Acupuncture is an effective alternative to medication for migraine

Background: Migraine is a highly prevalent primary headache disorder that impacts individuals and societies around the globe. Acupuncture can be used in migraine treatment and prevention due to its analgesic effects, safety profile, and modulation of neural pathways. However, there is a lack of conclusive evidence, and some reports present conflicting results.

Objective: The aim of this umbrella review is to evaluate the effectiveness of acupuncture in migraine treatment, comparing it to the standard pharmacological treatment.

Search strategy: MEDLINE (via PubMed), Embase, Web of Science (all databases), Cochrane, and Epistemonikos databases were searched for articles published prior to February 2024 in English, Portuguese, French and Spanish, and no date restriction was applied.

Inclusion criteria: Systematic reviews, with or without meta-analysis, of randomized controlled trials, comparing acupuncture with standard pharmacological treatment were included. Patients of all ages diagnosed with episodic or chronic migraine, with or without aura, according to international guidelines were included. The main outcome was the pain intensity. Secondary outcomes included days with migraine per month, response rate, quality of life, dropout rate, use of rescue medication, and adverse events.

Data extraction and analysis: Articles were initially evaluated based on the title and abstract, and later based on the full text, independently by two reviewers. For the meta-analysis, data were extracted from the primary studies, and a random effects model was used. The methodological quality of the included reviews was evaluated using the AMSTAR 2 tool and the degree of overlap was also evaluated. The certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

Results: Twenty-two reviews encompassing 24,635 patients were included. Most systematic reviews reported greater improvements and better tolerability in the acupuncture group. The meta-analysis showed a statistically significant reduction in pain intensity (standard mean difference [SMD]: -2.17; 95% confidence interval [CI] [-3.25; -1.10]; P < 0.001) and in days with migraine per month (SMD: -2.92; 95% CI [-4.65; -1.20]; P < 0.001), both favoring acupuncture, but high heterogeneity among results was found. Subgroup analysis confirmed that this reduction persisted at 3 months after cessation of treatment. However, the outcome variables for response to treatment and occurrence of adverse events did not meet the threshold for statistical significance. The quality of included reviews was low to moderate, and the degree of overlap was considered moderate.

Conclusion: Acupuncture is a safe and effective alternative to medication for migraine. It should be considered as a preventive treatment when conventional treatments are not effective, when there are contraindications to medication, or when non-pharmacological options are preferred. Please cite this article as: Pereira PA, Marto CM, Oliveiros B, Botelho MF. Acupuncture is an effective alternative to medication for migraine: An umbrella review. J Integr Med. 2025; Epub ahead of print.