Acupuncture for Prevention of Primary Headaches in Children and Adolescents: A Literature Overview for the Pediatric Neurologist

Headache is the most common neurological symptom among children and adolescents, affecting an increasing number of young people as they age. When attacks are intense and frequent, this condition can become truly disabling at any stage of life. Beyond the immediate suffering, excessive use of medications for symptom relief, inadequate treatment of migraine attacks, and other complex factors can cause headache to become chronic. For this reason, about one third of children with headache require preventive treatments to reduce attack frequency, intensity, and duration, avoid overuse of acute medications, and improve quality of life by reducing the disability caused by recurrent pain.

Although recent migraine prevention guidelines support the use of pharmacological and nonpharmacological therapies, an important study called CHAMP showed no significant differences in reduction of headache frequency among children treated with medications such as amitriptyline and topiramate compared with placebo. This has led to growing interest in the use of complementary and alternative medicine for pediatric pain management, including acupuncture. Although adult studies show promising results of acupuncture in headache prevention, data in children and adolescents are very limited.

The objective of this study was to perform a critical review of the scientific literature to better understand the role of acupuncture as preventive treatment for primary headaches in children and adolescents. The investigators sought to evaluate whether acupuncture is more effective than sham acupuncture or pharmacological preventive treatment, and to examine the tolerability of treatment and its possible benefits on psychiatric comorbidities such as anxiety and depression. To do so, they conducted a systematic review following rigorous scientific guidelines, analyzing all studies published between 1982 and 2023 that investigated the preventive use of acupuncture in primary headaches in young patients up to age 21.

Of the 90 studies initially identified, only five met the inclusion criteria, totaling 229 children and adolescents. Among these studies, two were controlled trials specifically evaluating reduction in headache frequency, intensity, and duration. Results were encouraging: true acupuncture proved significantly more effective than placebo in reducing headache frequency, with a decrease of seven to eight headache days per month in the true acupuncture group, compared with a reduction of only zero to one day in the placebo group. In addition, there was a significant reduction in pain intensity, measured on a 0-to-10 visual analog scale, with a decrease of 5.4 points in the true acupuncture group compared with only 1.6 points in the placebo group.

Attack duration was also significantly reduced.

The clinical implications of these findings are particularly relevant for families seeking alternatives to traditional pharmacological treatments or for cases in which conventional medications have not provided adequate relief. Studies showed that acupuncture had favorable tolerability, with no adverse events reported in most analyzed work. This is especially important when considering the side-effect profile some preventive medications can have in children and adolescents. The acupuncture experience was perceived positively by most patients participating in the studies, suggesting good acceptance of treatment in this age group.

In addition to direct benefits in reducing headache symptoms, some studies showed improvements in pain-related interference with the children's general functioning, including physical, social, and school activities. There was also a reduction in anxiety levels, although depressive symptoms did not change significantly. These findings are particularly relevant because chronic headaches in children frequently impact not only physical well-being but also social and academic development.

For clinicians, these results suggest that acupuncture can be considered a valid therapeutic option in the preventive treatment armamentarium for primary headaches in children and adolescents. The possibility of offering an effective nonpharmacological alternative is especially valuable in pediatrics, where minimizing medications is always desirable. In addition, the fact that acupuncture showed benefits in general functioning and anxiety suggests a potential holistic effect of the treatment.

However, it is important to recognize the significant limitations of this review. The small number of available studies and the heterogeneity of the studied populations represent important obstacles to drawing definitive conclusions. The age range of participants varied considerably, and not all studies were specifically focused on pediatric headaches. In addition, post-treatment follow-up was relatively short in most studies, making it difficult to assess whether the benefits are maintained over time.

The methodological quality of the studies also varied, with only one of the main studies receiving a high score on scientific quality criteria.

Although the few available studies on acupuncture as preventive treatment for pediatric primary headaches highlight its potential efficacy, despite their methodological limitations, more detailed and rigorously conducted studies are needed to definitively establish the role of this therapy. For families considering this option, it is important to discuss with qualified clinicians both the potential benefits and the limitations of the current evidence, ensuring that the decision is made in an informed and individualized way for each child.