Utility of Acupuncture Therapy for Adult Chronic Daily Headache Prophylaxis: A Systematic Review and Meta-Analysis

BACKGROUND Chronic daily headache (CDH) management remains challenging due to limited efficacy of standard preventive pharmacotherapies. Acupuncture has shown promise in chronic headache management. This study evaluated its sustained prophylactic efficacy for CDH. MATERIAL AND METHODS Following PRISMA guidelines, we systematically searched PubMed, EMBASE, the Cochrane Library, CNKI, VIP, Sinomed, and Wanfang Data (inception to September 2025) for randomized controlled trials (RCTs) comparing acupuncture with other interventions for CDH. Primary outcomes included headache frequency, days, intensity, duration, and analgesic use; subgroup analyses covered treatment modality, CDH subtype, and duration. RESULTS Twenty-two RCTs (1449 patients) were included. Compared with control, acupuncture significantly reduced headache frequency (mean difference [MD], -0.32; P=0.001), headache days (MD, -0.72; P<0.00001), intensity (standardized mean difference [SMD], -0.63; P=0.001), duration (SMD, -1.18; P=0.0001), and analgesic use (MD, -0.52; P<0.00001) after the intervention. These benefits persisted during follow-up: headache days (standardized mean difference [SMD], -0.70; P<0.00001), intensity (SMD, -1.11; P=0.008), duration (SMD, -1.83; P=0.003), and analgesic use (SMD, -0.60; P=0.007) remained reduced; headache frequency showed a trend toward reduction (SMD, -0.47; P=0.05). Subgroup analyses revealed consistent efficacy across various CDH subtypes, including chronic migraine and chronic tension-type headache, treatment durations (4-12 weeks), and intervention strategies (acupuncture alone or combined with medication), indicating broad clinical applicability. CONCLUSIONS Acupuncture yields clinically meaningful, sustained improvements in CDH, supporting its role as an effective routine and adjunctive prophylaxis and broader application in this population.