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

Journal of Neurology volume 267, pages 14–25 (2020)Cite this article

Abstract

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

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Acknowledgement

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.

Author information

Author notes

  1. Yao-Yao Chen and Juan Li contributed equally to this work.

Authors and Affiliations

  1. School of Acupuncture and Tuina, The Third Teaching Hospital/Institute of Acupuncture and Homeostasis Regulation, Chengdu University of Traditional Chinese Medicine, No. 1166 Liutai Avenue, Wenjiang District, Chengdu, 61000, China

    Yao-Yao Chen, Ling Yue, Tian-Wei She & Hui Zheng

  2. College of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China

    Juan Li

  3. Teaching Hospital/Clinical Medicine Department, Chengdu University of Traditional Chinese Medicine, Chengdu, China

    Min Chen

Authors
  1. Yao-Yao Chen
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  2. Juan Li
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  3. Min Chen
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  4. Ling Yue
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  5. Tian-Wei She
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  6. Hui Zheng
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Contributions

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.

Corresponding author

Correspondence to Hui Zheng.

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Conflicts of interest

The authors have no conflict of interest to declare in this study.

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Cite this article

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). https://doi.org/10.1007/s00415-019-09510-x

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  • DOI: https://doi.org/10.1007/s00415-019-09510-x

Keywords

  • Acupuncture
  • Propranolol
  • Migraine prophylaxis
  • Indirect treatment comparison
  • Meta-analysis