Acupuncture recommendations for migraine in headache treatment guidelines: a systematic review

To evaluate the quality of global headache guidelines regarding the recommendation of acupuncture for migraine treatment.

We searched 31 electronic databases and 15 guideline repositories from inception to October 2024, without language restrictions. We identified 25 guidelines meeting our inclusion criteria, and evaluated these for methodological, reporting and recommendation quality using the Appraisal of Guidelines Research and Evaluation (AGREE) II instrument, Reporting Items for Practice Guidelines in Healthcare (RIGHT) checklist, and AGREE Recommendations Excellence (REX) tool, respectively. We present our findings using descriptive statistics, and assess interrater reliability using intraclass correlation coefficients.

Of the 25 guidelines analysed, we observed that 40.0% (10/25) recommended acupuncture and 32.0% (8/25) provided conditional recommendations. Of the 18 guidelines recommending acupuncture, 77.8% (14/18) lacked procedural details; only 22.2% (4/18) specified treatment frequency and 16.7% (3/18) described needling techniques. We found that methodological quality was suboptimal, with the domain clarity of presentation scoring highest (75.2%) and applicability lowest (20.3%). We noted that reporting quality was inadequate, particularly in the review and quality assurance domain (18.8%). Only 4.0% (2/25) of guidelines provided high-quality acupuncture recommendations. The 2023 World Federation of Acupuncture-Moxibustion Societies guideline achieved the highest overall quality.

Current global headache guidelines provide limited and inadequately detailed recommendations for acupuncture in migraine treatment, constrained by low methodological quality. Strict adherence to standardized reporting, methodological rigour and recommendation frameworks is essential to generate high-quality evidence, guide clinical decision-making and enhance the global acceptance of acupuncture therapy for migraine.