Effectiveness of scalp acupuncture and comparison with traditional acupuncture for stroke: an overview of systematic reviews and updated evidence

Stroke is one of the leading causes of death and disability worldwide, placing enormous pressure on health systems globally. Between 1990 and 2019, the number of stroke cases rose dramatically by 70%, with related deaths increasing 43%. Given the limitations of conventional treatments — which include surgery, medications, and physical therapy — interest in complementary therapies, especially acupuncture, has grown. Among the various acupuncture modalities, scalp acupuncture has emerged as a promising approach for post-stroke recovery, based on the stimulation of specific scalp areas to activate brain regions related to movement and cognition.

This study aimed to systematically evaluate the efficacy of scalp acupuncture for stroke recovery, also comparing it with traditional acupuncture. Researchers conducted a broad review of the scientific literature, searching twelve different databases through September 2023, with no language restrictions. Only systematic reviews and meta-analyses analyzing adults with stroke treated with scalp acupuncture were included. The methodological quality of the studies was rigorously assessed using recognized scientific tools, including AMSTAR-2, ROBIS, PRISMA-A, and GRADE, which examine aspects such as transparency, methodological rigor, and reliability of results.

Researchers analyzed important outcomes such as neurological deficits, motor function, disability, and overall efficacy rate.

After careful analysis, seven systematic reviews encompassing studies conducted between 2012 and 2021 were included. The results showed that, although scalp acupuncture demonstrates significant positive effects, especially when combined with conventional medical treatment, the overall certainty of the evidence remains low because of methodological limitations in the original studies. Compared with traditional acupuncture, scalp acupuncture showed a larger effect size in improving neurological deficits in both the overall analysis and in the analysis restricted to high-quality studies. For motor function, scalp acupuncture was superior in the overall analysis, but traditional acupuncture showed better results when only high-quality studies were analyzed.

Regarding disability, traditional acupuncture had a slight advantage in the overall analysis, but scalp acupuncture outperformed it in the analysis of high-quality studies.

For patients and health care professionals, these findings suggest that scalp acupuncture can be a valuable therapeutic option in stroke recovery, particularly for improving neurological deficits and reducing disability. The technique appears to be safe, with few adverse events reported in the analyzed studies, including occasionally mild dizziness and skin redness at the application site. The fact that benefits are particularly apparent when combined with conventional medical treatment suggests that it can be an effective complementary therapy, not a replacement for standard treatment. For practitioners, the results indicate that scalp acupuncture can be integrated into rehabilitation protocols, offering an additional approach to improve patient outcomes.

The main limitations include the lack of standardization in the scalp acupuncture techniques used across different studies, with variations in application points, needle depth, and treatment duration. In addition, many original studies had methodological flaws, such as inadequate randomization and lack of appropriate blinding, which compromises confidence in the results. Heterogeneity across studies, including different stroke types and treatment protocols, also limited the ability to reach definitive conclusions.

In conclusion, although the current evidence has methodological limitations, this study highlights the potential of scalp acupuncture as a promising complementary therapy for stroke recovery. Results from high-quality studies show particular benefits in improving neurological deficits and reducing disability. To establish more solid clinical recommendations, future studies with greater methodological rigor, standardized protocols, and larger samples are needed. Research must also better differentiate between stroke types and establish clear guidelines for technique application, thereby contributing to its evidence-based integration into neurological rehabilitation protocols.