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Does the outcome of acupuncture differ according to the location of sham needling points in acupuncture trials for migraine? A systematic review and network meta-analysis

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Abstract

Various acupuncture clinical trials have been conducted on migraine; however, the conclusions remain controversial especially when acupuncture was compared with sham acupuncture. Sham acupuncture is sometimes performed at the same acupuncture points used for verum acupuncture despite the evidence on acupuncture point specificity. Four databases were searched for sham acupuncture or waiting list-controlled acupuncture trials for migraine on December 25, 2023. Sham acupuncture was classified according to the needling points: sham acupuncture therapy at verum points (SATV) or at sham points (SATS). Network meta-analysis was performed based on the frequentist framework for headache pain intensity and response rate. A total of 18 studies involving 1936 participants were analyzed. Headache pain intensity and response rate were significantly improved in verum acupuncture compared with SATS. However, there was no significant difference between SATV and verum acupuncture. When comparing SATS and SATV, there was no significant difference in headache pain intensity and response rate; however, the results were in favor of SATV. The effect of the risk of bias on the certainty of evidence between verum and sham acupunctures was judged to be generally low. SATV should not be misused as a placebo control to evaluate the efficacy of acupuncture.

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Acknowledgements

BL, HWL, and MSL were supported by the Korea Institute of Oriental Medicine (Nos. KSN2121211 and KSN23314112). LSW was supported by the National Center for Complementary and Integrative Health of the National Institutes of Health (No. R24 AT001293). The funders had no role in the design and conduct of the study, the collection, management, analysis, and interpretation of the data, the preparation, review, and approval of the manuscript, or the decision to submit the manuscript for publication.

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Authors and Affiliations

  1. KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, 34054, Republic of Korea

    Boram Lee & Myeong Soo Lee

  2. Department of Oriental Neuropsychiatry, Dong-Eui University College of Korean Medicine, Busan, 47227, Republic of Korea

    Chan-Young Kwon

  3. KM Convergence Research Division, Korea Institute of Oriental Medicine, Daejeon, 34054, Republic of Korea

    Hye Won Lee

  4. Department of Family Medicine & Community Health, Icahn School of Medicine at Mount Sinai, New York, 10029, USA

    Arya Nielsen

  5. Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, Maryland, 21201, USA

    L. Susan Wieland

  6. Korean Medicine Clinical Trial Center, Korean Medicine Hospital, Kyung Hee University, Seoul, 02447, Republic of Korea

    Tae-Hun Kim

  7. School of Health Sciences, Kristiania University College, Oslo, 0107, Norway

    Stephen Birch & Terje Alraek

  8. Department of Community Medicine, Faculty of Health Sciences, National Research Center in Complementary and Alternative Medicine (NAFKAM), Institute of Health Sciences, Tromsø, 9037, Norway

    Terje Alraek

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  1. Boram Lee
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Correspondence to Myeong Soo Lee.

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Conflicts of interest Boram Lee, Chan-Young Kwon, Hye Won Lee, Arya Nielsen, L Susan Wieland, Tae-Hun Kim, Stephen Birch, Terje Alraek and Myeong Soo Lee declare that they have no conflict of interest.

This manuscript is a review article and does not involve a research protocol requiring approval by the relevant institutional review board or ethics committee.

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Lee, B., Kwon, CY., Lee, H.W. et al. Does the outcome of acupuncture differ according to the location of sham needling points in acupuncture trials for migraine? A systematic review and network meta-analysis. Front. Med. 19, 53–63 (2025). https://doi.org/10.1007/s11684-024-1109-z

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