Acupuncture versus Various Control Treatments in the Treatment of Migraine: A Review of Randomized Controlled Trials from the Past 10 Years

Figures & data

Table 1 Search Strategy for the PubMed Database

Number	Search Terms
1	Acupuncture. Mesh.
2	Acupuncture. ti, ab
3	Acupuncture therapy. Mesh
4	Acupuncture therapy. ti, ab
5	(acupuncture) and (therapy). ti, ab
6	Acupoint. Mesh.
7	Acupoint. ti, ab
8	Acupuncture*
9	Body acupuncture. ti, ab
10	(body) and (acupuncture). ti, ab
11	Manual acupuncture. ti, ab
12	(manual) and (acupuncture). ti, ab
13	Electroacupuncture. ti, ab
14	(electro) and (acupuncture). ti, ab
15	1 or 2–14
16	Migraine. Mesh.
17	Migraine*. ti, ab.
18	Headache*. ti, ab.
19	16 or 17–18
20	Randomized controlled trial. pt
21	Controlled clinical trial. pt
22	Randomized controlled trials. Mesh.
23	Random allocation. Mesh.
24	Randomized. ti, ab
25	Randomly. ti, ab
26	Double-blind method. Mesh
27	Single-blind method. Mesh
28	Clinical trial. at
29	20 or 21–28
30	15 and 19 and 29

Note: *There is no limit to the number of matches.

Abbreviations: ti, title; ab, abstract; pt, article type.

Figure 1 Flow Diagram

Abbreviations: SRs, Systematic reviews; RCT, Randomized Controlled Trial.

Table 2 Study Characteristics

Methods	Design of Trial: Open-Label RCT
Frantisek Musil 2018^Citation9
Participants	Number of TG/CG: 42/44 Condition: migraine with or without aura (ICHD-3) Demographics: age (years): TG:45.6±12.8, CG: 46.5±10.3; 88.37% female Setting: Czech Duration of migraine (years): TG:26.9±12.9 and CG:23.0±14.1
Interventions	TG: Acupuncture CG: WL Acupuncture points: Ascending hyperactivity of liver yang: Fengchi, Taiyang, Shuai Gu. Optional acupuncture points (bilateral) by syndrome: Baihui, Xingjian, Taichong, Taixi, Xuanzhong, and Sanyinjiao; Deficiency of both Qi and blood: Hegu; Optional acupuncture points (bilateral) by syndrome: Baihui, Shang Xing, Zusanli, and Sanyinjiao; Wind phlegm blocking the meridians: Optional acupuncture points (bilateral) by syndrome:Feng Long, Zhongwan, and Yinlingquan;Blood stasis: Optional acupuncture points (bilateral) by syndrome: Sanyinjiao, Xuehai, and Ashi point Number of needles: 9–12 Depth of insertion: 10–30 mm Number of treatment sessions: 14 (25 minutes each, twice a week in the first 4 weeks, once a week during weeks 5–8 and once every 14 days during the last month) Duration: 12 weeks Follow-up: 6 months
Adverse event	One mild and common adverse event (Facial hematoma) resolved within 2 days without medication or medical help.
Kenan Tastan 2018^Citation29
Participants	Number of TG/CG: 30/30/30 Condition:/ Demographics: age (years): 33.0 ± 6.9; 71.11% female Setting: Turkey Duration of migraine (years):/
Interventions	TG: Acupuncture CG: Hypnotherapy; Acetaminophen Acupuncture points: bilateral LI4, LU7, SI3, ST6, ST8, ST36, SP6, KI3, TE5, TE18, BL2, BL12, BL60, GB20, LR2, LR3, and Taiyang, and unilateral GV14, GV20, and Yintang points, also ear SheMen, ear hypothalamus, and ear antidepressant points Number of needles:/ Depth of insertion: 0.5 cun Number of treatment sessions: 10 (30 minutes each,3 times a week) Duration:/ Follow-up:/
Adverse event	/
Zhengjie Li 2017^Citation36
Participants	Number of TG/CG: 11/11/13/11/16 Condition: MWOA (ICHD-2) Demographics: age (years): 21.29; 77.42% female Setting: China Duration of migraine (years): VA1: 5.24, VA2: 5.74, VA3: 5.62, SA: 4.83, WL: 6.11
Interventions	TG: Acupuncture CG: SA; WL Acupuncture points: VA1:Yanglingquan, Qiuxu and Waiguan. VA2:Xiyangguan, Diwuhui and Sanyangluo. VA3:Zusanli, Chongyang and Pianli Number of needles: 6 Depth of insertion: 5–15 mm Number of treatment sessions: 20 (20 minutes each, 5 times a week) Duration: 4 weeks Follow-up:/
Adverse event	/
Bahram Naderinabi 2017^Citation53
Participants	Number of TG/CG: 50/50/50 Condition: CM (ICHD-3) Demographics: age (years): AG:37.2±7.3, BG:36.8±7.4, CG:37.6±7.4; 68% female Setting: Iran Duration of migraine (years): AG:10.3±5.5, BG:9.2±5.3, CG:9.1±3.9
Interventions	TG: Acupuncture CG: botulinum toxin-A Acupuncture points: The acupuncture points used were mainly the GB41, GB 20, GB 15, GB14, GB10, GB8, LI 4, liver 3, Sanjiao 5, DU20, EX 2, Taiyang for individual migraine associated symptoms Number of needles: 10–12 Depth of insertion: 10–15 mm Number of treatment sessions: 30 (Once every 2 days) Duration: 2 months Follow-up: 3 months
Adverse event	The side effects of acupuncture treatment were only bleeding or subcutaneous hematoma formation and the adverse effects of botulinum toxin A included ptosis, facial masking or asymmetry.
Ling Zhao 2017^Citation8
Participants	Number of TG/CG: 83/80/82 Condition: MWOA (ICHD-2) Demographics: age (years): 38.1±14.1; 77.14% female Setting: China Duration of migraine (years): 9.26
Interventions	TG: Electro-acupuncture CG: SA; WL Acupuncture points: Acupuncture on 2 obligatory points, including GB20 and GB8. The 2 other points were chosen according to the syndrome differentiation of meridians in the headache region. The potential acupoints included SJ5, GB34, BL60, SI3, LI4, ST44, LR3, and GB40 Number of needles: 4 Depth of insertion: 0.3–1 cm Number of treatment sessions: 20 (30 min each, 5 times a week) Duration: 4 weeks Follow-up: 20 weeks
Adverse event	Seven patients (5 in the RA group and 2 in the SA group) reported AEs during the 24 weeks.
Yanyi Wang 2015^Citation19
Participants	Number of TG/CG: 11/11/13/11/16 Condition:/(ICHD-2) Demographics: age (years): TG:41.6±14.9 CG:43.8±13.4; 74% female Setting: Australia Duration of migraine (years): TG: 18.4±12.7 CG:21.1±13.3
Interventions	TG: Acupuncture CG: Superficial Needling at Nonacupoints Acupuncture points: Ascending hyperactivity of liver yang: Fengchi, Taiyang, Shuai Gu. Optional acupuncture points (bilateral) by syndrome:Baihui, Xingjian, Taichong, Taixi, Xuanzhong, and Sanyinjiao; Deficiency of both Qi and blood: Hegu; Optional acupuncture points (bilateral) by syndrome: Baihui, Shang Xing, Zusanli, and Sanyinjiao; Wind phlegm blocking the meridians: Optional acupuncture points (bilateral) by syndrome:Feng Long, Zhongwan, and Yinlingquan;Blood stasis: Optional acupuncture points (bilateral) by syndrome: Sanyinjiao, Xuehai, and Ashi point Number of needles: 9–12 Depth of insertion: 10–30 mm Number of treatment sessions: 16 (25 minutes each, twice per week for four weeks followed by once per week for another four weeks, then once every two weeks for four weeks, then once per month for another two months.) Duration: 20 weeks Follow-up: 1 year
Adverse event	/
Mehran Rezvani 2014^Citation32
Participants	Number of TG/CG: 40/40 Condition:/(ICHD-2) Demographics: age (years): TG:35.4 ± 9.5 CG:35.5 ±10; 68.75% female Setting: Iran Duration of migraine (years): TG:5.4 ± 4 CG:5.8 ± 3.6
Interventions	TG: Acupuncture CG: Yamamoto new scalp acupuncture Acupuncture points: On the basis of clinical symptoms and traditional Chinese physical examination and diagnosis, several points from the LI4, ST8, ST36, BL2, GB14, TB5, GB8, tai yang, SI3, BL10, BL60, GB20, LIV3, KID1, DU20, si shen cong, LU7, SP6, LIV2, ST36, and REN6 acupuncture points were selected. Number of needles:/ Depth of insertion: 10–15 mm Number of treatment sessions: 18 (30 minutes each, 3 times a week) Duration: 8 weeks Follow-up: 4 weeks
Adverse event	/
Mingxiao Yang 2014^Citation52
Participants	Number of TG/CG: 10/10/10 Condition: MWOA (ICHD) Demographics:/ Setting: China Duration of migraine (years):/
Interventions	TG: Electro-acupuncture CG: SE; WL Acupuncture points: Luxi, San Yangluo, and Xi Yangguan Number of needles: 6 Depth of insertion: 15–30 mm Number of treatment sessions:/ Duration:/ Follow-up:/
Adverse event	/
Ling Zhao 2014^Citation51
Participants	Number of TG/CG: 40/40 Condition: MWOA (ICHD-2) Demographics: age (years): TG:33.35±11.69 CG: 33.23±9.73; 71.25% female Setting: China Duration of migraine (years): TG: 10.58±7.40 CG: 9.93±5.73
Interventions	TG: Electro-acupuncture CG: SE Acupuncture points: Bilateral Waiguan, Fengchi, Yanglingquan, and Qiuxu Number of needles: 8 Depth of insertion: 25–35 mm Number of treatment sessions: 32 (30 minutes each, 4 times a week) Duration: 8 weeks Follow-up: 0
Adverse event	One case in the RA group suffered acupuncture fainting during acupuncture treatment
Mohsen Foroughipour 2014^Citation33
Participants	Number of TG/CG: 50/50 Condition: MWOA Demographics: age (years): 36.5; 59% female Setting: Iran Duration of migraine (years):/
Interventions	TG: Acupuncture CG: Superficial Needling at Nonacupoints Acupuncture points:/ Number of needles:/ Depth of insertion:/ Number of treatment sessions: 12 (30 minutes each, 3 times a week) Duration: 4 weeks Follow-up: 4 months
Adverse event	/
E Facco 2013^Citation56
Participants	Number of TG/CG: 50/50 Condition: MWOA (ICHD-2) Demographics: age (years): TG: 40 CG:34; 65.85% female Setting: Italy Duration of migraine (years): TG: 4 CG:4
Interventions	TG: Acupuncture CG: Valproic acid Acupuncture points: For exogenous syndromes the following acupoints were used: GB20, St8 (directing the needle towards GB8), EX-HN5, plus GB8, BL12, BL60, in wind-cold syndrome, TE5 and GV14 in wind-heat syndrome, and St40, SP6 and CV12 in wind-dampness syndrome. The endogenous syndromes were hyperactivity of liver yang (a), obstruction of middle jiao due to damp-phlegm (b), deficiency of kidney essence (c), stagnation of qi and blood (d). The acupoint selection in these syndromes was the following: a) GB8,20,38 St8 (towards GB8), LR3,4, EX-HN5; b) St8 (towards GB8), St40, SP9, GV23 (towards GV20), CV12, EX-HN5; c) GB12,20, BL10,12,23 KI3; d) GB8,20, SP6,10, LR3, EX-HN5, plus ashi points on GB channel Number of needles:/ Depth of insertion: According to classical prescription for each acupoint Number of treatment sessions: 20 (30 minutes each, twice a week, with one-week rest between the two courses.) Duration: 11 weeks Follow-up: 6 months
Adverse event	No event
Jie Yang 2012^Citation49
Participants	Number of TG/CG: 10/10/10 Condition: MWOA (ICHD) Demographics: age (years): 32.87 ± 8.71; 60% female Setting: China Duration of migraine (years):/
Interventions	TG: Electro-acupuncture CG: SE; WL Acupuncture points: Waiguan, Yang Lingquan, and Fengchi Number of needles: 6 Depth of insertion:/ Number of treatment sessions:/(30 minutes each) Duration:/ Follow-up:/
Adverse event	/
Lin-Peng Wang 2012^Citation39
Participants	Number of TG/CG: 75/75 Condition: Acute attack (ICHD-2) Demographics: age (years): TG: 37.8 ±10.6 CG:38.6 ± 12.6; 86.67% female Setting: China Duration of migraine (years):/
Interventions	TG: Acupuncture CG: SA Acupuncture points: The obligatory points included Baihui, Shenting, Touwei, Shuaigu, and Fengchi. According to different syndromes, additional points could be chosen individually: Waiguan and Yanglingquan for Shaoyang headache (TE-GB); Hegu and Neiting for Yangming headache (LI-ST); Kunlun and Houxi for Taiyang headache (SI-BL); Taichong and Qiuxu for Jueyin headache (PC-LR); Neiguan for nausea and vomit ing; and Taichong for dysphoria and susceptibility to rage Number of needles: 10–12 Depth of insertion: 10–15 mm Number of treatment sessions: 1 (30 minutes each) Duration: 1 day Follow-up: 3 day
Adverse event	Seven patients (three in RA group, four in SA group) reported mild AE during the study period.
Ying Li 2012^Citation12
Participants	Number of TG/CG: 121/119/118/118 Condition: Migraine with or without aura (ICHD) Demographics: age (years): 36.9±12.3; 82.77% female Setting: China Duration of migraine (years): 8.18
Interventions	TG: Electro-acupuncture CG: SE Acupuncture points: Shaoyang-specific acupuncture: Waiguan, Yanglingquan, Qiuxu, Fengchi; Shaoyang- nonspecific acupuncture: Luxi, Sanyangluo, Xiyangguan, Diwuhui; Yangming-specific acupuncture: Touwei, Pianli, Zusanli, Chongyang Number of needles: 4 Depth of insertion: 0.3–2 cun Number of treatment sessions: 20 (30 minutes each, once per day for five consecutive days followed by a two-day break) Duration: 4 weeks Follow-up: 3 months
Adverse event	37 patients (7.8%) experienced 42 adverse events during the study period
Thomas-Martin Wallasch 2012^Citation46
Participants	Number of TG/CG: 18/17 Condition:/(ICHD-2) Demographics: age (years): TG:37.2±9.6 CG:39.3±11.7; 88.57% female Setting: Germany Duration of migraine (years): TG: 16.8±11.2 CG:18.5±10.9
Interventions	TG: Acupuncture CG: SA Acupuncture points: Hegu, Zusanli, Waiguan, Zulinqi, Houxi, Shenmai, Baihui (DU20), Fengchi, Taiyang, Sizhukong, Taichong, Taixi Number of needles: 12 Depth of insertion:/ Number of treatment sessions: 8 (30 minutes each, once a week) Duration: 8 weeks Follow-up: 12 weeks
Adverse event	/
C-P Yang 2011^Citation62
Participants	Number of TG/CG: 33/33 Condition: CM (ICHD-2) Demographics: age (years): TG:47.6±7.4 CG:48.1±6.4; 89.39% female Setting: China Duration of migraine (years): TG: 13.2±3.5 CG:13.5±4.5
Interventions	TG: Acupuncture CG: topiramate Acupuncture points: bilateral Cuanzhu, Fengchi, Taiyang and midline Yintang Number of needles: 7 Depth of insertion: Standard to each point according to classic acupuncture point Number of treatment sessions: 24 (30 minutes each, twice a week) Duration: 12 weeks Follow-up: 0
Adverse event	In the RA group, side effects were reported by 6% of the patients
Lin-Peng Wang 2011^Citation31
Participants	Number of TG/CG: 70/70 Condition:/(ICHD-2) Demographics: age (years): TG: 39.2 ± 10.9 CG:39.9 ± 13.1; 85% female Setting: China Duration of migraine (years):/
Interventions	TG: Acupuncture plus placebo medication CG: flunarizine plus SA Acupuncture points: The obligatory points included Baihui, Shenting, Benshen, Shuaigu, and Fengchi. Additional points were chosen individually depending on different syndromes: Waiguan and Yanglingquan for Shaoyang headache (TE-GB); Hegu and Neiting for Yangming headache (LI-ST); Kunlun and Houxi for Taiyang headache (SI-BL); Taichong and Qiuxu for Jueyin headache (PC-LR); Neiguan for nausea and vomiting, and Taichong for dysphoria and susceptibility to rage Number of needles: 10–12 Depth of insertion: 10–15 mm Number of treatment sessions: 12 (30 minutes each, 3 times a week) Duration: 4 weeks Follow-up: 12 weeks
Adverse event	A total of 12 patients (5 in the acupuncture group, 7 in the control group) reported mild adverse effects during the study period.
Qin 2019^Citation20
Participants	Number of TG/CG: 19/19 Condition: MWOA (ICHD-3) Demographics: age (years): 18–43; 62.5% female Setting: China Duration of migraine (years):/
Interventions	TG: Acupuncture CG: SA Acupuncture points: Bilateral headache points, located at the midpoint of the anterior depression of the 1st and 2nd metatarsal joint of the dorsum of the foot Number of needles: 2 Depth of insertion: 25–40 mm Number of treatment sessions: 20 (Immediately release the needle when it reaches the sense of discharge and numbness, 5 times a week) Duration: 4 weeks Follow-up: 4 weeks
Adverse event	/
Guan 2019^Citation54
Participants	Number of TG/CG: 65/65/65 Condition: Migraine with or without aura (ICHD) Demographics: age (years): TG:45.98 ± 10.30 CG1:44.16 ± 9.82 CG2:46.44 ± 10.24; 68.89% female Setting: China Duration of migraine (years): TG: 0.80CG1:0.73 CG2: 0.84
Interventions	TG: Acupuncture CG: flunarizine hydrochloride Acupuncture points: The obligatory points included Baihui, Sishencong, Benshen, Shenting. Additional points were chosen individually depending on different syndromes: Guanyuan, Qihai, Zusanli for deficiency of both Qi and blood; Fenglong, Yinlingquan, for Phlegm; Taichong, Xingjian for Liver Yang hyperactivity; Xuehai, Geshu forQi and blood stasis. Number of needles:/ Depth of insertion:/ Number of treatment sessions: 20 (30 minutes each) Duration: 4 weeks Follow-up: 12weeks
Adverse event	/
Du 2019^Citation65
Participants	Number of TG/CG: 33/34 Condition: Migraine with or without aura (the Chinese migraine diagnosis and treatment guidelines) Demographics: age (years): TG: 55.74±5.28 CG: 56.58±6.14; 47.76% female Setting: China Duration of migraine (years): TG: 12.68±9.25 CG: 13.54±8.83
Interventions	TG: Acupuncture+ traditional Chinese herbal medicine CG: Tongqiao Huoxue Tang Acupuncture points: Baihui, Touwei, Taiyang, Neiguan, Xuehai, Qihai, Xuanlu, Waiguan, Shuaigu, Zulinqi Number of needles:/ Depth of insertion:/ Number of treatment sessions: 21 (25–30 minutes each, Once a day) Duration: 3 weeks Follow-up: 0
Adverse event	/
Hou 2019^Citation57
Participants	Number of TG/CG: 40/40 Condition:/ Demographics: age (years): TG:45.01±1.89 CG:44.39±1.33; 57.5% female Setting: China Duration of migraine (years):/
Interventions	TG: Acupuncture CG: flunarizine hydrochloride Acupuncture points: Baihui, Taiyang, Touwei, Sun, Zhengying, Zhongzhu, Xiaxi, Hegu and Taichong Number of needles:/ Depth of insertion:/ Number of treatment sessions: 14 (20 minutes each, Once a day) Duration: 2 weeks Follow-up: 0
Adverse event	/
Shen 2019^Citation38
Participants	Number of TG/CG: 35/35 Condition: CM (/) Demographics: age (years): TG;48.1±2.3 CG:48.3 ± 2.1; 45.71% female Setting: China Duration of migraine (years): TG:6.1±3.0 CG:6.4 ± 3.3
Interventions	TG: Acupuncture CG: SA Acupuncture points: Qiuxu, Jiaosun, Yanglingquan Number of needles:/ Depth of insertion:/ Number of treatment sessions: 20 (30 minutes each, 5 times a week) Duration: 4 weeks Follow-up: 0
Adverse event	One case of hematoma occurred in the RA group, 2 cases of hematoma 2 cases of needle stagnation occurred in the SA group
Zhang 2019^Citation59
Participants	Number of TG/CG: 24/24 Condition:/ Demographics: age (years): TG:36.85±3.47 CG:36.91±3.38; 60.42% female Setting: China Duration of migraine (years): TG;0.75±0.21 CG:0.81±0.19
Interventions	TG: Acupuncture CG: ergotamine caffeine Acupuncture points: Bilateral Shuaigu, Touwei, Taiyang, Hegu, Zhongzhu, Taichong, Zulinqi, Qubin, Jiaosun, Baihui, Zusanli, Xuanzhong, Waiguan. Number of needles:/ Depth of insertion:/ Number of treatment sessions: 30 (20–30 minutes each, Once a day) Duration: 1 month Follow-up: 0
Adverse event	/
Yu 2019^Citation44
Participants	Number of TG/CG: 43/40 Condition:/(ICHD-2) Demographics: age (years): TG:37. 17 ± 7. 68 CG:36. 81 ± 8. 02; 73.75% female Setting: China Duration of migraine (years): TG:2. 25 ± 1. 34 CG:2. 27 ± 1. 26
Interventions	TG: Acupuncture CG: SA Acupuncture points: Jiaosun, Fengchi, Waiguan, Yanglingquan and Qiuxu Number of needles:/ Depth of insertion:/ Number of treatment sessions: 1 (30 minutes each) Duration: 1 day Follow-up: 24 h
Adverse event	5 patients had adverse reactions, including 3 cases in the RA group (2 cases of fainting + 1 case of local bleeding), and 2 cases in the SA group (1 case of fainting + 1 case of local bleeding). Patients with fainting can recover after lying down and taking the needles out, and local bleeding is treated with local compression to stop bleeding. No serious adverse reactions occurred during the entire study.
Cheng 2019^Citation26
Participants	Number of TG/CG: 60/60 Condition:/(the classification and diagnosis of headache disorders published in the Journal of Neurology and Neurorehabilitation) Demographics: age (years): TG: 37.8 ±10.6 CG:38.6 ± 12.6; 63.33% female Setting: China Duration of migraine (years): TG:3.44±1.03 CG:3.42±1.02
Interventions	TG: Acupuncture+ traditional Chinese herbal medicine CG: Banxia Baizhu Tianma Tang Acupuncture points: Tianyou, Tianrong, Yifeng, Fengchi, Tianding, Taiyang, Hegu, Shuaigu, Taichong Number of needles:/ Depth of insertion: 0.5–1.2 cun Number of treatment sessions: 20 (30 minutes each, 5 times a week) Duration: 1 month Follow-up: 0
Adverse event	0
Wang 2018^Citation61
Participants	Number of TG/CG: 40/40 Condition:/ Demographics: age (years): TG:35. 4±3. 5 CG:36. 4± 3. 2; 53.75% female Setting: China Duration of migraine (years): TG:0. 6±0. 2 CG:0. 5±0. 3
Interventions	TG: Acupuncture CG: carbamazepine Acupuncture points: Shuaigu, Qubin, Tou wei, Jiaosun, Taiyang, Baihui, Hegu, Zusanli, Zhongzhu, Xuanzhong, Taichong, Waiguan, Zulinqi. Number of needles:/ Depth of insertion:/ Number of treatment sessions: 28 (20–30 minutes each. Once a day) Duration: 4 weeks Follow-up: 0
Adverse event	/
Peng 2018^Citation55
Participants	Number of TG/CG: 32/30 Condition: MWOA (ICHD-2) Demographics: age (years): TG:32.84±8.51 CG:33.65±8.85;72.58% female Setting: China Duration of migraine (years): TG:4.44±2.86 CG:4.37±2.71
Interventions	TG: Electroacupuncture CG: flunarizine hydrochloride Acupuncture points: Bilateral Qiuxu, Fengchi, Waiguan, Yanglingquan Number of needles: 8 Depth of insertion: 15–20 mm Number of treatment sessions: 12 (30 minutes each, 3 times a week) Duration: 4 weeks Follow-up: 0
Adverse event	/
Zhuo 2018^Citation64
Participants	Number of TG/CG: 30/30 Condition:/ Demographics: age (years): TG:27.9±12.6 CG:29.4±13.5; 78.33% female Setting: China Duration of migraine (years):/
Interventions	TG: Acupuncture+ flunarizine hydrochloride CG: flunarizine hydrochloride Acupuncture points:/ Number of needles:/ Depth of insertion:/ Number of treatment sessions:/ Duration: 1 month Follow-up: 0
Adverse event	/
Cong 2018^Citation27
Participants	Number of TG/CG: 60/60 Condition:/(ICHD) Demographics: age (years): TG:43.5±2.53 CG:42.3±2.58; 55.83% female Setting: China Duration of migraine (years): TG:2.24±0.86 CG:2.21±0.79
Interventions	TG: Acupuncture+ flunarizine hydrochloride+ nimodipine CG: flunarizine hydrochloride, nimodipine Acupuncture points: Baihui, Taiyang, Shuaigu, Xuanlu, Touwei, Fengchi, Waiguan, Taichong, Zulinqi, Hegu, Sanyinjiao. Number of needles:/ Depth of insertion:/ Number of treatment sessions:/(30 minutes each, Once a day) Duration: 8 weeks Follow-up: 0
Adverse event	In the treatment group, 1 case of dizziness and 2 cases of gastrointestinal reactions occurred; in the control group, 3 cases of dizziness, 5 cases of gastrointestinal reactions, and 1 case of arrhythmia, all improved without treatment
Ma 2018^Citation34
Participants	Number of TG/CG: 89/89 Condition: MWOA with acute attack (ICHD-3) Demographics: age (years): TG:36.25 ± 4.29 CG:36.00 ± 3.89; 43.43% female Setting: China Duration of migraine (years): TG:3.14 ± 1.49 CG:3.41±1.23
Interventions	TG: Acupuncture CG: Superficial Needling at Nonacupoints Acupuncture points: Baihui, Sishencong, Shenting, Yintang, Shuaigu, Quze, Ququan and Taichong Number of needles:/ Depth of insertion: 25 mm Number of treatment sessions: 12(30 minutes each, 3 times a week) Duration: 4 weeks Follow-up: 0
Adverse event	0
Xu 2018^Citation35
Participants	Number of TG/CG: 30/30 Condition: Migraine with or without aura (ICHD-2) Demographics: age (years): TG:45.07±2.34 CG:50.80±1.89; 81.67% female Setting: China Duration of migraine (years): TG:10.93±1.45 CG:13.57±1.43
Interventions	TG: Acupuncture CG: Superficial Needling at Nonacupoints Acupuncture points: Taiyang, Sizhukong, Jiaosun, Shougu, Fengchi, Waiguan, Zu Linwei (Bilaterally), A Shi point Number of needles:/ Depth of insertion: 10–40 mm Number of treatment sessions: 12 (20 minutes each, 2 times a week) Duration: 6 weeks Follow-up: 6 weeks
Adverse event	0
Yang 2018^Citation58
Participants	Number of TG/CG: 21/21 Condition: Migraine with or without aura (ICHD-2) Demographics: age (years): TG:34.5±3.3 CG:31.4±2.8; 82.05% female Setting: China Duration of migraine (years):/
Interventions	TG: Acupuncture CG: flunarizine hydrochloride Acupuncture points: Main points: Shuaigu, Touwei, Taiyang, Fengchi. Auxiliary points: Liver-yang hyperactivity plus Xingjian, Taichong; Phlegm turbidity upper disturbance plus Yinlingquan, Fenglong; Heat plus Xuanzhong, Waiguan, Quchi; Qi stagnation and blood stasis plus Geshu, Sanyinjiao, Xuehai; liver and kidney yin deficiency plus Sanyinjiao, Taixi. Number of needles:/ Depth of insertion:/ Number of treatment sessions:/(30 minutes each, 2–3 times a week) Duration: 4 weeks Follow-up: 24 weeks
Adverse event	A total of 7 patients under the acupuncture group had minor subcutaneous bleeding, no hematoma, ecchymosis, etc. No serious adverse events occurred, only 1 person fell off due to their own reasons, and no subjects withdrew from the test due to adverse events; 9 patients in the drug group experienced adverse events Among them, 7 of them reduced the dose of medication, including 3 people with drowsiness, 2 with constipation, 1 with depression, and 1 with myalgia; 2 people withdrew from the trial due to intolerable adverse reactions (drowsiness).
Wang 2017^Citation37
Participants	Number of TG/CG: 19/19 Condition: MWOA (ICHD-3) Demographics: age (years): 18–43; 52.63% female Setting: China Duration of migraine (years):/
Interventions	TG: Acupuncture CG: SA Acupuncture points: Bilateral headache points, located at the midpoint of the anterior depression of the 1st and 2nd metatarsal joint of the dorsum of the foot Number of needles: 2 Depth of insertion: 25–40 mm Number of treatment sessions: 20 (Immediately release the needle when it reaches the sense of discharge and numbness, 5 times a week) Duration: 4 weeks Follow-up: 4 weeks
Adverse event	/
Liang 2016^Citation25
Participants	Number of TG/CG: 30/30 Condition: CM (ICHD-2) Demographics: age (years): TG:46.5 CG:44.5; 65% female Setting: China Duration of migraine (years):/
Interventions	TG: Acupuncture CG: SA Acupuncture points: Bilateral Yanglingquan, Jiaosun, Qiuxu, Waiguan Number of needles: 8 Depth of insertion: 0.3–1.5 cun Number of treatment sessions: 20 (30 minutes each, 5 times a week) Duration: 4 weeks Follow-up: 0
Adverse event	/
Meng 2015^Citation40
Participants	Number of TG/CG: 30/30 Condition: MWOA with acute attack (ICHD-2) Demographics: age (years): TG:32. 65 ± 12. 73 CG:30. 09 ± 13. 39; 66.67% female Setting: China Duration of migraine (years): TG:4.13 ± 3.38 CG:4.50 ± 4.05
Interventions	TG: Acupuncture CG: SA Acupuncture points: Taiyang through Shuaigu and Toulinqi through Muchuang on the affected side, Bilateral Waiguan, Zhongzhu. Number of needles: 6 Depth of insertion:/ Number of treatment sessions: 20 (60 minutes each, 5 times a week) Duration: 4 weeks Follow-up: 0
Adverse event	/
Huang 2015^Citation21
Participants	Number of TG/CG: 10/10 Condition: MWOA (ICHD-2) Demographics: age (years): TG:28 ±4 CG:29 ±5; 55% female Setting: China Duration of migraine (years): TG:3. 3 ±1. 2 CG:2. 8 ± 0. 9
Interventions	TG: Acupuncture CG: SA Acupuncture points: Jiaosun, Waiguan, Yanglingquan, Qiuxu on the affected side Number of needles: 4 Depth of insertion:/ Number of treatment sessions: 10 (Once a day) Duration: 12 day Follow-up: 0
Adverse event	/
Zhang 2015^Citation50
Participants	Number of TG/CG: 55/55 Condition: MWOA (ICHD-2) Demographics: age (years): TG:24±3 CG:25±3; 52.73% female Setting: China Duration of migraine (years): TG: 4.2±3.5 CG: 3.7±3.1
Interventions	TG: Electroacupuncture CG: SE Acupuncture points: Fengchi, Waiguan, Sugu, Yanglingquan Number of needles: 8 Depth of insertion: 13–40 mm Number of treatment sessions: 1 (30 minutes each) Duration: 1 day Follow-up: 8 hours
Adverse event	0
Yang 2014^Citation47
Participants	Number of TG/CG: 30/30/30 Condition: Migraine with or without aura (ICHD-2) Demographics: age (years): TG:38.89±12.88 CG1:38.66±11.43 CG2:42.58±11.98; 53.33% female Setting: China Duration of migraine (years): TG:3.18±3.93 CG1:4.79±3.65 CG2:7.35±7.77
Interventions	TG: Acupuncture CG: SA Acupuncture points: Bilateral Taiyang, Fengchi, Waiguan, Yanglingquan, Qiuxu Number of needles: 10 Depth of insertion:/ Number of treatment sessions: 1 (30 minutes each) Duration: 1 day Follow-up: 24 h
Adverse event	0
Chang 2013.08.01^Citation22
Participants	Number of TG/CG: 30/30 Condition: Migraine with or without aura (ICHD-2) Demographics: age (years): TG:27.4 CG:25; 57.63% female Setting: China Duration of migraine (years): TG:6 CG:5.6
Interventions	TG: Acupuncture CG: SA Acupuncture points: Jiaosun, Waiguan, Yanglingquan, Qiuxu Number of needles: 8 Depth of insertion: 0.3–1.5 cun Number of treatment sessions:/(30 minutes each) Duration: 4 weeks Follow-up: 0
Adverse event	/
Zhang 2013^Citation45
Participants	Number of TG/CG: 30/30 Condition: Migraine with or without aura (ICHD-2) Demographics: age (years): TG:28.83 ± 7.57 CG:26.86 ± 6.66; 57.63% female Setting: China Duration of migraine (years):/
Interventions	TG: Acupuncture CG: SA Acupuncture points: Jiaosun, Waiguan, Yanglingquan, Qiuxu Number of needles: 8 Depth of insertion: 0.3–1.5 cun Number of treatment sessions: 20 (30 minutes each, 5 times a week) Duration: 4 weeks Follow-up: 0
Adverse event	/
Liu Mi 2013^Citation42
Participants	Number of TG/CG: 30/30/30 Condition: Migraine with or without aura (ICHD-2) Demographics: age (years): TG:38.89±12.88 CG1:38.66±11.43 CG2:42.58±11.98; 52.5% female Setting: China Duration of migraine (years): TG:3.18±3.93 CG1:4.79±3.65 CG2:7.35±7.77
Interventions	TG: Acupuncture CG: SA Acupuncture points: Bilateral Jiaosun, Fengchi, Waiguan, Yanglingquan, Qiuxu Number of needles: 10 Depth of insertion: 0.3–1.5 cun Number of treatment sessions: 1 (30 minutes) Duration: 1 day Follow-up: 24 h
Adverse event	/
Wang 2013^Citation30
Participants	Number of TG/CG: 76 Condition: Migraine with or without aura (ICHD-2) Demographics: age (years): 38.2±9.5; 76.32% female Setting: China Duration of migraine (years): 18.2±9.5
Interventions	TG: Acupuncture CG: bloodletting Acupuncture points: Local acupoint selection according to the meridian: Sizhukong, Sugu, Sun, Fengchi; remote acupoint selection (bilateral acupoints): Hegu, Lieqie, Taichong, Zu Linwei; internal medicine syndrome selection (bilateral acupoint selection): phlegm stasis plus Zhongwan, Fenglong, Yinlingquan, Xuehai, Geshu; Liver-yang hyperactivity plus Ganshu, Yanglingquan, Qiuxu, Taixi. Number of needles:/ Depth of insertion: 25–35 mm Number of treatment sessions: 1 (30 minutes) Duration: 1 day Follow-up: 24 h
Adverse event	/
Chang 2013.04.10^Citation23
Participants	Number of TG/CG: 30/29 Condition: Migraine with or without aura (ICHD-2) Demographics: age (years): TG;28.83±7.57 CG:26.86±6.66; 66.10% female Setting: China Duration of migraine (years): TG:3.71±2.24 CG:3.96±2.64
Interventions	TG: Acupuncture CG: SA Acupuncture points: Bilateral Jiaosun, Waiguan, Yanglingquan, Qiuxu Number of needles: 8 Depth of insertion:/ Number of treatment sessions: 20 (30 minutes each, 5 times a week) Duration: 4 weeks Follow-up: 1 months
Adverse event	/
Lin 2013^Citation48
Participants	Number of TG/CG: 30/29 Condition: Migraine with or without aura (ICHD-2) Demographics: age (years):/; 66.10% female Setting: China Duration of migraine (years):/
Interventions	TG: Acupuncture CG: SA Acupuncture points: Bilateral Jiaosun, Waiguan, Yanglingquan, Qiuxu Number of needles: 8 Depth of insertion:/ Number of treatment sessions: 20 (30 minutes each, 5 times a week) Duration: 4 weeks Follow-up: 1 month
Adverse event	/
Liu Zhao 2013^Citation43
Participants	Number of TG/CG: 30/30/30 Condition: Acute attack (ICHD-2) Demographics: age (years): TG:38.89±12.88 CG1:38.66±11.43 CG2:42.58±11.98; 53.33% female Setting: China Duration of migraine (years): TG:3.18±3.93 CG1:4.79±3.6 CG2:7.35±7.77
Interventions	TG: Acupuncture CG: SA Acupuncture points: Bilateral Jiaosun, Fengchi, Waiguan, Yanglingquan, Qiuxu Number of needles: 10 Depth of insertion:/ Number of treatment sessions: 1 (30 minutes) Duration: 1 day Follow-up: 24 h
Adverse event	0
Liu 2012^Citation41
Participants	Number of TG/CG: 30/30 Condition: Acute attack (ICHD-2) Demographics: age (years): TG:38.89±12.88 CG1:38.66±11.43 CG2:42.58±11.98; 53.33% female Setting: China Duration of migraine (years): TG:3.18±3.93 CG1:4.79±3.6 CG2:7.35±7.77
Interventions	TG: Acupuncture CG: SA Acupuncture points: Bilateral Jiaosun, Fengchi, Waiguan, Yanglingquan, Qiuxu Number of needles: 10 Depth of insertion:/ Number of treatment sessions: 1 (30 minutes) Duration: 1 day Follow-up: 24 h
Adverse event	0
Wu 2011^Citation63
Participants	Number of TG/CG: 30/30 Condition: MWOA (ICHD-2) Demographics: age (years): TG:39.6 ±9.7 CG:39.1 ±10.2; 66.67% female Setting: China Duration of migraine (years): TG:16.2 ±7.9 CG:15.4 ±9.1
Interventions	TG: Acupuncture CG: flunarizine hydrochloride Acupuncture points: A Shi, Baihui, Taiyang, Shuaigu, Fengchi, Benshen, Lieque Number of needles:/ Depth of insertion: 13–25 mm Number of treatment sessions: 24 (30 minutes each, 6 times a week) Duration: 4 weeks Follow-up: 0
Adverse event	/
Sheng 2010^Citation24
Participants	Number of TG/CG: 40/40 Condition:/(1998 edition of the ICHD) Demographics: age (years): 37; 51.52% female Setting: China Duration of migraine (years):/
Interventions	TG: Acupuncture+ flunarizine hydrochloride CG: flunarizine hydrochloride Acupuncture points: Fengchi, Touwei, Taiyang, Ashi Number of needles:/ Depth of insertion:/ Number of treatment sessions: 28 (30 minutes each, Once a day) Duration: 4 weeks Follow-up: 0
Adverse event	/
Geng 2010^Citation60
Participants	Number of TG/CG: 30/30 Condition:/(1988 edition of the ICHD) Demographics: age (years): TG:13–68 CG:16–69; 55% female Setting: China Duration of migraine (years): TG:0.17–9.33 CG:0.25–11.75
Interventions	TG: Acupuncture CG: nimodipine Acupuncture points: Fengfu, Fengchi, Taiyang, Laogong, Hegu, Zulinwei, Baihui Number of needles:/ Depth of insertion:/ Number of treatment sessions: 12 (30 minutes each, Once a day) Duration: 12 days Follow-up: 0
Adverse event	/

Abbreviations: TG, treatment group; CG, control group; RCT, randomized controlled trial; ICHD, international classification of headache disorders; MWOA, migraine without aura; VA, verum acupuncture; RA, true acupuncture; SA, sham acupuncture; WL, waiting list; CM, chronic migraine; AE, adverse event.

Figure 2 Annual distribution of the included studies evaluating acupuncture for migraine.

Figure 3 Risk of bias graph: review authors’ judgements about each risk of bias item presented as percentages across all included studies.

Figure 4 Risk of bias summary: review authors’ judgements about each risk of bias item for each included.

Figure 5 Forest plot of comparison: 1 RA vs. SA, outcome: headache frequency.

Figure 6 Summary of evidence of comparison: 1 RA vs. SA, outcome: headache frequency.

Figure 7 Forest plot of comparison: 2 acupuncture vs. waiting list, outcome: headache frequency.

Figure 8 Summary of evidence of comparison: 2 acupuncture vs. waiting list, outcome: headache frequency.

Figure 9 Forest plot of comparison: 3 acupuncture vs. western medicine, outcome: headache frequency.

Figure 10 Summary of evidence of comparison: 3 acupuncture vs. western medicine, outcome: headache frequency.

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