Acupuncture for migraine prevention

Acupuncture originated in traditional Chinese medicine, where points are chosen by meridian diagnosis. In adults with episodic migraine, a 2016 Cochrane review of 22 trials found that adding a course of acupuncture to usual care more than doubled the share of people whose headache frequency halved, with a smaller advantage over sham needling and results at least similar to preventive drugs with fewer side-effect dropouts. A 2026 review rates the advantage over sham as low certainty, and trials longer than a year are lacking.

Recovery

Evidence retrieved up to 15 October 2026

What the research shows

In adults with episodic migraine, trials that added a course of acupuncture to usual care found lower headache frequency than usual care alone, with headache frequency at least halved in about 41 of 100 people compared with 17 of 100; acupuncture may help people living well with migraine.

Moderate certainty

Further research may change the size of the effect.

Take care: see the safety noteBenefit

Who this is about

adults with episodic migraine

Practical note

Graded moderate: randomised trials with consistent direction (risk ratio 2.40, 4 trials, 2519 participants); downgraded one level because participants and assessors could not be blinded against a no-acupuncture control. The Cochrane authors describe courses of at least six sessions; the two recent trials here used 20 sessions over 4 to 8 weeks. No trial ran longer than a year.

Safety note

Serious adverse effects are rare but reported when acupuncture is delivered improperly or with non-sterile needles, including infections, punctured organs and nervous-system injury; trials used trained, licensed acupuncturists.

Sources

Supports “In four trials, acupuncture added to usual care or treatment of migraine on onset only (usually with pain-killers) resulted in 41 in 100 people having the frequency of headaches at least halved, compared to 17 of 100 people given usual care only.” (Plain language summary, Key results) Linde K, Allais G, Brinkhaus B, Fei Y, Mehring M, Vertosick EA, Vickers A, White AR. 2016. Cochrane Database of Systematic Reviews. Acupuncture for the prevention of episodic migraine. Copyright The Cochrane Collaboration, published by John Wiley and Sons; metadata and short quotes only
Supports “Twenty sessions of manual acupuncture was superior to sham acupuncture and usual care for the prophylaxis of episodic migraine without aura.” (Abstract, Conclusions) Xu S, Yu L, Luo X, Wang M, Chen G, Zhang Q, Liu W, Zhou Z, Song J, Jing H, Huang G, Liang F, Wang H, Wang W. 2020. BMJ. Manual acupuncture versus sham acupuncture and usual care for prophylaxis of episodic migraine without aura: multicentre, randomised clinical trial. CC BY-NC 4.0; credit Xu et al., BMJ 2020
Supports “There’s moderate-quality evidence that acupuncture may reduce the frequency of migraines (from a 2016 evaluation of 22 studies with almost 5,000 people).” (Headache and Migraine) National Center for Complementary and Integrative Health. 2022. NCCIH. Acupuncture: What You Need To Know. public domain; credit NCCIH

In migraine trials, adults receiving true acupuncture reported no more side effects than those receiving sham acupuncture, and a multicentre trial reported no severe adverse events; serious complications of acupuncture in general are rare and linked to non-sterile needles or improper delivery.

Moderate certainty

Further research may change the size of the effect.

Take care: see the safety noteNo clear effect

Who this is about

adults with episodic migraine receiving acupuncture from trained practitioners

Practical note

Graded moderate: randomised sham comparisons consistently found no excess of side effects, but trials are too small to detect rare serious events, which are known from case reports and broader reviews.

Safety note

When delivered improperly, acupuncture can cause infections, punctured organs and nervous-system injury; licensing of practitioners varies by place.

Sources

Supports “There were no differences in the number of side effects of real and 'fake' acupuncture, or the numbers dropping out because of side effects.” (Plain language summary, Key results) Linde K, Allais G, Brinkhaus B, Fei Y, Mehring M, Vertosick EA, Vickers A, White AR. 2016. Cochrane Database of Systematic Reviews. Acupuncture for the prevention of episodic migraine. Copyright The Cochrane Collaboration, published by John Wiley and Sons; metadata and short quotes only
Supports “No severe adverse events were reported.” (Abstract, Results) Xu S, Yu L, Luo X, Wang M, Chen G, Zhang Q, Liu W, Zhou Z, Song J, Jing H, Huang G, Liang F, Wang H, Wang W. 2020. BMJ. Manual acupuncture versus sham acupuncture and usual care for prophylaxis of episodic migraine without aura: multicentre, randomised clinical trial. CC BY-NC 4.0; credit Xu et al., BMJ 2020
Context “When not delivered properly, acupuncture can cause serious adverse effects, including infections, punctured organs, and injury to the central nervous system.” (Is acupuncture safe?) National Center for Complementary and Integrative Health. 2022. NCCIH. Acupuncture: What You Need To Know. public domain; credit NCCIH

In trials comparing acupuncture with preventive migraine drugs in adults with episodic migraine, acupuncture was at least similarly effective at reducing migraine frequency, and participants receiving acupuncture were less likely to report adverse effects or drop out because of them.

Low certainty

Further research is likely to change this.

No known concerns at usual amountsBenefit

Who this is about

adults with episodic migraine

Practical note

Graded low: only 3 trials (about 740 participants) contributed to the frequency comparison, the advantage seen after treatment was not significant at follow-up, and blinding was not possible. A 2025 meta-analysis of 15 studies found no significant difference from standard medical care in migraine days and noted that newer drug treatments have not been compared.

Safety note

Decisions about migraine medicines belong with the prescribing clinician; the trials compared acupuncture with older preventive drugs, not newer ones.

Sources

Supports “Trial participants receiving acupuncture were less likely to drop out due to adverse effects (OR 0.27; 95% CI 0.08 to 0.86; 4 trials, 451 participants) and to report adverse effects (OR 0.25; 95% CI 0.10 to 0.62; 5 trials 931 participants) than participants receiving prophylactic drugs” (Abstract, Main results) Linde K, Allais G, Brinkhaus B, Fei Y, Mehring M, Vertosick EA, Vickers A, White AR. 2016. Cochrane Database of Systematic Reviews. Acupuncture for the prevention of episodic migraine. Copyright The Cochrane Collaboration, published by John Wiley and Sons; metadata and short quotes only
Supports “Acupuncture showed no statistically significant difference as a prophylactic treatment for migraine in reducing the frequency of migraine days or pain intensity but did reduce the use of analgesics while improving patients' quality of life.” (Abstract, Results) Pistoia F, Cesarano S, Saporito G, Albanese M, Lucenti C, Scarsella S, Liguori A, Ronchi FU. 2025. European Journal of Neurology. Acupuncture Versus Standard Medical Care in the Prophylactic Treatment of Migraine: A Systematic Review and Meta-Analysis. publisher copyright; metadata and short quotes only; Courtesy of the U.S. National Library of Medicine
Context “review of nine studies that compared acupuncture with various drugs for preventing migraine found that acupuncture was slightly more effective, and study participants who received acupuncture were much less likely than those receiving drugs to drop out of studies because of side effects.” (Headache and Migraine) National Center for Complementary and Integrative Health. 2022. NCCIH. Acupuncture: What You Need To Know. public domain; credit NCCIH

In sham-controlled trials of adults with migraine, true acupuncture reduced migraine frequency somewhat more than sham needling, but the difference is small (about 50 versus 41 in 100 people with headache frequency at least halved).

Low certainty

Further research is likely to change this.

No known concerns at usual amountsBenefit

Who this is about

adults with episodic migraine

Practical note

Graded low: the Cochrane review (12 to 14 trials, about 1650 to 1825 participants) and a 2026 meta-analysis of 8 trials agree on direction, but heterogeneity was moderate (I2 47 to 61 percent in Cochrane), sham procedures differed between trials, and the 2026 review itself graded certainty low. Sham needling also produced sizeable improvements, so much of the overall benefit is not specific to true needling.

Sources

Supports “Among patients with migraine without aura, true acupuncture may be associated with long-term reduction in migraine recurrence compared with sham acupuncture or assigned to a waiting list.” (Abstract, Conclusions and Relevance) Zhao L, Chen J, Li Y, Sun X, Chang X, Zheng H, Gong B, Huang Y, Yang M, Wu X, Li X, Liang F. 2017. JAMA Internal Medicine. The Long-term Effect of Acupuncture for Migraine Prophylaxis: A Randomized Clinical Trial. publisher copyright; metadata and short quotes only; Courtesy of the U.S. National Library of Medicine
Supports “The frequency of headaches halved in 50 of 100 people receiving true acupuncture, compared with 41 of 100 people receiving 'fake' acupuncture.” (Plain language summary, Key results) Linde K, Allais G, Brinkhaus B, Fei Y, Mehring M, Vertosick EA, Vickers A, White AR. 2016. Cochrane Database of Systematic Reviews. Acupuncture for the prevention of episodic migraine. Copyright The Cochrane Collaboration, published by John Wiley and Sons; metadata and short quotes only
Supports “Acupuncture was associated with reductions in migraine frequency and pain intensity compared with sham procedures in adults with migraine without aura. However, evidence certainty ranged from low to very low” (Abstract, Conclusion) Qi G, Li M, Zheng S, Xu X. 2026. Journal of Pain Research. Acupuncture versus Sham Acupuncture for Migraine without Aura: A Systematic Review and Meta-Analysis. publisher copyright; metadata and short quotes only; Courtesy of the U.S. National Library of Medicine

What the tradition holds

TCM acupuncture for migraine selects points by meridian diagnosis of the headache, for example points for Yangming, Taiyang or Jueying meridian headache, added to a fixed set of core points, and holds that the choice of points matters.

Take care: see the safety noteUnclear

Who this is about

adults with episodic migraine

The tradition's frame

TCM

Traditional Chinese medicine classifies headache by the meridian it is held to follow and chooses acupuncture points along that meridian, with manual needling aimed at producing the de-qi sensation.

Practical note

In trials, sham needling at incorrect points or without skin penetration also reduced migraine frequency, and the extra effect of true points was small, which only partly supports point specificity.

Safety note

Serious adverse effects are rare but reported when acupuncture is delivered improperly; trials used trained, licensed acupuncturists with sterile needles.

Sources

Supports “Additional acupoints were selected on the basis of meridian diagnosis and the patient’s symptoms: bilateral ST8 for Yangming meridian headache, BL10 for Taiyang meridian headache, and DU20 for Jueying meridian headache.” (Methods, Interventions) Xu S, Yu L, Luo X, Wang M, Chen G, Zhang Q, Liu W, Zhou Z, Song J, Jing H, Huang G, Liang F, Wang H, Wang W. 2020. BMJ. Manual acupuncture versus sham acupuncture and usual care for prophylaxis of episodic migraine without aura: multicentre, randomised clinical trial. CC BY-NC 4.0; credit Xu et al., BMJ 2020
Context “In 15 trials, acupuncture was compared with 'fake' acupuncture, where needles are inserted at incorrect points or do not penetrate the skin.” (Plain language summary, Key results) Linde K, Allais G, Brinkhaus B, Fei Y, Mehring M, Vertosick EA, Vickers A, White AR. 2016. Cochrane Database of Systematic Reviews. Acupuncture for the prevention of episodic migraine. Copyright The Cochrane Collaboration, published by John Wiley and Sons; metadata and short quotes only
Context “Acupuncture has been in use in some form for at least 2,500 years. It originated from traditional Chinese medicine but has gained popularity worldwide since the 1970s.” (What is acupuncture?) National Center for Complementary and Integrative Health. 2022. NCCIH. Acupuncture: What You Need To Know. public domain; credit NCCIH