Acupuncture modulates migraine-related neural and neuroendocrine regulatory pathways

Migraine is a common, disabling neurological disorder driven by neurovascular and neuroinflammatory mechanisms. Although calcitonin gene-related peptide (CGRP)-targeted and serotonergic drugs have improved treatment, many patients still respond inadequately or experience side effects. Acupuncture is widely used as a non-pharmacological alternative, yet its mechanistic basis lacks systematic integration.

Accumulating clinical and experimental evidence suggest that acupuncture effectively reduces migraine frequency, pain intensity, and disability, with sustained preventive benefits. Neuroimaging studies reveal that acupuncture modulates key brain regions and networks involved in pain perception, emotional regulation, and descending pain control, including the default mode, salience, and sensorimotor networks. At the molecular level, preclinical evidence indicates that acupuncture may modulate CGRP signaling, serotonergic neurotransmission, neuronal excitability, and inflammatory pathways, thereby attenuating central sensitization and neuroimmune activation. Emerging evidence further suggests that acupuncture affects hypothalamic metabolic pathways involving glucagon-like peptide-1 (GLP-1) and orexin. Given that these neuropeptides are also implicated in the pathogenesis of migraines, this finding may offer a potential mechanistic perspective on how acupuncture alleviates this condition. These findings support a multi-level regulatory role of acupuncture that extends beyond symptomatic analgesia.

Acupuncture is supported as a preventive therapy for select migraine patients, but mechanistic evidence remains heterogeneous and mostly associative or preclinical. While a multilevel framework might link acupuncture-evoked brain, molecular, and homeostatic changes, direct validation in migraine is needed. Future work should prioritize standardized interventions, credible sham controls, longitudinal neuroimaging, and integrated molecular readouts to elucidate response mechanisms and predictive biomarkers.

Not applicable.