- This meta-analysis suggests that acupuncture was superior to propranolol in reducing migraine episodes and was associated with less harmful adverse events in indirect comparison.
Why this matters
- Propranolol is recommended for migraine prevention in multiple guidelines; acupuncture has not been compared with propranolol directly.
- National Institute for Health and Care Excellence (NICE) guideline recommends acupuncture for preventing migraine attacks.
- 19 randomised controlled trials (n=3656) comparing the effect of acupuncture or propranolol vs sham acupuncture, placebo, waiting-list control or usual care were included.
- Primary outcome: migraine episodes (the number of migraine days and frequency during a 4-week assessment period).
- Secondary outcomes: number of migraine days, migraine frequency, responder rate, and adverse event rate.
- Funding: None disclosed.
- Acupuncture vs propranolol was associated with significantly fewer migraine episodes over a 4-week period (standardised mean difference [SMD], −0.74; 95% CI, −1.04 to −0.44).
- Acupuncture (SMD, −1.57; 95% CI, −2.08 to −1.06) and propranolol (SMD, −0.83; 95% CI, −1.42 to −0.24) showed significant reduction in migraine frequency vs waiting-list control.
- Acupuncture vs propranolol was associated with fewer adverse events (OR, 0.82; 95% CI, 0.11-5.94).
- Evidence was indirect.
- Variation in the doses of propranolol (60-180 mg/day) may underestimate its efficacy.
- Acupuncture prescriptions were not consistent in 12 trials which included acupuncture.