Acupuncture versus propranolol in migraine prophylaxis: an indirect treatment comparison meta-analysis

J Neurol. 2020 Jan;267(1):14-25. doi: 10.1007/s00415-019-09510-x. Epub 2019 Aug 21.


Background: Propranolol is recommended as first-line treatment for preventing migraine attacks; acupuncture has not been compared with propranolol in a head-to-head trial.

Objective: To compare acupuncture with propranolol using indirect treatment comparison meta-analysis.

Method: We searched MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL). Randomized controlled trials comparing acupuncture or propranolol with sham acupuncture, placebo, waiting-list control or usual care were included. We extracted information from the included trials using a standardized extraction form. The primary outcome was migraine episodes. The secondary outcomes included migraine days, migraine frequency, and adverse events.

Results: We included 19 RCTs (n = 3656) after screening 1078 articles. The analysis showed that acupuncture had a significant advantage over propranolol in reducing migraine episodes over a 4-week period (SMD - 0.74, 95% CI - 1.04 to - 0.44). Acupuncture also had a significant advantage over waiting-list control in decreasing migraine frequency (SMD - 1.57, 95% CI - 2.08 to - 1.06). Acupuncture caused fewer adverse events than propranolol (RR 0.82, 95% CI 0.11-5.94).

Conclusions: Acupuncture had a better effect than propranolol in reducing migraine episodes in indirect comparison. The result should be confirmed in subsequent head-to-head studies. Registration: PROSPERO CRD42018108585.

Keywords: Acupuncture; Indirect treatment comparison; Meta-analysis; Migraine prophylaxis; Propranolol.

Publication types

  • Comparative Study
  • Meta-Analysis

MeSH terms

  • Acupuncture Therapy*
  • Adrenergic beta-Antagonists / pharmacology*
  • Humans
  • Migraine Disorders / drug therapy*
  • Migraine Disorders / prevention & control*
  • Outcome Assessment, Health Care*
  • Propranolol / pharmacology*


  • Adrenergic beta-Antagonists
  • Propranolol