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

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


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


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.


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).


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

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The systematic review was financially supported by the National Natural Science Foundation of China (no. 81774321 and no. 81473777) granted to Min Chen and Hui Zheng, respectively, and it was also supported by Innovation Team Project from Chengdu University of Traditional Chinese Medicine (no. CXTD1701) granted to Hui Zheng.

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Authors and Affiliations



HZ conceived the study design. MC developed the search strategy and searched the electronic databases. YY Chen and Min Chen screened the retrieved RCTs. JL and LY extracted information from the included RCTs, and TWS evaluated the risk of bias. HZ performed data synthesis. YYC and JL wrote the first draft of this manuscript, and all authors revised the manuscript and approved it for publication.

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Correspondence to Hui Zheng.

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Chen, YY., Li, J., Chen, M. et al. Acupuncture versus propranolol in migraine prophylaxis: an indirect treatment comparison meta-analysis. J Neurol 267, 14–25 (2020).

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