Acupuncture for Migraine in Denver

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Design

Review of randomized trials, each at least 8 weeks long, in adults with episodic migraine. Acupuncture was compared with no acupuncture, imitation acupuncture or preventive drugs. Searched to early 2016.

Result

Against no acupuncture, headaches were cut at least in half in 41% versus 17% (4 studies, 2,519 people). Against imitation acupuncture the gain was small: 50% versus 41% after treatment, and 53% versus 42% at follow-up. Against preventive drugs, 57% versus 46% at 3 months and 59% versus 54% at 6 months, though the 6-month gap was not statistically clear. Acupuncture caused fewer drop-outs and fewer side effects than the drugs.

Limit

Trials against no acupuncture or drugs could not be blinded, so bias is possible. The authors rate the evidence as moderate overall and say studies longer than one year are lacking.

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Design

Randomized trial at 3 clinical sites in China. Adults aged 18 to 65 with migraine without aura, 2 to 8 times a month, got true acupuncture, imitation acupuncture or a waiting list. Treatment was 5 days a week for 4 weeks, with follow-up to 24 weeks.

Result

At week 16, attack frequency fell by 3.2 with true acupuncture, 2.1 with imitation acupuncture and 1.4 on the waiting list. True acupuncture beat imitation by 1.1 attacks (95% CI 0.4 to 1.9) and the waiting list by 1.8 (95% CI 1.1 to 2.5). Imitation acupuncture was not statistically different from the waiting list.

Limit

It enrolled people with migraine without aura, not chronic migraine, and ran in China. Five visits a week is more than most people can do.

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Design

Randomized trial in 7 hospitals in China. 150 adults new to acupuncture, with episodic migraine without aura, got 20 sessions over 8 weeks of manual acupuncture, non-penetrating imitation acupuncture at non-acupuncture points, or usual care alone.

Result

At weeks 17 to 20, migraine days fell by 3.9 with manual acupuncture versus 2.2 with imitation acupuncture (adjusted difference -2.1, 95% CI -2.9 to -1.2). Attacks fell by 2.3 versus 1.6. About 79% and 75% felt a needle go in, so people could not tell the two apart. No severe adverse events.

Limit

The gap was clear only in the later weeks (migraine days from weeks 13 to 20, attacks from weeks 17 to 20). It enrolled only people new to acupuncture, in China.

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Design

Single-blind randomized trial at one hospital in Beijing. 120 adults with migraine without aura got 12 sessions of 30 minutes over 4 weeks, with real acupuncture or imitation acupuncture at non-acupuncture points.

Result

Monthly migraine days fell by a median of 1.0 more with real acupuncture (95% CI -2.0 to 0; P = .02). Headache days, days of acute medicine use and pain scores also fell by a median of 1.0 more.

Limit

The gap was about one day a month, from one site, and the confidence interval reaches zero. The trial also tested brain-scan prediction, which does not help patients today.

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Design

Single-blind trial in four centers in China. Adults with migraine without aura got 12 sessions of manual penetrating needling or non-penetrating needling at the same points. The abstract says both 192 and 198 people, and 99 were assigned to each group.

Result

At 16 weeks, the drop in attacks was not statistically clear (mean difference -0.6, 95% CI -1.5 to 0.05; p = 0.069). More people responded to real needling (17.2 points more, 95% CI 5.2 to 29.1) and pain fell more (mean difference -0.6). Adverse events occurred in 5.1% with real needling.

Limit

The main outcome missed statistical significance. Because the imitation needling used the same points, it may not be fully inactive.

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Design

Randomized trial of 66 people with chronic migraine. One group (33) got 24 sessions of acupuncture over 12 weeks. The other (33) took topiramate, up to 100 mg a day.

Result

Moderate or severe headache days a month fell from 20.2 to 9.8 with acupuncture and from 19.8 to 12.0 with topiramate (p < .01). Side effects occurred in 6% versus 66%. The gap held in people overusing acute medicine.

Limit

It was small and had no imitation acupuncture group, so people knew which treatment they had.

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Design

Single-blind, double-dummy trial. 60 adults with chronic migraine got acupuncture plus placebo pills, or topiramate 50 to 100 mg a day plus imitation acupuncture, for 12 weeks. 123 people were screened.

Result

Monthly migraine days fell 2.79 more with acupuncture than with topiramate at weeks 1 to 12 (95% CI -4.65 to -0.94, p = 0.004) and 3.25 more at weeks 13 to 24 (95% CI -5.57 to -0.92). No severe adverse events.

Limit

It was small. It shows acupuncture did better than topiramate, but it does not show how much was due to needle placement rather than placebo effect.

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Design

Network meta-analysis of randomized trials in chronic migraine comparing topiramate, acupuncture and botulinum toxin A (BoNT-A) for results at week 12.

Result

Acupuncture ranked best for monthly headache days and topiramate for monthly migraine days, but neither was significantly better than BoNT-A. Topiramate caused the most side-effect drop-outs.

Limit

The authors say BoNT-A is still the primary preventive treatment for chronic migraine and call for head-to-head trials. 11 of the 15 trials had low risk of bias.

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Design

Bayesian network meta-analysis of 32 randomized trials of migraine prevention, comparing acupuncture, preventive drugs, imitation acupuncture and placebo.

Result

Acupuncture beat placebo for monthly migraine days (mean difference -1.78, 95% credible interval -2.89 to -0.70), about the same as drugs (-1.72). Acupuncture did not differ significantly from drugs on migraine days or from imitation acupuncture on any outcome. It did better than drugs for headache intensity and pain reliever use.

Limit

The imitation acupuncture groups also improved, so a needle-specific effect is hard to show. A network meta-analysis compares some treatments only through indirect links.

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Design

Network meta-analysis of 50 trials comparing placebo versions of acupuncture, cognitive behavioral therapy and three kinds of brain or nerve stimulation in migraine prevention.

Result

Imitation acupuncture had the greatest effect on the number of attacks and on headache frequency. Imitation magnetic and electrical brain stimulation did best for migraine days. The authors say the strong placebo effect of imitation acupuncture should be considered when judging the benefit of real acupuncture.

Limit

These are indirect comparisons of placebo groups across different trials. They do not show that real acupuncture has no specific effect.

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Design

Double-dummy, participant-blinded trial in four centers in China. 172 women with migraine linked to their period got 24 sessions of acupuncture plus placebo pills, or naproxen plus imitation acupuncture.

Result

Migraine days per perimenstrual period fell by 0.94 with acupuncture and 0.61 with naproxen (difference 95% CI 0.17 to 0.50; P < 0.001). In women treated over three cycles, the benefit lasted through six cycles.

Limit

The gap was about a third of a day per period. The control was a drug, not placebo alone, and the trial ran in China.

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Design

Systematic review and meta-analysis of randomized trials of acupuncture for menstrual migraine, searched to April 2025.

Result

Compared with control treatments, acupuncture lowered pain scores, reduced how often attacks came and how long they lasted, and improved response rates and headache impact scores. The review found a favorable safety profile.

Limit

Certainty was low overall, and results varied widely between trials. The authors say large, well-designed trials are urgently needed.

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Design

Systematic review of randomized trials of acupuncture for acute migraine attacks in adults, searched to July 2022.

Result

Compared with imitation acupuncture or placebo, acupuncture may raise headache freedom at 2 hours (risk ratio 6.03, 95% CI 1.62 to 22.41, 2 studies, 180 people, low certainty). Compared with drugs, it made little to no difference to headache freedom or relief at 2 hours (low certainty). Adverse events were about the same as with imitation acupuncture.

Limit

Certainty was low to very low for most results, and the headache freedom result rests on two small studies. The authors say new high-quality studies are needed.

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Design

Single-blind trial at one hospital in China. 80 people having an acute migraine without aura got 10 minutes of real acupuncture or non-penetrating blunt needling.

Result

At 10 minutes, 92.5% (37 of 40) responded to real acupuncture versus 12.5% (5 of 40) with imitation. Pain and nausea scores were lower with real acupuncture. No adverse events were seen.

Limit

It is one small trial from one site. The gap is far bigger than in most prevention trials, so it needs to be repeated before anyone relies on it. It did not show whether relief lasted.

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Design

Cochrane review of randomized trials in adults with episodic or chronic tension-type headache, comparing acupuncture with routine care, imitation acupuncture or other treatments.

Result

In two large trials against routine care or treating attacks only, headache frequency fell by at least half in 48% versus 19% and 45% versus 4%. Against imitation acupuncture (four trials), it was 51% versus 43%.

Limit

Neither large trial was blinded, and evidence quality was moderate or low. No trial found acupuncture clearly better than physiotherapy, massage or exercise. Effects beyond four months were not studied.

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Design

England's national guideline on headaches, first published in 2012 and last updated on 3 June 2025. It covers when to refer, how to diagnose and how to treat.

Result

For migraine prevention it says to consider propranolol, topiramate or amitriptyline. If none worked, was tolerated or was suitable, it says to consider up to 10 sessions of acupuncture over 5 to 8 weeks, based on your preference, other health conditions and risk of side effects. It gives the same course for chronic tension-type headache. It also asks doctors to be alert to medication overuse headache and to advise stopping overused acute medicine.

Limit

This is English guidance, not American. It places acupuncture after the standard preventive drugs for migraine, and it does not list acupuncture among acute treatments.

It can help prevent attacks, though the extra benefit over imitation acupuncture is small. A 2016 Cochrane review of 22 trials and 4,985 people found headaches were cut at least in half in 41% of people given acupuncture and 17% given no acupuncture. Against imitation acupuncture, it was 50% versus 41%. The authors rate the evidence as moderate. Part of the benefit may come from placebo effects, which are strong in migraine trials.

Most trials gave 12 to 24 sessions over 4 to 12 weeks. NICE in England suggests up to 10 sessions over 5 to 8 weeks. I plan about 8 to 12 visits over 8 weeks, then space visits out as your attacks drop. After the first five visits, I go over your headache diary with you. If your attacks have not changed by then, I will tell you.

The evidence is stronger for episodic migraine, which means headaches on fewer than 15 days a month. Chronic migraine means headaches on 15 or more days a month. For chronic migraine, two small trials of 66 and 60 people found acupuncture reduced headache or migraine days more than topiramate. Larger placebo-controlled trials are still needed. If you take pain relievers on many days a month, tell your doctor, because overuse can cause rebound headaches. NICE says doctors should watch for this when triptans or combination pain relievers are used on 10 or more days a month, or plain pain relievers on 15 or more days a month.

The evidence is much weaker than for prevention. A 2023 review of 21 trials found acupuncture may bring more pain freedom at 2 hours than imitation acupuncture, but the certainty was low to very low. One small 2026 trial of 80 people found 92.5% responded within 10 minutes versus 12.5% with imitation needling. A gap that large needs to be repeated before anyone relies on it. I do not treat acupuncture as a replacement for your rescue medicine, so please take it as your doctor directed.

I found no trial that tested acupuncture only in migraine with aura. Several recent trials enrolled only people with migraine without aura, so I cannot say it works better or worse with aura. Aura is a short warning, such as flashing lights or blind spots, that comes before or with the headache. If you have a new type of aura, or aura with weakness, numbness or trouble speaking, see your doctor first.

It may. In a 2022 trial of 172 women with migraine linked to their period, migraine days around each period fell by 0.94 with acupuncture and 0.61 with naproxen, a small gap that favored acupuncture. A 2025 review of 39 trials rated the overall certainty low. NICE suggests a headache diary for at least two cycles to confirm the pattern, and your doctor should confirm the diagnosis.

A review of 21 prospective studies found serious side effects in about 1 in 10,000 patients, and about 9 in 100 noticed a minor effect such as bleeding or soreness at a needle site. Several migraine trials reported no severe adverse events. Tell your doctor you are trying acupuncture. See your doctor first if any of these fit you. A sudden “worst headache of your life,” or thunderclap onset. Headache with fever and a stiff neck. A new headache after a head injury. Headache with weakness, numbness, vision loss, confusion or trouble speaking. New headaches after age 50. Headaches that keep getting worse. Headaches with a cancer history or a weakened immune system. A new severe headache during pregnancy.

No. Please do not stop or change preventive or rescue medicine without your doctor. In the Cochrane review, acupuncture did about as well as preventive drugs and caused fewer side effects, but that is a decision for you and your doctor. NICE places acupuncture after propranolol, topiramate and amitriptyline for migraine prevention, for people who did not benefit, could not tolerate them or could not take them. I work alongside your doctor.

At The Subtle Point a 90-minute first visit is $150 and follow-ups are $60 for 30 minutes of acupuncture, $95 for 60 minutes of acupuncture with Tuina massage, or $130 for 90 minutes of acupuncture with Tuina massage and cupping. HSA and FSA cards work, and you receive a superbill for your insurer. You can book online with the Book online button on this page or call (720) 285-6251.