Comparison of Acupuncture and Sham Acupuncture in Migraine Treatment: An Overview of Systematic Reviews
Li et al. · The Neurologist · 2022
Evidence Level
MODERATEOBJECTIVE
To compare the efficacy of acupuncture versus sham acupuncture in the treatment of migraine through a systematic review
WHO
2,725 patients with migraine across 20 randomized controlled trials
DURATION
Treatments of 4 to 20 weeks with follow-up of up to 1 year
POINTS
GB-8, GB-20, EX-HN5, LI-4, GB-40, GB-34, TE-5 (main points used)
🔬 Study Design
True acupuncture
n=1363
Manual acupuncture, electroacupuncture, or balance acupuncture
Sham acupuncture
n=1362
Superficial insertion at points unrelated to migraine
📊 Results in numbers
Reduction in migraine frequency
Improvement on visual analog pain scale
Higher responder rate
Reduction in migraine days
📊 Outcome Comparison
Migraine frequency (post-treatment)
This study analyzed 20 trials with nearly 3,000 patients to verify whether acupuncture is truly effective against migraine, comparing it with 'fake' acupuncture. The results show that true acupuncture was superior at reducing both attack frequency and pain intensity, although there was no significant difference in the number of migraine days.
Article summary
Plain-language narrative summary
This meta-analysis represents a comprehensive analysis of the efficacy of acupuncture in migraine treatment, compiling data from 20 randomized controlled trials with 2,725 patients. Migraine affects approximately 1 billion people worldwide and represents the sixth most disabling disease according to the Global Burden of Diseases study, imposing substantial economic costs estimated between €18 and €111 billion annually in Europe alone. The investigators conducted a systematic search of four major databases (PubMed, Cochrane Library, Web of Science, and EMBASE) through April 2021, focusing specifically on the comparison between true acupuncture and sham acupuncture. Included studies covered patients diagnosed with migraine according to International Headache Society or ICD-10 criteria, with treatments ranging from 4 to 20 weeks and follow-up of up to one year.
True acupuncture primarily used points such as GB-8 (Shuaigu), GB-20 (Fengchi), EX-HN5 (Taiyang), LI-4 (Hegu), GB-40 (Qiuxu), GB-34 (Yanglingquan), and TE-5 (Waiguan), while sham acupuncture used superficial insertion at points unrelated to migraine. The results demonstrated superiority of true acupuncture across multiple outcomes. For reduction in migraine frequency after treatment, acupuncture showed a mean difference of -0.52 (95% CI: -0.71 to -0.34, P < 0.00001), and this remained significant at follow-up with a mean difference of -0.51 (95% CI: -0.70 to -0.32, P < 0.00001). For pain intensity measured by the Visual Analog Scale, acupuncture was superior with a mean difference of -0.72 (95% CI: -1.17 to -0.27, P = 0.002) after treatment and -0.82 (95% CI: -1.31 to -0.33, P = 0.001) at follow-up.
The responder rate also favored acupuncture, with a relative risk of 1.28 (95% CI: 1.00-1.64, P = 0.05). However, there was no statistically significant difference in the number of migraine days between groups, either after treatment (P = 0.08) or at follow-up (P = 0.12). Of the nine studies that reported medication use, five showed a reduction in dose in the acupuncture group compared with the sham group. As for adverse events — reported in 13 studies with 2,159 participants — they were predominantly mild to moderate, including bruising, tingling, fatigue, and dizziness, with rapid resolution after treatment.
Limitations include significant between-study heterogeneity, the inherent difficulties of blinding in acupuncture research, variations in treatment protocols, and potential publication bias due to inclusion of only English-language studies. The clinical implications suggest that acupuncture offers specific benefits beyond placebo effect in migraine treatment. The authors explain that the specific effect of acupuncture is related to appropriate selection of points and meridians, producing the 'de qi' (得气) sensation that does not occur in sham acupuncture. This evidence can guide clinicians to consider acupuncture as a viable therapeutic option for patients with migraine, especially given the favorable safety profile and demonstrated benefits in attack frequency and intensity.
Strengths
- 1Large sample size of 2,725 patients
- 2Rigorous methodology following PRISMA and Cochrane guidelines
- 3Specific comparison with appropriate sham control
- 4Analysis of multiple clinically relevant outcomes
Limitations
- 1High between-study heterogeneity
- 2Blinding difficulties inherent to acupuncture
- 3Variation in treatment protocols across studies
- 4Possible publication bias from inclusion of English-language studies only
Expert Commentary
Dr. Marcus Yu Bin Pai
MD, PhD · Pain Medicine · Physical Medicine and Rehabilitation · Medical Acupuncture
▸ Clinical Relevance
Migraine remains one of the most challenging diagnoses in the pain clinic, especially when the patient has already exhausted two or three lines of pharmacological prophylaxis or has contraindications to the available agents. This meta-analysis of 2,725 patients consolidates acupuncture as a prophylactic alternative with demonstrated specific efficacy — mean difference of -0.52 in frequency and -0.72 in VAS intensity — data that exceed the sham effect and support formal indication. The favorable safety profile, with mild and self-limited adverse events, makes its use feasible in pregnant patients, in patients with cardiovascular comorbidities, or in those averse to polypharmacy. The reduction in medication use observed in five of the nine studies that tracked this outcome reinforces acupuncture's usefulness as an adjunctive strategy to reduce medication-overuse headache, a frequent scenario in tertiary headache clinics.
▸ Notable Findings
The most methodologically relevant finding is the maintenance of true acupuncture's superiority over sham at both the end of treatment and at follow-up for frequency and pain intensity — mean differences of -0.51 and -0.82, respectively — suggesting that the effect does not dilute over time, which is uncommon for non-pharmacological interventions. The dissociation between outcomes is striking: acupuncture was effective for frequency and intensity but did not significantly reduce migraine days, indicating that the intervention may modify the quality of attacks without necessarily compressing the full calendar of affected days. The responder rate with RR = 1.28 is clinically meaningful in a setting where every prevented attack represents tangible functional gain. The mechanistic hypothesis centered on de qi (得气) and selection of specific meridian points — GB-20, GB-8, TE-5, among others — provides a neurophysiological rationale for the observed difference versus sham.
▸ From My Experience
In my pain clinic practice, I typically observe a perceptible response to acupuncture in migraine within the first three to four sessions, usually manifested as reduced attack intensity before any change in frequency — consistent with the dissociation reported in this meta-analysis. I generally run cycles of ten to twelve weekly sessions as an acute phase, followed by biweekly maintenance for three to four months depending on clinical response. I routinely combine acupuncture with supervised aerobic training and, when there is an associated cervicogenic component, with dry needling of suboccipital trigger points — a combination that has yielded results superior to either modality alone. The profile that responds best, in my observation, is the patient with high-frequency episodic migraine, without established medication overuse, and with an associated stress or dysautonomic component. I avoid initiating acupuncture in the medication-overuse phase without first structuring a supervised withdrawal.
Full original article
Read the full scientific study
The Neurologist · 2022
DOI: 10.1097/NRL.0000000000000386
Access original articleScientific Review
Marcus Yu Bin Pai, MD, PhD
CRM-SP: 158074 | RQE: 65523 · 65524 · 655241
PhD in Health Sciences, University of São Paulo. Board-certified in Pain Medicine, Physical Medicine and Rehabilitation, and Medical Acupuncture. Scientific review and curation of every entry in this library.
Learn more about the author →Medical disclaimer: This content is for educational purposes only and does not replace consultation, diagnosis, or treatment by a qualified professional. Some information may be assisted by artificial intelligence and is subject to inaccuracies. Always consult a physician.
Content reviewed by the medical team at CEIMEC — Integrated Centre for Chinese Medicine Studies, a reference in Medical Acupuncture for over 30 years.
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