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

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 \u2009=\u20093656) 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