Efficacy of Acupuncture and Pharmacotherapy for Migraine Prophylaxis: A Systematic Review and Meta-Analysis.

Purpose: This meta-analysis aimed to systematically evaluate the efficacy and safety of acupuncture compared to conventional oral medications for the prophylactic treatment of migraine, following the PRISMA guidelines.

Methods: Comprehensive searches of international and Chinese databases were conducted up to January 2024 using terms such as "migraine" and "acupuncture". Two researchers independently screened studies and extracted data. Following the refinement of the inclusion criteria during the revision process, only studies focusing on the prophylactic treatment of migraine were included in the final analysis. The primary outcomes included migraine intensity, frequency of migraine attacks, number of migraine days, and the proportion of patients achieving at least a 50% reduction in migraine days. The secondary outcomes included migraine duration, the overall effective rate, and the overall effective rate at 6 months follow-up. Meta-analyses were conducted using RevMan 5.3.

Results: Nineteen randomized controlled trials (2296 patients) were included. Compared to conventional medication, acupuncture was associated with greater reductions in frequency of migraine attacks (SMD = -0.17, 95% CI [-1.05, -0.37]; P < 0.0001), migraine intensity (MD = -1.48, 95% CI [-2.51, -0.46]; P = 0.005), number of migraine days (MD = -1.50, 95% CI [-2.52, -0.48]; P = 0.004), and migraine duration (SMD = -0.60, 95% CI [-0.81, -0.40]; P < 0.00001). A higher proportion of patients achieved at least a 50% reduction in migraine days (RR = 2.08, 95% CI [1.22, 3.55]; P = 0.007). Acupuncture also showed a higher overall effective rate (RR = 1.25, 95% CI [1.16, 1.35]; P < 0.00001) and overall effective rate at 6 months follow-up (RR = 1.34, 95% CI [1.19, 1.50]; P < 0.00001), with fewer adverse events reported. However, the overall quality of evidence was moderate to low.

Conclusion: Acupuncture may offer potential benefits in the prophylactic treatment of migraine; however, substantial heterogeneity across studies, methodological limitations, and the moderate to low quality of evidence limit the certainty of these findings. Further high-quality randomized controlled trials are needed to confirm these results.