Efficacy of Acupuncture-Related Therapy for Migraine: A Systematic Review and Network Meta-Analysis

**Summary on the Efficacy of Acupuncture in the Treatment of Migraine: A New Scientific Analysis**

Migraine represents one of the leading neurologic disorders worldwide, affecting approximately 1 billion people globally. This condition is characterized by recurrent throbbing headaches, usually localized on one side of the head, often accompanied by nausea, vomiting, and increased sensitivity to light, sound, and odors. Especially prevalent in people between 15 and 49 years of age, migraine not only causes significant physical suffering but also represents the second leading cause of years lived with disability among neurologic disorders, surpassed only by stroke. The impact extends beyond pain, being a risk factor for ischemic stroke and frequently associated with mental disorders such as anxiety and depression.

Conventional treatment of migraine is primarily based on medications such as nonsteroidal anti-inflammatory drugs, sedatives, antidepressants, and calcium channel blockers. Although effective, these medications frequently cause side effects such as gastrointestinal discomfort, drowsiness, fatigue, and skin rash, which leads many patients to have low treatment adherence. In addition, prolonged use can result in medication dependence. In this context, acupuncture has emerged as a promising therapeutic alternative, recognized as a "green" therapy due to its convenience, safety, low cost, and lasting effects without causing dependence.

This study performed a systematic review and network meta-analysis to comparatively assess different acupuncture modalities in the treatment of migraine. The investigators conducted a comprehensive search across nine scientific databases, including PubMed, EMBASE, and others, from inception to August 2023. Only randomized controlled clinical trials with at least 30 participants per group were included, comparing acupuncture-related therapies with conventional pharmacologic treatment for different types of migraine. The investigators assessed studies for methodological quality using the Cochrane Risk of Bias 2.0 tool and statistically analyzed the data using fixed- or random-effects models, depending on the heterogeneity among studies.

The analysis included 34 studies involving 3,365 people with migraine, with a mean age of approximately 39 years and 68% of participants being women. The results demonstrated that acupuncture-related therapies were superior to medication treatment alone in all aspects evaluated. In reducing pain intensity, measured by the Visual Analog Scale, acupuncture proved more effective than medications, with a mean difference of 1.29 points favoring acupuncture. Regarding migraine attack frequency, patients treated with acupuncture had, on average, almost 2 fewer attacks per month compared with the medication group.

The duration of pain episodes was also significantly reduced with acupuncture, being on average 3.29 hours shorter, and the number of migraine days per month was reduced by approximately 1 day.

The network analysis allowed comparison of different acupuncture modalities with each other. "Special acupuncture methods" — which include innovative techniques, specialized instruments, or unique application theories — demonstrated the greatest efficacy in reducing pain intensity, followed by the combination of acupuncture with medications and traditional acupuncture. To reduce attack frequency, the bloodletting with cupping technique proved most effective, although this result should be interpreted with caution due to the small number of studies. In reducing episode duration, the combination of acupuncture with medications was most effective, while for decreasing the number of migraine days, traditional acupuncture showed the best results.

Clinically, these findings have important implications for both patients and healthcare professionals. For people who suffer from migraine, especially those who experience side effects with medications or have low response to pharmacologic treatment, acupuncture offers an effective and safe therapeutic alternative. The analysis of adverse events showed that only 14 of the 34 studies reported side effects, and four studies did not observe any adverse reaction in the acupuncture group. The incidence of side effects was substantially lower in the acupuncture groups (6.72%) compared with the medication groups (21.84%).

Adverse effects of acupuncture, when present, were mild and primarily included dizziness, drowsiness, and small subcutaneous hematomas, contrasting with the effects of medications that included nausea, vomiting, gastrointestinal discomfort, and sleep disturbances.

For healthcare professionals, this study provides robust evidence that different acupuncture modalities have distinct efficacies, suggesting that the choice of technique should be personalized according to the specific characteristics of each patient. The study identified that the selection of acupuncture points follows specific patterns based on pain location and affected meridians, with points such as Fengchi, Taiyang, and Shuaigu being frequently used. The research also highlighted that special acupuncture methods, developed through the integration of clinical experience with traditional Chinese theories, may offer superior therapeutic advantages compared with conventional acupuncture.

The study presents some important limitations that should be considered when interpreting the results. First, the relatively small number of studies for some specific acupuncture modalities, such as bloodletting with cupping and electroacupuncture, limits the ability to make more precise comparisons between techniques. Second, the significant heterogeneity among included studies suggests variations in patient populations, treatment protocols, and outcome measures that may affect the generalizability of findings. Third, most studies focused on migraine without aura, with limited evidence for specific types such as vestibular migraine and menstrual migraine, restricting the applicability of results to these subgroups.

Additionally, the lack of direct comparative studies between different acupuncture modalities limits the precision of indirect comparisons performed in the network meta-analysis.

In conclusion, this comprehensive scientific analysis provides convincing evidence that acupuncture-related therapies represent effective and safe treatment options for migraine, offering significant advantages over medication treatment alone in terms of reducing pain intensity, frequency, duration, and number of migraine days. The findings suggest that different acupuncture modalities have distinct efficacies, with special acupuncture methods being particularly promising. To optimize clinical outcomes, it is essential that healthcare professionals consider individual patient characteristics when selecting the most appropriate acupuncture modality. Although these