Key Finding
Botulinum toxin A was the most effective pharmacological prophylaxis for reducing monthly migraine days in chronic migraine patients, yet no drug significantly improved migraine-related disability scores compared to placebo.
Chronic migraine — defined as 15 or more headache days per month — can be debilitating, affecting work, relationships, and overall quality of life. Researchers wanted to know which preventive medications work best and are safest for people living with this condition, so they pooled data from 24 high-quality clinical trials involving nearly 9,000 patients in a large comparison study called a network meta-analysis.
The results showed that Botulinum toxin A (commonly known as Botox) was the most effective at reducing the number of migraine days per month. A medication called Topiramate was best at cutting migraine frequency in half for some patients. A newer class of drugs called CGRP monoclonal antibodies — including Eptinezumab — showed a strong safety profile with fewer side effects. Importantly, none of the medications studied showed a meaningful improvement in migraine-related disability scores compared to placebo.
So what does this mean if you're exploring acupuncture for migraine prevention? Acupuncture is increasingly recognised as a complementary option for chronic migraine management, and many patients use it alongside — or instead of — medication. Studies suggest acupuncture may help reduce migraine frequency with fewer side effects than some pharmaceutical options. The finding that even the best-performing drugs showed modest disability improvements leaves real room for integrative approaches like acupuncture to fill the gap.
If you experience chronic migraines, it's worth having an open conversation with both your doctor and an acupuncture practitioner about combining strategies for the best results. Always seek care from a fully qualified, licensed acupuncture practitioner with experience treating headache disorders.
This systematic review and network meta-analysis (NMA) evaluated the efficacy and safety of pharmacological prophylaxis for chronic migraine (CM), pooling data from 24 RCTs (n = 8,789). Outcomes included monthly migraine day (MMD) reduction, ≥50% responder rate, MIDAS scores, and adverse event incidence. Botulinum toxin A demonstrated the greatest MMD reduction versus placebo (MD = 3.88; 95% CI: 0.48–7.28), while Topiramate achieved the highest ≥50% responder rate (RR = 50.06; 95% CI: 3.18–787.30). Notably, no pharmacological intervention produced statistically significant improvements in MIDAS disability scores. Eptinezumab showed the most favourable safety profile (RR = 1.09; 95% CI: 0.80–1.54). CGRP monoclonal antibodies ranked closely behind Botulinum toxin A in the overall benefit-risk profile. The absence of significant disability score improvements across all agents underscores a clinically meaningful gap that integrative interventions, including acupuncture, may address as adjunctive or primary prophylactic strategies.
Browse our directory of verified licensed practitioners near you.
Find a practitioner →📌 Acupuncture reduces migraine symptoms in rat models primarily by suppressing CGRP, substance P, and 5-HT neurotransmitters, inhibiting microglial activation, and modulating the descending pain modulatory system to reduce neurogenic inflammation and central sensitization.
📌 A non-linear dose-response analysis found that 16 acupuncture sessions delivered three times per week over approximately two months produced the greatest reduction in migraine attack frequency, with diminishing benefits beyond this threshold.
📌 Cupping therapy was associated with an 83% higher likelihood of treatment success in migraine patients (RR 1.83, 95% CI: 1.52–2.21), with wet cupping demonstrating the strongest effect.