Carlo Maria Giovanardi1*, Michela Cinquini2, Marco Aguggia3, Gianni Allais4, Manuela Campesato5, Sabina Cevoli6, Fabio Gentili7, Annunzio Matrà8 and Silvia Minozzi2

• 1Italian Federation of Acupuncture Societies, Bologna, Italy
• 2Laboratory of Clinical Research Methodology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
• 3SOC Neurologia e Centro Cefalee, Ospedale Cardinal Massaia, Asti, Italy
• 4Department of Surgical Sciences, Women's Headache Center, University of Turin, Turin, Italy
• 5UO Anaestesia and Pain Therapy Unit Melotti, Department of Emergency and Urgency, Bologna, Italy
• 6IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
• 7General Practitioner, Specialist in Internal Medicine, Bologna, Italy
• 8General Practitioner, Bologna, Italy

Introduction: Migraine is a chronic paroxymal neurological disorder characterized by attacks of moderate to severe headache and reversible neurological and systemic symptoms. Treatment of migraine includes acute therapies, that aim to reduce the intensity of pain of each attack, and preventive therapies that should decrease the frequency of headache recurrence. The objective of this systematic review was to assess the efficacy and safety of acupuncture for the prophylaxis of episodic or chronic migraine in adult patients compared to pharmacological treatment.

Methods: We included randomized-controlled trials published in western languages that compared any treatment involving needle insertion (with or without manual or electrical stimulation) at acupuncture points, pain points or trigger points, with any pharmacological prophylaxis in adult (≥18 years) with chronic or episodic migraine with or without aura according to the criteria of the International Headache Society.

Results: Nine randomized trials were included encompassing 1,484 patients. At the end of intervention we found a small reduction in favor of acupuncture for the number of days with migraine per month: (SMD: −0.37; 95% CI −1.64 to −0.11), and for response rate (RR: 1.46; 95% CI 1.16–1.84). We found a moderate effect in the reduction of pain intensity in favor of acupuncture (SMD: −0.36; 95% CI −0.60 to −0.13), and a large reduction in favor of acupuncture in both the dropout rate due to any reason (RR 0.39; 95% CI 0.18 to 0.84) and the dropout rate due to adverse event (RR 0.26; 95% CI 0.09 to 0.74). Quality of evidence was moderate for all these primary outcomes. Results at longest follow-up confirmed these effects.

Conclusions: Based on moderate certainty of evidence, we conclude that acupuncture is mildly more effective and much safer than medication for the prophylaxis of migraine.