migraine in favor of acupuncture compared with waitlist (MD -1.84; 95% CI -2.31, -1.37; p < 0.001) or flunarizine (MD -2.00; 95% CI -2.35, -1.65; p < 0.001) at 3 months after treatment were found, and the differences reached the minimal clinically important difference (MCID).
Conclusion This review found that the durable effect of acupuncture for episodic migraine lasted at least 3 months after treatment. More high-quality studies with longer follow-up periods in the future are needed to confirm the findings.

1.1.2. Beier 2022

Beier D, Callesen HE, Carlsen LN, Birkefoss K, Tómasdóttir H, Wűrtzen H, Christensen HW, Krøll LS, Jensen M, Høst CV, Hansen JM. Manual joint mobilisation techniques, supervised physical activity, psychological treatment, acupuncture and patient education in migraine treatment. A systematic review and meta-analysis. Cephalalgia. 2022 Jan;42(1):63-72. https://doi.org/10.1177/03331024211034489

Background Many people suffering from migraine combine pharmacological and non-pharmacological treatments. The purpose of this systematic review is to provide an updated guideline for some widely used non-pharmacological treatment options for migraine.
Methods We conducted a systematic literature review of randomized studies of adults with migraine treated with manual joint mobilisation techniques, supervised physical activity, psychological treatment, acupuncture and patient education. The main outcomes measured were days with headache and quality of life. Recommendations were formulated based on the Grade of Recommendation, Assessment, Development and Evaluation (GRADE) approach including patient preferences based on expert opinion and questionnaire data.
Results The overall level of certainty of the evidence was low to very low. Manual therapy techniques and psychological treatment did not change the studied outcomes. Supervised physical activity might have a positive impact on quality of life, acupuncture on headache frequency, intensity, quality of life and the use of attack-medicine. Patient education might improve self-rated health and quality of life and increase the number of well-informed patients.
Conclusion Based on observed effects, the lack of serious adverse events, and patients' preferences, we make weak recommendations for considering the investigated interventions as a supplement to standard treatment.

1.1.3. Pi 2022 ☆☆

Pi C, Liu Y, Li L, Tang W, Yan X, Yu S. Effects on neuromodulation, acupuncture, and aerobic exercises on migraine and tension-type headache outcomes: A systematic review and meta-analysis. Medicine (Baltimore). 2022 Nov 11;101(45):e30530. https://doi.org/10.1097/MD.0000000000030530

Background Headache disorders are common diseases that cause a social burden. This systematic review and meta-analysis aimed to evaluate the effects of various non-pharmacological treatments to address or prevent acute headaches, including neuromodulation, acupuncture, and aerobic exercises in patients with episodic migraine and tension-type headache (TTH).
Methods We performed a systematic search of the electronic databases PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure, WANFANG MEDICINE ONLINE, and Chinese Medical Journal database using Stata/SE 14.0 to obtain weighted mean differences (WMDs). The outcomes included monthly headache days, headache intensity, headache duration, days per month of acute medication use, and the Medical Outcomes Study 36-Item Short-Form Health Survey.
Results Of 872 identified articles, 27 were included in the meta-analysis. Neuromodulation was associated with reduced headache days (WMD: -1.274, 95% CI [-1.914, -0.634], P < .001), duration (WMD: -2.2, 95% CI [-3.32, -0.107], P < .001) and medication consumption (WMD: -1.808, 95% CI [-2.546, -1.071], P < .001) in cases of migraine. Acupuncture was associated with the alleviation of headache days (WMD: -0.677, 95% CI [-0.932, -0.422], P < .001) and intensity (WMD: -0.893, 95% CI [-1.573, -0.212], P = .01) in cases of migraine and acute medication use (WMD: -3.29, 95% CI [-4.86, -1.72], P < .001) in cases of TTH. Aerobic exercise was associated with reduced headache duration (WMD: -5.1, 95% CI [-8.97, -1.22], P = .01) in cases of TTH. The risk of bias for included articles was moderate.
ConclusionsThere is low- and moderate-quality evidence that neuromodulation, acupuncture, and aerobic exercises are associated with attenuated headache symptoms in patients with episodic migraine or TTH. However, high-quality studies are needed to draw more detailed conclusions.

1.1.4. Fan 2021 ★★★

Fan SQ, Jin S, Tang TC, Chen M, Zheng H. Efficacy of acupuncture for migraine prophylaxis: a trial sequential meta-analysis. J Neurol. 2021;268(11):4128-4137. [223040]. doi

Background Acupuncture is commonly used for migraine prophylaxis; however, evidence of its efficacy was equivocal. Aim: We aimed to evaluated the efficacy of acupuncture in migraine prophylaxis and calculated the required information size (RIS) to determine whether further clinical studies are required.
MethodsWe searched Cochrane library, EMBASE and PubMed from inception to April 23th, 2020. Randomized trials that compared acupuncture with conventional drug therapy or sham acupuncture were included. The primary outcome was migraine episodes. Secondary outcomes were responder rate and adverse event.
ResultsTwenty studies (n = 3380) met the inclusion criteria. When it comes to migraine episodes, Acupuncture was superior over sham acupuncture [SMD = - 0.29, 95% CI (- 0.47 to - 0.11), P = 0.002] after treatment, while the difference between acupuncture and prophylactic drugs was not significant [SMD = - 0.21, 95% CI (- 0.42 to 0.00), P = 0.06].Both TSA graphs indicated that more RCTs are needed. As for responder rate, the results after treatment showed that acupuncture was statistically significantly better than sham acupuncture [RR 1.30, 95% CI (1.09-1.55), P = 0.003] as well as conventional drugs [RR 1.24, 95% CI (1.04-1.48), P = 0.01]. Both of their cumulative Z-curves intersected with the trial sequential monitoring boundaries favoring acupuncture. Compared to prophylactic medication, acupuncture can cause less adverse events [RR 0.34, 95% CI (0.14-0.81), P = 0.01].
ConclusionAcupuncture can reduce migraine episodes compared to sham one and can be an alternative and safe prophylactic treatment for conventional drugs therapy, but it should be further verified through more RCTs. Available studies suggested acupuncture was superior to sham acupuncture and conventional drugs in terms of responder rate as verified by TSA.

1.1.5. Zheng 2021 (vs Botulinum neurotoxin A and Topiramate, network meta-analysis) ★

Zheng H, Huang SL, Chen YY, Tang TC, Qin D, Chen M. Topiramate, acupuncture, and BoNT-A for chronic migraine: a network meta-analysis. Acta Neurol Scand. 2021. [195024]. doi

BackgroundBotulinum neurotoxin A (BoNT-A) was the primary choice for preventive treatment of chronic migraine. Topiramate and acupuncture showed promising effect for chronic migraine, but their effectiveness relative to BoNT-A was rarely studied. We aimed to perform a network meta-analysis to compare the effectiveness and acceptability between topiramate, acupuncture, and BoNT-A.
MethodsWe searched OVID Medline, Embase, the Cochrane register of controlled trials (CENTRAL), the Chinese Clinical Trial Register, and clinicaltrials.gov for randomized controlled trials (RCTs) that compared topiramate, acupuncture, and BoNT-A with any of them or placebo in the preventive treatment of chronic migraine. A network meta-analysis was performed by using a frequentist approach and a random-effects model. The primary outcomes were reduction in monthly headache days and monthly migraine days at week 12. Acceptability was defined as the number of dropouts owing to adverse events.
ResultsWe included 15 RCTs (n = 2545). Eleven RCTs were at low risk of bias. The network meta-analyses (n = 2061) showed that acupuncture (2061 participants; standardized mean difference [SMD] -1.61, 95% CI: -2.35 to -0.87) and topiramate (582 participants; SMD -0.4, 95% CI: -0.75 to -0.04) ranked the most effective in the reduction of monthly headache days and migraine days, respectively; but they were not significantly superior over BoNT-A. Topiramate caused the most treatment-related adverse events and the highest rate of dropouts owing to adverse events.
ConclusionsTopiramate and acupuncture were not superior over BoNT-A; BoNT-A was still the primary preventive treatment of chronic migraine. Large-scale RCTs with direct comparison of these three treatments are warranted to verified the findings.

1.1.6. Giovanardi 2020 (vs Pharmacological Prophylaxis)☆☆

Giovanardi CM, Cinquini M Aguggia M, Allais G, Campesato M,Cevoli S et al, Acupuncture vs. Pharmacological Prophylaxis of Migraine: A Systematic Review of Randomized Controlled Trials.Front. Neurol.2020;11:576272.doi]

Introduction Migraine is a chronic paroxymal neurological disorder characterized by attacks of moderate to severe headache and reversible neurological and systemic symptoms. Treatment of migraine includes acute therapies, that aim to reduce the intensity of pain of each attack, and preventive therapies that should decrease the frequency of headache recurrence. The objective of this systematic review was to assess the efficacy and safety of acupuncture for the prophylaxis of episodic or chronic migraine in adult patients compared to pharmacological treatment.
Methods We included randomized-controlled trials published in western languages that compared any treatment involving needle insertion (with or without manual or electrical stimulation) at acupuncture points, pain points or trigger points, with any pharmacological prophylaxis in adult (≥18 years) with chronic or episodic migraine with or without aura according to the criteria of the International Headache Society.
Results Nine randomized trials were included encompassing 1,484 patients. At the end of intervention we found a small reduction in favor of acupuncture for the number of days with migraine per month: (SMD: −0.37; 95% CI −1.64 to −0.11), and for response rate (RR: 1.46; 95% CI 1.16–1.84). We found a moderate effect in the reduction of pain intensity in favor of acupuncture (SMD: −0.36; 95% CI −0.60 to −0.13), and a large reduction in favor of acupuncture in both the dropout rate due to any reason (RR 0.39; 95% CI 0.18 to 0.84) and the dropout rate due to adverse event (RR 0.26; 95% CI 0.09 to 0.74). Quality of evidence was moderate for all these primary outcomes. Results at longest follow-up confirmed these effects.
ConclusionsBased on moderate certainty of evidence, we conclude that acupuncture is mildly more effective and much safer than medication for the prophylaxis of migraine.

1.1.7. Min 2020 (vs flunarizine)☆

Min J, Yun-Ling Z, Yan LU, Xing L, Xiao L, Jing-Jing W et al. [Systematic review and Meta-analysis on randomized controlled trial of efficacy and safety for acupuncture versus Flunarizine in treatment of migraine.] China Journal of Chinese Materia Medica (Zhongguo Zhong Yao Za Zhi). 2020 Nov;45(21):5083-5092. [Article in Chinese]

Aim To systematically evaluate the effectiveness and safety of acupuncture versus flunarizine hydrochloride in the treatment of migraine.
MethodsFour Chinese databases (CNKI, VIP, WanFang, CBM), three English databases (the Cochrane Library EMbase, Medline) and ClinicalTrail. gov were systematically and comprehensively retrieved. The retrieval time was from the establishment of each database to January 8, 2020. Randomized controlled trials (RCT) for acupuncture versus flunarizinein in the treatment of migraine were screened out according to inclusion criteria and exclusion criteria. The included studies were evaluated with the Cochrane bias risk assessment tool, meta quantitative analysis of the included studies was conducted by RevMan 5. 3, and the outcome indicators were evaluated for evidence quality and strength of recommendation by the GRADE system.
Results A total of 1 033 literatures were retrieved, and 23 studies were finally included. Except for 4 multiarm tests, the total sample size was 1 548, including 785 in acupuncture group and 763 in flunarizine group. The overall quality of the included studies was not high. Meta-analysis results showed that the acupuncture group was superior to the flunarizine group in reduction of headache frequency (SMD=－1. 00, 95%CI[－1. 45, －0. 54], P<0. 000 1). In reduction of headache intensity, acupuncture group was superior to flunarizine group (SMD=－1. 05, 95%CI[－1. 41, －0. 68], P<0. 000 01). In reduction of headache duration, acupuncture group was superior to flunilizine group (SMD=－1. 42, 95%CI[－1. 83, －1. 02], P<0. 000 1). The acupuncture group was superior to flunarizine group (MD=－0. 17, 95%CI[－0. 21, －0. 13], P<0. 000 01) in reduction of the painkillers taking frequency. The acupuncture group was superior to flunarizine group (SMD=－0. 94, 95%CI[－1. 35, －0. 52], P<0. 000 1) in alleviation of Paroxysmal symptoms, such as nausea and vomiting. The GRADE system showed that the evidence level of the above indicators was extremely low, and the strength of recommendation was low. As for the occurrence of adverse reactions, the adverse reactions reported in the acupuncture group included in the study were all mild adverse reactions, like drowsiness, subcutaneous bleeding, local pain, subcutaneous hematoma and dizziness needle.
ConclusionsThe available evidence showed that acupuncture has a better efficacy than flunarizine hydrochloride in the treatment of migraine in adult patients. However, due to the high bias risk in the included studies, the conclusions of this study shall be adopted with caution, and more high-quality studies shall be carried out for verification in the future.

1.1.8. Ou 2020 ☆☆☆

Ou MQ, Fan WH, Sun FR, Jie WX, Lin MJ, Cai YJ, Liang SY, Yu YS, Li MH, Cui LL, Zhou HH. A Systematic Review and Meta-analysis of the Therapeutic Effect of Acupuncture on Migraine. Front Neurol. 2020:11-596. [210326]. doi

Background Migraine is an intractable headache disorder, manifesting as periodic attacks. It is highly burdensome for patients and society. Acupuncture treatment can be beneficial as a supplementary and preventive therapy for migraine.
ObjectivesThis systematic review and meta-analysis aimed to investigate the efficacy and safety of acupuncture for migraine, and to examine transcranial doppler changes after acupuncture.
MethodsReports, conference, and academic papers published before March 15, 2019 in databases including PubMed, Cochrane library, Embase, China National Knowledge Infrastructure, WANFANG Database, Chinese journal of Science and Technology, and China Biomedical were searched. Randomized controlled trials (RCTs) involving acupuncture, sham acupuncture, and medication in migraine were included. The Cochrane Collaboration software, RevMan 5.3, was used for data processing and migration risk analysis.
ResultsTwenty-eight RCTs were included. 15 RCTs included medication only, 10 RCTs included sham acupuncture only, and 3 RCTs included both. The study included 2874 patients, split into 3 groups: acupuncture treatment group (n = 1396), medication control group (n = 865), and sham acupuncture control group (n = 613). The results showed that treatment was more effective in the acupuncture group than in the sham acupuncture group (MD = 1.88, 95% CI [1.61, 2.20], P < 0.00001) and medication group (MD = 1.16, 95% CI [1.12, 1.21], P < 0.00001). Improvement in visual analog scale (VAS) score was greater in the acupuncture group than in the sham acupuncture group (MD = -1.00, 95% CI [-1.27,-0.46], P < 0.00001; MD = -0.59, 95% CI [-0.81,-0.38], P < 0.00001), and their adverse reaction rate was lower than that of the medication group (RR = 0.16, 95% CI [0.05, 0.52], P = 0.002). The improvement of intracranial blood flow velocity by acupuncture is better than that by medication, but the heterogeneity makes the result unreliable.
Conclusions Acupuncture reduced the frequency of migraine attacks, lowered VAS scores, and increased therapeutic efficiency compared with sham acupuncture. Compared with medication, acupuncture showed higher effectiveness with less adverse reactions and improved intracranial blood circulation. However, owing to inter-study heterogeneity, a prospective, multicenter RCT with a large sample is required to verify these results.

1.1.9. Zhang 2020 (vs Standard Pharmacological Therapy) ☆☆

Zhang N, Houle T, Hindiyeh N, Aurora SK. Systematic Review: Acupuncture vs Standard Pharmacological Therapy for Migraine Prevention. Headache. 2020;60(2):309-317. [220775]. doi

BackgroundStandard pharmacological treatment of migraine has many shortcomings. Acupuncture is becoming a more widely used therapy for the prevention and treatment of migraine, but its effectiveness is still in question when compared to the pharmacological treatments even though very few of these have Class A and B evidence for migraine prevention. This is a systematic review of data from existing randomized trials that compare the effectiveness of acupuncture treatment with conventional migraine preventative medications.
MethodsCustom-designed strategy was used for searching Pubmed (includes MEDLINE), Scopus (includes EMBASE). The inclusion criteria were English language and randomized trials. No date restriction was utilized. We included randomized trials and randomized controlled trials in adult patients that compared the clinical effects of acupuncture with a standard migraine preventive medication in patients with a diagnosis of chronic or episodic migraine with or without aura. We excluded letters and studies on acupuncture for headaches other than migraine. Two reviewers checked eligibility; extracted information on patients, interventions, methods, and results; and assessed the quality of the acupuncture intervention based on the American Academy of Neurology Classification of evidence matrix for therapeutic trials. The present review was not registered.
ResultsOut of the 706 search results, 7 clinical trial, with a total of 1430 participants, met inclusion criteria for trials comparing the effectiveness of acupuncture to standard pharmacologic treatment. Several of the studies showed acupuncture to be more effective than standard pharmacological treatments for migraine prevention; however, methodological heterogeneity precluded aggregation of these data.
ConclusionsThere is growing evidence that acupuncture is just as effective and has fewer side effects than many of the standard pharmaceutical agents that are currently used. However, the heterogeneity of the existing studies limits the effective comparison and analysis.

1.1.10. Chen 2019 (vs Propranolol) ☆☆

Chen YY, Li J, Chen M, Yue L, She TW, Zheng H. Acupuncture versus propranolol in migraine prophylaxis: an indirect treatment comparison meta-analysis. J Neurol. 2019 [199102].

BackgroundPropranolol is recommended as first-line treatment for preventing migraine attacks; acupuncture has not been compared with propranolol in a head-to-head trial.
Objective To compare acupuncture with propranolol using indirect treatment comparison meta-analysis.
Method We searched MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL). Randomized controlled trials comparing acupuncture or propranolol with sham acupuncture, placebo, waiting-list control or usual care were included. We extracted information from the included trials using a standardized extraction form. The primary outcome was migraine episodes. The secondary outcomes included migraine days, migraine frequency, and adverse events.
ResultsWe included 19 RCTs (n = 3656) after screening 1078 articles. The analysis showed that acupuncture had a significant advantage over propranolol in reducing migraine episodes over a 4-week period (SMD - 0.74, 95% CI - 1.04 to - 0.44). Acupuncture also had a significant advantage over waiting-list control in decreasing migraine frequency (SMD - 1.57, 95% CI - 2.08 to - 1.06). Acupuncture caused fewer adverse events than propranolol (RR 0.82, 95% CI 0.11-5.94).
Conclusions Acupuncture had a better effect than propranolol in reducing migraine episodes in indirect comparison. The result should be confirmed in subsequent head-to-head studies.

1.1.11. Pu 2019 ☆☆☆

Pu Shengxiong, Ouyang Qingrong, Yang Fei, Li Zhimin, Cao Xing, Luo Jiaming. [Life quality of acupuncture patients with migraine prophylaxis: a Meta-analysis]. Chongqing Medical Journal. 2019;1:106-11. [199991].

ObjectiveAcupuncture is widely used in migraine prevention, this systematic review specialized in evaluating the therapeutic effect of acupuncture on migraine prophylaxis life quality of patients to provide basis for clinical application of acupuncture.
Methods Searched database from PubMed, Cochrane library, WanFang and CNKI prior to December 2017, screened the randomized controlled trials(RCT) of acupuncture for migraine prophylaxis. And then, the included studies would be assessed and extracted the medical outcome study for Meta-analysis.
Results A total of 9 RCTs and 2015 migraineurs were included. There were pronounced difference (P0.05) for physical component summary in acupuncture comparing to the control [MD=3.96,95%CI(2.11,5.81)], the sham group [MD=1.06,95%CI(0.15,1.96)] and the drug group [MD=2.47,95%CI(1.46,3.47)]. There were no difference (P0.05) in the acupuncture group comparing the control group [MD=0.53,95%CI(-2.02,3.07)] and sham acupuncture [MD=0.92,95%CI(-0.08,1.91)], and statistical difference in acupuncture comparing the drug group [MD=1.18,95%CI(0.12,2.23)].
Conclusion Acupuncture could be beneficial to life quality in acupuncture for migraine prophylaxis. There was specific therapeutic effects for physical assessment but the undefined effects for mental assessment

1.1.12. Shen 2019 ☆☆

Shen Feng-Jiao, Xu Jia, Zhan Yi-Jun, Fu Qin-Hui, Pei Jian. Acupuncture for migraine: A systematic review and meta-analysis. World Journal of Acupuncture-Moxibustion. 2019;29(1):7-14. [199980].

ObjectiveThe goal of this study is to systematically assess the effectiveness of acupuncture compared with medication for migraine.
Methods The Cochrane Library, PubMed, MEDLINE, Embase, China National Knowledge Infrastructure (CNKI), Sinomed, the Chongqing VIP full-text periodical database (VIP) and Wanfang were searched by computer to identify the randomized controlled trails comparing acupuncture with medication for migraine from the beginning of these databases to August 2018, supplementing with literature retrospective and manual searches. Review Manager 5.2 was used for statistical analysis.
ResultsA total of 13 trails including 1218 participants met the selection criteria. (1) The meta-analysis of 3 articles showed that acupuncture was more effective in reducing the frequency of migraine attacks (MD = −2.03; 95% CI: −2.77 to −1.30; P < 0.0 0 0 01) than medication. (2) The meta-analysis of three articles showed that acupuncture was more effective in reducing the number of migraine days (MD = −1.65; 95% CI: −2.78 to −0.52; P = 0.004) than medication after treatment. (3) The meta-analysis of six articles showed that acupuncture was more effective in reducing VAS (MD = −1.26; 95% CI: −1.48 to −1.04; P < 0.0 0 0 01) after treatment. (4) The meta-analysis of two articles showed that acupuncture was more effective in reducing VAS (MD = −1.07; 95% CI: −1.63 to −0.51; P = 0.0 0 02) during follow-up. (5) The meta-analysis of seven articles showed that the total effective rate of acupuncture was higher than that of medication (MD = 1.27; 95% CI: 1.16 to 1.37; P < 0.0 0 0 01). In addition, fewer adverse effects in acupuncture groups were reported than in medication groups. Overall the quality of the evidence was low.
ConclusionThe results of this meta-analysis showed that acupuncture is more effective and safer than medication for migraine. Acupuncture can be considered a treatment option for patients willing to undergo this treatment. But more high-quality studies, based on standardized, comprehensive and objective evaluation, are required to enhance the reliability of the conclusion.

1.1.13. Chen 2018

Chen Le, He Xiaozuo, Xu Haiyan, Zhou Zhigen, Liu Can, Yang Zuozuo. [A Meta-analysis on randomized controlled trials of acupuncture for migraine]. Hunan Journal of Traditional Chinese Medicine. 2018;2:125-9. [199992].

Objective 通过Meta分析评价针灸治疗偏头痛的疗效及安全性。To evaluate the effectiveness and safety of acupuncture for migraine by meta-analysis.
Methods 计算机检索中国知网、维普及万方等数据库,检索2000~2017年的相关文献,收集针灸治疗偏头痛的随机对照试验。评价研究质量,提取资料,并采用Review Manage5.2进行系统分析。Computer retrieves databases such as China Knowledge Network and Weifang Wanfang, retrieves relevant documentation from 2000 to 2017 and collects randomized controlled trials on acupuncture for migraine. Evaluate the quality of the study, extract the data, and use Review Manage 5.2 for system analysis.
Results共纳入文献18篇,包含1730例患者,Meta分析结果显示,针灸治疗组的总有效率优于对照组[OR=5.11,95%CI为(3.83,6.85),P<0.01];治愈率优于对照组[OR=1.62,95%CI为(1.41,1.86),P<0.01];不良反应率低于对照组[OR=1.13,95%CI为(0.05,0.34),P<0.01]。漏斗图的结果显示左右不对称,提示纳入评价的文献很可能存在发表性偏倚。In total, 18 articles were included in the literature, including 1730 patients . The meta-analysis showed that the total effective rate of the acupuncture treatment group was greater than that of the control group [OR = 5.11, 95% CI (3.83, 6.85), P <0.01] ; The cure rate was better than that of the control group [OR = 1.62, 95% CI (1.41, 1.86), P <0.01], the adverse reaction rate was lower than that of the group control [OR = 1.13, 95% CI (0.05, 0.34), P <0.01]. Funnel chart results show left-right asymmetry, suggesting that the literature included in the journal is likely to have a publication bias.
Conclusions针灸治疗偏头痛疗效优于单纯西药治疗,但由于本系统评价纳入研究质量较低,尚需更多高质量的随机对照试验验证其疗效及安全性。acupuncture on migraine is better than Western medicine alone, but due to the poor quality of this systematic review, high-quality randomized controlled trials are needed to verify efficacy and safety.

1.1.14. Cui 2018 ☆☆

Cui Qiu-yue , He Qiao-ying , Fang Jian-qiao , et al. [Meta-analysis of Time-effect Evaluation of Acupuncture Treatment for Migraine]. Shanghai Journal of Acupuncture and Moxibustion. 2018;37(4):466. [181189].

ObjectiveTo evaluate the immediate, short-term and Long-term therapeutic effects of acupuncture on migraine.
Method Computer searches of PubMed, Embase, Chinese Biomedical Literature Database (CBM), Chinese Scientific and Technological Journal Database (VIP) and Wanfang Standards Database (WFSD) were made in combination with manual searching to retrieve clinical data about acupuncture treatment for migraine. The outcome measure was the VAS pain score. The time was limited between Jan. 1 st, 200 1 and Dec. 31st, 20 1 6.
Result Fifteen articles with randomized controlled trial were included. The meta-analysis showed no statistically significant difference in the immediate effect between acupuncture and sham acupuncture or Western drugs. The short-term and long-term effects of acupuncture were better than those of sham acupuncture or Western drugs.
Conclusion Acupuncture is an effective way to treat and prevent migraine. The immediate therapeutic effect of acupuncture on migraine needs further study.

1.1.15. Jiang 2018 (Quality of Life) ☆☆

Jiang Y, Bai P, Chen H, Zhang XY, Tang XY, Chen HQ, Hu YY, Wang XL, Li XY, Li YP, Tian GH. The Effect of Acupuncture on the Quality of Life in Patients With Migraine: A Systematic Review and Meta-Analysis. Front Pharmacol. 2018. [189093].

BackgroundAcupuncture is frequently used as an efficient method to prevent and treat migraines. However, its effect on the quality of life remains controversial.
Methods Seven databases, such as PubMed and Cochrane Library were searched to retrieve reference lists of eligible trials and related reviews. Randomized controlled trials that were published in Chinese and English were included.
Results Acupuncture resulted in lower Visual Analog Scale scores than the medication group at 1 month after treatment (MD -1.22, 95%CI -1.57 to -0.87; low quality) and 1-3 months after treatment (MD -1.81, 95%CI -3.42 to -0.20; low quality). Compared with sham acupuncture, acupuncture resulted in lower Visual Analog Scale scores at 1 month after treatment (MD -1.56, 95%CI -2.21 to -0.92; low quality).
ConclusionAcupuncture exhibits certain efficacy both in the treatment and prevention of migraines, which is superior to no treatment, sham acupuncture and medication. Further, acupuncture enhanced the quality of life more than did medication.

1.1.16. Xu 2018 ★

Xu J, Zhang FQ, Pei J, Ji J. Acupuncture for migraine without aura: a systematic review and meta-analysis. J Integr Med. 2018;16(5):312-321. [189777].

BackgroundMigraine without aura (MWoA), the most common type of migraine, has great impacts on quality of life for migraineurs. Acupuncture is used in the treatment and prevention of migraine for its analgesic effects.
ObjectiveThe aim of this systematic review and meta-analysis is to systematically assess the therapeutic and preventive effect of acupuncture treatment and its safety for MWoA.
MethodsSEARCH STRATEGY: Nine electronic databases (PubMed, MEDLINE, Cochrane Library, Lilacs, Embase, China National Knowledge Infrastructure (CNKI), Chongqing VIP (CQVIP), Wanfang Data and Chinese Clinical Trial Registry (ChiCTR)) were systematically searched from their beginning through June 2017 using MeSH terms such as “acupuncture, acupuncture therapy, electro-acupuncture, ear acupuncture, acupuncture points, acupuncture analgesia,” and “migraine disorders, cluster headache.” Manual searching included other conference abstracts and reference lists. INCLUSION CRITERIA: Randomized controlled trials (RCTs) with a clinical diagnosis of MWoA, which were treated with acupuncture versus oral medication or sham acupuncture treatment. DATA EXTRACTION AND ANALYSIS: Two evaluators screened and collected literature independently; they extracted information on participants, study design, interventions, follow-up, withdrawal and adverse events and assessed risk of bias and quality of the acupuncture intervention. The primary outcomes were frequency of migraine (FM) and number of migraine days (NM). Secondary outcomes included the visual analogue scale (VAS) score, effective rate (ER) and adverse events. Pooled estimates were calculated as mean difference (MD) with 95% confidence interval (CI) for continuous data and relative risk (RR) with 95% CI for dichotomous data.
ResultsOverall, 14 RCTs including 1155 participants were identified. The analysis found that acupuncture had a significant advantage over medication in reducing FM (MD = -1.50; 95% CI: -2.32 to -0.68; P < 0.001) and VAS score (MD = 0.97; 95% CI: 0.63-1.31; P < 0.00001) and had a higher ER (RR = 1.30; 95% CI: 1.16-1.45; P < 0.00001). Acupuncture also had a significant advantage over sham acupuncture in the decrease of FM (MD = -1.05; 95% CI: -1.75 to -0.34; P = 0.004) and VAS score (MD = -1.19; 95% CI: -1.75 to -0.63; P < 0.0001). Meanwhile, acupuncture was more tolerated than medication because of less side effect reports (RR = 0.29; 95% CI: 0.17-0.51; P < 0.0001). However, the quality of evidence in the included studies was mainly low (to very low), making confidence in the FM and VAS score results low.
ConclusionOur meta-analysis shows that the effectiveness of acupuncture is still uncertain, but it might be relatively safer than medication therapy in the treatment and prophylaxis of MWoA. Further proof is needed.

1.1.17. Zuo 2018

Zuo Zuoyuan, Du Ruosang, Cui Hai, Yuan Hongzuo, Zhang Zuo, Wang Baohua, Zheng Shumei. [Meta-analysis of acupuncture treating migraine in recent 10 years]. Continuing Medical Education. 2018;4:157-8. [202141].

目的 系统评价针刺治疗偏头痛的疗效,为临床治疗提供医学依据.方法 计算机检索CNKI、CBM、VIP及万方Data数据库,搜集针刺治疗偏头痛的随机对照试验文章,并辅以追溯纳入的文献,及手工检索的方式以补充获得相关文献.检索年限为2007年1月1日—2016年12月31日,根据纳入、排除标准筛选文献并评价纳入研究质量,提取资料后,进行Meta分析.结果 共纳入24篇RCT,其中20篇对照组为西药,2篇对照组为安慰针,2篇对照组为中药.Meta分析结果显示,针刺组治疗偏头痛有效率优于西药组[RR=3.96,95％CI(3.02,5.19),P<0.00001],优于安慰针刺组[RR=5.70,95％CI(1.88,17.27),P=0.002],优于中药组[RR=7.58,95％CI(2.30,24.92),P=0.0009].结论 目前研究提示,针刺治疗偏头痛的有效率高于西药、中药、安慰针刺治疗,但高质量、大样本的研究相对不足,需要进一步证实.
Objective To systematically evaluate the efficacy of acupuncture in the treatment of migraine and provide medical evidence for clinical treatment.
MethodsThe computer searched the CNKI, CBM, VIP, and Wanfang Data databases to collect randomized controlled trial articles on acupuncture for migraine, supplemented by retrospectively included Documents, and manual search methods to supplement relevant documents. The search period was from January 1, 2007 to December 31, 2016. The literature was screened according to the inclusion and exclusion criteria and the quality of the included studies was evaluated. After the data were extracted, meta-analysis was performed.
Results A total of 24 RCTs were included, of which 20 were in the western medicine group, 2 in the control group were comfort needles, and 2 in the control group were traditional Chinese medicine. Meta analysis results showed that the acupuncture group was more effective in treating migraine than the western medicine group [RR = 3.96, 95% CI (3.02, 5.19), P <0.00001], better than the comfort acupuncture group [RR = 5.70, 95% CI (1.88, 17.27), P = 0.002], better than the Chinese medicine group [RR = 7.58 , 95% CI (2.30, 24.92), P = 0.0009].
Conclusion The current study suggests that the effective rate of acupuncture for migraine is higher than that of western medicine, traditional Chinese medicine and comfort acupuncture, but the research of high quality and large samples is relatively insufficient. Needs further confirmation.

1.1.18. Pu 2017 ☆☆

Pu Shengxiong, Tan Ge, Deng Yong, Li Lunxi, Zhu Qiuwen, Jiang Huahua. [Effectiveness and safety of acupuncture versus drug treatment for migraine prophylaxis:a meta-analysis], Journal of Chongqing Medical University. 2017;10:1293-8. [199990].

ObjectiveTo systematically evaluate the effectiveness and safety of acupuncture and drugs for migraine prevention, and to ilitate the clinical application of acupuncture.
MethodsDatabases of Pubmed, Cochrane library, EMBASE, CBM, VIP, Wan Fang Data and CNKI were searched from database foundation to October 2015. The randomized controlled trials(RCTs)of acupuncture and drugs for migraine prophylaxis were screened and retrieved. The outcome data were grouped 3-4 months after randomization and 5-6months after randomization based on follow-up. And then, the included studies were assessed and data were extracted to do meta-analysis.
ResultsA total of 7 RCTs and 1 285 patients with migraine were included in this study. There were significant differences in response rate(RR=1.24,95%CI=1.04 to 1.47,P=0.020),migraine days(SMD=-0.30,95%CI=-0.45 to-0.16,P=0.000),intensity of headache(SMD=-0.32,95%CI=-0.52 to-0.11,P=0.000)during 3~4 months after randomization ; and also in migraine days(MD=-0.66,95%CI=-1.18 to-0.13,P=0.010),intensity of headache(SMD=-0.31,95%CI=-0.47 to-0.15,P=0.000)during 5-6 months after randomization; but there was no difference in response rate (RR=1.18,CI=0.97 to 1.43),P=0.110)during 5-6 months after randomization. Compared to drug therapy acupuncture group had more effectiveness, less migraine days, lighter headache intensity. It was fail to deal with heterogeneity(I2=77%)of adverse events ; after descriptive analysis, there was less adverse events in research period.
Conclusion Acupuncture had better clinically effectiveness and more safety than drug therapy in migraine prophylaxis. More high quality researches should been carried on to enhance the reliability.

1.1.19. Linde 2016 (prevention) ☆☆☆

Linde K, Allais G, Brinkhaus B, Fei Y, Mehring M, Vertosick EA, Vickers A, White AR. Acupuncture for the prevention of episodic migraine. Cochrane Database Syst Rev. 2016. [186250].

BackgroundAcupuncture is often used for migraine prevention but its effectiveness is still controversial. We present an update of our Cochrane review from 2009.
ObjectivesTo investigate whether acupuncture is a) more effective than no prophylactic treatment/routine care only; b) more effective than sham (placebo) acupuncture; and c) as effective as prophylactic treatment with drugs in reducing headache frequency in adults with episodic migraine.
Search MethodWe searched the Cochrane Central Register of Controlled Trials (CENTRAL: 2016, issue 1); MEDLINE (via Ovid, 2008 to January 2016); Ovid EMBASE (2008 to January 2016); and Ovid AMED (1985 to January 2016). We checked PubMed for recent publications to April 2016. We searched the World Health Organization (WHO) Clinical Trials Registry Platform to February 2016 for ongoing and unpublished trials. Selection Criteria: We included randomized trials at least eight weeks in duration that compared an acupuncture intervention with a no-acupuncture control (no prophylactic treatment or routine care only), a sham-acupuncture intervention, or prophylactic drug in participants with episodic migraine. Data Collection And Analysis: Two reviewers checked eligibility; extracted information on participants, interventions, methods and results, and assessed risk of bias and quality of the acupuncture intervention. The primary outcome was migraine frequency (preferably migraine days, attacks or headache days if migraine days not measured/reported) after treatment and at follow-up. The secondary outcome was response (at least 50% frequency reduction). Safety outcomes were number of participants dropping out due to adverse effects and number of participants reporting at least one adverse effect. We calculated pooled effect size estimates using a fixed-effect model. We assessed the evidence using GRADE and created 'Summary of findings' tables.
Main ResultsTwenty-two trials including 4985 participants in total (median 71, range 30 to 1715) met our updated selection criteria. We excluded five previously included trials from this update because they included people who had had migraine for less than 12 months, and included five new trials. Five trials had a no-acupuncture control group (either treatment of attacks only or non-regulated routine care), 15 a sham-acupuncture control group, and five a comparator group receiving prophylactic drug treatment. In comparisons with no-acupuncture control groups and groups receiving prophylactic drug treatment, there was risk of performance and detection bias as blinding was not possible. Overall the quality of the evidence was moderate. Comparison with no acupunctureAcupuncture was associated with a moderate reduction of headache frequency over no acupuncture after treatment (four trials, 2199 participants; standardised mean difference (SMD) -0.56; 95% CI -0.65 to -0.48); findings were statistically heterogeneous (I² = 57%; moderate quality evidence). After treatment headache frequency at least halved in 41% of participants receiving acupuncture and 17% receiving no acupuncture (pooled risk ratio (RR) 2.40; 95% CI 2.08 to 2.76; 4 studies, 2519 participants) with a corresponding number needed to treat for an additional beneficial outcome (NNTB) of 4 (95% CI 3 to 6); there was no indication of statistical heterogeneity (I² = 7%; moderate quality evidence). The only trial with post-treatment follow-up found a small but significant benefit 12 months after randomisation (RR 2.16; 95% CI 1.35 to 3.45; NNT 7; 95% 4 to 25; 377 participants, low quality evidence). Comparison with sham acupunctureBoth after treatment (12 trials, 1646 participants) and at follow-up (10 trials, 1534 participants), acupuncture was associated with a small but statistically significant frequency reduction over sham (moderate quality evidence). The SMD was -0.18 (95% CI -0.28 to -0.08; I² = 47%) after treatment and -0.19 (95% CI -0.30 to -0.09; I² = 59%) at follow-up. After treatment headache frequency at least halved in 50% of participants receiving true acupuncture and 41% receiving sham acupuncture (pooled RR 1.23, 95% CI 1.11 to 1.36; I² = 48%; 14 trials, 1825 participants) and at follow-up in 53% and 42%, respectively (pooled RR 1.25, 95% CI 1.13 to 1.39; I² = 61%; 11 trials, 1683 participants; moderate quality evidence). The corresponding NNTBs are 11 (95% CI 7.00 to 20.00) and 10 (95% CI 6.00 to 18.00), respectively. The number of participants dropping out due to adverse effects (odds ratio (OR) 2.84; 95% CI 0.43 to 18.71; 7 trials, 931 participants; low quality evidence) and the number of participants reporting adverse effects (OR 1.15; 95% CI 0.85 to 1.56; 4 trials, 1414 participants; moderate quality evidence) did not differ significantly between acupuncture and sham groups. Comparison with prophylactic drug treatmentAcupuncture reduced migraine frequency significantly more than drug prophylaxis after treatment ( SMD -0.25; 95% CI -0.39 to -0.10; 3 trials, 739 participants), but the significance was not maintained at follow-up (SMD -0.13; 95% CI -0.28 to 0.01; 3 trials, 744 participants; moderate quality evidence). After three months headache frequency at least halved in 57% of participants receiving acupuncture and 46% receiving prophylactic drugs (pooled RR 1.24; 95% CI 1.08 to 1.44) and after six months in 59% and 54%, respectively (pooled RR 1.11; 95% CI 0.97 to 1.26; moderate quality evidence). Findings were consistent among trials with I² being 0% in all analyses. Trial participants receiving acupuncture were less likely to drop out due to adverse effects (OR 0.27; 95% CI 0.08 to 0.86; 4 trials, 451 participants) and to report adverse effects (OR 0.25; 95% CI 0.10 to 0.62; 5 trials 931 participants) than participants receiving prophylactic drugs (moderate quality evidence).
Authors' Conclusions The available evidence suggests that adding acupuncture to symptomatic treatment of attacks reduces the frequency of headaches. Contrary to the previous findings, the updated evidence also suggests that there is an effect over sham, but this effect is small. The available trials also suggest that acupuncture may be at least similarly effective as treatment with prophylactic drugs. Acupuncture can be considered a treatment option for patients willing to undergo this treatment. As for other migraine treatments, long-term studies, more than one year in duration, are lacking.

1.1.20. Pu 2016 (acute attack) ☆☆

Pu Shengxiong, Tan Ge, Wang Dayan, Chen jinjin , Jiang Li. [Analgesic effect of acupuncture during migraine acute attack period: a meta-analysis]. Chongqing Medical Journal. 2016;10:1353-135. [186966].

Objective To evaluate the effect of acupuncture for treating migraine acute attack to offer some evidence‐based basis for clinical application .
Methods The Chinese and English literatures on the acupuncture for treating migraine acute attack were retrived from January 1989 to December 2014 , the literatures were screened according to inclusion and exclusion criteria , the Meta‐analysis was performed on these chose literatures .
Results A total of 5 studies were included and 618 migraineurs were involved , four literatares were performed the Meta‐analysis , and 1 literature was performed the description analysis . Meta‐analysis re‐sults showed that there was statistically significant differences between the acupuncture group and the sham acupuncture group in the VAS score reduction value at 2 h [MD=0 . 36 , 95% CI: 0 . 08 , 0 . 65 , P=0 . 01] , 4 h [MD=0 . 49 , 95% CI: 0 . 14 , 0 . 84 , P=0 . 007] after acupuncture;while when the VAS score was used as the evaluation indicator , there was no statistically significant differences were found at 2 h [MD= -0 . 38 , 95% CI: -0 . 83 , 0 . 07 , P=0 . 10] , 4 h [MD= -0 . 42 , 95% CI: -0 . 96 , 0 . 12 , P=0 . 12] after acupuncture in the VAS score between the acupuncture group and the sham acupuncture group .
Conclusion Acupuncture could effectively relieve the intensity of headache in migraine , the analgesic effect of acupuncture for treating migraine attacks is significantly superior to the sham acupuncture group , while with the VAS score as the evaluation indicator , the difference between the acupuncture group and the sham acupuncture group has no statistical significance .

1.1.21. Pu 2016 (prevention)

Pu S. [Effectiveness and Safety of Acupuncture versus Drug Treatment for Migraine Prophylaxis: A Meta-Analysis]. Chongqing Medical University, Chengdu, China. 2016. [193216].

Cité Zhang 2019 [203221].

1.1.22. Song 2016 (prévention) ☆☆

Song Qian, Zhao Shoufa, Li Li, Shen Yan, Wang Shu. [Meta-analysis on prevention comparison of acupuncture with western medicine for migraine]. Liaoning Journal of Traditional Chinese Medicine. 2016;4:821-826;. [187034].

Objective To evaluate the efficacy comparison of acupuncture and western medicine for migraine.
Methods We searched the Cochrane Library, Pub Med, Medline, CNKI, VIP and Wan Fang to identify the randomized controlled trials comparing acupuncture with western medicine for migraine. The quality of included studies was critically assessed and the data analysis was performed with The Cochrane Collaboration’ s Rev Man5. 2.
ResultsEighteen studies were included. The Meta-analysis showed in treating migraine, the short-term response rate [RR = 2. 76, 95% CI (2. 03, 3. 77), P < 0. 00001]and the long-term response rate [RR = 4. 17, 95% CI (2. 80, 6. 20), P < 0. 00001] of acupuncture was significant better than that of western medicine. It also showed that acupuncture was significantly better than Metoprolol in reducing migraine times [RR =-0. 79, 95% CI (-1. 39, -0. 20), P = 0. 009].
Conclusion The short and long-term effectiveness of acupuncture is significant better than that of western medicine in migraine treatment. However, due to the poor quality and small sample of the included trials, more large-scale multi-center randomized trails are needed.

1.1.23. Yang 2016 (vs sham) ☆☆☆

Yang Y, Que Q, Ye X, Zheng Gh. Verum versus sham manual acupuncture for migraine: a systematic review of randomised controlled trials. Acupunct Med. 2016;34(2):76-83.[190445].

Objectives Manual acupuncture (MA) is commonly used as a treatment for migraine in China. However, its specific clinical effects have been challenged on the basis that some of its effects may relate to psychological or 'placebo' mechanisms. Objective: To identify the effectiveness of verum MA compared with sham acupuncture for the treatment of migraine.
Methods Eight electronic databases were searched for randomised controlled trials (RCTs) evaluating the effect of verum versus sham MA on migraine. The quality of included trials was assessed using the 'risk of bias' tool provided by the Cochrane Handbook for Systematic Review of Intervention. RevMan 5.2 software was used for data analysis.
Results Ten trials with 997 participants were included. Most trials had high methodological quality and were at low risk of bias. Meta-analysis showed superior effects of verum MA over sham acupuncture on the total effective rate, reflected by a reduction in the 'not effective' rate (relative risk (RR) 0.24, 95% CI 0.15 to 0.38; p<0.0001, four trials) and a reduced recurrence rate (RR 0.47, 95% CI 0.28 to 0.81; p=0.006, two trials), but no significant differences in headache intensity, frequency or duration, accompanying symptoms and use of medication. No severe adverse events related to acupuncture occurred during treatment with either verum or sham MA
Conclusions Current clinical evidence suggests that verum acupuncture is superior to sham acupuncture in migraine, reflected by a higher total effective rate and decreased recurrence rate. Nevertheless, further large-scale RCTs with a rigorous design are required to confirm these findings in view of the relative paucity of eligible RCTs and small sample sizes of those included.

1.1.24. Dai 2015

Dai X, Lin C. [A meta-analysis of treating migraine by acupuncture]. Clinical Journal of Chinese Medicine. 2015;7(35):1-3. [197043].

Cité Zhang 2019 [203221].

1.1.25. Chen 2014

Chen W. [Systematic Reviews for Short-Term Effects of Acupuncture in Treating Migraine]. Chengdu University of Traditional Chinese Medicine, Chengdu, China. 2014. [159380].

Cité Zhang 2019 [203221].

1.1.26. Yang 2014 (vs flunarizine) ☆☆

Yang Jia, Shen Yan, Wang Shu. [Systematic review on efficacy for migraine treatment by acupuncture and flunarizine]. World Science and Technology-Modernization of Traditional Chinese Medicine. 2014;7:1608-161. [187070].

ObjectivesThis article was aimed to evaluate the efficacy of acupuncture and flunarizine for migraine treatment.
MéthodsRandomized controlled trials (RCTs) in migraine treatment by acupuncture and flunarizine were searched in the Pubmed, Cochrane Library, CNKI, VIP, and W anfang database. The quality of inclusion criteria was assessed according to the Cochrane Collaboration's recommended methodand the effective data was extracted. Then, the RevMan5. 2 software was used in the summary and analysis of the effective literatures.
ResultThe results showed that the total sample size was893 cases, with 10 studies according to the inclusion criteria. Meta-analysis showed that the short-term efficacy of the treatment group was higher than the control group [RR = 1. 27, 95%CI (1. 11, 1. 45), P<0. 000 4]; the long-term efficacy of the treatment group was higher than the control group [RR = 1. 76, 95%CI (1. 05, 2. 94), P=0. 03]; headache degree of improvement was better than the control group [MD = -2. 00, 95%CI (-3. 01, -0. 99), P=0. 000 1].
Conclusion It was concluded that acupuncture was more effective than flunarizine in migraine treatment. However, the whole study sample size was relatively small, the quality assessment was not high, and the funnel plot analysis was left-right asymmetry, which indicated the presence of publication bias. It was concluded that more high-quality clinical cases should be confirmed in the future.

1.1.27. Zheng 2012 ☆☆☆

Zheng Shu-Mei, Cui Hai. [Acupuncture for migraine: a meta-analysis]. Chinese Journal of Information on Traditional Chinese Medicine. 2012;6:20-23. [186949].

Objective To evaluate the effectiveness of acupuncture treatment for migraine.
Methods The randomized controlled trials (RCTs) in PubMed, Embase, CBM, CNKI, VIP and WanFang database from January 1, 2000 to December 31, 2010 were electronically searched, and the references in relevant reviews were also manually searched. The quality of the included studies was assessed. Two reviewers independently screened the trials according to inclusion and exclusion criteria, extracted the data, and assessed the methodology quality. Meta-analysis was performed using the Cochrane Collaboration’s RevMan 5. 1 software.
Results Thirty-three RCTs were finally included. The results of meta-analysis showed that compared with western medicine [28 RCTs, RR=1. 24, 95%CI (1. 16, 1. 34), P<0. 000 01], Chinese medicine [3 RCTs, RR=1. 29, 95%CI (1. 14, 1. 45), P<0. 000 01], and placebo acupuncture [ (3 RCTs, RR=1. 87, 95%CI (1. 17, 2. 98), P=0. 009], the improvement rates of acupuncture were significantly higher.
Conclusions This study shows the improvement rates of acupuncture for migraine are higher than western medicine, Chinese medicine and placebo acupuncture, but it needs more higher quality of RCTs to enforce.

1.1.28. Gao 2011 ☆☆☆

Gao Xiao-Mei, Wang Bo-Song, Song Yan-Yan, Qi Hong, Rong Zheng-Xing, Wang Hao. [Acupuncture for migraine: a systematic review and meta-analysis of randomized controlled trials]. Chinese Journal of Clinical Pharmacology and Therapeutics. 2011;5:530-537. [186939].

Aim:To precisely assess the efficacy of acupuncture in migraine therapy, and analyze the reasons of different conclusions between domestic and foreign clinical trails.
Methods: Pubmed, Cochrane Library, and Chinese Biomedical Literature Database (CMB) were searched to obtain the randomized controlled trials (RCTs) of acupuncture for the treatment of migraine. Data were synthesized using RevMan 5. 0 software provided by the Cochrane Collaboration.
Results: Twelve high-quality RCTs comparing verum acupuncture with sham acupuncture were included in the meta-analysis. The results showed that at the end of treatment the responder rate of verum and sham acupuncture were 49. 5% and 43. 3%, respectively. Acupuncture treatment could significantly reduced the severity of migraine by increasing responder rate (OR=1. 28, 95%CI: 1. 02-1. 61, P=0. 03). The responder rate of verum and sham acupuncture at the end of follow-up were 47. 7% and 38. 5%, respectively, but the difference between them was not significant (OR=1. 33, 95%CI: 0. 70-2. 51, P=0. 39). In subgroup analysis, RCTs in China showed significantly amelioration of migraine by acupuncture either at the end of treatment or follow-up (P<0. 05), while RCTs in abroad showed no significant difference between two groups at the end of treatment or follow-up (P>0. 05).
Conclusion The meta-analysis suggested that acupuncture was effective in the treatment of migraine but the effectiveness was not maintained after the withdrawal of acupuncture therapy. Since the conclusions of RCTs conducted in China and abroad are quite different, more full-scale RCTs following the principles of traditional Chinese medicine are recommended to further warrant the effectiveness of acupuncture.

1.1.29. Linde K 2009 (prevention) ☆☆

Linde K, Allais G, Brinkhaus B, Manheimer E, Vickers A, White AR. Acupuncture for migraine prophylaxis. Cochrane Database Syst Rev. 2009;1:CD001218. 153159

Purpose To investigate whether acupuncture is a) more effective than no prophylactic treatment/routine care only; b) more effective than ’sham’ (placebo) acupuncture; and c) as effective as other interventions in reducing headache frequency in patients with migraine.
Methods Search strategy : The Cochrane Pain, Palliative & Supportive Care Trials Register, CENTRAL, MEDLINE, EMBASE and the Cochrane Complementary Medicine Field Trials Register were searched to January 2008. Selection criteria : We included randomized trials with a post-randomization observation period of at least 8 weeks that compared the clinical effects of an acupuncture intervention with a control (no prophylactic treatment or routine care only), a sham acupuncture intervention or another intervention in patients with migraine. Data collection and analysis : Two reviewers checked eligibility; extracted information on patients, interventions, methods and results; and assessed risk of bias and quality of the acupuncture intervention. Outcomes extracted included response (outcome of primary interest), migraine attacks, migraine days, headache days and analgesic use. Pooled effect size estimates were calculated using a random-effects model.
Results Twenty-two trials with 4419 participants (mean 201, median 42, range 27 to 1715) met the inclusion criteria. Six trials (including two large trials with 401 and 1715 patients) compared acupuncture to no prophylactic treatment or routine care only. After 3 to 4 months patients receiving acupuncture had higher response rates and fewer headaches. The only study with long-term follow up saw no evidence that effects dissipated up to 9 months after cessation of treatment. Fourteen trials compared a ’true’ acupuncture intervention with a variety of sham interventions. Pooled analyses did not show a statistically significant superiority for true acupuncture for any outcome in any of the time windows, but the results of single trials varied considerably. Four trials compared acupuncture to proven prophylactic drug treatment. Overall in these trials acupuncture was associated with slightly better outcomes and fewer adverse effects than prophylactic drug treatment. Two small low-quality trials comparing acupuncture with relaxation (alone or in combination with massage) could not be interpreted reliably.
Conclusion In the previous version of this review, evidence in support of acupuncture for migraine prophylaxis was considered promising but insufficient. Now, with 12 additional trials, there is consistent evidence that acupuncture provides additional benefit to treatment of acute migraine attacks only or to routine care. There is no evidence for an effect of ’true’ acupuncture over sham interventions, though this is difficult to interpret, as exact point location could be of limited importance. Available studies suggest that acupuncture is at least as effective as, or possibly more effective than, prophylactic drug treatment, and has fewer adverse effects. Acupuncture should be considered a treatment option for patients willing to undergo this treatment.

1.1.30. Wang 2008 (Chinese Literature)

Wang YY , Zheng Z and Xue CCL. Acupuncture for Migraine: A Systematic Review of Chinese Literature. Australian Journal of Acupuncture and Chinese Medicine. 2008;3(1):3. [193129].

IntroductionAcupuncture is widely used for the treatment of migraine, but its effectiveness is inconclusive based on findings of two recent systematic reviews. However, these reviews included very few studies conducted in Asian countries. Research papers published in Chinese are yet to be reviewed to determine their role in the overall understanding of the effectiveness and safety of acupuncture for migraine.
Objectives Is acupuncture more effective than no treatment, sham/placebo acupuncture, or as effective as other interventions for migraine?
MethodsSearch Strategies: Electronic search was performed in the two most comprehensive Chinese e-databases, Vi Pu and Wan Fang. Keywords used were a combination of acupuncture, headache, migraine, Chinese medicine, electroacupuncture and point-stimulation. Selection Criteria: Randomised, controlled trials comparing acupuncture with any type of control interventions and reporting at least one of the clinically related outcome measures for migraine were selected. Data Collection and Analysis: Characteristics of the studies were extracted by two independent reviewers. Reporting quality and validity were assessed using the Jadad Scale, Internal Validity Scale and Oxford Pain Validity Scale. STRICTA was used to assess the reporting quality of acupuncture treatment. RevMan 4.2 was used for data analysis.
ResultsSeventeen studies with a total of 2097 participants (median 91; range 62–216) met the inclusion criteria. Ten studies compared acupuncture alone with western medications. The remaining seven trials compared a combined therapy of acupuncture and other therapies with western medications. None of the studies compared acupuncture with no-treatment control or sham/placebo acupuncture. None of the 17 studies was considered of high quality. Studies indicated that acupuncture alone was superior to western medications (RR 1.55, 95% CI 1.27 to 1.88). In comparison to studies included in the other two reviews, the Chinese studies in this review had a larger sample size and acupuncture treatments were more frequent.
ConclusionThere is moderate evidence that acupuncture is more effective than western pharmacotherapy. Due to the poor quality and validity of included studies, this conclusion requires further assessment. Data from Chinese literature should be included in future systematic reviews.

1.1.31. Griggs 2006 ☆

Griggs C, Jensen J. Effectiveness of Acupuncture for migraine: critical literature review. J Adv Nurs. 2006;54(4):491-501. [141239].

AimThe aim of this paper is to evaluate previous research studies on acupuncture for migraine with reference to the Standards for Reporting Interventions in Controlled Trials of Acupuncture guidelines.
Background. It is estimated that around 2-15% of the world's population are affected by migraine headaches. Thirteen per cent of adults in the United Kingdom suffer with chronic pain, migraine headaches accounting for 7% of cases. Migraine pain relief is grounded in pharmacology. Acupuncture for migraine has been widely researched. However, inconsistent and low quality results have been produced. Recently, published Standards for Reporting Interventions in Controlled Randomized Trials of Acupuncture guidelines recommend important information that must be included in research in order to be valid and reliable.
Methods. Searches were conducted between September 2003 and May 2004 using the Ovid Medline 1966-2004, British Medical Journal, Blackwell Synergy, Science Direct, The Lancet and Cochrane Library Issue 1 databases. Searches were limited to the previous 20 years and to publications in the English language only.
Findings. Thirteen randomized controlled trials met the inclusion criteria and were critically reviewed for methodological quality, reporting of acupuncture needling details, practitioner background, control interventions and use of a diagnostic criterion. Findings agreed with previous literature reviews that the majority of studies of acupuncture for migraine research are of poor quality, with conflicting results. Few studies met the criteria of the Standards for Reporting Interventions in Controlled Trials of Acupuncture recommendations. Overall, the quality of research in this area must be questioned.
Conclusions. In the light of these findings, practitioners may face a dilemma when considering the use of acupuncture for migraine. Therefore, large, high quality randomized controlled trials of acupuncture for migraine are needed. Until better quality research is published, with verification of the benefits of acupuncture for migraine, provision of this alternative therapy should not be expanded or withdrawn.

1.1.32. Scott 2006

Scott SW and Deare JC. Acupuncture for Migraine: A Systematic Review. Australian Journal of Acupuncture and Chinese Medicine. 2006;1(1):3-14. [190769].

Background Migraine is a highly prevalent and often severely disabling disorder. Migraine patients often employ therapies such as acupuncture. To date a systematic review of acupuncture for migraine headache alone has not been published. Given that migraine has a pathophysiology that is distinct from other headaches, it is appropriate and timely that the studies of acupuncture for the treatment of migraine be systematically reviewed.
ObjectivesTo determine whether acupuncture is more effective than no treatment for migraine, more effective than ‘sham’ or placebo acupuncture for migraine, or as effective as other interventions used to treat and prevent migraine.
MethodsSelection criteria: Randomised controlled trials of needle acupuncture that breaks the skin for migraine headache. Data collection: The authors used a standardised collection form to abstract data independently. Information on acupuncture protocol, STRICTA criteria, methodological quality (Jadad, IVS) and treatment outcomes were collected.
ResultsTwenty-five studies with a total of 3004 patients (median = 62; range = 30–794) met the inclusion criteria. Three trials compared acupuncture to waiting list. Eleven trials compared acupuncture to sham acupuncture studies. The results were heterogeneous. Five studies found no significant effects over the sham procedure. Four studies reported a trend in favour of acupuncture. The remaining two small studies reported results in which the acupuncture group did significantly better than those in the sham group. Thirteen studies compared acupuncture to various pharmacotherapies and all found acupuncture to be at least as effective as drug treatment.
Conclusion The current evidence suggests that acupuncture is significantly superior to waiting list, at least as good as sham acupuncture, and of comparable efficiency to several proven drug therapies for the treatment and prevention of migraine.

1.1.33. Goslin 1999 ☆☆

Goslin RE, Gray RN, McCrory DC, Penzien D, Rains J, Hasselblad V. Behavioral and physical treatments for migraine headache AHRQ Technical reviews. 1999; 2.[169140].

ObjectivesTo identify and summarize evidence from controlled trials on the efficacy of behavioral and physical treatments for migraine.
Search strategyA strategy combining the MeSH term “headache” (exploded) and a previously published strategy for identifying randomized controlled trials was used on the January 1966 to December 1996 MEDLINE database. Other computerized bibliographic databases, textbooks, and experts were also utilized. Selection criteria: English-language controlled trials involving patients with migraine in which at least one treatment offered was a behavioral or physical treatment were selected. Data collection and analysis: Measures of headache index and headache frequency reported as group means (and standard deviations) were used to calculate standardized mean differences (or effect sizes). Where similar trials provided data, meta-analysis of efficacy measures was performed. The number of patients obtaining at least a 50% reduction in headache index, frequency, or severity was recorded and used to calculate odds ratios.
Main resultsBehavioral treatments for migraine have a consistent body of research indicating efficacy. Summary effect sizes from a meta-analysis of 18 trials suggest that relaxation training, thermal biofeedback combined with relaxation training, electromyographic (EMG) biofeedback, and cognitive-behavioral therapy are all modestly effective in treating migraine when compared to a wait-list control. Thermal biofeedback alone or combined with cognitive-behavioral therapy yielded similar effect sizes that failed to reach statistical significance. Physical treatments have been less often studied. Six small trials of acupuncture yielded mixed results. Other physical treatments for which controlled trials have been reported include transcutaneous electrical nerve stimulation (TENS) (2 trials), cervical mobilization and manipulation (1 trial), occlusal adjustment (1 trial), and hyperbaric oxygen (1 trial).
ConclusionsEach of the behavioral therapies considered has modest efficacy for migraine. There is little information about which patients will benefit from particular behavioral approaches; the choice among them may, for the present, depend more on availability and acceptability than on data about efficacy. There are insufficient data about any of the physical treatments to draw conclusions about their efficacy.

1.2. Special Clinical Forms

1.2.1. Menstrual Migraine

1.2.1.1. Yang 2022 Ø

Yang M, Du T, Long H, Sun M, Liang F, Lao L. Acupuncture for menstrual migraine: a systematic review. BMJ Support Palliat Care. 2022 Dec;12(e6):e882-e892. doi: 10.1136/bmjspcare-2019-002024. Epub 2020 Mar 2. PMID: 32122964.

Background and objectiveIn clinical practice, the evidence of acupuncture used as a treatment for migraine without aura is employed interchangeably to guide treatment for menstrual migraine. However, its effect and safety are not substantiated. This study aimed to assess the efficacy of acupuncture on the frequency and pain intensity of menstrual migraine.
Methods We searched PubMed, Cochrane Library, China National Knowledge Infrastructure (CNKI) and other two Chinese databases from their inception to 1 May 2019. This study included randomised controlled trials of women with menstrual migraine receiving acupuncture or a valid control. Two reviewers independently completed study selection, data extraction and risk of bias assessment. We combined data with a fixed-effect model in RevMan. Clinical outcomes included migraine frequency and duration, headache intensity, and adverse events.
Results Thirteen studies with 826 subjects were included, 9 of which had data suitable for meta-analyses. Current evidence showed that acupuncture was not superior to sham acupuncture in reducing monthly migraine frequency and duration, average headache intensity, and analgesic use at completion of treatment or follow-up. Pooled data demonstrated a significant improvement in mean headache intensity in the acupuncture group compared with drugs. However, all studies were underpowered and associated with moderate to high risk of bias. No serious adverse event was related to acupuncture treatment.
Conclusions There is no convincing evidence to support the use of acupuncture in treating menstrual migraine. Acupuncture cannot yet be recommended to patients with menstrual migraine until more solid evidence is produced.
1.2.1.2. Zhao 2016

Zhao Y. [Data Mining and Systematic Review of Modern Acupuncture Treatment for Menstrual Migraine]. Chengdu University of Traditional Chinese Medicine, Chengdu, China. 2016. [196744]. |Cité Zhang 2019 [203221]. |

1.3. Special Acupuncture Techniques

1.3.1. Comparison of Acupuncture techniques

1.3.1.1. Liu 2024

Liu Y, Wang Y, Mi C, Wang Z, Han Y, Qi X, Ding X. Efficacy of Acupuncture-Related Therapy for Migraine: A Systematic Review and Network Meta-Analysis. J Pain Res. 2024 Mar 15;17:1107-1132. https://doi.org/10.2147/JPR.S452971

Objective Migraine is a common neurological disorder, which resulting in significant societal and personal burdens. Acupuncture has attracted widespread attention in migraine prophylaxis and treatment in recent years. Although some studies have confirmed the effectiveness of acupuncture therapy in treating migraines, there is still a lack of comprehensive evaluation regarding the comparison between different types of migraines and various acupuncture therapies. Furthermore, certain special acupuncture methods have not received sufficient attention and research. Therefore, the objective of this study is to summarize and expand upon previous research, update existing evidence, and compare the efficacy of different acupuncture therapies for migraine. We aim to provide stronger evidence-based support for clinical practice through this study, thereby promoting wider application of acupuncture therapy in migraine treatment.
Methods A exhaustive and methodical search was conducted across the nine databases: PubMed, EMBASE, Web of Science, Scopus, the Cochrane Library, CBM, CNKI, WANFANG and VIP Data. The Visual Analog Scale (VAS) scores, migraine attack frequency, duration, days of attack and adverse effects were observation indicators.
Results This study included 34 studies involving a total of 3365 migraineurs. The results of the study demonstrated that acupuncture therapy reduced VAS scores of migraine patients better compared to medication (MD=-1.29, 95% CI=[-1.67,-0.92]) and exhibited greater efficacy in reducing the frequency of migraine attacks (MD=-1.95, 95% CI=[-3.06,-0.85]), the duration of attacks (MD=- 3.29, 95% CI=[-4.65,-1.93]), and days of attack (MD=-1.02, 95% CI=[-1.58,-0.47]). Significant heterogeneity suggested that different acupuncture therapies had varying effects, and that the efficacy of the same therapy may also vary in different migraine types. In the context of network meta-analysis, the SUCRA of acupuncture therapies for reducing VAS scores was ranked as special acupuncture method (98.3%), acupuncture plus medicine (71.9%), and acupuncture (54.5%). Blood-letting and cupping was the most effective treatment for lowering the frequency of migraine attacks. The most effective treatment for shortening the duration of migraine was acupuncture plus medication (81.2%). When it comes to decreasing the days of migraine, acupuncture (80.3%) came out on top. 14 studies reported the occurrence of adverse effects, of which 4 studies had no adverse effects in the test group.
Conclusion Initial findings indicate that acupuncture-related therapy exhibits superior effectiveness in the treatment of migraine and clinical decision-making should be patient-specific.

1.3.2. Sham acupuncture

1.3.2.1. Sun 2023

Sun C, Xiong Z, Sun C, Liu T, Liu X, Zhang Q, Liu B, Yan S, Liu C. Placebo response in sham-acupuncture-controlled trials for migraine: A systematic review and meta-analysis. Complement Ther Clin Pract. 2023 Nov;53:101800. https://doi.org/10.1016/j.ctcp.2023.101800

Aim To understand the placebo response of acupuncture and its effect on migraine and optimize the design of future acupuncture clinical trials on migraine treatment.
Methods Randomized controlled trials with sham acupuncture as a control in migraine treatment were searched in four English databases from inception to September 1, 2022. The primary outcome was placebo response rate. Secondary outcomes were migraine symptoms, emotional condition, and quality of life. Factors associated with placebo response were also explored. Results were combined using risk difference (RD) or standardized mean difference (SMD) and 95% confidence interval (CI) with a random effects model.
Results The final analysis included 21 studies involving 1177 patients. The pooled response rate of sham acupuncture was 0.34 (RD, 95% CI 0.23-0.45, I2 89.8%). The results (SMD [95% CI]) showed significant improvements in migraine symptoms (pain intensity -0.56 [-0.73 to -0.38], and episode conditions -0.55 [-0.75 to -0.35]); emotional condition (anxiety scale -0.49 [-0.90 to -0.08] and depression scale -0.21 [-0.40 to -0.03]); and quality of life on the Migraine-Specific Quality-of-Life Questionnaire (restrictive 0.78 [0.61-0.95]; preventive 0.52 [0.35-0.68]; and emotional 0.45 [0.28-0.62]) and on the Medical Outcomes Study Short-Form (physical 0.48 [0.34-0.62] and mental 0.21 [0.02-0.41]). Only acupuncture treatment frequency had a significant impact on the placebo response rate (RD 0.49 vs. 0.14; p = 0.00).
Conclusions The effect sizes for placebo response of sham acupuncture varied across migraine treatment trials. Further studies should routinely consider adjusting for a more complete set of treatment factors.

1.3.3. Electroacupuncture

1.3.3.1. Li 2019

Li X, Dai Q, Shi Z, Chen H, Hu Y, Wang X, Zhang X, Tian G. Clinical Efficacy and Safety of Electroacupuncture in Migraine Treatment: A Systematic Review and Network Meta-Analysis. Am J Chin Med. 2019;47(8):1755-1780. [208484]. doi

Background Considering the heavy burden of migraine, it is essential to update insufficient and/or outdated clinical evidence supporting electroacupuncture (EA) in migraine therapy.
Methods In this study, a literature search of seven medical databases was performed. After data extraction and quality evaluation, 13 randomized controlled trials, including 1559 patients, were assessed in this analysis.
Results Results demonstrated that EA was superior to control treatment (Western medicine, sham-EA, blank control, acupuncture, and acupoint catgut embedding) according to the visual analog scale (VAS) score, frequency of headache attack (Western medicine, sham-EA, blank control), self-rating anxiety scale (SAS [blank control]), self-rating depression score (SDS [Western medicine and blank control]), and clinical efficiency (Western medicine and sham-EA) after treatment (P<0.05 ). Results of network meta-analysis (for VAS, SAS, and SDS) demonstrated statistically significant differences in VAS scores for EA compared with sham-EA, acupuncture with sham-EA, acupoint catgut embedding with sham-EA, and acupoint catgut embedding with blank control. Rank probability analysis of VAS, SAS, and SDS scores all demonstrated that EA ranked first. Most studies were symmetrically distributed on both sides of the midline in funnel plots for VAS, SAS, and SDS, which indicated a low likelihood of small sample effects. Sensitivity analysis confirmed the stability of the studies included in this research.
Conclusions EA is one of several effective treatments for migraine pain symptoms, and, to some extent, anxiety and depression. Nevertheless, multi-center studies with large sample sizes and/or well-designed randomized controlled trials (RCTs) will be needed in the future.

1.3.4. Shaoyang acupoints

1.3.4.1. Duan 2019

Duan Kaixuan, Zhu Wei, Mao Fangqun, Zhang Wansheng, Li Ruiming. [Effectiveness of Shaoyang acupoint Penetration Acupuncture Versus Normal Acupuncture Treatment for Migraine prophylaxis: a Meta -analysis]. Chinese Journal of Ethnomedicine and Ethnopharmacy. 2019;1:58-64. [201729].

目的:系统评价少阳经透刺对比常规针刺对偏头痛的治疗效果,为透刺的临床应用提供循证依据.方法:检索中国知网、万方数据库、维普期刊数据库、中国生物医学文献数据库、Pubmed和Cochrane library,检索时间为建库至2018年1月,收集少阳经穴位透刺和常规针刺治疗偏头痛的临床随机对照试验.按照Cochrane系统评价手册评价纳入文献的质量并使用Review Manager 5.3软件对纳入研究进行Meta分析.结果:共纳入10项研究,总样本量647例.Meta分析显示:透刺在有效率[RR=1.14,CI(1.08,1.22),P<0.0001]、治疗后VAS值[MD=-2.16,CI(-2.54,-1.79),P<0.00001]、即时镇痛VAS差值[MD=1.03,CI(0.62,1.45),P<0.00001]、头痛持续时间[MD=-0.32,CI(-0.46,-0.18),P<0.00001]均明显优于常规针刺.结论:少阳经透刺相对于常规针刺治疗偏头痛有更好的疗效,但还需要更多的高质量研究增强循证证据.

[Automatic translation].
Objective To systematically evaluate the therapeutic effect of Shaoyang acupoint penetration versus conventional acupuncture on migraine, and provide evidence-based evidence for clinical application of spurs.
Methods Search China Knowledge Network, Wanfang Database, Weipu Journal Database, China Biomedical Literature Database, Pubmed and Cochrane library, the search time was from Jianku to January 2018, collecting randomized controlled trials of Shaoyang acupoint penetration and conventional acupuncture for migraine. According to the Cochrane systematic review manual, the quality of the included literature was evaluated and used. Review Manager 5.3 software for meta-analysis of the included studies.
Results A total of 10 studies were included, with a total sample size of 647. Meta-analysis showed that the penetration was effective [RR=1.14, CI(1.08, 1.22), P<0.0001] VAS value after treatment [MD=-2.16, CI(-2.54,-1.79), P<0.00001], immediate analgesia VAS difference [MD=1.03, CI(0.62, 1.45), P<0.00001], headache persistence Time [MD=-0.32, CI(-0.46,-0.18), P<0.00001] was significantly better than conventional acupuncture.
Conclusion Shaoyang acupoint penetration has better curative effect than conventional acupuncture for migraine, but More high-quality research is needed to enhance evidence-based evidence.

1.3.5. Pricking Blood Therapy

1.3.5.1. Du 2014

Du YZ, Jia CS, Shi J, Liu X, Zhang XX, Wang JL, Sun YH, Li XF, Zhang XP, Zhang X, Gang WJ. [A meta-analysis on pricking blood therapy for migraine]. Acupuncture Research. 2014;39(3):232-7. [174692].

ObjectiveTo evaluate the therapeutic effect of pricking blood therapy for migraine.
Methods: We searched all the original papers about pricking blood therapy for migraine in common databases as the Chinese National Knowledge Infrastructure Database (CNKI), Chinese Biomedical Library (CBM), Ovid, Science Direct, Socolar, and Sci Finder (1949 -2012), Wanfang Data (1998-2012) and Foreign Medical Journal Service (FMJS, 1990-2012). The original articles were searched in accordance with a pre-defined standards (simple pricking blood treatment, or the pricking blood therapy was the principal approach), while those about other diseases (such as cerebrovascular disease, cervical spondylosis, etc.) evoked migraine, pricking blood used as a complementary therapy, case report, specialists' experience summary, reviews, surveys, news articles, animal studies were excluded. Then, a Meta-analysis was made by software Review Manager 5.1.
Results: A total of 11 clinical trial papers involving 826 cases of migraine were included in the present paper. Three of them were high-quality researches, and the other eight were low quality researches. Results of Meta-analysis indicated that the therapeutic effect of the pricking blood therapy was significantly superior to that of non-bleeding therapies in relieving migraine [OR = 6.23, 95% CI: (4.03, 9.63), Z = 8.24, P < 0.00 001]. However, the poor symmetry of funnel plot suggested a risk of bias.
Conclusion The pricking blood therapy is effective for relieving migraine, but larger sample clinical trials, particularly randomized controlled trials are definitely needed for confirming the conclusion.

1.3.6. Auricular acupuncture

1.3.6.1. Fernández-Hernando 2023

Fernández-Hernando D, Fernández-de-Las-Peñas C, Pareja-Grande JA, García-Esteo FJ, Mesa-Jiménez JA. Management of auricular transcutaneous neuromodulation and electro-acupuncture of the vagus nerve for chronic migraine: a systematic review. Front Neurosci. 2023 Jun 15;17:1151892. https://doi.org/10.3389/fnins.2023.1151892

Background Migraine is a type of primary headache that is accompanied by symptoms such as nausea, vomiting, or sensitivity to light and sound.
Objective The aim of this study was to conduct a systematic review on the effectiveness of non-invasive neuromodulation, auricular transcutaneous vagus nerve stimulation (at-VNS), and electro-ear acupuncture of the vagus nerve in patients with migraine headaches.
Methods Six databases were searched from inception to 15 June 2022 for clinical trials, in which at least one group received any form of non-invasive neuromodulation of the vagus nerve for managing migraine with outcomes collected on pain intensity and related disability. Data, including participants, interventions, blinding strategy, outcomes, and results, were extracted by two reviewers. The methodological quality was assessed with the PEDro scale, ROB, and Oxford scale.
Results The search identified 1,117 publications with nine trials eligible for inclusion in the review. The methodological quality scores ranged from 6 to 8 (mean: 7.3, SD: 0.8) points. Low-quality evidence suggests some positive clinical effects for the treatment of chronic migraine with 1 Hz with at-VNS and ear-electro-acupuncture compared with the control group at post-treatment. Some of the studies provided evidence of the relationship between chronic migraine and a possible positive effect as a treatment with at-VNS and the neurophysiological effects using fMRI. Six of the studies provided evidence using fMRI of the relationship between chronic migraine and a possible positive effect as a treatment with at-VNS and the neurophysiological effects. Regarding all included studies, the level of evidence with the Oxford scale was level 1 (11.17%), six studies were graded as level 2 (66.66%), and two studies were graded as level 3 (22.2%). With the PEDro score, five studies got a low methodological score < 5 and only four got a score superior to 5, being highly methodological quality studies. For ROB, most of the studies were high risk and only a few of them received a low risk of bias. The pain intensity, migraine attacks, frequency, and duration were measured by three studies with positive results at post-treatment. And only 7% reported adverse events using at-VNS. All studies reported results at a post-treatment period in their respective main outcomes. And all studies with fMRI provided strong evidence of the relationship between the Locus Coeruleus, Frontal Cortex, and other superior brain areas with the auricular branch of the Vagus nerve with at-VNS.
Conclusion Some positive effects regarding the effect of non-invasive neuromodulation, auricular transcutaneous vagus nerve stimulation (at-VNS), and electro-ear acupuncture of the vagus nerve on migraine is reported in the current literature, but there are not enough data to obtain strong conclusions.

1.3.7. Scalp acupuncture

1.3.7.1. Kim 2023

Kim CY, Hwang EH, Heo I, Park SY, Shin BC, Hwang MS. Effectiveness and safety of scalp acupuncture for treating migraine: A systematic review and meta-analysis. Complement Ther Med. 2023 Nov;78:102991. https://doi.org/10.1016/j.ctim.2023.102991

Objective Migraine is a prevalent and disabling neurological disorder affecting a significant proportion of the global population. Although medications are the primary treatment option, their efficacy remains unclear. Thus, alternative therapies such as scalp acupuncture have gained momentum; however, evidence for the effectiveness of scalp acupuncture remains insufficient. Therefore, this review provides evidence regarding the effectiveness and safety of scalp acupuncture for the treatment of migraines.
Methods Design: PubMed, EMBASE, CENTRAL, Oriental Medicine Advanced Searching Integrated System, Korean Studies Information Service System, Korean Medical Database, NDSL, Citation Information by NII, and China National Knowledge Infrastructure were searched from their inception to September 2022 to identify randomised controlled trials (RCTs) without language restrictions. Data were collected and analysed independently by two reviewers. The RoB 2.0 tool was used to evaluate the risk of bias, and a meta-analysis was conducted using RevMan software (V5.4).
Results Eight RCTs including 874 patients were selected. Scalp acupuncture had a higher total effective rate (relative risk [RR]:1.24; 95% confidence interval [CI]:1.08-1.43; P < 0.01) than that of ordinary acupuncture. The headache index decreased significantly (standardised mean differences [SMD]:-1.27; 95% CI:-2.06 to -0.48; P < 0.01), and the total effective rate was higher (RR:1.20; 95% CI:1.06-1.37; P < 0.01) with scalp acupuncture than with medications. However, evidence supporting the effectiveness of scalp acupuncture was not robust. No adverse events were reported.
Conclusion Scalp acupuncture appears to be more effective than other treatments for migraines. However, their safety remains uncertain.

1.4. Special outcome

1.4.1. Mental health

1.4.1.1. Li 2023

Li Z, Feng J, Yin S, Chen X, Yang Q, Gao X, Che D, Zhou L, Yan H, Zhong Y, Zhu F. Effects of acupuncture on mental health of migraine patients: a systematic review and meta-analysis. BMC Complement Med Ther. 2023 Aug 4;23(1):278. https://doi.org/10.1186/s12906-023-04103-8

Background Migraine is a neurological disease characterized by moderate to severe headache and various neurological symptoms. It is often cause mood and anxiety disorders that can seriously affect quality of life. Acupuncture has been claimed to have a role in treating neuropsychiatric disorders and is becoming increasingly popular. However, it remains unclear whether current evidence is sufficient to support acupuncture in improving mental health in migraine patients.
Objectives This systematic review and meta-analysis aimed to investigate the effect of acupuncture on the management of pain and mood disorders in patients with migraine.
Methods We searched PubMed, Cochrane Library, Embase, Web of Science, Chinese National Knowledge Infrastructure (CNKI) and Wan Fang Data Knowledge Service Platform for reports, conferences and academic papers published before January 1, 2022. Randomized controlled trials (RCTs) including acupuncture, sham acupuncture and medication for migraine were included. Stata 16.0 software and Cochrane RoB2.0 were used for data processing and migration risk analysis.
Result Thirteen randomized controlled trials containing 1766 migraine patients were included in the present study, the results showed that compared with sham acupuncture and medication, acupuncture seemed to have advantage in improving SAS (WMD: -5.64;95% CI: -10.89, -0.39; p = 0.035) and SDS (WMD: -4.65; 95% CI: -9.25, -0.05; p = 0.048) in migraine patients. And it seems to be more effective in improving MH (SMD: 0.77; 95% CI: 0.19, 1.35; p = 0.009), VAS (SMD: -1.06; 95% CI: -1.73, -0.4; p = 0.002;) and MSQ (WMD: 4.76; 95% CI: 2.36, 7.15; p < 0.001) than sham acupuncture and medication.
Conclusion The present results suggest that, compared with Western medicine and sham acupuncture, acupuncture seems to be able to effectively improve anxiety and depression in migraine patients.And it may be more effective in improving SF36-mental health, VAS and MSQ than shame acupuncture or Western medicine. The results of this study need to be verified by higher quality RCTs.

2. Overviews of Systematic Reviews

2.1. Lu 2022

Lu TT, Lu CC, Li MX, Ke LX, Cai H, Yang KH. Reporting and methodological quality of meta-analyses of acupuncture for patients with migraine: A methodological investigation with evidence map. J Integr Med. 2022 May;20(3):213-220. https://doi.org/10.1016/j.joim.2022.02.003

Background Acupuncture has been widely used to relieve migraine-related symptoms. However, the findings of previous systematic reviews (SRs) and meta-analyses (MAs) are still not completely consistent. Their quality is also unknown, so a comprehensive study is needed.
ObjectiveTo evaluate the reporting and methodological quality of these MAs concerning acupuncture for migraine, and summarize evidence about the efficacy and safety of acupuncture for migraine.
Search strategy PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Chinese Biomedical Databases, Wanfang Data, and VIP databases were searched from inception to September 2020, with a comprehensive search strategy.
Inclusion criteria The pairwise MAs of randomized controlled trials (RCTs) concerning migraine treated by acupuncture or acupuncture-based therapies, with a control group that received sham acupuncture, medication, no treatment, or acupuncture at different acupoints were included.
Data extraction and analysis Two independent investigators screened studies, extracted relevant data, and assessed reporting and methodological quality using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 and A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2), then all results were cross-checked. Spearman correlation test was used to evaluate the correlation between reporting and methodological quality scores.
ResultsA total of 20 MAs were included in this study. The included MAs indicated that acupuncture was efficacious and safe in preventing and treating migraine when compared with control intervention. There was a high correlation between reporting and methodological quality scores (rs = 0.87, P < 0.001). The quality of the included SRs needs to be improved mainly with regard to protocol and prospective registration, using a comprehensive search strategy, summarizing the strength of evidence body for key outcomes, a full list of excluded studies with reasons for exclusion, reporting of RCTs' funding sources, and assessing the potential impact of risk of bias in RCTs on MA results.
Conclusion Acupuncture is an effective and safe intervention for preventing and treating migraine, and could be considered as a good option for patients with migraine. However, the reporting and methodological quality of MAs included in this overview is suboptimal. In the future, AMSTAR 2 and PRISMA tools should be followed when making and reporting an SR with MA.

2.2. Li 2020

Li YX, Xiao , Zhou J, He MX, Shi LH, Li J, Zheng H, Jin RJ. Effectiveness and Safety of Acupuncture for Migraine: An Overview of Systematic Reviews. Pain Res Manag. 2020. [207643]. doi

BackgroundMigraine is a common neurological disease, which burdens individuals and society all over the world. Acupuncture, an important method in Traditional Chinese Medicine, is widely used in clinical practice as a treatment for migraine. Several systematic reviews (SRs) have investigated the effectiveness and safety of acupuncture for migraine.
ObjectiveTo summarize and critically assess the quality of relevant SRs and present an objective and comprehensive evidence on the effectiveness and safety of acupuncture for migraine.
Methods Data Sources. MEDLINE, Embase, Cochrane Library, PROSPERO database, Chinese National Knowledge Infrastructure (CNKI), Chinese Biological Medicine (CBM), China Science and Technology Journal (SCTJ), and WanFang database (WF) were searched from inception to December 2019 and grey literatures were manually searched. Selection Criteria. SRs which meet the criteria were independently selected by 2 reviewers according to a predetermined protocol. Data Extraction. Characteristics of included SRs were independently extracted by 2 reviewers following a predefined data extraction form. Review Appraisal. The methodological quality, risk of bias, and reporting quality of included SRs were assessed, respectively, by a Measurement Tool to Assess Systematic Reviews (AMSTAR) 2, the Risk of Bias in Systematic reviews (ROBIS) tool, and the Preferred Reporting Item for Systematic Review and Meta-analysis-Acupuncture (PRISMA-A) statement. The quality of outcomes was evaluated by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE).
Results A total of 15 SRs were included. All the SRs were published between 2011-2019. Based on AMSTAR 2, 14 out of 15 SRs were rated critically low quality and 1 was rated low quality. According to ROBIS tool, 9 SRs (60%) were low risk of bias. With the PRISMA-A checklist, we found 11 out of 15 SRs were found adequately reported over 70%. With the GRADE tool, we found high quality of evidence indicated that the effective rate of acupuncture was superior to western medicine in treatment of migraine. Besides, acupuncture reduced more headache days and the times of using painkiller and was more effective in reducing the frequency and degree of headache than western medicine and sham acupuncture. Limitations. There might be some missing information. The accuracy of the conclusions may be decreased reduced since we were unable to synthesis all the evidence.
Conclusion Based on high quality of evidence, we concluded that acupuncture may be an effective and safe therapy for migraine. However, the quality of SRs in acupuncture for migraine still needs more improvement.

2.3. Zhang 2019

Zhang XT, Li XY, Zhao C, Hu YY, Lin YY, Chen HQ, Shi ZF, Zhang XY, Shang HC, Tian GH. An Overview of Systematic Reviews of Randomized Controlled Trials on Acupuncture Treating Migraine. Pain Res Manag. 2019. [203221].

ObjectivesTo review the evidence of acupuncture for acute and preventive treatment of migraine for further awareness of the effect of acupuncture for migraine. Design: An overview of systematic reviews and meta-analyses (SR/Mas) for randomized controlled trials.
Material and MethodsWe searched PubMed, Embase, the Cochrane Library, China Knowledge Resource Integrated Database, VIP Chinese Journal Full Text Database, WANFANG Data, and China Biology Medicine disc from their establishment to May 27, 2018. SR/Mas of randomized controlled trials comparing the effect of the acupuncture intervention with another treatment control in migraine patients were included.
Results428 SRs were identified, and 15 of them were included. Only 4 SR/Mas were assessed by GRADE, which showed certainty of most evidence being low or very low. Assessed by AMSTAR-2, fourteen was critically low rating overall confidence in the results, and 1 was low rating overall confidence in the results. Evidence suggested that acupuncture has a significant advantage of pain improvement, efficacy, and safety relative to blank control, sham acupuncture, or drug treatment, but some of these results are contradictory.
Conclusions We found that acupuncture on treating migraine has the advantage for pain improvement and safety, but the quality of SR/Mas of acupuncture for migraine remains to be improved.

3. Clinical Practice Guidelines

⊕ positive recommendation (whatever the level of evidence stated)
Ø negative recommendation (or lack of evidence)

3.1. Duodecim EBM Guidelines (Finland) 2022 ⊕

Version française (EBMFrance.net). Migraine. Duodecim 2022. https://www.ebmfrance.net/fr/Pages/ebm/ebm00792.aspx

Formes non pharmacologiques de prophylaxie : exercice, physiothérapie, acupuncture (B), formation de relaxation.

3.2. Istituto Superiore di Sanità (ISS, Italy) 2022 ⊕

Agopuntura per la terapia del dolore. Linea guida pubblicata nel Sistema Nazionale Linee Guida Roma, 25 luglio 2022. https://snlg.iss.it/wp-content/uploads/2022/07/LG-412_FISA_Agopuntura-per-terapia-dolore.pdf

Quesito 1: Dovrebbe essere utilizzata l’agopuntura per la profilassi dell’emicrania cronica ed episodica rispetto al trattamento farmacologico?
Raccomandazione clinica: Nei pazienti adulti a rischio di emicrania cronica o episodica si suggerisce di proporre la profilassi con agopuntura rispetto al trattamento farmacologico. Certezza nelle prove: moderata. Forza della raccomandazione: Condizionata a favore di agopuntura.

3.3. Taiwan Headache Society (THS, Taiwan) 2022 ⊕

  • Wu JW, Yang CP. 2022 Taiwan Guidelines for Preventive Treatment of Migraine. Acta Neurol Taiwan. 2022 Sep 30;31(3):164-202. doi 🔓
  • Lau CI, Wang YF; Treatment Guideline Subcommittee of the Taiwan Headache Society. 2022 Taiwan Guidelines for Acute Treatment of Migraine. Acta Neurol Taiwan. 2022 Jun 30;31(2):89-113. doi
Acupuncture: Less side effects, can be used for patients with side effects of oral drugs. Episodic migraine (strength of evidence B, grade of recommendation I). Chronic migraine (strength of evidence C, grade of recommendation I).
Acute treatment: more studies are needed to confirm the acute treatment.

3.4. Japanese Association for the Study of Pain (JASP) Committee for Clinical Practice Guideline for the Management of Chronic Pain (Japan) 2021 ⊕

The Committee for Clinical Practice Guideline for the Management of Chronic Pain. Clinical Practice Guidelines For the Management of Chronic Pain . Tokyo: Publication Department of Medical Books, Shinko Trading Co. Ltd.; 2021 . https://paincenter.gloomy.jp/paincenter/wp-content/uploads/2022/02/chronicpaintreatmentguide2021e.pdf

CQ N-5-3: Is acupuncture useful for chronic migraine/chronic tension-type headache? Answer: Acupuncture may be useful for preventing chronic migraine. Its effects for preventing chronic tension-type headache, however, are not superior to those of physical therapy and relaxation. Recommendation Grade: 2 (weak) – Implementation is weakly recommended.Summary of Overall Evidence: C (low).

3.5. Japanese Society of Neurology, Japanese Headache Society, Japanese Society of Neurological Therapeutics (Japan) 2021 ⊕

Japanese Society of Neurology. The Japanese Headache Society, Japanese Society of Neurological Therapeutics. Zutsu no Shinryo Gaidorain [Clinical Practice Guidelines For headache, 2021] . Tokyo: Igaku Shoin Ltd.; 2021 [in Japanese]. Cited by Okawa Y, Yamashita H, Masuyama S, Fukazawa Y, Wakayama I. Quality assessment of Japanese clinical practice guidelines including recommendations for acupuncture. Integr Med Res. 2022 Sep;11(3):100838. https://doi.org/10.1016/j.imr.2022.100838

Acupuncture. Prevention of migraines:Recommendation to use (Weak). Acute migraines: Recommendation to use (Weak)

3.6. Société Française d'Etudes des Migraines et Céphalées (SFEMC, France) 2021 ⊕

Demarquay G, Mawet J, Guégan-Massardier E, de Gaalon S, Donnet A, Giraud P, Lantéri-Minet M, Lucas C, Moisset X, Roos C, Valade D, Ducros A. Revised guidelines of the French headache society for the diagnosis and management of migraine in adults. Part 3: Non-pharmacological treatment. Rev Neurol (Paris). 2021;177(7):753-759. [221834]. doi

Rnpt5. In patients with episodic migraine asking for non-pharmacological treatments or achieving insufficient efficacy with pharmacological treatments, propose acupuncture as an alternative or a supplement to pharmacological prophylaxis. Strength of recommendation: strong.

3.7. Australian and New Zealand College of Anaesthetists (ANZA) 2020 ⊕

Acute Pain Management: Scientific Evidence Australian and New Zealand College of Anaesthetists (ANZA). 2020:1317P. [205268] . URL.

Acupuncture may reduce the frequency of tension-type headaches and migraine (U) (Level I [Cochrane Review]); in migraine, it may be better tolerated than pharmacological prophylaxis (N) (Level I [Cochrane Review]).

3.8. Ministry of Public Health of Qatar (MOPH, Qatar) 2020 ⊕

Headache in adults. National Clinical Guidelines . Ministry of Public Health of Qatar (MOPH). 2020;:. [219468]. URL

Migraine. Acupuncture : A course of up to 10 sessions of acupuncture over 5-8 weeks (Level 2, grade A1).

3.9. British Association for the Study of Headache (BASH, UK) 2019 ⊕

Ahmed F, Bahra A, Tyagi A, Weatherby S. National headache management system for adults, 2019. British Association for the Study of Headache; 2019. BASH

Preventive treatments in tension-type headache: Acupuncture, starting dose: 6 treatment sessions

3.10. Brazilian Headache Society (Brazil) 2019 ⊕

Kowacs F, Roesler CAP, Piovesan ÉJ, Sarmento EM, Campos HC, Maciel JA Jr, Calia LC, Barea LM, Ciciarelli MC, Valença MM, Costa MENM, Peres MFP, Kowacs PA, Rocha-Filho PAS. Consensus of the Brazilian Headache Society on the treatment of chronic migraine. Arq Neuropsiquiatr. 2019;77(7):509-520. [200284].

Acupuncture. Recommendation : B, evidence : 1 class I trial and 2 class II trials

3.11. European Headache Federation (EHF) 2019 Ø

Steiner TJ, Jensen R, Katsarava Z, Linde M, MacGregor EA, Osipova V, Paemeleire K, Olesen J, Peters M, Martelletti P. Aids to management of headache disorders in primary care (2nd edition) : on behalf of the European Headache Federation and Lifting The Burden: the Global Campaign against Headache. J Headache Pain. 2019;20(1):57. [200002].

Prophylactic management of episodic migraine: Acupuncture has differing forms, and is highly dependent on the skill of the therapist. There is limited evidence that acupuncture can be effective in reducing intensity and frequency of migraine attacks, but large clinical trials have failed to distinguish between acupuncture and sham procedures. Benefits experienced by some patients may be attributable to placebo effect.

3.12. National Institute for Health and Clinical Excellence (NICE, UK) 2019 ⊕

Nice CKS Clinical knowledge summaries).. Migraine. London (UK): National Institute for Health and Clinical Excellence (NICE). 2019:54p. [196017].

Consider non-pharmacological therapies as an adjunct or alternative to pharmacological therapy depending on the specific clinical situation and the person’s preference, including: Acupuncture (up to 10 sessions over 5–8 weeks) if both topiramate and propranolol are unsuitable or ineffective.

3.13. Société Suisse pour l’étude des Céphalées (SSC, Switzerland) 2019 ⊕

Céphalées et algies faciales, Recommandations thérapeutiques Révision 2019, 10E édition Société Suisse pour l’étude des Céphalées (SSC). 2019. 9P . [203683]. doi

Traitement de la crise : L’effet bénéfique de l’acupuncture a été démontré.

3.14. Deutschen Gesellschaft für Neurologie & Deutschen Migräne- und Kopfschmerzgesellschaft (DGN & DMKG, Germany) 2018 ⊕

  • Diener HC, Gaul C, Kropp P. Leitlinien für Diagnostik und Therapie in der Neurologie. Therapie der Migräne-attacke und Prophylaxe der Migräne Deutschen Gesellschaft für Neurologie (DGN), Deutschen Migräne- und Kopfschmerzgesellschaft (DMKG). 2018:100p. [202168].
  • Diener HC, Holle-Lee D, Nägel S, Dresler T, Gaul C, Göbel H et al. Treatment of migraine attacks and prevention of migraine: Guidelines by the German Migraine and Headache Society and the German Society of Neurology. Clinical and Translational Neuroscience. 2019;3(1). [203759]. doi
Acupuncture can be used to prevent migraine in patients who refuse or can not tolerate drug prophylaxis.
The superiority of a classical acupuncture over a sham acupuncture is minimal.

3.15. Kaiser Permanente Washington (KPWA, USA) 2018 ⊕

Migraine and Tension Headache Guideline. Kaiser Permanente Washington (KPWA). 2018:21p. [198815].

Options for migraine prophylaxis: Acupuncture Moderate evidence supports the effectiveness of acupuncture over sham acupuncture in reducing migraine frequency and medication use in adult patients who have not responded to prophylactic medications. There is no evidence on the impact of acupuncture on migraine severity. There is no evidence of the effectiveness of acupuncture in teens.

3.16. Canadian Medical Association (CMA, Canada) 2017 ⊕

Lignes directrices canadiennes relatives à l’utilisation des opioïdes pour le traitement de la douleur chronique non cancéreuse, Canadian Medical Association. 2017:110P. [196698].

Recommandation 1: Lorsqu’on envisage le traitement d'un patient atteint de douleur chronique non cancéreuse nous recommandons l’optimisation de la pharmacothérapie non opioïde et du traitement non pharmacologique plutôt qu’un essai d’opioïdes (Recommandation Forte).
Le tableau 2 énumère certains des traitements spécifiques disponibles pour la prise en charge de la douleur chronique non cancéreuse ainsi que les données probantes appuyant chacun de ces traitements .
Douleurs dorsales, ostéo-arthrite du genou, douleurs cervicales, fibromyalgie, céphalées graves ou migraines. Qualité des données probantes : Faible ou très faible. Thérapies dont l’efficacité est appuyée par certaines données probantes : acupuncture, yoga, massothérapie, manipulation rachidienne, manipulation ostéopathique, tai-chi et approches de relaxation peuvent aider certains patients à gérer leur douleur.

3.17. Ministry of Public Health of Qatar (MOPH, Qatar) 2017 ⊕

Headache in adults. Clinical Guidelines for the State of Qatar. Ministry of Public Health of Qatar (MOPH). 2017. [221303]. URL

Migraine. Acupuncture : A course of up to 10 sessions of acupuncture over 5-8 weeks (Level 2, grade A1).

3.18. Taiwan Headache Society (TGSOTHS, Taiwan) 2017 ⊕

Huang TC, Lai TH, Taiwan Headache Society TGSOTHS. Medical Treatment Guidelines for Preventive Treatment of Migraine. Acta Neurol Taiwan. 2017;26(1):33-53. [200003].

Although acupuncture in alternative therapy is a preference of Chinese people, it is still difficult to quantify the location, extent, depth and time of acupuncture. In 2016, Cochrane empirical resources systematic literature review and comprehensive analysis of 22 trials (20), compared with no The acupuncture (acupuncture), the relative risk ratio (RR) for a 50% reduction in the frequency of headaches was 2.40 (95% CI: 2.08-2.76); compared to the pseudo-needle (sham acupuncture), it was 1.23 (95% CI: 1.11) -1.36); 1.24 (95% CI: 1.08-1.44) compared to prophylactic drug therapy. Therefore, acupuncture can reduce the incidence of migraine, but it is only slightly better than pseudo-needle, so it is recommended to provide a choice for patients who are willing to receive this treatment, the recommended level is (B, III).

3.19. Toward Optimized Practice, Institute of Health Economics (TOP, IHE, Canada) 2016 ⊕

Toward Optimized Practice. Primary Care Management of Headache in Adults. Edmonton (AB): Toward Optimized Practice. 2016. 76P. [168209].

Do : Acupuncture can be considered in the prophylactic treatment of patients with migraine. Treatment should consist of at least one to two sessions per week for several (2 or more) months, with each treatment lasting approximately 30 minutes (Systematic review).

3.20. National Institute for Health and Clinical Excellence (NICE, UK) 2015 ⊕

Headaches in over 12s: diagnosis and management. National Institute for Health and Clinical Excellence (NICE, UK). 2015:30p. [198812].

Migraine with or without aura . Prophylactic treatment 1.3.20 . If both topiramate and propranolol[2012] are unsuitable or ineffective, consider a course of up to 10 sessions of acupuncture over 5–8 weeks according to the person's preference, comorbidities and risk of adverse events. [2012, amended 2015] The updated evidence review did not look at acupuncture so this part of the recommendation is unchanged and the use of gabapentin has been removed.

3.21. Australian and New Zealand College of Anaesthetists (ANZCA, Autralia- New Zealand) 2015 ⊕

Acute Pain Management: Scientific Evidence. Australian and New Zealand College of Anaesthetists. 2015:714P. [196721].

4. Acupuncture may be effective in other acute pain settings (S) (Level I [PRISMA]), including acute burns and back pain (New) (Level I [PRISMA]), tension-type headaches and migraine (New) (Level I [Cochrane Review]).

3.22. Société Suisse pour l’étude des Céphalées (SSC, Switzerland) 2014 ⊕

Céphalées et algies faciales, Recommandations thérapeutiques Révision 2014, 9E édition, Société suisse pour l’étude des céphalées (SSC). 2014. 65p. [203685]. doi

Traitement préventif : L’effet bénéfique de l’acupuncture a été démontré.

3.23. Institute for Clinical Systems Improvement (ICSI, USA) 2013 ⊕

Beithon J, Gallenberg M, Johnson K, Kildahl P, Krenik J, Liebow M, Linbo L, Myers C, Peterson S, Schmidt J, Swanson J. Diagnosis and treatment of headache. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI). 2013; :92P. [157651].

Acupuncture. A systematic (Cochrane) review of acupuncture in migraine prophylaxis demonstrated that adding acupuncture to patients getting only acute treatment for headaches reduced the number of headaches patients had. When true and sham acupuncture were compared, they both reduced the number of headaches. There was no difference in benefit between true and sham acupuncture groups when results for all trials were pooled. Acupuncture demonstrated slightly better outcomes and fewer adverse effects than drugs shown to be helpful for prophylaxis (Linde, 2009 [Systematic Review]).

3.24. Latin american consensus (Latin America) 2013 ⊕

Giacomozzi AR, Vindas AP, Silva AA Jr, Bordini CA, Buonanotte CF, Roesler CA, et al,. Latin american consensus on guidelines for chronic migraine treatment. Arq Neuropsiquiatr. 2013;71(7):478-86. (eng). [170663]

The use of non-pharmacologic measures and complementary therapies for chronic migraine is limited due to the lack of studies for this specific condition. One exception to this affirmation is acupuncture, which has been evaluated and obtained promising results.

3.25. Colorado Division of Workers' Compensation (USA) 2012 ⊕

Colorado Division of Workers' Compensation. Traumatic brain injury medical treatment guidelines. Denver (CO): Colorado Division of Workers' Compensation. 2012; :119P. [168082].

There is strong evidence that acupuncture and sham acupuncture are prophylactic for migraines. There is good evidence that acupuncture has similar results as medication prophylaxis. There is some evidence that sham acupuncture is better than no treatment for migraine prophylaxis. These procedures should only be continued if functional gains are documented.

3.26. Croatian Society for Neurovascular Disorders, Croatian Medical Association (Croatia) 2012 ⊕

Vuković Cvetković V, Kes VB, Serić V, Solter VV, Demarin V, Janculjak D, Petravić D, Lakusić DM, Hajnsek S, Lusić I, Bielen I, Basić S, Sporis D, Soldo SB, Antoncić I; Croatian Society for Neurovascular Disorders, Croatian Medical Association. Report of the Croatian Society for Neurovascular Disorders, Croatian Medical Association. Evidence based guidelines for treatment of primary headaches–2012 update. Acta Clin Croat. 2012;51(3):323-78. [222897]. URL

Migraine: a Cochrane review on its use in migraine concludes that acupuncture is effective and should be considered as a prophylactic measure for patients with frequent or insufficiently controlled migraine attacks.
Migraine and pregnancy: Among nonpharmacological migraine prophylaxis, only relaxation techniques, biofeedback in particular, and acupuncture have accumulated sufficient evidence in support of their efficacy and safety.

3.27. Danish Headache Society (DHS, Denmark) 2012 Ø

Bendtsen L, Birk S, Kasch H, Aegidius K, Sørensen PS, Thomsen LL, Poulsen L, Rasmussen MJ, Kruuse C, Jensen R. Reference programme: diagnosis and treatment of headache disorders and facial pain (2nd Edition). J Headache Pain. 2012;13(suppl 1):1-29. [202379].

Migraine with and without aura: Controlled trials of the effect of acupuncture have yielded diverging results.

3.28. National Institute for Health and Clinical Excellence (NICE, UK) 2012 ⊕

National Clinical Guideline Centre. Headaches: diagnosis and management of headaches in young people and adults. London (UK): National Institute for Health and Clinical Excellence (NICE). 2012; :38P. [167732]. Appendices. 630P. [200007].

Migraine with or without aura, Prophylactic treatment. 1.3.20 If both topiramate and propranolol are unsuitable or ineffective, consider a course of up to 10 sessions of acupuncture over 5–8 weeks according to the person's preference, comorbidities and risk of adverse events. [2012, amended 2015]

3.29. Società Italiana per lo Studio delle Cefalee (SISC, Italia) 2012 ⊕

Sarchielli P, Granella F, Prudenzano MP, Pini LA, Guidetti V, Bono G, Pinessi L, Alessandri M, Antonaci F, Fanciullacci M, Ferrari A, Guazzelli M, Nappi G, Sances G, Sandrini G, Savi L, Tassorelli C, Zanchin G. Italian guidelines for primary headaches: 2012 revised version. J Headache Pain. 2012;13 Suppl 2:S31-70. [202377].

Acupuncture
Preventive treatment: level of evidence (A), level of recommendation (II).
Symptomatic treatment: level of evidence (-) Level of recommendation (IV)

3.30. Société française d’étude des migraines et des céphalées (SFEMC, France) 2012 Ø

Lanteri-Minet M, Valade D, Geraud G, Lucas C, Donnet A. Prise en charge diagnostique et thérapeutique de la migraine chez l’adulte et chez l’enfant. Revue Neurologique. 2013. 169:14-29. [173328].

Les données de la littérature ne permettent pas de conclure quant à l’efficacité de l’acupuncture (méthodologie grade A)

3.31. Société Suisse pour l’étude des Céphalées (SSC, Switzerland) 2012 ⊕

Céphalées et algies faciales, Recommandations thérapeutiques Révision 2012, 8E édition, Société suisse pour l’étude des céphalées (SSC). 2012. 17P. [168599]. doi

Traitement préventif, Mesures de médecine alternative: celles-ci sont controversées. Les résultats obtenus en pratique sont contradictoires. On manque par ailleurs d’observations à long terme. Seul l’effet bénéfique de l’acupuncture a été démontré.
L’acupuncture est efficace dans la prophylaxie de la migraine.

3.32. British Association for the Study of Headache (BASH, UK) 2010 ⊕

BASH. Guidelines for all healthcare professionals in the diagnosis and management of migraine, tension-type headache, cluster headache, medication-overuse headache; British Association for the Study of Headache. 2010;53P. [196913].

Acupuncture may provide additional benefit to routine care.

3.33. Scottish Intercollegiate Guidelines Network (SIGN, Scotland) 2008 ⊕

Scottish Intercollegiate Guidelines Network (SIGN). Diagnosis and management of headache in adults. A national clinical guideline. Edinburgh (Scotland): Scottish Intercollegiate Guidelines Network (SIGN). 2008. 88P. [156330].

Acupuncture should be considered for preventive management in patients with migraine (grade of recommendation: B).

3.34. European Headache Federation (EHF) 2007 ⊕

European Headache Federation. European principles of management of common headache disorders in primary care J Headache Pain. 2007;8:S1-47. [169126].

Acupuncture benefits some people with migraine or tension-type headache although large clinical trials have failed to distinguish between acupuncture and sham procedures. It requires skilled and individualised therapy.

3.35. National Association of Pediatric Nurse Practitioners (NAPNP, USA) 2007 Ø

Gunner KB, Smith HD, Ferguson LE, et al. Practice guideline for diagnosis and management of migraine headaches in children and adolescents: Part two. J Pediatr Health Care. 2007;22(1):52-9. [202300].

Evidence-based treatment recommendations in children for the use of hypnosis, acupuncture, transcutaneous electrical nerve stimulation, chiropractic or osteopathic cervical manipulation, occlusal adjustment, and hyperbaric oxygen as preventive or acute therapy for migraine are not yet possible.

3.36. Société française d’étude des migraines et des céphalées (SFEMC, France) 2004 Ø

Géraud G, Lantéri-Minet M, Lucas C, et al. French Guidelines for the Diagnosis and Management of Migraine in Adults and Children. Clinical Therapeutics. 2004;26(8):1305-18. [202028].

Data in the literature are insufficient to draw conclusions about the efficacy of acupuncture, homeopathy and cervical manipulation for the prevention of migraine.

3.37. Agence Nationale d’Accréditation et d’Évaluation en Santé (ANAES, France) 2002 Ø

Prise en charge diagnostique et thérapeutique de la migraine chez l’adulte et chez l’enfant : aspects cliniques et économiques. ANAES 2002. [134033].

Les données de la littérature ne permettent pas de conclure quant à l’efficacité de l’acupuncture dans la prévention de la migraine.

3.38. American Academy of Neurology (AAN, USA) 2000 Ø

Campbell JK, Penzien DB. Evidenced-based guidelines for migraine headache: behavioral and physical treatments. American Academy of Neurology. 2000;:29p. [202247].
Silberstein SD. Practice parameter: evidence-based guidelines for migraine headache (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2000;55(6):754-62. [202274].

Evidenced-based treatment recommendations are not yet possible regarding the use of hypnosis, acupuncture, TENS, cervical manipulation, occlusal adjustment, and hyperbaric oxygen as preventive or acute therapy for migraine.

3.39. Canadian Headache Society 1998 (CHS, Canada) Ø

Pryse-Phillips WE Et Al. Guidelines for the nonpharmacologic management of migraine in clinical practice. Canadian Headache Society. CMAJ. 1998. 159(1):47-54. [58787]

Transcutaneous electrical stimulation (level II-2 evidence) and acupuncture (level I evidence, class B recommendation) have been claimed in small series to provide some relief from migraine. Patients who enquire about transcutaneous electrical stimulation and acupuncture should be made aware of the lack of firm evidence as to the benefits and costeffectiveness of these treatments in the management of migraine (class C recommendation).

4. Randomized controlled trials

4.1. Sources

Systematic reviews and guidelines for a listing of randomized control trials included:

  1. Giovanardi 2020:Giovanardi CM, Cinquini M Aguggia M, Allais G, Campesato M,Cevoli S et al, Acupuncture vs. Pharmacological Prophylaxis of Migraine: A Systematic Review of Randomized Controlled Trials.Front. Neurol.2020;11:576272.doi (n=9)
  2. Ou 2020 : Ou MQ, Fan WH, Sun FR, Jie WX, Lin MJ, Cai YJ, Liang SY, Yu YS, Li MH, Cui LL, Zhou HH. A Systematic Review and Meta-analysis of the Therapeutic Effect of Acupuncture on Migraine. Front Neurol. 2020:11-596. [210326]. doi.
  3. Chen 2019 : Chen YY, Li J, Chen M, Yue L, She TW, Zheng H. Acupuncture versus propranolol in migraine prophylaxis: an indirect treatment comparison meta-analysis. J Neurol. 2019 [199102].
  4. Kowacs 2019: Kowacs F, Roesler CAP, Piovesan ÉJ, Sarmento EM, Campos HC, Maciel JA Jr, Calia LC, Barea LM, Ciciarelli MC, Valença MM, Costa MENM, Peres MFP, Kowacs PA, Rocha-Filho PAS. Consensus of the Brazilian Headache Society on the treatment of chronic migraine. Arq Neuropsiquiatr. 2019;77(7):509-520. [200284].
  5. Shen 2019 : Shen Feng-Jiao, Xu Jia, Zhan Yi-Jun, Fu Qin-Hui, Pei Jian. Acupuncture for migraine: A systematic review and meta-analysis. World Journal of Acupuncture-Moxibustion. 2019;29(1):7-14. [199980].
  6. Jiang 2018 : Jiang Y, Bai P, Chen H, Zhang XY, Tang XY, Chen HQ, Hu YY, Wang XL, Li XY, Li YP, Tian GH. The Effect of Acupuncture on the Quality of Life in Patients With Migraine: A Systematic Review and Meta-Analysis. Front Pharmacol. 2018. [189093].
  7. Xu 2018 : Xu J, Zhang FQ, Pei J, Ji J. Acupuncture for migraine without aura: a systematic review and meta-analysis. J Integr Med. 2018;16(5):312-321. [189777].
  8. Linde 2016 : Linde K, Allais G, Brinkhaus B, Fei Y, Mehring M, Vertosick EA, Vickers A, White AR. Acupuncture for the prevention of episodic migraine. Cochrane Database Syst Rev. 2016. [186250].
  9. Yang 2016 : Yang Y, Que Q, Ye X, Zheng Gh. Verum versus sham manual acupuncture for migraine: a systematic review of randomised controlled trials. Acupunct Med. 2016;34(2):76-83.[190445].
  10. Scott 2006 : Scott SW and Deare JC. Acupuncture for Migraine: A Systematic Review. Australian Journal of Acupuncture and Chinese Medicine. 2006;1(1):3-14. [190769].

4.2. List

RCT Control Sources
2018 Musil F, Pokladnikova J, Pavelek Z, Wang B, Guan X, Valis M. Acupuncture in migraine prophylaxis in Czech patients: an open-label randomized controlled trial. Neuropsychiatr Dis Treat. 2018 ;14:1221-1228. Chen 2019
2018 Tastan K, Ozer Disci O, Set T. A Comparison of the Efficacy of Acupuncture and Hypnotherapy in Patients With Migraine. Int J Clin Exp Hypn. 2018;66(4):371-385. [197922]. Ou 2020
2018 Wu Jiamin, Li Xinhao, Wu Jinzhen, et al. [Clinical Observation of Zhu's Scalp Acupuncture Treating Migraine]. Journal of Clinical Acupuncture and Moxibustion. 2018;34(8):52. [184339]. Ou 2020
2018 Xiao Lei, Wang Yan, Wang Sheng, Wang Li-Xin, Cui Qi, Zhang Chen, Yao Lu-Hong, Shao Jing-Yu, Xing Jun. [Clinical Study on Electro-acupuncture Treatment of Migraine in Surface Projection Zone of the Pyramid Decussation]. Chinese Journal of Information on TCM. 2018;25:97-9. [210641]. Ou 2020
2018 Yang J , Shen Y , Wang S . [Observation of clinical effect of acupuncture compared with flunarizine hydrochloride in the treatment of migraine. Modern Tradit Chin Med Mater Mater-World Sci Technol]. 2018;20(5):750–5 . Shen 2019
2018 Zhao Z, Se JH, Shi G, Li N. The observation on different effectiveness between the embedding needle therapy and medication in the preventative treatment of chronic migraine. World Journal of Acupuncture-Moxibustion. 2018;28(4):242. [196511]. Flunarizine Giovanardi 2020
2017 Chen K. [Analysis of the application and clinical effect of acupuncture and moxibustion for migraine]. Jia Ting Yi Yao. (1):35–6. Ou 2020
2017 Huang G, Sun Q, and Huang R. Observation on the curative effect of acupuncture combined with gabapentin in the treatment of migraine. Clin. Med. Eng. 2017 ;24 :615–616. Jiang 2018
2017 Li D. [Clinical Study on Treatment of Migraine with Hyperactivity of Liver Yang by means of “Ping Wan Li Zhi Acupuncture Manipulation”]. [M.Medicine]. Kunming: Yunnan University of TCM. 2017 Jiang 2018
2017 Liu L. Clinical study on acupuncture for migraine. Contemp. Med. Forum. 2017;15:128–129. Jiang 2018
2017 Liu Q, Qin X, and Zhang Y. [Warming-unblocking needling for migraine without aura: 30 cases]. TCM Res. 2017;30:37–40 Jiang 2018
2017 Naderinabi B, Saberi A, Hashemi M, Haghighi M, Biazar G, Abolhasan Gharehdaghi F, Sedighinejad A, Chavoshi T. Acupuncture and botulinum toxin A injection in the treatment of chronic migraine: A randomized controlled study. Caspian J Intern Med. 2017;8(3):196-204. [171531]. -Valproate
-Botulinum toxin 		Giovanardi 2020, Kowacs 2019
2017 Shu W, Peng T, Huang X, Hu S, Zhou C, Xie G, et al. [Observations on the efficacy of intermittent liver-nourishing and mind regulating acupuncture in preventive treatment of migraine]. Shanghai J Acup Moxib. 2017;36:727–730. Ou 2020, Jiang 2018
2017 Wang J, Qin X, Xie W, Wang W. [Migraine without aura treated with balance acupuncture therapy: a randomized controlled trial]. Chinese Acupuncture and Moxibustion. 2017;37(8):805-809. [52222]. Ou 2020
2017 Yan MH , Cai YW , Fu QH , Pei J . [A brief analysis of acupoint compatibility of acupuncture in treating migraine]. Chin J Acupunct Moxi. 2017;6(12):69–73 . Shen 2019
2017 Zhang K, Chen J, Shi Q. [Effect analysis of acupuncture acupoint injection in the treatment of 60 cases with migraine]. Chinese Community Doctors. 2017;(33):98-9. [210577]. Ou 2020
2017 Zhao L, Chen J, Li Y, Sun X, Chang X, Zheng H et al . The long-term effect of acupuncture for migraine prophylaxis: a randomized clinical trial. JAMA Intern Med. 2017;177:508-515. -Sham acupuncture
-Waiting list 		Ou 2020, Chen 2019
2017 Zhou Z. [Clinical research on chronic migraine treated by nourishing liver and kidney acupuncture therapy]. Si Chuan Zhong Yi. 2017;35:204–206. Jiang 2018
2016 Cai Taojian. [Clinical observation of balancing acupuncture acupuncture at headache points in patients with migraine without aura]. Guangzhou University of Traditional Chinese Medicine, MA thesis. [210579]. Ou 2020
2016 Chen F. [Clinical observation of ashi point treating migraine with syndrome of hyperactivity of liver Yang]. J Pract Trad Chin Med. 2016;32:259–260. Jiang 2018
2016 Han S, Guo Y, Wei Y, Sun YZ. [Clinical study on migraine treated by acupuncture based on different periods and preconditioning]. Zhen Jiu Lin Chuang Za Zhi 2016;32(9):27 Xu 2018
2016 Jiang J, and Zheng Y. [Clinical observation of acupuncture on the treatment of migraine and its influence on headache integral]. Hebei J Tradit Chin Med. 2016;38:1382–1384. Jiang 2018
2016 Liang R, Zhang S, and Xie Y. [Study about influence of brain metabolism in patients with chronic migraine after acupuncture at shaoyang specific acupoints]. Chin Arch Tradit Chin Med. 2016;34:918–920. Jiang 2018
2016 Liu B. [Clinical efficacy of electric acupuncture therapy in the treatment of patients with migraine]. China Foreig Med Treat. (35):7–9. Ou 2020
2016 Liu B, and Yan J. [ Observation of clinical effect about syndrome differentiation acupuncture therapy on chronic migraine and autonomic nerve function]. Shanghai J Tradit Chin Med. 2016;50:65–67. Jiang 2018
2016 Su HY , Li J , Du YH . [Clinical observation of 35 cases of migraine treated by tiaoxue and shugan acupuncture]. Hunan J Tradit Chin Med.2016;32(8):102–3 . Ou 2020, Shen 2019, Jiang 2018
2016 Sun Y, Guo W, and Sun Y. [Observation on acupuncture for migraine without aura]. J Front Med. 2016;6:307–308. Ou 2020, Jiang 2018
2016 Wang SJ, Ye GX, Liu XF, Guan ST. [Clinical study on treatment of migraine with acupuncture combined with phlebotomy therapy between the eyebrows]. Xian Dai Zhong Yi Yao. 2016;36(6):62–4 Xu 2018
2016 Zhang X. [Clinical Research of Acupuncture Treatment of Vestibular Migraine (Dizzy-Wind Yang Interference)]. [M. Medicine]. Jilin: Changchun University of Traditional Chinese Medicine. 2016 Jiang 2018
2016 Zhang Y. [Clinical Study on Warming-unblocking Needling for Migraine of Blood Stasis Type]. [M. Medicine]. Lanzhou: Gansu University of Chinese Medicine. 2016 Ou 2020, Jiang 2018
2016 Zheng C. [Through Clinical Observation of Acupoint Needle Head with Shaoyang Meridian in Treatment of Chronic Migraine]. [M. Medicine]. Harbin: Heilongjiang University of Traditional Chinese Medicine. 2016. Jiang 2018
2015 Chen S. [Clinical Study of Lai’s Tong-Yuan Therapy in Migraine With Aura With Excessive Rising of Liver-Yang]. Dissertation/Ph.D. thesis. Guangzhou University of Chinese Medicine, Guangzhou, China. [210601]. Ou 2020
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2014 Chen J. Evaluating the Prophylaxis and Long-Term Effectiveness of Meridian-Based Acupuncture for Migraine: A Randomized, Controlled Trial. Dissertation/Ph.D. thesis. Chengdu University of TCM, Chengdu, China. [210587]. Ou 2020
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