Cochrane review of acupuncture for migraine
NICE recommendations
Traditional acupuncture






Research suggests that there are more than 190,000 migraine attacks every day in the UK1 and according to the Migraine Trust, migraine is the third most common disease in the world, affecting about one in seven people.2 There is no known cause for migraine, although most people with it are genetically predisposed to migraine.

Chronic migraine affects approximately 2% of the world population and three times as many women as men get migraines. Prevalence of migraine varies with age, rising through early adult life and declining in the late 40s and early 50s.

Acupuncture is a therapy in which thin needles are inserted into the skin at particular points. It originated in China, and is now used in many countries to treat people with migraine. There is a large body of evidence to suggest that acupuncture is effective in the treatment of migraine.


Cochrane review of acupuncture for migraine

A systematic review of acupuncture for migraine prophylaxis, conducted by Cochrane in 2016, included 4,985 participants in 25 randomised controlled trials, firmly placing it among the most well studied treatments.3

The review found that adding acupuncture to symptomatic treatment of attacks reduces the frequency of headaches. Contrary to previous findings, the updated evidence also suggested that there is an effect over sham, but this effect is small. Sham is simply a diluted form of acupuncture, not a placebo, so the difference would not be expected to be large.

It also showed that the available trials also suggested that acupuncture may be at least similarly effective as treatment with prophylactic drugs.

Acupuncture can be considered an option for patients willing to undergo this treatment, the review concluded.


NICE recommendations

NICE recommends that patients are offered a course of up to 10 sessions of acupuncture as a treatment to prevent migraine if neither topiramate nor propranolol work well.4



Two surveys conducted independently of each other and published in the British Medical Journal in 2001 concluded that the risk of a serious adverse reaction to acupuncture is less than 1 in 10,000. This is far less than many orthodox medical treatments.

One survey was of traditional acupuncturists and the other of doctors and physiotherapists who practise acupuncture. A total of 66,000 treatments were reviewed altogether, with only a handful of minor and transient side effects recorded.5,6

A 2003 survey of 6,000 patients of acupuncture produced almost identical figures.

There are very few side effects from acupuncture when practised by a fully qualified practitioner of traditional acupuncture. Any minor side effects that do occur, such as dizziness or bruising around needle points, are mild and self-correcting.


Seven reasons why acupuncture is good for migraine:

It provides pain relief

Pain relief is provided by stimulating nerves located in muscles and other tissues, acupuncture leads to release of endorphins and other neurohumoral factors and changes the processing of pain in the brain and spinal cord.7,8


It reduces inflammation

Increasingly there is evidence that inflammation is associated with migraine. Acupuncture promotes the release of vascular and immunomodulatory factors that can counter this.9-11

One review article presented the evidence that the antiinflammatory actions of acupuncture are mediated via the reflexive central inhibition of the innate immune system. Both laboratory and clinical evidence have recently shown the existence of a negative feedback loop between the autonomic nervous system and the innate immunity.10


It reduces the degree of cortical spreading depression

This is an electrical wave in the brain associated with migraine.12


It reduces plasma levels of calcitonin gene-related peptide and substance P

These are pain-signalling neuropeptides that may be implicated in the pathophysiology of migraine.13


It modulates extracranial and intracranial blood flow

Changes in cranial blood flow don’t necessarily initiate migraine pain but may contribute to it.14


It affects serotonin levels in the brain

Serotonin may be linked both to the initiation of migraines and to the relief of acute attacks (through triptans, drugs that promote serotonin levels).14


It increases local microcirculation

This aids the dispersal of swelling.15 In a study, Acupuncture stimulation and phototherapy were directly confirmed to increase the diameter and blood flow velocity of the peripheral arterioles. Acupuncture stimulation and phototherapy, associated with minimal systemic and local side effects, can enhance the microcirculation and may be a useful supportive treatment for diseases caused by poor peripheral blood flow.


About the BAcC:

The British Acupuncture Council (BAcC) has a membership of nearly 3,000 professionally qualified acupuncturists. It is the UK’s largest professional body for the practice of acupuncture. BAcC members practise a traditional, holistic style of acupuncture diagnosis and treatment based on a system developed and refined over 2,000 years. To achieve BAcC membership, practitioners must first undertake extensive training in traditional acupuncture (minimum three years full-time or part-time equivalent), which includes physiology, anatomy and other biomedical sciences appropriate to the practice of acupuncture.


Traditional acupuncture

Traditional acupuncture as practised by members of the BAcC is based on Chinese medicine principles that have been developed, researched and refined for over 2,500 years. Traditional acupuncture is holistic, not focused on isolated symptoms. It regards pain and illness, whether physical or mental, to be a sign the whole body is out of balance. Western or medical acupuncture is a more recent development practised predominantly by doctors and physiotherapists, who use acupuncture techniques within their existing scope of practice on the basis of a western medical diagnosis


Mark Bovey, Research manager at the British Acupuncture Council

Conflict of interest: none declared



1. Steiner T, Stovne L, Birbeck G, et al. Migraine: the seventh disabler. J Headache Pain. 2013; 14(1): 1

2. Steiner TJ, Scher AI, Stewart WF, et al. The prevalence and disability burden of adult migraine in England and their relationships to age, gender and ethnicity.  Cephalalgia 2003; 23(7): 519–27



5. MacPherson H. The York acupuncture safety study: prospective survey of 34 000 treatments by traditional acupuncturists. BMJ 2001; 323: 486

6. White A, Hayhoe S, Hart A, et al Survey of Adverse Events Following Acupuncture (SAFA): a prospective study of 32,000 consultations Acupuncture in Medicine 2001;19: 84–92

7. Zhao C, Stillman M, Rozen T.  Traditional and Evidence‐Based Acupuncture in Headache Management: Theory, Mechanism, and Practice. Headache 2005; 45(6): 716–30

8. Pomeranz B. (2001) Acupuncture Analgesia — Basic Research. In: Stux G., Hammerschlag R. (eds) Clinical Acupuncture. Springer, Berlin, Heidelberg

9. Brain Res Bull. 2008 Mar 28;75(5):698-705. doi: 10.1016/j.brainresbull.2007.11.015. Epub 2007 Dec 26.

10. Kim HW, Uh DK, Yoon SY, et al. Low-frequency electroacupuncture suppresses carrageenan-induced paw inflammation in mice via sympathetic post-ganglionic neurons, while high-frequency EA suppression is mediated by the sympathoadrenal medullary axis. Brain Res Bull 2008; 75(5): 698-705

11. Zijlstra FJ, van den Berg-de Lange I, Huygen FJ, Klein J. Anti-inflammatory actions of acupuncture. Mediators Inflamm. 2003; 12(2): 59–69

12. Shi H, Li JH, Ji CF, et al. Effect of electroacupuncture on cortical spreading depression and plasma CGRP and substance P contents in migraine rats. Zhen Ci Yan Jiu. 2010; 35(1): 17–2

13. Park K, Kim H, Baek SY, et al. Effect of Acupuncture on Blood Flow Velocity and Volume in Common Carotid and Vertebral Arteries in Migraine Patients Medical Acupuncture Vol. 21, No. 1 ORIGINAL PAPERS

14. Effects of acupuncture on calcitonin gene-related peptide gene expressions in the brain of migraine rats.

15. Komori M, Takada K, Tomizawa Y, et al.  Microcirculatory responses to acupuncture stimulation and phototherapy. Anesth Analg 2009; 108(2): 635-4