{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T02:11:06Z","timestamp":1790043066906,"version":"4.0.1"},"reference-count":33,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ EBM"],"accepted":{"date-parts":[[2023,6,15]]},"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:p><jats:bold>Objective<\/jats:bold><\/jats:p><jats:p>To evaluate the effect and safety of acupuncture for acute migraine attacks in adults.<\/jats:p><jats:sec><jats:title>Design and setting<\/jats:title><jats:p>We searched PubMed, MEDLINE(OVID), Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Chinese Science and Technology Periodical Database and Wanfang database from inception to 15 July 2022. We included randomised controlled trials (RCTs) published in Chinese and English comparing acupuncture alone against sham acupuncture\/placebo\/no treatment\/pharmacological therapy or comparing acupuncture plus pharmacological therapy against the same pharmacological therapy. Results were reported as risk ratios (RRs) for dichotomous outcomes or mean differences (MDs) for continuous outcomes, with 95% CIs. Risk of bias was assessed with the Cochrane tool and the certainty of the evidence (CoE) with GRADE.<\/jats:p><\/jats:sec><jats:sec><jats:title><jats:named-content content-type=\"indent\">Main outcome measures<\/jats:named-content><\/jats:title><jats:p>a) The rate of headache freedom (pain score=0) at 2h after the treatment; b) the rate of headache relief (at least 50% reduction of pain score); c) headache intensity at 2h after the treatment(study data from scales measuring pain intensity, including visual analogue scale, numerical rating scale) d) the improvement of headache intensity at 2h after the treatment; e) the improvement values of migraine-associated symptoms; f) adverse events.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We included 21 RCTs from 15 studies with 1926 participants comparing acupuncture against other interventions. Comparing to sham acupuncture or placebo, acupuncture may result in an increase in the rate of headache freedom (RR 6.03, 95% CI 1.62 to 22.41, 180 participants, 2 studies, I<jats:sup>2<\/jats:sup>=0%, low CoE) and the improvement of headache intensity (MD 0.51, 95% CI 0.16 to 0.85, 375 participants, 5 studies, I<jats:sup>2<\/jats:sup>=13%, moderate CoE) at 2 hours after treatment. It also may result on a higher rate of headache relief (RR 2.29, 95% CI 1.16 to 4.49, 179 participants,3 studies, I<jats:sup>2<\/jats:sup>=74%, very low CoE) and greater improvement of migraine-associated symptoms (MD 0.97, 95% CI 0.33 to 1.61, 90 participants, 2 studies, I<jats:sup>2<\/jats:sup>=0%, very low CoE) at 2 hours after treatment but the evidence is very uncertain. Meanwhile the analysis indicates acupuncture probably results in little to no difference in adverse events compared with sham acupuncture (RR 1.53, 95% CI 0.82 to 2.87, 884 participants, 10 studies, I<jats:sup>2<\/jats:sup>=0%, moderate CoE). In acupuncture plus pharmacological intervention versus the same pharmacological intervention, acupuncture plus pharmacological therapy may result in little to no difference in the rate of headache freedom (RR 1.55, 95% CI 0.99 to 2.42, 94 participants, 2 studies, I<jats:sup>2<\/jats:sup>=0%, low CoE), the rate of headache relief (RR 1.20, 95% CI 0.91 to 1.57, 94 participants, 2 studies, I<jats:sup>2<\/jats:sup>=0%, low CoE) at 2 hours after treatment and adverse events(RR 1.48, 95% CI 0.25 to 8.92, 94 participants, 2 studies, I<jats:sup>2<\/jats:sup>=0%, low CoE). However, it may result in a reduction in headache intensity (MD \u22121.05, 95% CI \u22121.49 to \u22120.62, 129 participants, 2 studies, I<jats:sup>2<\/jats:sup>=0%, low CoE) and an increase in the improvement of headache intensity (MD 1.18, 95% CI 0.41 to 1.95, 94 participants, 2 studies, I<jats:sup>2<\/jats:sup>=0%, low CoE) at 2 hours after treatment compared with pharmacological therapy only. In comparison to pharmacological intervention, acupuncture may result in little to no difference in the rate of headache freedom (RR 0.95, 95% CI 0.59 to 1.52, 294 participants, 4 studies, I<jats:sup>2<\/jats:sup>=22%, low CoE), the rate of headache relief (RR 0.95, 95% CI 0.80 to 1.14, 206 participants, 3 studies. I<jats:sup>2<\/jats:sup>=0%, low CoE) at 2 hours and adverse events (RR 0.65, 95% CI 0.35 to 1.22, 294 participants, 4 studies, I<jats:sup>2<\/jats:sup>=0%, low CoE) after treatment. The evidence is very uncertain about the effect of acupuncture on the headache intensity (MD \u22120.07, 95% CI \u22121.11 to 0.98, 641 participants, 5 studies, I<jats:sup>2<\/jats:sup>=98%, very low CoE) and the improvement of headache intensity (MD \u22120.32, 95% CI \u22121.07 to 0.42, 95 participants, 2 studies, I<jats:sup>2<\/jats:sup>=0%, very low CoE) at 2 hours after treatment compared with pharmacological intervention.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The body of evidence suggests that acupuncture may be more effective than sham acupuncture in the treatment of migraine. Acupuncture may also be as effective as pharmacological therapy. However, the certainty evidence across outcomes was low to very low and new high-quality studies can provide more clarity.<\/jats:p><\/jats:sec><jats:sec><jats:title>PROSPERO registration number<\/jats:title><jats:p>CRD42014013352.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjebm-2022-112135","type":"journal-article","created":{"date-parts":[[2023,7,7]],"date-time":"2023-07-07T17:20:17Z","timestamp":1688750417000},"page":"228-240","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":19,"title":["Acupuncture for acute migraine attacks in adults: a systematic review and meta-analysis"],"prefix":"10.1136","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2925-3824","authenticated-orcid":false,"given":"Yunlu","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruosang","family":"Du","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hai","family":"Cui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongwen","family":"Yuan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shumei","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,7,7]]},"reference":[{"key":"2024052111041504000_28.4.228.1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(20)30925-9"},{"key":"2024052111041504000_28.4.228.2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4610.2011.02061.x"},{"key":"2024052111041504000_28.4.228.3","doi-asserted-by":"crossref","DOI":"10.1007\/s11886-014-0524-1","article-title":"Migraine and the risk for stroke and cardiovascular disease","volume":"16","author":"Sacco","year":"2014","journal-title":"Curr Cardiol Rep"},{"key":"2024052111041504000_28.4.228.4","first-page":"881","article-title":"Guidelines for the diagnosis and treatment of migraine in China 2022 edition","volume":"28","year":"2022","journal-title":"Chinese Journal of Pain Medicine"},{"key":"2024052111041504000_28.4.228.5","doi-asserted-by":"publisher","DOI":"10.2165\/11630590-000000000-00000"},{"key":"2024052111041504000_28.4.228.6","first-page":"04","article-title":"Acupuncture in the treatment of migraine: research advances in recent decade","volume":"33","author":"Zhu","year":"2017","journal-title":"Journal of Clinical Acupuncture and Moxibustion"},{"key":"2024052111041504000_28.4.228.7","doi-asserted-by":"publisher","DOI":"10.1001\/jama.280.17.1518"},{"key":"2024052111041504000_28.4.228.8","unstructured":"China Association for the Study Pain (CASP) . China diagnosis and management of migraine. Chin J Pain Med 2011."},{"key":"2024052111041504000_28.4.228.9","doi-asserted-by":"publisher","DOI":"10.1177\/0333102414545348"},{"key":"2024052111041504000_28.4.228.10","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"2024052111041504000_28.4.228.11","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2014-006968","article-title":"Acupuncture for acute migraine attacks in adults: a systematic review protocol","volume":"5","author":"Du","year":"2015","journal-title":"BMJ Open"},{"key":"2024052111041504000_28.4.228.12","unstructured":"The International classification of headache disorders. In: . 2nd edition. 24 Suppl 1. Cephalalgia, 2004: 9\u2013160."},{"key":"2024052111041504000_28.4.228.13","doi-asserted-by":"publisher","DOI":"10.1177\/0333102417738202"},{"key":"2024052111041504000_28.4.228.14","unstructured":"Higgins JPT , Altman DG , Sterne JAC , et al . And on behalf of the Cochrane statistical methods group and the Cochrane bias methods Group(Editors). Chapter 8: assessing risk of bias in included Studies.In:Higgins JPT. Cochrane Handbook for Systematic Reviews of Interventions Version 2011;5.1.0. Available: http:\/\/www.cochrane-handbook.org"},{"key":"2024052111041504000_28.4.228.15","unstructured":"Review Manager (RevMan) . Computer program. Version 5.4. The Cochrane Collaboration, 2020."},{"key":"2024052111041504000_28.4.228.16","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2288-5-13","article-title":"Estimating the mean and variance from the median, range, and the size of a sample","volume":"5","author":"Hozo","year":"2005","journal-title":"BMC Med Res Methodol"},{"key":"2024052111041504000_28.4.228.17","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2796.2003.01081.x"},{"key":"2024052111041504000_28.4.228.18","unstructured":"Yang XG , Liang FR . A randomized controlled trial of Acupuncture for treating migraine with selecting Acupoints along Meridian [dissertation]. Chengdu, Chengdu Univ TCM, 2009"},{"key":"2024052111041504000_28.4.228.19","first-page":"2005","article-title":"Efficacy of scalp point-through-point on acute migraine attacks","volume":"21","author":"Deng","year":"2012","journal-title":"Journal of Emergency in Traditional Chinese"},{"key":"2024052111041504000_28.4.228.20","first-page":"1562","article-title":"Effect of Acupuncture at specific Acupoints of Shaoyang channel on acute migraine of 30 cases","volume":"53","author":"Liu","year":"2012","journal-title":"Journal of Traditional Chinese Medicine"},{"key":"2024052111041504000_28.4.228.21","unstructured":"Yang F , Fan GQ . The observation of row of thrust Acupuncture and Rizatriptan and combine of both for synergistic analgesia therapeutic on acute stage of migraine without Aura.[Dissertation]. 2015."},{"key":"2024052111041504000_28.4.228.22","first-page":"993","article-title":"Clinical observation on horizontal penetration Needling combined with Rizatriptan Monobenzoate tablets for migraine without aura in acute stage","volume":"41","author":"Kou","year":"2021","journal-title":"Chinese Acupuncture & Moxibustion"},{"key":"2024052111041504000_28.4.228.23","doi-asserted-by":"crossref","first-page":"S173","DOI":"10.1007\/s10072-011-0525-4","article-title":"Ear Acupuncture in the treatment of migraine attacks: a randomized trial on the efficacy of appropriate versus inappropriate Acupoints","volume":"32 Suppl 1","author":"Allais","year":"2011","journal-title":"Neurol Sci"},{"key":"2024052111041504000_28.4.228.24","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1111\/j.1526-4637.2012.01376.x","article-title":"Efficacy of Acupuncture for acute migraine attack: a multicenter single blinded, randomized controlled trial","volume":"13","author":"Wang","year":"2012","journal-title":"Pain Med"},{"key":"2024052111041504000_28.4.228.25","first-page":"127","article-title":"Timeliness law on the immediate analgesia on acute migraine treated with Electroacupuncture at Shaoyang Meridian points","volume":"35","author":"Zhang","year":"2015","journal-title":"Zhongguo Zhen Jiu"},{"key":"2024052111041504000_28.4.228.26","first-page":"1","article-title":"Immediate analgesic effects of Acupuncture on migraine without aura during acute episode","volume":"34","author":"Ma","year":"2018","journal-title":"Journal of Clinical Acupuncture and Moxibustion"},{"key":"2024052111041504000_28.4.228.27","first-page":"159","article-title":"Transient analgesic effect of Electroacupuncture at Taiyang (EX-HN 5) for treatment of migraine with hyperactivity of the liver-Yang","volume":"27","author":"Zhou","year":"2007","journal-title":"Zhongguo Zhen Jiu"},{"key":"2024052111041504000_28.4.228.28","first-page":"113","article-title":"Treatment observation on the instant effects of needing SI Guan points matching Qubin penetration Shuai Gu in treating migraine","volume":"30","author":"Ren","year":"2012","journal-title":"Journal of Sichuan of Traditional Chinese"},{"key":"2024052111041504000_28.4.228.29","first-page":"168","article-title":"A comparative study of clinical effects of Zolmitriptan and flat Acupuncture in treatment of analgesia in migraine patients without aura","volume":"47","author":"Wu","year":"2020","journal-title":"Liaoning Journal of Traditional Chinese Medicine"},{"key":"2024052111041504000_28.4.228.30","first-page":"1285","article-title":"Effects of Acupuncture for acute migraine without aura","volume":"19","author":"Xiao","year":"2021","journal-title":"Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease"},{"key":"2024052111041504000_28.4.228.31","unstructured":"Deng ZH , Li Y . The study of Acupuncture with specific Acupoints in Shaoyang Meridian for treating migraine attacks [dissertation]. Chengdu, Chengdu Univ TCM, 2012"},{"key":"2024052111041504000_28.4.228.32","first-page":"1353","article-title":"Analgesic effect of Acupuncture during migraine acute attack period: a meta analysis","volume":"45","author":"SX","year":"2016","journal-title":"Chongqing Medicine"},{"key":"2024052111041504000_28.4.228.33","first-page":"466","article-title":"Meta-analysis of time-effect evaluation of Acupuncture treatment for migraine","volume":"37","author":"QY","year":"2018","journal-title":"Shanghai Journal of Acupuncture and Moxibustion"}],"container-title":["BMJ Evidence-Based Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjebm-2022-112135","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,21]],"date-time":"2024-05-21T18:40:49Z","timestamp":1716316849000},"score":1,"resource":{"primary":{"URL":"https:\/\/ebm.bmj.com\/lookup\/doi\/10.1136\/bmjebm-2022-112135"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,7]]},"references-count":33,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2023,7,21]]},"published-print":{"date-parts":[[2023,8]]}},"alternative-id":["10.1136\/bmjebm-2022-112135"],"URL":"https:\/\/doi.org\/10.1136\/bmjebm-2022-112135","relation":{},"ISSN":["2515-446X","2515-4478"],"issn-type":[{"value":"2515-446X","type":"print"},{"value":"2515-4478","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,7]]}}}