A trial sequential meta-analysis showed that for migraine management, acupuncture can be a safe alternative as a preventive measure with a higher responder rate than sham acupuncture and conventional medications.

In order to establish if more clinical investigations are necessary, researchers calculated the required information size (RIS) and assessed the effectiveness of acupuncture in migraine prevention. Cochrane Library, EMBASE, and PubMed databases were explored. Included were randomized trials that contrasted acupuncture with sham acupuncture or traditional medication treatment. Overall, 20 studies (n = 3380) satisfied the criteria for inclusion. Migraine attack was the major endpoint. Side effects and responder rate were the secondary outcomes. After treatment, acupuncture outperformed sham acupuncture (Standard Mean Deviation [SMD] = - 0.29) in terms of preventing migraine attacks, although there was no profound difference between acupuncture and preventive medications (SMD = - 0.21).

More RCTs are required, according to both trial sequential analysis (TSA) graphs. Acupuncture was statistically superior to sham acupuncture [Risk Ratio [RR] 1.30] and conventional medications [RR 1.24] in terms of responder rate, according to the data obtained after the therapy. The sequential trial monitoring borders intersected with both of their cumulative Z-curves, favoring acupuncture. Acupuncture had a lower risk of adverse effects than preventive medicines [RR 0.34].

For patients who experience frequent and uncontrollable migraine attacks, acupuncture is recommended as an optional preventative treatment, especially for those who refuse standard pharmacological therapy due to excruciating side effects. However, additional robust trials are warranted to substantiate the findings.