{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T10:59:52Z","timestamp":1768215592047,"version":"3.49.0"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T00:00:00Z","timestamp":1768176000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Fu\u2019s Subcutaneous Needling (FSN) is a novel acupuncture technique that has demonstrated significant efficacy in pain management. However, its effectiveness in treating migraine without aura (MWoA) has not been systematically validated. Therefore, this study aims to evaluate the analgesic efficacy of FSN and its impact on headache frequency and patients\u2019 quality of life (QoL) in comparison with guideline-recommended pharmacotherapy (flunarizine hydrochloride). Additionally, this study will assess the influence of FSN on hemodynamic changes in the prefrontal cortex to further elucidate its underlying mechanisms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study is a randomized controlled clinical trial involving 44 participants, who are randomly allocated at a 1:1 ratio to either the FSN group or the medication group. Participants in the FSN group receive FSN treatment twice weekly for 4\u202fweeks, while those in the medication group are administered 5\u202fmg oral flunarizine hydrochloride capsules nightly for the same duration. Both groups are followed up for 3\u202fmonths post-treatment. The primary outcome is the change in monthly migraine days (MMDs). From baseline after 4\u202fweeks of treatment. Secondary outcome measures including the Migraine-Specific Quality of Life (MSQOL) score, headache diary records, Migraine Disability Assessment (MIDAS), Visual Analog Scale (VAS) scores and near-infrared spectroscopy (NIRS) are also used to validate clinical efficacy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2025.1689562","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T08:01:18Z","timestamp":1768204878000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Fu\u2019s Subcutaneous Needling treatment for migraine without aura: a randomized controlled trial protocol"],"prefix":"10.3389","volume":"16","author":[{"given":"Wenqi","family":"Guo","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yusha","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jian","family":"Sun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,12]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1177\/0333102417738202","article-title":"Headache Classification Committee of the International Headache Society (IHS) the international classification of headache disorders, 3rd edition","volume":"38","author":"Arnold","year":"2018","journal-title":"Cephalalgia"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1286","DOI":"10.1111\/head.13613","article-title":"Life with migraine: effects on relationships, career, and finances from the chronic migraine epidemiology and outcomes (CaMEO) study","volume":"59","author":"Buse","year":"2019","journal-title":"Headache"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1111\/j.1526-4610.2007.00993.x","article-title":"Comorbidity of migraine and psychiatric disorders\u2014a national population-based study","volume":"48","author":"Jette","year":"2008","journal-title":"Headache"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"241","DOI":"10.4103\/0971-5916.166528","article-title":"Knowledge of serotype prevalence & burden of invasive pneumococcal disease: a prerequisite to vaccine introduction in the country","volume":"142","author":"Kanungo","year":"2015","journal-title":"Indian J Med Res"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1186\/s10194-018-0846-2","article-title":"Migraine is first cause of disability in under 50s: will health politicians now take notice?","volume":"19","author":"Steiner","year":"2018","journal-title":"J Headache Pain"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1186\/1129-2377-14-47","article-title":"Health-care utilization for primary headache disorders in China: a population-based door-to-door survey","volume":"14","author":"Liu","year":"2013","journal-title":"J Headache Pain"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1186\/s10194-020-01117-2","article-title":"Migraine treatment and healthcare costs: retrospective analysis of the China health insurance research association (CHIRA) database","volume":"21","author":"Yu","year":"2020","journal-title":"J Headache Pain"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1016\/j.jns.2011.11.021","article-title":"Diagnosis and treatment status of migraine: a clinic-based study in China","volume":"315","author":"Li","year":"2012","journal-title":"J Neurol Sci"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"869","DOI":"10.1016\/j.jpain.2007.06.002","article-title":"Contribution of myofascial trigger points to migraine symptoms","volume":"8","author":"Giamberardino","year":"2007","journal-title":"J Pain"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1186\/s10194-018-0913-8","article-title":"Myofascial trigger points in migraine and tension-type headache","volume":"19","author":"Do","year":"2018","journal-title":"J Headache Pain"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1061","DOI":"10.1111\/j.1468-2982.2006.01162.x","article-title":"Myofascial trigger points, neck mobility and forward head posture in unilateral migraine","volume":"26","author":"Fernandez-de-Las-Penas","year":"2006","journal-title":"Cephalalgia"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1002\/ejp.1127","article-title":"Children with migraine: provocation of headache via pressure to myofascial trigger points in the trapezius muscle?-a prospective controlled observational study","volume":"22","author":"Landgraf","year":"2018","journal-title":"Eur J Pain"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1129","DOI":"10.1097\/PHM.0000000000001504","article-title":"Effects of dry needling technique into trigger points of the sternocleidomastoid muscle in migraine headache: a randomized controlled trial","volume":"99","author":"Rezaeian","year":"2020","journal-title":"Am J Phys Med Rehabil"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"5954","DOI":"10.1038\/s41598-020-62701-9","article-title":"Alleviation of migraine symptoms by application of repetitive peripheral magnetic stimulation to myofascial trigger points of neck and shoulder muscles-a randomized trial","volume":"10","author":"Renner","year":"2020","journal-title":"Sci Rep"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1007\/s11916-010-0114-x","article-title":"Cervicogenic headache: a review comparison with migraine, tension-type headache, and whiplash","volume":"14","author":"Vincent","year":"2010","journal-title":"Curr Pain Headache Rep"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1097\/AJP.0000000000000390","article-title":"Active trigger points in the cervical musculature determine the altered activation of superficial neck and extensor muscles in women with migraine","volume":"33","author":"Florencio","year":"2017","journal-title":"Clin J Pain"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"569","DOI":"10.1016\/j.jbmt.2014.01.006","article-title":"Upper cervical mobility, posture and myofascial trigger points in subjects with episodic migraine: case-control study","volume":"18","author":"Tali","year":"2014","journal-title":"J Bodyw Mov Ther"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1186\/s10194-019-0960-9","article-title":"Quantitative magnetic resonance imaging of the upper trapezius muscles-assessment of myofascial trigger points in patients with migraine","volume":"20","author":"Sollmann","year":"2019","journal-title":"J Headache Pain"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1089\/acm.2006.6125","article-title":"Fu's subcutaneous needling: possible clinical evidence of the subcutaneous connective tissue in acupuncture","volume":"13","author":"Fu","year":"2007","journal-title":"J Altern Complement Med"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"e38274","DOI":"10.1097\/MD.0000000000038274","article-title":"Understanding tightened muscle in knee osteoarthritis and the impacts of Fu's subcutaneous needling: a pilot trial with shear-wave elastography and near-infrared spectroscopy","volume":"103","author":"Yang","year":"2024","journal-title":"Medicine (Baltimore)"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"103080","DOI":"10.1016\/j.ctim.2024.103080","article-title":"Effects of Fu's subcutaneous needling on clinical efficacy and psychological cognitive characteristics in patients with chronic non-specific low back pain: a randomized controlled trial","volume":"85","author":"Zhang","year":"2024","journal-title":"Complement Ther Med"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"7184","DOI":"10.3390\/jcm11237184","article-title":"Efficacy of Fu's subcutaneous needling in treating soft tissue pain of knee osteoarthritis: a randomized clinical trial","volume":"11","author":"Chiu","year":"2022","journal-title":"J Clin Med"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1864","DOI":"10.1016\/j.pain.2011.04.006","article-title":"Efficacy of acupuncture for migraine prophylaxis: a single-blinded, double-dummy, randomized controlled trial","volume":"152","author":"Wang","year":"2011","journal-title":"Pain"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1177\/0333102411417901","article-title":"Guidelines for controlled trials of drugs in migraine: third edition. A guide for investigators","volume":"32","author":"Tfelt-Hansen","year":"2012","journal-title":"Cephalalgia"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"881","DOI":"10.3969\/j.issn.1006-9852.2022.12.00","article-title":"Chinese guidelines for the diagnosis and treatment of migraine (2022 edition)","volume":"28","year":"2022","journal-title":"Chin J Pain Med"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1140","DOI":"10.1073\/pnas.83.4.1140","article-title":"Focal physiological uncoupling of cerebral blood flow and oxidative metabolism during somatosensory stimulation in human subjects","volume":"83","author":"Fox","year":"1986","journal-title":"Proc Natl Acad Sci USA"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1137","DOI":"10.1007\/s12035-018-1130-9","article-title":"Role of the prefrontal cortex in pain processing","volume":"56","author":"Ong","year":"2019","journal-title":"Mol Neurobiol"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"1280","DOI":"10.1016\/j.clinph.2005.01.016","article-title":"Decreased vasoreactivity to right cerebral hemisphere pressure in migraine without aura: a near-infrared spectroscopy study","volume":"116","author":"Shinoura","year":"2005","journal-title":"Clin Neurophysiol"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"149344","DOI":"10.1016\/j.brainres.2024.149344","article-title":"Reduced oxygen supply to the prefrontal cortex during the Stroop task in migraine patients with aura: a preliminary functional near-infrared spectroscopy study","volume":"1849","author":"Zengin","year":"2025","journal-title":"Brain Res"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"376","DOI":"10.1016\/0013-4694(87)90206-9","article-title":"Cerebral location of international 10-20 system electrode placement","volume":"66","author":"Homan","year":"1987","journal-title":"Electroencephalogr Clin Neurophysiol"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"762","DOI":"10.1097\/j.pain.0000000000001456","article-title":"Flunarizine as prophylaxis for episodic migraine: a systematic review with meta-analysis","volume":"160","author":"Stubberud","year":"2019","journal-title":"Pain"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"244","DOI":"10.1111\/j.1468-1331.2006.01181.x","article-title":"Trigger point evaluation in migraine patients: an indication of peripheral sensitization linked to migraine predisposition?","volume":"13","author":"Calandre","year":"2006","journal-title":"Eur J Neurol"},{"key":"ref33","first-page":"121","volume-title":"The foundation of Fu's subcutaneous needling","author":"Fu","year":"2016"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1111\/head.13723","article-title":"Systematic review: acupuncture vs standard pharmacological therapy for migraine prevention","volume":"60","author":"Zhang","year":"2020","journal-title":"Headache"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"13","DOI":"10.13703\/j.0255-2930.20240628-k0002","article-title":"Clinical efficacy of Fu\u2019s subcutaneous needling based on \u201cmulti-joint muscle spiral balance chain\u201d theory for cervical vertigo and its effect on blood flow velocity of vertebral artery","volume":"45","author":"Gong","year":"2025","journal-title":"Zhongguo Zhen Jiu"},{"key":"ref36","volume-title":"Myofascial pain and dysfunction, the trigger point manual, the upper half of body","author":"Simons","year":"1999"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"186","DOI":"10.3389\/fnins.2017.00186","article-title":"Compression at myofascial trigger point on chronic neck pain provides pain relief through the prefrontal cortex and autonomic nervous system: a pilot study","volume":"11","author":"Morikawa","year":"2017","journal-title":"Front Neurosci"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"877","DOI":"10.1016\/S1474-4422(17)30299-5","article-title":"Global, regional, and national burden of neurological disorders during 1990-2015: a systematic analysis for the global burden of disease study 2015","volume":"16","year":"2017","journal-title":"Lancet Neurol"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2025.1689562\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T08:01:20Z","timestamp":1768204880000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2025.1689562\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,12]]},"references-count":38,"alternative-id":["10.3389\/fneur.2025.1689562"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2025.1689562","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,12]]},"article-number":"1689562"}}