Table 7.

Acupuncture for acute migraine: SRs with and without meta-analyses

Authors, Year	Modality	SR	Meta-Analysis	Setting/Condition, n	Outcomes/Comparators	Results	Quality and Recommendations, Next Steps
Pu et al. 2016 [102] (Chinese language)	Acupuncture	NA	5 trials	Acute migraine n = 618	At 2 hours and 4 hours in acute migraine.	Acupuncture could effectively relieve the intensity of pain in acute migraine.	Quality unclear. Analgesic effect of acupuncture is significantly superior to sham acupuncture.
Coeytaux et al. 2016 [103]	Acupuncture	Overview of SRs	Overview of meta-analyses	Migraine, HA prevention: Cochrane SR (n = 22 studies, n = 4,985 participants) Tension-type HA: Cochrane SR (n = 12 trials, 2,349 participants) Chronic HA	HA frequency and response; compared with routine care (n = 5 studies); sham acupuncture control (n = 15); prophylactic drug tx (n = 5) HA response and number of HA days; compared to routine care (n = 2); sham acupuncture (n = 7); physiotherapy, massage or relaxation (n = 4) Specific outcome is unclear; compared with sham acupuncture (n= unclear)	Significant improvement in HA frequency compared with routine care and with prophylactic drug tx at 2 months. Acupuncture was significantly superior to routine care and sham acupuncture for response and reduction in HA days at 2, 3–4, and 5–6 months. Significantly larger effect size compared with sham acupuncture.	Quality not assessed. Acupuncture should be tx option to prevent migraine. Acupuncture should be a tx option for frequent episodic or chronic tension HA. None stated.
Zhang et al. 2019 [104]	Acupuncture	Overview of 15 SRs	Overview of 15 meta-analyses	Acute and preventive tx of migraine (n = 13 migraine; n = 1 included episodic migraine; n = 1 menstrual migraine included)	n = 15 VAS, clinical outcome, frequency Controls= no acupuncture, sham acupuncture, drug tx	n = 6 acupuncture superior to drugs; n = 4 acupuncture superior to sham acupuncture, drugs; n = 3 acupuncture superior to sham acupuncture; n = 1 acupuncture superior to drugs, other TCM txs; n = 1 acupuncture superior to tx migraine but did not mention control group in conclusions.	Methodological quality low. Acupuncture has advantage in pain improvement of VAS score, HA days/frequency, analgesic use, and efficacy of response rate. Poor quality of studies indicates better-quality research needed.
Li et al. 2020 [105] Overview of SRs	Acupuncture (body acupuncture, EA, ear acupuncture, warm acupuncture, scalp acupuncture)	Overview of 15 SRs	NA	n = 15 SRs	Sham acupuncture, placebo, medicine, other nonpharmacologic therapy, wait list. Primary outcome: effective rate. Secondary outcomes: intensity, frequency, duration of HA; use of painkiller, quality of life, recurrence, AEs.	AMSTAR 2 rating: 14/15 critically low-quality rating and 1 low quality. PRISMA-A: 11/15 adequately reporting over 70%. GRADE: high-quality evidence of acupuncture being superior to Western medicine (fewer HA days and painkiller uses, reduced frequency and HA degree compared with Western medicine or sham acupuncture).	High-quality evidence using GRADE tool. Acupuncture could be an effective and safe therapy for migraine, but quality of SRs need to be improved.
Yang et al. 2020 [106]	Acupuncture or acupoint stimulation with needle, heat, electricity, pressure, laser	13 trials n = 826	9 trials	Menstrual migraine	Sham devices; routine care; medications; acupuncture with medications. Primary outcome: number of migraines per month at completion of acupuncture tx. Secondary outcomes: days with migraine per month; mean HA intensity by VAS; medication use; frequency of migraines per month 3–6 months follow-up; AEs.	Acupuncture was not superior to sham acupuncture to reduce monthly migraine frequency and duration, intensity, or analgesic use. Pooled data: significant improvement in mean HA intensity in acupuncture group compared with drugs. Studies were underpowered, moderate to high risk of bias. No AEs.	Quality moderate. No strong evidence to support acupuncture in tx of menstrual migraine.
Natbony and Zhang 2020 [98]	4 ear acupuncture methods; 1 body acupuncture	Nonsystematic review	NA	Acute migraine (5) ED setting; episodic migraine prevention outpatient (1 SRM, 2 trials); chronic migraine prevention outpatient (3).	Pain reduction for acute migraine; reduction in migraine days in episodic and chronic migraine. Compared with various medications.	Acupuncture has potential for acute migraine in ED; acupuncture appears more effective than no tx or sham for prevention of episodic migraine. More study is needed for chronic migraines and to address barriers to access for acute migraines. Effective dosage and frequency of tx overall needs to be addressed in trials and the duration of benefit.	Quality not assessed. Acupuncture is a valid option for prevention of episodic migraines and has potential in ED for acute migraines.
Halker et al. 2020 [29]	Overview acute tx for episodic migraine (including acupuncture)	Included 4 acupuncture trials	NA	Outpatient, acute migraine, n = 475	3 trials compared with placebo; acupuncture superior to placebo on pain scale at 1 day.	Acupuncture could improve acute migraine pain compared with sham.	SOE low for acupuncture. More research is needed. SOE low or insufficient for opioids for acute migraine.

AE = adverse event; AMSTAR 2 = Measurement Tool to Assess Systematic Reviews; GRADE = Grading of Recommendations Assessment, Development, and Evaluation; HA = headache; NA = not applicable; PRISMA A = Preferred Reporting Item for Systematic Review and Meta-analysis-Acupuncture; SOE = strength of evidence; TCM = traditional Chinese medicine; tx = treatment.