TABLE 2.
The neuroimaging characteristic of current trials of acupuncture in the treatment of migraine.
| Study | Clinical trial design | Clinical condition | Intervention | Comparison | Neuroimaging technology | Acupoints | Acupuncture parameters | Outcomes |
| Wei et al. (2022) | Pilot study | MwoA | EA (n = 30) | HC (n = 30) | rsfMRI | GB8 | 15° angle, 0.5 inches, 8 min, once EA: 2 Hz, 1 mA |
FC: Right dorsal anterior insula-right postcentral gyrus↓ Right posterior insula-left precuneus↑ Correlation: FC value of the left precuneus was positively correlated with VAS score |
| Zhang et al. (2021) | RCT | MMoA | Acupuncture (n = 25) | Sham acupuncture (n = 25) | rsfMRI (ALFF, ReHo) | Bilateral GB20, GB8, PC6, SP6, LR3 | differed in 0.5–1.5 cm, twisted and rotated (90°< amplitude <180°) 1–2 Hz, deqi, 30 min, 3 months, 9 ± 2 times a month |
Clinical outcome: SAS, SDS, VAS, intensity of migraine, frequency of attacks ↓ ALFF: Right middle frontal gyrus↑ Left anterior cingulate, right inferior frontal gyrus↓ ReHo: Right superior frontal gyrus, left cuneus, and right MFG↑ Right superior temporal gyrus↓ Correlation: Altered ALFF value in the left ACC was positively correlated with the decreases in the SAS, SDS scores in TA |
| Tian et al. (2021) | Controlled trial | MwoA | Acupuncture (n = 52) | HC (n = 60) | rsfMRI | Bilateral GB34, GB40, TE5, GB33, GB42, TE8, ST36, ST42, LI6 | 5–15 mm, deqi, 30 min, 4 weeks, 5 sessions per week |
Clinical outcome: SAS, SDS, headache intensity↓ FC: Amygdala and insula, Amyg and SFG, CG and SFG, Hipp and SFG, and Tha subregions↓ Amygdala and MFG, Hipp and MFG, Hipp and INS, IPL and INS, IPL and MFG, IPL and SFG, and Tha subregions↑ Correlation: FCs between the left Amyg and left MFG, the left Amyg and left SFG correlated with the rate of improvement in headache intensity |
| Liu et al. (2021b) | Controlled trial | MwoA | Acupuncture (n = 40) | HC (n = 16) | rsfMRI (ReHo) | GV20, EX-HN5, GB5, GB15, LI4, LR3 EA: bilateral GB20, GB8, |
Deqi, 20 min, 6 weeks, 2 sessions per week EA: 2 Hz, 0.1–1.0 mA |
Clinical outcome: Migraine days, VAS, SAS, SDS↓ MSQ↑ ReHo: Cerebellum, angular gyrus↑ (after 12 acupuncture sessions) Correlation: Positive correlations of the change in ReHo value in the angular gyrus with days of migraine at baseline and with the change in number of days with migraine |
| Yin et al. (2020) | Controlled trial | MwoA | Acupuncture (n = 40) | HC (n = 40) | rsfMRI (zALFF) | Bilateral TE5, GB34, GB40, TE8, GB33, GB42, LI6, ST36, ST42 | Deqi, 30 min, 4 weeks, 5 sessions per week |
Clinical outcome: VAS↓ zALFF: Right middle occipital gyrus and left middle occipital gyrus↓ Correlation: zALFF value of right middle occipital gyrus positively correlated with the improvement of VAS scores zALFF value of left middle occipital gyrus positively correlated with the relief of mean migraine days zALFF value of right fusiform positively correlated with the duration |
| Zou et al. (2019) | Controlled trial | CM | Acupuncture (n = 14) | HC (n = 18) Self-control (n = 14) |
rsfMRI (ICA,SBA) | Bilateral: TE5, GB20, GB8, ST8 | 5–15 mm, deqi, 30 min, 36 weeks, 3 sessions per week |
Clinical outcome: Headache attacks, monthly mean/immediate VAS, headache days, acute headache medications↓ FC: Between the right temporal lobe and left ACC, between the right TPL and bilateral superior medial gyrus, and between the right TPL and right PRECUN↑ Correlation: Increased z-scores within the DMN (L_SPFG and L_PRECUN) were associated with reduced immediate VAS scores, and increases in z-scores of the L_PRECUN were negatively correlated with reductions in the monthly amount of acute headache medications. |
| Gu et al. (2018) | Controlled trial | MwoA | Acupuncture (n = 15) | HC (sham acupuncture) (n = 14) | MRS | GV20; bilateral GB20, LR2 | 1.5–2.5 cm, deqi, EA with dilatational wave, 30 min, 5 sessions, once per week |
Clinical outcome: VAS, mean duration of headache attacks↓ NAA/Cr in the bilateral thalamus↑ Correlation: Correlation between NAA/Cr and VAS in bilateral thalamus in post-treatment follow-up |
| Li et al. (2017) | Controlled trial | MwoA | Acupuncture (n = 100) VA (n = 60) SA (n = 20) WT (n = 20) |
HC (n = 46) | rsfMRI (ALFF) | Bilateral VA1: GB34, GB40, TE5 VA2: GB33, GB42, TE8 VA3: ST36, ST42, L16 |
5–15 mm, deqi, 30 min, 4 weeks, 5 sessions per week |
ALFF: Post- vs. pre-treatment: Bilateral orbitofrontal cortex, bilateral RVM/TCC and bilateral rostral midbrain↑ Left middle occipital cortex/cuneus↓ VA vs. SA: Bilateral RVM/TCC↑ |
| Li et al. (2017) | Controlled trial | MwoA | Acupuncture (n = 100) VA (n = 60) SA (n = 20) WT (n = 20) |
HC (n = 46) | rsfMRI ICA.SBA | Bilateral VA1: GB34, GB40, TE5 VA2: GB33, GB42, TE8 VA3: ST36, ST42, L16 |
5–15 mm, deqi, 30 min, 4 weeks, 5 sessions per week |
ICA outcomes: Post- vs. Pre-treatment rs-fc of the right precuneus with rFPN, of left middle frontal gyrus with rFPN↓; rs-fc with the bilateral posterior cingulate cortex for rFPN↑ Right precuneus rs-fc with the bilateral rACC/mPFC, ventral striatum, middle/inferior occipital gyrus, cuneus, DLPFC and cerebellum, left VLPFC and right superior temporal gyrus↑ Correlation: Decreased rs-fc with the bilateral precuneus, right paracentral gyrus and postcentral gyrus for rFPN positively associated with a decrease in headache intensity |
| Zhang Y. et al. (2016) | controlled trial | MwoA | Acupuncture (n = 12) | HC (n = 12) | rsfMRI | Bilateral: TE23, GB8, GB20, EX-HN5, LI4, LR3, TE5, GB34, GB41 | 1.5–2.5 cm, deqi, 30 min, 4 weeks, 5 sessions per week |
Clinical outcome: VAS and PSQI scores, duration and frequency of migraine attacks↓ FC: Bilateral superior frontal gyrus, medial frontal gyrus, precuneus, inferior parietal lobule, posterior cingulate cortex, cingulate gyrus, superior temporal gyrus, middle temporal gyrus, and supramarginal gyrus↑ |
| Li et al. (2016) | controlled trial | MwoA | Acupuncture (n = 100) VA (n = 60) SA (n = 20) WT (n = 20) |
HC (n = 46) | rsfMRI SBA |
Bilateral VA1: GB34, GB40, TE5 VA2: GB33, GB42, TE8 VA3: ST36, ST42, L16 |
5–15 mm, deqi, 30 min, 4 weeks, 5 sessions per week |
FC: Post- vs. Pre-treatment: FC between vlPAG and the bilateral middle cingulate cortex and rACC, and left mPFC↑ VA vs. SA: FC between vlPAG and the bilateral middle cingulate cortex and rACC, and left mPFC↑ Correlation: Negative association between VAS (post-pre) and rs-fc (post-pre) between vlPAG and brain regions including bilateral rACC and MCC, and left superior frontal gyrus, thalamus, putamen, caudate and cerebellum, and right supplementary motor area (SMA)/preSMA and middle frontal gyrus |
| Li et al. (2015) | Controlled trial | MwoA | Acupuncture (n = 12) | HC (n = 12) | rsfMRI (ICA) DTI |
Bilateral: TE23, GB8, GB20, EX-HN5, LI4, LR3, TE5, GB34, GB41 | 1.5–2.5 cm, deqi, 30 min, 4 weeks, 5 sessions per week |
Clinical outcome: VAS scores, duration and frequency of migraine attacks↓ FC: FC with the RFPN in the left precentral gyrus, the left supramarginal gyrus, the left inferior parietal lobule, and the left postcentral gyrus↑ Correlation: Increased FC was negatively correlated with the decrease of VAS scores after treatment |
| Zhao et al. (2014) | RCT | MwoA | Acupuncture (n = 40) | Inactive acupuncture (n = 40) | rsfMRI (ReHo) |
Group A: bilateral TE5, GB20, GB34, GB40; Group B: bilateral TE22, PC7, GB37, SP3 |
2.5–3.5 cm, rotation (90°< amplitude <180°) at a frequency of 1–2 Hz repeated 1–3 times to acquire deqi, 30 min, 8 weeks, 4 sessions per week |
Clinical outcome: VAS↓ ReHo: ReHo in the bilateral thalamus, ACC, STG, SMA, insular, cuneus, lingual gyrus, cerebellum, and brainstem ↑ ReHo in the bilateral posterior cingulate cortex (PCC), middle frontal gyrus (MFG), angular gyrus, precuneus, middle temporal gyrus (MTG), left hippocampus, inferior parietal lobule, inferior temporal gyrus (ITG), and right postcentral gyrus↓ Correlation: Decrease in the VAS score was significantly related to the increased average ReHo values in the ACC |
| Yang et al. (2014) | RCT | Migraine | Acupuncture (n = 10) | Sham acupuncture (n = 10) Migraine group (blank) (n = 10) |
PET-CT | Bilateral: TE19, TE8, GB33 | 15–30 mm, deqi, electrodes on auxiliary needles punctured 2 mm lateral to the points and 2 mm in depth, 100 Hz, 0.1–1.0 mA, 30 min, once | Bilateral middle frontal gyrus, left postcentral gyrus, left precuneus, right parahippocampus, left cerebellum and left middle cingulate cortex↑ Left Middle Temporal Cortex (MTC)↓ |
| Yang et al. (2012) | RCT | Migraine | Acupuncture (n = 10) | Control acupuncture group (n = 10) Migraine group (blank) (n = 10) |
PET-CT | Bilateral: TE5, GB34, GB20 | EA: 15–30 mm, deqi, electrodes on auxiliary needles punctured 2 mm lateral to the points and 2 mm in depth, 100 Hz, 0.1–1.0 mA, 30 min, once | Brain metabolism in the middle temporal cortex (MTC), orbital frontal cortex (OFC), insula, middle frontal gyrus, angular gyrus, post-cingulate cortex (PCC), the precuneus, and the middle cingulate cortex↑ Brain metabolism in the parahippocampus, hippocampus, fusiform gyrus, postcentral gyrus, and cerebellum↓ |
| Bäcker et al. (2004) | Pilot study | Migraine | Acupuncture (n = 10) | HC (n = 10) | Functional Transcranial Doppler |
GB41, LR3, TE5, EX-HN5, TE23, GV20, GB20 | GB41, LR3 30 min, 10 sessions, twice a week for the first 4 weeks and once a week for the following 2 weeks |
Overshooting cerebral blood flow velocity and a delayed decline in MCA, PCA. |
MMoA, menstrual migraine without aura; EM, episodic migraine; CM, chronic migraine; MwoA, migraine without aura; HC, healthy controls; VA, verum acupuncture; SA, sham acupuncture; WT, waiting-list; SAS, self-rating anxiety scale; SDS, self-rating depression scale; ICA, independent component analysis; VAS, Visual Analog Scale; MIDAS, Migraine Disability Assessment scale; rp, responders; nrp, non-responders; NAA, N-acetylaspartate; Cr, creatine; PPT, pressure pain threshold; BoNTA, Onabotulinumtoxin A; rACC, rostral anterior cingulate cortex; vlPAG, ventrolateral periaqueductal gray; mPFC, medial prefrontal cortex; STG, superior temporal gyrus; SMA, supplementary motor area; SFG, superior frontal gyrus; MFG, middle frontal gyrus; MCC, middle cingulate cortex; ReHo, regional homogeneity; CBFV, cerebral blood flow velocity; PCA, posterior cerebral artery; MCA, middle cerebral artery; TENS, transcutaneous electrical nerve stimulation; NS, no significant; EA, electrical acupuncture; FC, functional connection; ALFF, amplitude of low frequency; rsfMRI, resting state functional magnetic resonance imaging; CG, cingular gyrus; SBA, seed-based analysis; RVM, rostroventromedial medulla; TCC, trigeminocervical complex; RCT, randomized clinical trial; DTI, diffusion tensor imaging; PET-CT, positron emission tomography-computed tomography; MRS, magnetic resonance spectroscopy; MSQ, migraine-specific quality of life questionnaire; PFC, prefrontal cortex; FPN, fronto-parietal network; DLPFC, dorsolateral prefrontal cortex; VLPFC, ventrolateral prefrontal cortex; IPL, inferior parietal lobe; GB, gallbladder meridian; ST, stomach meridian; LI, large intestine meridian; GV, governor vessel; EX-HN, Tojingbu Xue Points of Head and Neck; LR, liver meridian; SP, spleen meridian; PC, pericardium meridia; TE, triple energizer meridian.