Devanty Anggraini, Rifki Albana

Efficacy and Safety of Acupuncture Compared with Standard Treatment in Migraine Without Aura: A Systematic Review of Randomized Controlled Trials

Introduction

Efficacy and safety of acupuncture compared with standard treatment in migraine without aura: a systematic review of randomized controlled trials. Systematic review: Acupuncture effectively and safely treats migraine without aura, reducing frequency, intensity, and medication use. Improves quality of life with fewer side effects than standard pharmacological therapy.

Abstract

Introduction:Migraine without aura is a common neurological disorder that imposes a substantial global burden. While pharmacological therapy remains the cornerstone of treatment, limitations such as side effects, contraindications, and medication overuse highlight the need for complementary approaches. Acupuncture has been proposed as a potential alternative due to its neuromodulatory and analgesic effects. Methods: This systematic review followed PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. Searches were conducted in PubMed, ProQuest, SAGE Journals, and EuropePMC, including only randomized controlled trials comparing acupuncture with standard pharmacological treatments in migraine without aura. Outcomes of interest included headache frequency, intensity, acute medication use, quality of life, and safety. Risk of bias was assessed using the Cochrane RoB 2.0 tool. Results: Eight randomized controlled trials involving patients with migraine without aura were included. Acupuncture consistently reduced migraine frequency, with greater decreases in headache days and attack frequency compared with drugs such as flunarizine and valproic acid. Significant reductions in pain intensity were observed in several studies, with acupuncture showing either comparable or superior effects relative to pharmacological therapy. Acupuncture also led to earlier and more sustained reductions in acute medication use, potentially lowering the risk of medication overuse headache. Quality of life improvements were reported in domains of physical function, emotional well-being, and migraine-specific indices. Adverse events were generally mild and transient (e.g., local bleeding, discomfort), and occurred less frequently than with standard medications, which were associated with drowsiness, weight gain, or gastrointestinal symptoms. Discussion and Conclusion: Acupuncture demonstrates favorable efficacy and safety compared with standard pharmacological treatments in migraine without aura, offering reductions in frequency, intensity, and medication use, alongside improvements in quality of life. Given heterogeneity in protocols and some methodological limitations, further large-scale multicenter trials with standardized designs are warranted to confirm these findings and guide clinical practice.

Review

This systematic review robustly investigates the comparative efficacy and safety of acupuncture versus standard pharmacological treatments for migraine without aura, addressing a critical need for complementary approaches given the limitations of conventional therapies. Adhering to rigorous PRISMA guidelines and the Cochrane Handbook, the authors systematically identified and analyzed eight randomized controlled trials. A significant finding is the consistent reduction in migraine frequency, with acupuncture demonstrating superior decreases in headache days and attack frequency compared to drugs such as flunarizine and valproic acid. Furthermore, the review highlights comparable or superior effects of acupuncture on pain intensity, positioning it as a highly promising intervention for core migraine symptoms. Beyond its direct efficacy on headache parameters, the review underscores several other compelling benefits of acupuncture. Patients receiving acupuncture experienced earlier and more sustained reductions in acute medication use, a crucial outcome that may mitigate the risk of medication overuse headache. Improvements in quality of life were also consistently reported across physical function, emotional well-being, and migraine-specific indices. Notably, the safety profile of acupuncture was favorable, with adverse events being generally mild and transient (e.g., local bleeding, discomfort) and occurring less frequently than those associated with standard medications, which often include drowsiness, weight gain, or gastrointestinal issues. This excellent safety profile further strengthens the argument for acupuncture's role in migraine management. In conclusion, this systematic review provides compelling evidence that acupuncture offers favorable efficacy and safety compared with standard pharmacological treatments in migraine without aura, making it a valuable alternative or adjunct for patients. The clear benefits in reducing frequency, intensity, medication use, and improving quality of life, coupled with a superior safety profile, warrant its consideration in clinical practice. However, acknowledging the identified heterogeneity in protocols and some methodological limitations among the included trials, the authors appropriately call for further large-scale, multicenter trials with standardized designs. Such future research is essential to solidify these promising findings and provide definitive guidance for integrating acupuncture into evidence-based migraine management strategies.

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